ABSTRACT Background Chronic pain affects more than 1 in 5 adults in the United States. Our understanding of pain has improved, particularly regarding psychosocial factors. Compelling evidence supports pain neuroscience education for chronic pain, but the best methods for implementation in clinical practice remain unclear. Objective The aim was to evaluate the impact of a flipped learning pain education model in physical therapy on the function of patients with chronic pain. In addition, the purpose was to describe the predicted and actual number of physical therapy visits in this population. Methods A retrospective, uncontrolled single‐therapist chart review was conducted. Adults diagnosed with chronic pain who received physical therapy using the flipped learning pain education model and had pre‐ and post‐rehabilitation Patient‐Specific Functional Scale (PSFS) scores were included. The main outcome was change in the PSFS. The number of predicted visits was derived from the Focus on Therapeutic Outcomes tool. Results A total of 28 individuals (68% women) were identified. PSFS scores significantly increased from a median of 2.0 (interquartile range, IQR 3.2) to 8.6 (IQR 2.9) ( p < 0.001). At baseline, the median predicted number of visits was 12.0 (IQR 4.0), while the median actual visits were 5.0 (IQR 1.8). A total of 24 patients (85.7%) achieved or exceeded the minimal clinically important difference. Conclusions PSFS scores were higher at the final recorded visit in this selected complete‐case cohort receiving physical therapy using a flipped learning model. The findings should be interpreted with caution due to the exploratory nature of the study.
ABSTRACT Background Knee osteoarthritis (KOA) is a chronic condition with a high global prevalence, often resulting in functional decline. Faced with this, many people turn to the internet to find information about the disease and available treatments. Besides the amount of content available online, it does not ensure its accuracy, quality and readability. This study aims to evaluate the accuracy, quality and readability of KOA‐related information available on Instagram, TikTok, Google and YouTube in Brazilian Portuguese. Methods Google and YouTube searches were performed using ‘Tratamento de osteoartrite de joelho’, ‘Tratamento de artrose no joelho’ and ‘Tratamento de artrite no joelho’. For each term, the first 20 results were selected. Searches on Instagram and TikTok were conducted using the hashtags: #artrosenojoelho, #artrosedojoelho, and #artrosedejoelho, selecting the first 100 posts for each term. All the research was done on June 19, 2024. Content accuracy was assessed against a reference resource on knee osteoarthritis, information quality was assessed using DISCERN, and the readability of Google content was evaluated using the Flesch–Kincaid Grade Level scale. Results We found that the information about medical management was the most classified as inaccurate. The overall DISCERN score indicated low quality (2.3 ± 0.7) and 78% of Google texts required at least 14 years of schooling to read. Conclusion As digital platforms have become a widely used source of health information, our findings raise concerns about the potential for misinformation to delay effective treatment and perpetuate low‐value care.
ABSTRACT Background Sciatica and lumbar radicular pain are prevalent symptoms affecting a large proportion of people worldwide. Many patients seek complementary and alternative medicine for pain relief. This study aimed to evaluate the efficacy and safety of Ushaq capsule, a herbal formulation from Traditional Persian Medicine, on pain intensity and disability in patients with lumbar radiculopathy. Methods This randomized, double‐blind, placebo‐controlled clinical trial included 68 patients randomly assigned to intervention or placebo groups. All participants were allowed to use diclofenac 50 mg (up to three tablets daily) as rescue medication for breakthrough pain. Participants in the intervention group received 3 Ushaq capsules daily for 6 weeks, while the placebo group received identical microcrystalline cellulose capsules. Pain intensity and disability were assessed using the Visual Analogue Scale (VAS) and Roland Morris Disability Questionnaire (RMDQ). The primary endpoint was the change in VAS score from baseline to week 6. Safety was evaluated through clinical adverse event monitoring and laboratory tests. Results No significant baseline differences were observed between the groups ( p > 0.05). The mean VAS score was significantly lower in the Ushaq group from the second week onward ( p = 0.019) and remained significant until the end of the study ( p = 0.003). The RMDQ score decreased significantly in both groups, but the reduction in the Ushaq group was not significantly greater than that in the placebo group ( p = 0.218). No serious adverse events were reported; only mild, transient gastrointestinal discomfort occurred ( Ushaq : 6.5%, placebo: 4.3%). Conclusions Ushaq capsules as adjunctive therapy with diclofenac as rescue medication showed greater pain reduction compared to placebo with a favourable safety profile. Larger, longer‐term trials with active comparators are needed to confirm these preliminary findings. Trail Registration The research was registered with the Iranian Registry of Clinical Trials (IRCT) and received registration number IRCT20200418047124N1
ABSTRACT Objective This systematic review and meta‐analysis evaluated the measurement properties of handheld dynamometry (HHD) for assessing isometric ankle muscle strength in healthy individuals. Methods A comprehensive search was conducted in PubMed, EMBASE, CINAHL, Web of Science, SPORTDiscus, PsycINFO, Scopus, and the Virtual Health Library, with no language or date restrictions. Observational and methodological studies assessing dorsiflexors, plantar flexors, invertors, or evertors using HHD were eligible if they reported reliability, measurement error, or construct validity against isokinetic dynamometry. Random‐effects meta‐analyses were performed by measurement property and testing configuration, following COSMIN guidance. Results Twenty‐four studies were included. Inter‐rater reliability was good for dorsiflexors (ICC = 0.89, 95% CI 0.80–0.94), plantar flexors (ICC = 0.86, 95% CI 0.72–0.93), invertors (ICC = 0.79, 95% CI 0.66–0.87), and evertors (ICC = 0.75, 95% CI 0.46–0.90). Intra‐rater reliability ranged from good to excellent (ICC = 0.88–0.91). External fixation was associated with numerically higher inter‐rater ICCs for dorsiflexors and plantar flexors although subgroup differences were not statistically significant. Construct validity was strong for dorsiflexors ( r = 0.87, 95% CI 0.42–0.98) but uncertain for plantar flexors ( r = 0.72, 95% CI −0.20–0.96). Measurement error remained indeterminate due to the absence of an established minimal important change. Certainty of evidence was high for reliability and low for construct validity; measurement error was not graded. Conclusion HHD provides reliable assessment of isometric ankle strength, including without external fixation. Evidence for construct validity, particularly for plantar flexors, and for measurement error remains limited.
ABSTRACT Background Unhelpful beliefs about low back pain are associated with altered movement behaviour during lifting. Brief educational videos may offer a scalable approach to modify such beliefs, but their impact on movement behaviour remains unclear. Objective To investigate whether a short educational video can reduce unhelpful back pain beliefs and promote a more stoop‐like lifting behaviour in healthy adults. Methods In this assessor‐blind randomised controlled trial, 50 healthy office workers were assigned to an experimental group (educational video on back pain beliefs and management) or a control group (anatomy video). Outcomes were measured before and immediately after the intervention and included the 10‐item Back Pain Attitudes Questionnaire (Back‐PAQ10), lumbar curvature range of motion (RoM), and lifting strategy (Stoop‐Squat Index) during lifting and lowering of 5 and 15 kg boxes. Linear mixed‐effects models evaluated Group, Time, and interaction effects. Results Back‐PAQ10 scores showed a larger reduction in the intervention group (Δ = 6.12, p < 0.001) than the control group (Δ = 0.88, p = 0.002), with a significant Group × Time interaction ( p < 0.001). Lumbar curvature RoM decreased ( p < 0.001), but no Group × Time interaction occurred ( p = 0.604). The Stoop‐Squat Index showed a main effect for Time ( p = 0.005), but no Group × Time interaction ( p = 0.935). Conclusion A brief educational video effectively improved back pain beliefs but did not alter lifting behaviour or spinal motion. This dissociation between cognitive and motor responses suggests that changing movement patterns may require more intensive or interactive interventions.
