INTRODUCTION:Patient education handouts are used to enhance patient knowledge and support decision making, although many handouts do not meet recommended readability benchmarks. For people with hallux valgus, there is a dearth of co-designed, credible, evidence-based and readable resources to enhance health literacy. The aim of this study was to co-design an evidence-based, clinically accurate handout for hallux valgus targeting a readability level of grade seven or below. METHODS:Between October 2023 and August 2024, a descriptive qualitative design was used across two stages. Stage 1 involved focus groups with six health professionals and two individuals with hallux valgus to inform content development. Stage 2 presented a prototype to five health professionals and 10 individuals with hallux valgus for feedback on clarity, completeness and accuracy. Readability was assessed using Flesch Reading Ease and Flesch-Kincaid Grade Level tools. RESULTS:The handout included information about the characteristics of hallux valgus and a balance between non-surgical and surgical approaches, with transparency about limited evidence for some treatments. Participants emphasised the need for clarity, relevance, and accessibility and reinforced that treatment decisions, especially surgery, are often not urgent and can evolve over time. The handout is a starting point for discussion and not a standalone resource. The final version meets the readability standards for ages 9-10 years. The readability was further enhanced with the use of visuals and adherence to accessibility guidelines. CONCLUSION:A co-designed, evidence-based handout was produced that meets recommended readability and accessibility standards for consumer health information.
BACKGROUND:Chronic low back pain (CLBP) is one of the leading causes of disability. Evidence suggests that women experience and report pain differently than men, showing lower thresholds, greater intensity, and higher frequency of pain reports. Understanding these differences is crucial for the interpretation of standardized questionnaires. The aim of the study was to investigate sex differences in the descriptors of the McGill Pain Questionnaire (MPQ) chosen by men and women with CLBP and their relationship with pain intensity. METHODS:This is a descriptive, cross-sectional, and observational study. Men and women with nonspecific CLBP aged 18-80 years and numerical pain rating scale (NPRS) > 1, were recruited. Participants completed sociodemographic forms, NPRS and the MPQ. RESULTS:The study assessed 310 participants (women: n = 201, 64.8%; men: n = 109, 35.2%). Out of the 20 subcategories analysed, five showed a difference in the prevalence of words between sexes (subcategories 1, 5, 6, 9, and 11). The most frequently selected words of the MPQ, with over 80% of responses, were 'crushing', 'aching', 'tiring', 'tight', and 'cool'. A correlation was found between NPRS and total PRI, sensory PRI, and miscellaneous PRI were observed only in women (p < 0.05, r > 0.3). CONCLUSION:This study reinforces the importance of considering sex when interpreting standardized questionnaires in CLBP. Although pain intensity measured by the NPRS did not differ significantly between sexes, women presented higher MPQ-derived scores and different qualitative pain descriptors. These findings suggest that qualitative pain expression may differ between sexes and should be interpreted within a broader biopsychosocial context.
BACKGROUND:Physiotherapists in primary care frequently manage patients with musculoskeletal disorders that may conceal serious underlying pathologies, leading to diagnostic uncertainty. Although safety netting is recommended to enhance diagnostic reasoning and ensure patient safety, its conceptualisation and implementation in physiotherapy remain poorly understood. PURPOSE:This study aimed to explore how physiotherapists understand and apply safety netting in clinical practice, with particular attention to diagnostic uncertainty, patient safety and interprofessional collaboration. METHODS:A generic qualitative study was undertaken in France. Twenty-eight (28) physiotherapists were purposively recruited to achieve maximum variation in clinical experience, practice setting and postgraduate training. Semi-structured interviews were analysed using an inductive reflexive thematic analysis. RESULTS:An interpretive typology comprising three diagnostic uncertainty scenarios (controlled, manageable and challenging uncertainty), was developed. The typology shows that safety netting implementation is shaped by the interaction between clinical expertise, organisational support, interprofessional collaboration and access to healthcare resources. Controlled uncertainty was characterised by integrated support systems that facilitated confident clinical decision-making, whereas challenging uncertainty reflected fragmented care pathways, limited resources and reduced confidence in managing serious underlying pathologies. Across all scenarios, participants framed safety netting as a dynamic patient-centred framework, integrating clinical assessment, clinical reasoning, patient education, follow-up planning and referral decision-making. CONCLUSIONS:In physiotherapy, safety netting appears to be a context-dependent approach to managing diagnostic uncertainty rather than a standardised procedure. The proposed typology provides a conceptual framework for understanding how individual, professional and organisational factors interact to shape safety netting implementation, with implications for physiotherapy education, interprofessional collaboration and patient safety.
OBJECTIVE:To explore the individual, interpersonal, community, organisational, and policy-level factors that influence physical activity among people with arthritis in England, using the Social Ecological Model as the analytical framework. STUDY DESIGN:Qualitative research. METHODS:Semi-structured interviews were conducted with three stakeholder groups: people with arthritis (n = 10), healthcare professionals (n = 18), and providers of community physical activity services (n = 6). Participants were recruited via the charity Arthritis UK. Interviews were audio-recorded, transcribed verbatim, and analysed thematically, with the identified themes mapped to the domains of the social-ecological model. RESULTS:Factors influential on physical activity were identified at individual, interpersonal, community, organisational, policy, and environmental levels. Individual-level factors included the relationship with physical activity, knowledge, understanding and reassurance, physical and emotional pain, and alignment with personal interests. Interpersonal influences encompassed support from family and peers, and conversations with healthcare professionals, particularly physiotherapists. Community-level factors included access, suitability, and the opportunity for social interactions. Organisational-level factors included short-term funding, staffing shortages and expertise, and signposting challenges. Policy and environmental factors included social norms around physical activity, and the interpretation of the physical activity guidelines. CONCLUSIONS:Physical activity promotion for people with arthritis requires a multi-level approach that addresses barriers and harnesses facilitators across the social-ecological spectrum. Tailored advice, improved referral pathways, sustainable funding, and inclusive activity promotion and provision are needed to support participation. These findings can inform the design of person-centred, contextually relevant interventions to increase physical activity in this population.
INTRODUCTION:Upper extremity conditions such as carpal tunnel syndrome (CTS) are more prevalent in patients with diabetes mellitus (DM) than in the general population. This prospective study aimed to determine the viability of DM screening for patients presenting with upper extremity musculoskeletal disorders in an orthopaedic hand clinic and to inform future testing criteria for orthopaedic surgeons. METHODS:Patients with a diagnosis of CTS, trigger finger, Dupuytren's contracture, and/or De Quervain's disease were prospectively enroled. Eighty-four patients (60.7% female, 60.0% White) underwent point-of-care haemoglobin A1c (HbA1c) fingerstick testing at their appointment at the orthopaedic surgeon's office. Patient demographics and disease characteristics (symptom laterality, diagnosis of upper extremity pathologies) were collected and compared between patients with HbA1c within normal limits (HbA1c < 5.7) and in the range of prediabetes or type 2 DM (HbA1c ≥ 5.7). RESULTS:Among 84 patients, 58.3% had HbA1c in the range of prediabetes and 4.8% in the T2DM range. The most prevalent upper extremity condition was trigger finger (78.6%), and 62.1% of patients presenting with trigger finger had elevated HbA1c. Among patients with prediabetes/T2DM, 43.4% did not have a primary care provider. Patients with elevated HbA1c were significantly more likely to have unilateral symptoms (p = 0.03) and be female (p = 0.008). CONCLUSIONS:Hand surgeons can successfully identify patients with elevated HbA1c, particularly in the range of prediabetes where the disease state is more reversible. Point-of-care HbA1c testing could be incorporated into hand surgery practices as a low-cost and rapid intervention to optimise outcomes of surgery and facilitate earlier treatment of hyperglycemia.
BACKGROUND:Beliefs about pain influence not only how individuals experience spinal pain but also their management behaviours. Health professionals are considered to play a central role in shaping these beliefs, yet little is known about how they evolve over time and which factors contribute to their development. This study explored how spinal pain beliefs develop across the patient journey from symptom onset to the point of MRI examination, applying the method of Patient Journey Mapping. METHODS:Semi-structured interviews were conducted with six individuals experiencing long-term spinal pain. Interviews were transcribed ad verbatim and analysed using Malterud's systematic text condensation. An illustrative patient journey was then mapped, linking final code groups to touchpoints that reflected the development of pain beliefs in one informant. RESULTS:Three code groups were constructed: (1) Influence of health professionals, (2) Societal and cultural influences, and (3) Lived experiences with pain. Informants' beliefs about spinal pain were dynamic, shaped and reshaped by influences across the three code groups, showing considerable change over time. Encounters with health professionals emerged as particularly influential, often reinforcing biomedical understandings. However, when information was conflicting or incongruent, it frequently gave rise to doubt and uncertainty. CONCLUSION:This study demonstrates the value of Patient Journey Mapping in uncovering how spinal pain beliefs dynamically evolve through cumulative influences of healthcare encounters, social context, and lived bodily experiences. The findings highlight the critical role of health professionals, underscoring the need for clear and consistent communication to foster helpful understandings of pain and avoid reinforcing limiting or maladaptive understandings.
BACKGROUND:In France, two care models have recently been introduced to improve access to physiotherapy for patients with musculoskeletal complaints: direct access to physiotherapists (PTs) and medical task sharing and task shifting between family physicians (FPs) and PTs. While these models aim to improve timely access to non-pharmacological care, French FPs' perceptions and acceptability remain largely unexplored. OBJECTIVE:To explore French FPs' acceptability and perceptions regarding direct access physiotherapy and FP-PT task sharing and task shifting for patients with musculoskeletal complaints in primary care. METHODS:We conducted a qualitative study using semi-structured interviews with 18 FPs, with one FP included per French region (18 regions). Twenty-seven FPs were contacted and 18 agreed to participate. Interviews were transcribed verbatim and analysed in NVivo using an inductive thematic analysis informed by Braun and Clarke's six phases. Saturation was operationalised as the absence of substantially new codes or candidate themes during iterative analysis; this threshold was reached after 14 interviews and confirmed by four additional interviews. RESULTS:FPs described both models as acceptable in principle, but not unconditionally. For direct access, they emphasised the need for clear patient selection criteria, structured training, clinical guidelines, and secure communication channels. For task sharing and task shifting, acceptability depended on formal protocols, competence assurance, and explicit medico-legal accountability. Across both models, a cross-cutting tension emerged: FPs reported high confidence in PTs they knew and worked with, while simultaneously questioning the readiness of the profession to assume expanded responsibilities without stronger governance. CONCLUSION:French FPs did not reject these models, but their acceptance was cautious, conditional, and strongly context dependent. Implementation will likely require staged deployment, postgraduate training pathways, shared information systems, and explicit legal and organisational safeguards.
PURPOSE:Using experience-based co-design (EBCD) methodology, we aimed to co-design and pilot a culturally adapted osteoporosis programme with older people from culturally and linguistically diverse (CALD) communities in Australia. METHODS:This three-phased study was conducted in one of the most culturally diverse regions in Australia. Twelve end users from three selected language communities with lived experience of osteoporosis and eight subject matter experts were recruited for the first two phases. Phases 1 and 2 utilised interviews and workshops to explore challenges experienced during osteoporosis diagnosis and management and co-designed the key elements for the MultIcultural commuNities co-DeSigned ostEoporosis Toolkit (MINDSET) programme. This programme was piloted with the selected communities (Phase 3) and evaluated for acceptability (participants' satisfaction) and efficacy. The latter was measured by comparing the differences in pre/post Osteoporosis Knowledge Assessment Tool (OKAT) scores among end users. RESULTS:Common challenges identified included (i) lack of access to reliable information, (ii) osteoporosis perceived as a normal part of ageing, and (iii) lack of resources to guide discussions with general practitioners. The programme was piloted with 132 participants (n = 46 Cantonese-speaking, n = 52 Mandarin-speaking and n = 34 Vietnamese-speaking). All participants were highly satisfied with the programme, with 90% of participants stating that they would likely/very likely recommend the programme to others. A significant improvement in pre-post scores on the OKAT was also observed across all groups (mean difference = +2.03, 95% CI 1.42 to 2.63, p < 0.001). CONCLUSIONS:MINDSET is an acceptable community-based education programme to improve short-term osteoporosis-specific knowledge for people from selected culturally diverse backgrounds.
INTRODUCTION:Metabolic syndrome is a well-established cluster of cardiovascular risk factors with increasing relevance to musculoskeletal pain, function, and rehabilitation. Beyond its recognised effects on cardiovascular health, its systemic biological consequences may influence pain mechanisms, tissue health, recovery, and rehabilitation outcomes. Understanding these effects may enhance clinicians' assessment, clinical reasoning, and management of individuals presenting with musculoskeletal disorders. METHOD:This narrative conceptual paper explores the potential biological mechanisms through which metabolic syndrome may influence musculoskeletal pain and rehabilitation. It proposes a clinically relevant framework to support the integration of metabolic health into musculoskeletal assessment and clinical reasoning, illustrated through a structured clinical vignette. DISCUSSION:Musculoskeletal clinicians are increasingly managing individuals with complex, multimorbid presentations. Consideration of metabolic syndrome provides an additional dimension to clinical reasoning by recognising how systemic metabolic dysfunction may contribute to pain persistence, impaired tissue healing, reduced physical function, and variable responses to rehabilitation. Incorporating these factors into assessment and treatment planning may facilitate more individualised, person-centred rehabilitation strategies and optimise clinical outcomes. CONCLUSION:Metabolic syndrome should be considered within the wider context of the biopsychosocial model and the social determinants of health, recognising their influence on health inequalities, disease burden, and rehabilitation outcomes. Integrating metabolic health into person-centred musculoskeletal practice may enhance clinical decision-making, support more targeted rehabilitation, and ultimately improve patient outcomes.
BACKGROUND:Musculoskeletal (MSK) conditions are leading causes of disability worldwide. Although clinical guidelines recommend non-pharmacological interventions, surgical and invasive procedures remain frequently used, yet their efficacy beyond placebo effects is not well established. OBJECTIVE:To systematically review the effects of invasive procedures compared with placebo controls in patients with MSK conditions. METHODS:MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, EMBASE, and Web of Science were searched from inception to August 2024. Eligible studies were RCTs comparing any invasive procedure with a sham or placebo in patients with MSK conditions and measuring pain, disability, function, or quality of life. All analyses were pairwise comparisons. Risk of bias was assessed using the Cochrane RoB Tool and certainty of evidence using GRADE. Random-effects meta-analyses were conducted when at least two trials provided data. RESULTS:Twenty-three RCTs (2412 participants) were included. In 18 studies (78%), invasive procedures showed no superiority over placebo, with some placebo groups demonstrating better outcomes. Moderate-certainty evidence showed vertebroplasty provided no additional benefit for pain at 1 month (MD 0.42; 95% CI -0.84 to 1.68; I2 = 73%) or 6 months (MD 0.90; 95% CI -0.06 to 1.87; I2 = 0%). Arthroscopic decompression did not improve shoulder function at 6 months (MD -3.68; 95% CI -8.57 to 1.22; low-certainty). Radiofrequency denervation and intradiscal therapies showed no consistent benefit over sham for low back pain (very low-certainty). CONCLUSIONS:Invasive procedures were not superior to placebo for most non-life-threatening MSK conditions. Further rigorous placebo-controlled trials are needed. TRIAL REGISTRATION:This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42024534187.
BACKGROUND:Chronic neck pain is frequently associated with disturbed sleep, yet evidence on physiotherapy's impact on objective sleep parameters remains limited. To our knowledge, this study is the first to evaluate the effects of exercises, interferential current therapy (IFT) and myofascial release therapy on sleep quality and polysomnographic parameters in this population. METHODS:Thirty adult men with chronic neck pain and poor sleep were randomised (1:1) in a two-arm, assessor-blinded trial. Group 1 received therapeutic exercise plus interferential current therapy; Group 2 received the same plus myofascial release (MFR), 7 weeks. Outcomes included subjective sleep quality as a primary outcme, polysomnographic (PSG) architecture and pain as secondary outcomes. RESULTS:Sleep quality improved significantly in both groups (time effect p < 0.001), with greater overall improvement in Group 2 (group effect p = 0.003). For PSG parameters, both groups improved. Compared with exercise + IFT, adding MFR produced greater changes in PSG N1% and REM% (Time × Group interaction), while other PSG parameters showed similar improvements across groups. CONCLUSION:Physiotherapy significantly improved pain and sleep outcomes in patients with chronic neck pain. Exercise with IFT enhanced sleep continuity, while combining exercise with myofascial release further optimized sleep architecture, particularly N1% and REM%. These findings highlight the added value of multimodal physiotherapy for pain management and sleep improvement. TRIAL REGISTRATION:This clinical trial was registered at the Clinical Trials Registry of India under the registration number CTRI/2019/09/021028.
INTRODUCTION:Although whole-body vibration (WBV) therapy has already demonstrated efficacy in improving lower-limb muscle strength, it is still unclear whether it has similar potential for improving handgrip strength. OBJECTIVE:To verify the efficacy of WBV on handgrip strength. METHODS:The search was conducted on September 5, 2025, in PubMed, Embase, CENTRAL, CINAHL, SPORTDiscus, Web of Science, LILACS, PEDro, and SciELO. Risk of bias was assessed via the PEDro scale, and certainty of evidence using GRADE. Meta-analyses were performed using the standardized mean difference (SMD) under random- or fixed-effects models according to heterogeneity levels. RESULTS:Thirty-four studies (1272 participants) were included (32.4% had a high risk of bias). Compared with controls, acute WBV showed no significant effect on handgrip strength, with moderate-certainty evidence (SMD = 0.09, p = 0.34). Chronic WBV produced a significant but small effect, supported by very low-certainty evidence (SMD = 0.33, p = 0.01). Sensitivity analysis excluding high-risk-of-bias studies rendered the chronic effect non-significant (p = 0.07). Exploratory subgroup analyses of chronic interventions showed a significant interaction for body positioning (p = 0.02), with significant effects for direct hand contact (SMD = 0.76, p = 0.03) and static standing (SMD = 0.52, p = 0.03). Compared with resistance training, evidence was inconclusive and of very low certainty (SMD = -2.43, p = 0.25). CONCLUSION:Chronic WBV involving direct hand contact may be associated with more pronounced effects on handgrip strength; however, these findings are exploratory, supported by very low-certainty evidence, and require confirmation by future trials.
BACKGROUND:Exercise-based randomized controlled trials are essential for guiding the management of knee osteoarthritis, but their interpretability depends on transparent reporting of both intervention and comparator groups. The term usual care (UC) is frequently used as a comparator, yet its reporting quality remains unclear. OBJECTIVE:To evaluate the reporting completeness of UC comparator groups in randomized controlled trials (RCTs) of exercise-based interventions for knee osteoarthritis. METHODS:This systematic review included RCTs of exercise-based interventions for adults with knee osteoarthritis that used UC as a comparator. Searches were conducted in MEDLINE, EMBASE, CENTRAL, PEDro, CINAHL, and SPORTDiscus up to December 2024. Reporting completeness was assessed using the Template for Intervention Description and Replication (TIDieR) checklist and analysed using continuous and dichotomised approaches. RESULTS:Sixty-seven RCTs were included. Reporting completeness of UC interventions was consistently low. Median TIDieR scores (range 0-12) were higher for exercise interventions (4.0; IQR 3-5) than for UC comparators (1.0; IQR 1-2). Continuous analyses detected significant differences between groups, whereas dichotomised analyses did not. Only 22.3% of exercise-based interventions achieved high reporting completeness. No improvement was observed after publication of the TIDieR checklist, and no meaningful association was found between methodological quality and reporting completeness. CONCLUSIONS:Reporting of UC comparator groups in exercise-based RCTs for knee osteoarthritis is poor and has not improved over time. Although exercise interventions are better reported, overall completeness remains low, highlighting the need for improved reporting practices to support clearer interpretation of clinical trial evidence.
INTRODUCTION:Infection with SARS-CoV-2 may result in persistent functional impairment after the acute phase of the disease. Emerging evidence suggests that the presence and intensity of COVID-19-related symptoms may be associated with deficits in muscle strength and physical performance during the post-infection period. Our objective was to compare physical performance after the acute phase of COVID-19 between symptomatic and asymptomatic individuals, focusing on exercise capacity and peripheral muscle strength. METHODS:This cross-sectional, prospective study included 76 adults aged 18-77 years, registered in the Brazilian Unified Health System. Participants were classified as symptomatic or asymptomatic based on clinical records. Physical activity level was assessed using the International Physical Activity Questionnaire (IPAQ). Physical performance was evaluated through handgrip strength and exercise capacity measured by the Incremental Shuttle Walking Test (ISWT). Multivariate analysis of covariance (MANOVA) and univariate analyses (ANCOVA) were performed, adjusted for age, sex, and physical activity level. RESULTS:The presence of COVID-19-related symptoms was independently associated with lower handgrip strength (p = 0.0099) after adjustment for covariates. No significant differences were observed in exercise capacity between the symptomatic and asymptomatic groups (p = 0.497). Effect size analysis demonstrated a moderate association between symptom presence and peripheral muscle strength, whereas the association with exercise capacity was small. CONCLUSION:Symptomatic individuals after COVID-19 exhibited reduced peripheral muscle strength despite no significant differences in exercise capacity between the groups. These findings underscore the relevance of handgrip strength assessment as a simple and sensitive tool for identifying residual functional impairment in post-COVID-19 follow-up.
OBJECTIVES:To describe how patients with chronic pain experienced participation in a multimodal rehabilitation programme (MMR) in primary care. METHODS:The study had a descriptive qualitative design with an inductive approach, including 10 participants (6 women and 4 men, aged 36-57). The MMR took place at a primary care centre in southern Sweden and consisted of face-to-face meetings twice a week for 6 to 7 weeks. The multidisciplinary team included a physiotherapist, an occupational therapist, a healthcare counsellor, and a physician. Individual in-person interviews were conducted using open-ended questions and analysed using qualitative content analysis. RESULTS:The results illustrate participants' varied experiences of participation in MMR in primary care, described in three themes with six sub-themes: (1) knowing the pain (grasping the pain and voicing needs); (2) embracing pain (being recognised and empowered); and (3) building resilience (enhancing skillset and becoming proactive). CONCLUSIONS:MMR offered a structure to address chronic pain beyond symptoms, fostering better communication with healthcare professionals and promoting autonomy. It encouraged a shift towards a biopsychosocial understanding of pain and resilience building. Tailoring MMR to individual needs and previous experiences could further strengthen its impact on diverse groups of patients with chronic pain.
Background Frozen shoulder, also known as adhesive capsulitis, is a common and disabling condition that causes shoulder pain and progressive stiffness. Patient information leaflets (PILs) are produced by UK National Health Service (NHS) Trusts to help patients understand frozen shoulder and treatment options. However, the content and consistency of these PILs and their alignment with national clinical guidance are currently unclear.Objectives This study aimed to identify, analyse and describe the non-surgical management recommendations presented in publicly available NHS Trust PILs for frozen shoulder and to assess their alignment with the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary and British Elbow and Shoulder Society (BESS) best practice resources.Methods An online search was undertaken by one reviewer to identify publicly available PILs produced by NHS Trusts detailing non-surgical management of frozen shoulder. Relevant data were extracted and analysed by one reviewer and verified by five reviewers. Descriptive statistics were used to summarise findings.Results Thirty-eight PILs were identified from 38 NHS Trusts with publication dates ranging from April 2013 to March 2025. Considerable variation was observed in the content, including reference to analgesia, activity modification, exercise prescription and corticosteroid injections. No single PIL reflected all key elements recommended in the NICE Clinical Knowledge Summary and BESS best practice.Conclusion The findings demonstrate substantial variation in content, frequent misalignment with current national guidance and best practice exercise recommendations. Such variation may limit and may reduce the clarity, consistency and usefulness of information provided to patients.
BACKGROUND:Chronic musculoskeletal pain (CMP) is a major cause of disability, with biopsychosocial effects that may be worsened by long waiting times for care. OBJECTIVE:This study aimed to describe the profile of patients with CMP on the waiting list for physiotherapy. METHODS:We conducted a cross-sectional study using an online survey distributed via telephone. Participants' information was obtained from the Municipal Health Department. The survey assessed data on clinical, physical and psychosocial characteristics. RESULTS:Overall, we contacted 1208 individuals, and 134 completed the survey. The most common pain sites were the right shoulder (44.0%), lower back (42.5%), right hand (38.8) and right knee (38.8). Nearly half of the participants reported pain in 4 or more pain sites in the last seven days (49.3%) and use of antidepressants (48.5%) or analgesics (45.5%). Symptoms of anxiety and depression were present in 45.5% and 35.8% of participants, respectively. One out of five participants reported being unable to work in the last 30 days due to their health conditions. Only 23.9% had previously received physiotherapy care, and among these, 68.7% waited one year or longer for treatment. CONCLUSIONS:Patients on the waiting list for physiotherapy commonly report pain, psychosocial symptoms and functional disability. Strategies to improve timely access for physiotherapy are needed to reduce the burden of CMP.
Background Most patients with polymyalgia rheumatica (PMR) are managed in primary care. Provision of health information to patients on management strategies and potential side effects is important given the complexity of this condition. This study aimed to describe the recall of information of people with PMR in receiving information from their treating doctor and their perceived need for further information.Methods Data were taken from a survey between September and November 2024 characterising the presentation and experiences of Australians with PMR collected from an online patient support group. Reported data included recall of provision of information from their treating doctor on aspects of management strategies including pain management, medication side effects, fatigue management and physical activity. Free responses regarding areas of further information desired were provided and thematically analysed.Results One hundred and forty nine individuals participated in the online questionnaire. Information received on pain management (80.7%), maintaining bone strength (75.7%) and remaining physically active (79.7%) were the topics most recalled by respondents. Information related to fatigue (50.0%), fitness and strength (50.5% and 52.3%) and activity modification (49.1%) were less likely to be recalled. Thematic analysis of free responses revealed a desire for more specific guidance with regard to activity participation and exercise, medication side effects, balancing activity and pain and access to other sources of information.Conclusion The majority of people with PMR recall receiving information about their condition from their treating doctor but seek further and more specific advice regarding aspects of managing their pain and function. Collaborative opportunities exist to supplement care with other health professionals.
BACKGROUND:Leading cause of global disability, lower back pain, affects 84% of adults and costs the U.S. $134 billion annually. Traditional care fails to improve outcomes despite rising spending. This study assessed the effectiveness of a digital musculoskeletal integrated practice unit (IPU) in reducing pain and function in adults with back pain. METHODS:We conducted a retrospective cohort study of 784 adults (18-95 years) with low back pain enroled in our IPU between September 2023 and February 2025. Intervention included virtual physician/nurse practitioner and physical therapist assessments, coordinated care with health coaching and nutrition counselling, and digital physical therapy. Primary outcomes were improvement in pain (Numeric Pain Rating Scale) and function (Single Assessment Numeric Evaluation). Analyses used paired t-tests for within-subject changes, multivariable linear regression adjusting for baseline severity, follow-up duration, age, sex, and comorbidities, and engagement-stratified analyses to assess associations between visit frequency and outcomes. RESULTS:Among 784 patients (mean age 60.1 ± 17.0 years), mean pain scores decreased 4.94 ± 0.07 to 2.61 ± 0.08 (p < 0.001, Cohen's d = -1.02), with 61.9% achieving the MCID of ≥ 2-point pain reduction. Among patients with severe baseline pain (≥ 7), 78.1% achieved pain MCID. Among the 688 patients (87.8%) with paired functional data, SANE scores increased 51.18 ± 0.96 to 74.97 ± 0.83 (p < 0.001, Cohen's d = 0.94), with 58.0% achieving SANE MCID of ≥ 15 points. CONCLUSIONS:Digital musculoskeletal IPU care for low back pain may provide convenient access to care for patients while supporting clinical effectiveness.
