Background Previous research has raised the question of the extent to which physical therapists possess sufficient knowledge of cervical vascular pathologies and blood flow limitations and the clinical reasoning skills to appropriately identify a patient who is having an underlying vascular pathology. Objectives This study aims to investigate: (1) which risk factors are assessed during patient interviews and their frequency; (2) the physical examination tests used, therapists' training in these tests, and their confidence in performing them; (3) therapists’ knowledge of cervical spine treatment risks and associated risk factors; and (4) whether these outcomes differ based on therapist characteristics. Design A cross-sectional digital survey. Methods A combination of descriptive statistics and multivariate testing. Results/findings 774 completed surveys were included in the data analysis. Most respondents reported routinely addressing cardiovascular risk factors, trauma history and contraindications during patient interviews. Peripheral neurological examination was most frequently used (72%), whereas auscultation (8%) and arterial pulse palpation (5%) were rarely applied. Positional testing, although no longer recommended, remained commonly used. Confidence varied, particularly for cranial nerve examination. Forty-eight percent perceived increased dissection risk after manipulation versus 15% after mobilization, and mobilization was generally considered safer. Conclusions Respondents sufficiently addressed risk factors in the patient interview. Regarding the physical examination, improvement of physical therapists’ knowledge and skills in cranial nerve examination is needed, and positional testing should be avoided as it is no longer recommended. Participants’ knowledge of cervical spine treatment risks and risk factors is variable and ongoing updating of clinical knowledge is important, as conclusions may change over time.

OBJECTIVES:Neck pain is common and generally benign, but in rare cases it may be the early symptom of vertebral artery dissection (VAD). To date, no published secondary analysis addressing red flags for VADs in patients whose primary complaint is neck pain, nor any describing the typical clinical presentation, demographic characteristics, and common risk factors of VAD, has been published. Therefore, this scoping review addresses that gap by systematically mapping available evidence on red flags, predisposing risk factors, clinical features at presentation, and demographic profiles in patients presenting primarily with neck pain due to extracranial vertebral artery dissection. METHODS:A systematic search was conducted in MEDLINE, Embase, Web of Science, and CINAHL. Primary studies on adults with extracranial VAD and neck pain were included. Two authors independently selected studies and extracted data on clinical predictors. RESULTS:Forty-six studies (38 case reports, 8 case series) involving 58 patients were included. Most patients (63.8%) were female, with a mean age of 36.8 years. Neck pain was typically unilateral, severe, and poorly responsive to analgesics, often radiating to the head, upper limb, or shoulder; in half of the cases no identifiable cause of onset could be determined, while trauma or sudden neck movements accounted for another third. Risk factors were inconsistently reported, with current smoking and hypertension the most commonly documented. Neurological symptoms were present in two-thirds of cases, most frequently upper limb weakness and dizziness, while systemic symptoms (mainly nausea and vomiting) occurred in 24.1%. Physical examination findings were also inconsistently reported: motor deficits, sensory loss, and reflex abnormalities were each documented in roughly 40-47% of cases, and cranial nerve examination was described in only 25.9% of cases and was unremarkable in most of these. CONCLUSION:Symptoms and demographic features in extracranial VAD cases with neck pain are highly variable. Due to limited diagnostic accuracy data and inconsistent reporting, the clinical utility of red flags remains uncertain. Until more robust evidence becomes available, clinicians should adhere to expert recommendations for screening for VAD while maintaining a high level of vigilance. Further large-scale observational studies are needed to assess the diagnostic value of red flags in this context.

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.

Musculoskeletal (MSK) conditions remain a leading source of global disability, and manual therapy (MT) features in multimodal guideline concordant care; however, teaching in clinical programs that involve MT often remains technique-centric and insufficiently aligned with contemporary, person-centred teaching and practice. The present paper synthesizes literature and recent professional discourse to advance an educational framework that operationalizes modern clinical teaching across professions. To present a review-informed, consensus-driven, student centred framework for clinical education involving MT, designed to cultivate safe, effective, culturally responsive, and evidence-based graduates. Elements supporting a positive, student-centred learning experience were developed inductively by the lead author, then a narrative review of the literature was conducted on the elements, or pillars as they were designated. This was followed by iterative process to refine and further develop the ideas with a group of international educators, clinicians, and researchers across multiple professions. Consensus was achievedon the core elements of a modern clinical education framework. The framework is anchored in basic sciences and clinical skills, and articulated through six teachable pillars: self-awareness, communication, cultural respect, epistemic humility, intellectual curiosity, and professional identity, delivered via high engagement, student-centred teaching. It provides practical curriculum guidance (crossyear learning outcomes, assessment strategies, and implementation vignettes) to embed person-centred communication, bias mitigation, cultural safety, evidence-based practice competencies, lifestyle medicine integration, and interprofessional collaboration. Together, the six pillars offer a novel approach to student-centred learning. A six-pillar, multi-profession approach offers actionable guidance for modern clinical education involving MT and supports the development of graduates prepared for contemporary MSK care: technically competent, evidence-based communicators who are culturally responsive and collaborative across healthcare teams.

BackgroundCurrently, there is conflicting clinimetric data on the patient-rated tennis elbow evaluation (PRTEE) and a paucity of evidence regarding the reliability, validity, and responsiveness of the numeric pain rating scale (NPRS), and tennis elbow function scale (TEFS) in patients with lateral elbow tendinopathy. ObjectivePerform a comprehensive clinimetric analysis of the NPRS, PRTEE, and TEFS in a sample of patients (n = 143) with lateral elbow tendinopathy. MethodsEstablish the reliability, construct validity, responsiveness, meaningful clinically important difference (MCID), and minimal detectable change (MDC90) values for the NPRS, PRTEE, and TEFS at the 3-month follow-up. ResultsThe NPRS [intraclass correlation coefficient (ICC2,1): 0.54, 95% confidence interval (CI): 0.17-0.78], PRTEE (ICC2,1: 0.62, 95% CI: 0.21-0.86), and the TEFS (ICC2,1: 0.71, 95% CI: 0.14-0.90) exhibited moderate reliability. All three outcomes exhibited excellent responsiveness [NPRS: area under the curve (AUC): 0.94, 95% CI: 0.89-0.98]; PRTEE: (AUC: 0.96, 95% CI 0.93-0.99); TEFS: (AUC: 0.95, 95% CI: 0.91-0.98). The MCID and MDC90 were 2.3 and 1.4 for the NPRS, 14.8 and 9.7 for the PRTEE, and 7.5 and 5.7 for the TEFS, respectively. All three patients reported outcome measures also demonstrated strong construct validity (Pearson's r from 0.71 to 0.83, p < .001). ConclusionThe NPRS, PRTEE, and TEFS are clinimetrically sound patient reported outcome measures for patients with lateral elbow tendinopathy at a 3-month follow-up. Registration at ClinicalTrials.govNCT03167710.

Neck pain and whiplash are prevalent disorders with high socio-economic burden. Beliefs and expectations influence their prognosis, causing chronicisation. We aimed to investigate the perspective of the Italian population. We conducted an online survey among Italian adults recruited through social media. The main outcomes were the Whiplash Beliefs Questionnaire (WBQ) total score and its subscales, recovery expectations, and anxiety/stress items. Independent variables were history of neck pain, whiplash, and associated symptoms, with adjustment for age, gender, marital status, employment, and type of job. Associations were assessed using linear regression for WBQ outcomes and proportional odds logistic regression for recovery expectations and anxiety/stress. One thousand thirty-four participants were included. Most responders were women (65

BACKGROUND:The numeric pain rating scale (NPRS) and shoulder pain and disability index (SPADI) are commonly used patient-reported outcome measures (PROMs) in patients with rotator cuff tendinopathy. To date, there are gaps in the evidence supporting the clinimetric properties of these PROMs for patients treated with subacromial pain syndrome (SAPS). METHODS:A clinimetric analysis (n = 145) was performed to examine the reliability, construct validity, responsiveness, interpretability, minimal detectable change (MDC95) and minimum clinically important difference (MCID) of the NPRS and SPADI for "improved" (global rating of change from +3 to +7) and "much-improved" (global rating of change from +5 to +7) patients at 3-months follow-up. RESULTS:The NPRS (ICC: 0.86; 95 %CI, 0.33-0.96) and SPADI (ICC: 0.79; 95 %CI 0.12-0.94) exhibited good reliability and excellent responsiveness (NPRS: area under the curve (AUC) = 0.96, 95 %CI 0.92-0.99; SPADI: AUC = 0.90, 95 %CI 0.84-0.95) in this patient population. Both outcomes demonstrated strong construct validity (Pearson's r; p < 0.001). The MDC95 was a 1.7- and 20.5-point change for the NPRS and SPADI, respectively. For the NPRS, the MCID was a 1.5-point change in the "improved" group and a 2.5-point change in the "much improved" group. For the SPADI, the MCID was an 18-point or 50 % change for the "improved" group, and a 25-point or 70 % change in the "much improved" group. CONCLUSIONS:The NPRS and SPADI demonstrated sound clinimetric properties in patients with SAPS. The MCID exceeded measurement error in the "much improved" group. Diagnosis, type of intervention, level of improvement, and measurement error should be considered when applying the MCID.

BACKGROUND CONTEXT:The numeric pain rating scale (NPRS), Oswestry disability index (ODI) and the Roland-Morris disability questionnaire (RMDQ) are commonly used patient-reported outcome measures (PROMs) in patients with low back pain. However, there is a paucity of evidence supporting the reliability, validity, and responsiveness of these PROMs in patients with lumbar spinal stenosis (LSS) treated with conservative interventions including spinal manipulation, electrical dry needling, joint mobilization, and exercise. PURPOSE:To establish the reliability, construct validity, responsiveness, minimal detectable change (MDC), and minimum clinically important difference (MCID) of the NPRS, ODI, and RMDQ in patients with LSS. STUDY DESIGN/SETTING:Clinimetric analysis of a prior randomized clinical trial. PATIENT SAMPLE:One hundred twenty-eight (n = 128) patients with LSS treated with outpatient physical therapy, including manual therapy, exercise and electrical dry needling. OUTCOME MEASURES:PROMs included the NPRS, ODI, RMDQ, and the global rating of change scale (GROC). METHODS:The MDC (90 % and 95 % confidence interval) and MCID was established for "improved" (GROC: +3 to + 7) and "much-improved" (GROC: +5 to + 7) patients at 3-months follow-up. The intraclass correlation coefficient (ICC2,1) was analyzed at 2 weeks, 6 weeks and 3-months. Pearson's correlation (r) was also calculated. RESULTS:The NPRS (ICC2,1 = 0.55; [95 % CI: 0.19-0.79]) exhibited moderate reliability, while the ODI (ICC2,1 = 0.86; [95 % CI: 0.70-0.94]) and RMDQ (ICC2,1 = 85; [95 % CI: 0.64-0.94]) exhibited good reliability at the 3-month follow-up. All PROMs exhibited acceptable responsiveness (area under the curve range 0.73 to 0.92; p < 0.001) and strong construct validity (Pearsons r: range 0.51 to 0.72; p < 0.001). The MDC95 was 2.3 points for the NPRS, 8.5 points for the ODI, and 6.1 points for the RMDQ. The MCID exceeded measurement error in the "much improved" patients for the NPRS (2.8 points) and the ODI (8.5 points), but did not for the RMDQ (4.5 points). CONCLUSIONS:All three PROMs demonstrated suitable clinimetric properties in patients with LSS. Based on this analysis, patients who are "much improved" should have at least a 2.8-point reduction on the NPRS, and an 8.5-point reduction on the ODI to be considered clinically meaningful, and to exceed the measurement error. The MCID of the RMDQ did not exceed measurement error in either improvement category.

BACKGROUND AND OBJECTIVE:Exercise is a crucial component of a multimodal treatment for improving function and reducing pain in patients with non-specific neck pain. This study aims to investigate the knowledge, attitudes, practices and the influence of professional characteristics of Italian specialised musculoskeletal physiotherapists compared with non-specialised physiotherapists. The influence of professional characteristics on exercise prescription for individuals with non-specific neck pain was also investigated. MATERIALS AND METHODS:This observational study was reported according to the CHERRIES checklist. A 30-question survey was conducted from August 2023 until January 2024. RESULTS:A total of 446 Italian physiotherapists participated; 57.3% were Orthopaedic Manipulative Physical Therapists (OMPTs). Most (84%) reported being trained in exercise prescription for neck pain, but many were unfamiliar with certain muscular assessment tests which have been described in the literature (e.g., cervical extensor endurance test [35%], scapular holding test [41%]). 79% of the OMPTs and 56% of non-specialised physiotherapists (non-OMPTs) prescribed exercise for patients with neck pain, with 84% of the OMPTs and 68% of non-OMPTs agreeing that exercise should be part of neck pain management. 81% of the OMPTs and 63% of non-OMPTs reported being trained in the prescription of resistance training for patients with neck pain. However, OMPTs prescribed it less frequently. CONCLUSIONS:Italian physiotherapists are trained in exercise prescription for neck pain but lack familiarity with key muscle assessment tests. There is a need for enhanced training in aerobic and resistance exercise prescription to align with international guidelines and ultimately improve patient outcomes.

OBJECTIVE:Perform a clinimetric analysis of the visual analogue scale (VAS) and active pain-free mouth opening (PFMO) in patients with muscular temporomandibular disorder (mTMD). METHODS:Reliability (intraclass correlation coefficient=ICC), construct validity, responsiveness (area under the curve=AUC), minimal detectable change (MDC), and minimal clinically important difference (MCID) values were calculated. RESULTS:The VAS-24hr (ICC=0.59), VAS-7day (ICC= 0.54), and PFMO (ICC=0.86) exhibited acceptable reliability. Both the VAS (AUC=0.96) and PFMO (AUC=0.87) exhibited a high level of responsiveness. The MCID was 15.5mm (VAS-24 and VAS-7day) and 3.5mm (PFMO) in the improved group; and 27.5mm (VAS-24), 21mm (VAS-7day), and 6.6mm (PFMO) in the much-improved group. The MDC was 9.6mm (VAS-24), 9.5mm (VAS-7day), and 6.1mm (PFMO). All outcomes demonstrated strong construct validity (Pearson's r; p<0.001) . CONCLUSIONS:All three outcome measures demonstrated acceptable clinimetric properties in patients with mTMD at the 3-month follow-up. The MCID lies outside measurement error in all outcomes in the much-improved group.      .

OBJECTIVES:To translate, cross-culturally adapt and study the psychometric properties of the Wisconsin Running Injury and Recovery Index (UWRI) in Italian runners with running-related injuries (RRI). DESIGN:clinometric study. SETTING:5 private outpatient physical therapy clinics. PARTICIPANTS:144 subjects with RRI. MAIN OUTCOME MEASURES:UWRI translation was performed following international guidelines. Structural validity (confirmatory factor analysis [CFA]), internal consistency (Cronbach's alpha [α]), test-retest reliability (intraclass correlation coefficient [ICC]), measurement error (minimal detectable change [MDC]), and construct validity (hypothesis testing). RESULTS:UWRI translation was performed without issues. CFA showed a two-factor structure (i.e., running progression and symptom surveillance subscale) (comparative fit index = 0.988; Tucker-Lewis index = 0.977; root mean square error of approximation = 0.049; standardized root mean square residual = 0.042). Each subscale presented high internal consistency (α = 0.92 and 0.75 for the running progression and symptom surveillance subscales, respectively), excellent and good test-retest reliability (ICC = 0.99 and 0.89 for the running progression and symptom surveillance subscales, respectively), and acceptable measurement error (MDC = 0.33 and 2.3 points for the running progression and symptom surveillance subscales, respectively). Construct validity was moderate for both subscales as 50.0 % (2/4) of a-priori hypotheses were satisfied. CONCLUSION:The validation process revealed acceptable psychometric properties of the UWRI Italian version, which can be used for research and clinical purposes.

BACKGROUND:C1-C2 fusion is a well-established procedure for treating instability at the upper cervical spine. However, its precise impact on cervical range of motion (ROM) and the degree to which thoracolumbar or global compensations can restore functional mobility remain incompletely understood. Moreover, patient-reported outcomes after such surgery are not fully characterized. This study addresses four questions: (1) How does C1-C2 fusion affect cervical ROM compared to healthy controls? (2) Can thoracolumbar and global compensations restore normal mobility? (3) What is the impact on quality of life measured by the Neck Disability Index (NDI) and the Short Form Health Survey 36 (SF-36)? (4) Are these compensations sufficient for activities of daily living? HYPOTHESIS:We hypothesized that while C1-C2 fusion would significantly reduce cervical ROM, compensatory mechanisms would enable patients to preserve sufficient motion for daily activities, albeit with a potential decrease in quality of life. PATIENTS AND METHODS:This retrospective observational study included 19 patients (11 males, 8 females) who underwent Goel-Harms C1-C2 fusion between 2010 and 2021, with a minimum six-month postoperative follow-up. Cervical ROM (flexion-extension, lateral bending, rotation) was measured using the Cervical Range of Motion (CROM) device in three scenarios: no compensation, thoracolumbar compensation, and global compensation. We performed a comparison with the normal values reported in literature. Patient-reported outcomes were evaluated using the NDI and SF-36 questionnaires. Statistical analyses included t-tests, repeated measures ANOVA, and correlation tests. RESULTS:(1) Cervical ROM was significantly reduced in operated patients compared to controls (p < 0.001). (2) Thoracolumbar and global compensations partially restored mobility, with extension remaining notably limited. (3) Patients reported moderate disability on the NDI and lower SF-36 subscale scores (particularly in physical functioning and pain domains). (4) Despite reduced cervical motion, most activities of daily living were achievable through compensatory mechanisms. DISCUSSION:C1-C2 fusion substantially restricts upper cervical mobility, yet thoracolumbar and global compensations help maintain functional ROM for daily tasks. Nevertheless, the observed reduction in quality of life highlights the importance of thorough preoperative counseling. These findings align with existing literature on balancing spinal stability with motion preservation. Larger prospective studies are needed to refine patient selection and optimize postoperative rehabilitation. LEVEL OF EVIDENCE:IV; retrospective observational study.

Introduction: Temporomandibular disorders (TMDs), neck pain (NP), and cervicogenic headache (CGH) frequently co-occur. We aimed to assess TMD prevalence and orofacial clinical features in adults with NP or CGH versus asymptomatic controls. Methods: We searched PubMed, CINAHL, Web of Science, and Scopus from inception to 31 July 2025. Eligible designs were analytical cross-sectional studies comparing TMD prevalence, signs, or symptoms between NP/CGH patients and controls. Outcomes included TMD prevalence, jaw mobility, masticatory muscle pressure pain thresholds (PPT), and palpation findings. Risk of bias was appraised with the JBI analytical cross-sectional checklist. Random-effects meta-analyses synthesized odds ratios (ORs) for dichotomous and mean/standardized mean differences (MDs/SMDs) for continuous outcomes; heterogeneity was quantified with I2 (and τ2 where available). Small-study effects were inspected visually (k < 10). Certainty of evidence was assessed with GRADE. Results: From 4130 records, nine studies met the criteria (eight NP, 400 subjects; one CGH, 44 subjects). NP was associated with higher TMD prevalence versus controls (OR 3.64, 95% CI 1.35-9.84; I2 = 13%). Jaw mobility was reduced in either pain-free opening (one study), unassisted opening (one study), or maximum assisted opening (three studies; MD -6.16 mm, 95% CI -10.05; -2.28; I2 = 83%). PPTs were lower in symptomatic groups for masseter (SMD -1.11, 95% CI -1.89 to -0.32; three studies; I2 = 92.6%) and temporalis (SMD -0.77, 95% CI -1.04 to -0.50; five studies; I2 = 69%). Myofascial trigger points and pain on palpation of masticatory muscles or TMJ were more frequent in experimental groups. Discussion: The findings suggest consistent associations between NP/CGH and TMD prevalence with signs of orofacial dysfunctions. Certainty of evidence was very low due to the cross-sectional design, incomplete confounding control, and moderate heterogeneity for several outcomes. Conclusions: Adults with NP/CGH show higher TMD prevalence and reduced jaw mobility with lower masticatory PPTs. The results support integrated assessment, and prospective longitudinal studies are needed.

Background: Scar impairments impose a significant economic burden and negatively impact an individual’s well-being and quality of life. However, there is a lack of standardization in physical therapy interventions for scar management. Objective: This study aimed to provide a comprehensive overview of studies addressing non-invasive physical therapy interventions for scar management. Methods: This scoping review was conducted following the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. Six databases were searched, and additional studies were retrieved through gray literature and the reference lists of included articles. All studies considering non-invasive physical therapy interventions for scar management were included. No restrictions were applied regarding time, context or publication type. Results were illustrated using descriptive statistics and summarized in an infographic. Results: Out of 13,419 initial records, 92 studies met the inclusion criteria. Most articles were narrative reviews (n = 41) followed by randomized controlled trials (RCT) (n = 18). The most reported interventions were pressure therapy (n = 41), physical therapy modalities (n = 37), silicone-based products (n = 29) and massage (n = 20). Conclusions: Scar management involves a wide range of physical interventions. However, research has predominantly focused on adults, particularly those with burns, with limited attention given to pediatric or non-adult populations. Furthermore, there is significant variability in the application parameters, scar localization and size. Examining the included study designs, most of the research presented reduced sample sizes and lacked control groups. Notably, almost half of the studies were based on expert opinions. Future high-quality research is needed to identify evidence-based interventions for the clinical management of scars.

BACKGROUND:Periosteal and intraarticular electrical dry needling (PIEDN) has been found to reduce pain, stiffness, and disability in individuals with knee osteoarthritis (OA) in the short-term. Optimum dosing interval of PIEDN to maintain these improvements in the longer-term has yet to be determined. OBJECTIVE:Compare the longer-term effects (30 weeks) of three different dosing intervals of PIEDN boosters on pain, stiffness, and disability in individuals with knee OA, and to quantify the effect size of PIEDN as a stand-alone treatment. METHODS:Patients with knee OA (n = 586) received PIEDN (1-2 times per week) over 6 weeks. Patients were then randomized to receive a PIEDN booster session once every 4 weeks (n = 195), once every 8 weeks (n = 197), or no further treatment (n = 194) for the next 6 months. The primary outcome was the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. RESULTS:Patients receiving PIEDN every 4 weeks experienced significantly greater improvements in disability (WOMAC: F = 33.060; p < .001) than those receiving PIEDN every 8 weeks, or those receiving no further treatment. Patients receiving PIEDN boosters every 4 weeks experienced significantly greater improvements in pain (NPRS: F = 25.678, p < .001; WOMAC-Pain: F = 22.816, p < .001), stiffness (WOMAC-Stiffness: F = 27.416, p < .001) and function (WOMAC-Physical Function: F = 32.856; p < .001). The between-group effect size was large (WOMAC: SMD = 1.32; 95% CI: 1.10, 1.54) at 30 weeks in favor of the group that received PIEDN every 4 weeks. The between-group effect size was large for the NPRS (SMD = 1.14; 95% CI: 0.93, 1.36) at 30 weeks for the PIEDN-4 group. At 30 weeks, significantly more patients in the PIEDN-4 group (n = 123, 63.1%) had completely stopped taking medication compared to the control group (X2 = 70.158; p < .001; n = 41, 21.1%). CONCLUSION:PIEDN boosters every 4 weeks were a more effective dosage regimen for maintaining improvements in pain, stiffness, function, and disability than once every 8 weeks or no further treatment sessions.Trial Registration: www.clinicaltrials.gov NCT05365061 May 4, 2022.

BACKGROUND:Degenerative cervical myelopathy (DCM) is a clinical syndrome characterized by a progressive compression of the spinal cord. DCM often looks like common symptoms of aging or bilateral carpal tunnel syndrome in its early stages, requiring careful differential diagnosis. Identifying DCM is a real challenge as no validated screening tools are available for making the DCM diagnosis. Potentially, individuals with DCM may experience misdiagnosis or substantial diagnostic delays, with an enhanced risk of irreversible neurological consequences if not promptly addressed. Despite the increasing prevalence, there is a lack of awareness about DCM among both the public and healthcare professionals. However, patients may seek physiotherapy to obtain a diagnosis or access treatment. METHODS:A comprehensive (non-systematic) review of the literature about DCM epidemiology, pathophysiology, clinical presentation, diagnostic methods, and management was conducted. RESULTS:A guide and essential knowledge to facilitate clinicians to understand DCM and to enhance clinical reasoning skills, performance and interpretation of the examination are provided. Interdisciplinary collaboration and optimal referral methods are also handled. CONCLUSION:The aim of this article is to summarize and enhance physiotherapists' essential knowledge of the differential diagnosis and management of patients with DCM.

OBJECTIVE: To summarize the perceptions and experiences of patients living with whiplash-associated disorders (WADs). DESIGN: Qualitative evidence synthesis. LITERATURE SEARCH: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Embase, Physiotherapy Evidence Database (PEDro), PsycINFO, MEDLINE, Scopus, SPORTDiscus, and Web of Science databases were searched up to June 2024 and updated in October 2024. STUDY SELECTION CRITERIA: Inclusion criteria were (1) qualitative primary studies or mixed methods studies with clear identification of participants and findings from the qualitative methods, (2) published in English or Italian, (3) included participants aged ≥16 years, and (4) focused on participants' experiences with a diagnosis of WAD. DATA SYNTHESIS: Metasummary and metasynthesis processes were conducted following Sandelowski and Barroso's methodology. The confidence of the findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. RESULTS: Eighteen studies were included, comprising a total of 349 participants. Overall, 330 target findings were collected, analyzed, and grouped into 15 categories attributable to 5 main themes: (1) "WAD changed my body," (2) "WAD destabilized my daily life," (3) "WAD has consumed my thoughts," (4) "The recovery journey from WAD," (5) "Life goes on after WAD." The methodological quality of all studies revealed only minor concerns. The GRADE-CERQual assessment indicated moderate confidence in the findings, due to serious concerns regarding their relevance to the patient experience of WAD. CONCLUSION: People with WAD experienced a wide range of interconnected physical, emotional, cognitive, and social challenges. Addressing these multifaceted needs through a biopsychosocial approach can guide more effective management strategies and improve long-term outcomes for patients with WAD. J Orthop Sports Phys Ther 2025;55(9):1-19. Epub 25 July 2025. doi:10.2519/jospt.2025.13156.

Background: Given the relationship between reduced pulmonary and respiratory muscle function in neck pain, incorporating breathing exercises into neck pain management may be beneficial. Purpose: The purpose of this study was to investigate the benefits of breathing exercises for treating neck pain. Methods: We searched PubMed (MEDLINE), PEDro, CINAHL, Scopus, and EMBASE databases, up to the 28 of February 2024. Randomized controlled trials evaluating the impact of breathing exercises on reducing pain and disability in both persistent and recent neck pain were selected. A meta-analysis was conducted for each outcome of interest; however, if quantitative methods were not possible, a qualitative synthesis approach was used. The risk of bias was assessed using the Cochrane RoB 2.0 Tool (version 22 August 2019). We used the GRADE approach to judge the certainty of the evidence. Results: Five studies were included. Meta-analysis showed a statistically significant reduction in pain (standardized mean difference (SMD), −10.16; 95% CI: −14.82, −5.50) and disability (SMD, −0.80; 95% CI: −1.49, −0.11), in favor of breathing exercises. Qualitative synthesis for pulmonary functional parameters resulted in a statistically significant improvement for FVC, MIP, MEP, and MVV, in favor of breathing exercises. Conclusions: Breathing exercises showed significant short-term effects in reducing pain and disability for persistent neck pain. They also provided benefits for functional respiratory parameters. However, the evidence certainty is low.

Background and Objectives: The aging population and the COVID-19 pandemic have led to a rise in severe conditions, including musculoskeletal (MSK) disorders. Although MSK conditions are often managed in primary care, they may sometimes mask serious illnesses requiring urgent diagnosis. The red flag (RF) concept is essential for identifying signs and symptoms of potentially severe disease. However, RF criteria vary across clinical guidelines and lack consistency. With the growing role of direct access to physiotherapy—bypassing physician referral—physiotherapists must develop strong differential diagnostic skills to identify serious pathologies that mimic MSK disorders. This review aims to systematically map how RFs are defined in MSK clinical practice guidelines (CPGs), supporting the move toward a standardized definition for clinical and research use. Materials and Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane databases. Included studies were CPGs and systematic reviews (SRs) of CPGs addressing MSK disorders and incorporating the RF concept. Data extraction followed a rigorous process, and RF definitions were synthesized and compared in table format. Results: Out of thirteen-thousand three-hundred and ninety-three articles identified, fourteen met inclusion criteria (seven CPGs and seven SRs of CPGs), spanning both physiotherapy and medical fields. All definitions described RFs as signs or symptoms indicating possible serious pathology requiring further investigation or referral. Some definitions referred broadly to “patterns of signs or symptoms”, while others offered more precise criteria. Conclusions: This review highlights the lack of a standardized RF definition in MSK care, leading to inconsistencies in clinical decision-making and diagnosis. To improve patient safety and guide clinicians—especially in direct-access contexts—a unified, internationally recognized definition of RFs is needed in future guidelines.