PURPOSE:Low back pain (LBP) is a complex, multifactorial condition with numerous contributors across biopsychosocial domains. To advance understanding of this complexity, we synthesized diverse expert knowledge on treatment effectiveness and underlying mechanisms using a systems-based, collaborative modeling approach. METHODS:Twenty-nine experts from diverse disciplines created individual fuzzy cognitive maps (FCMs) to represent their understanding of factors affecting pain, disability, and quality of life (QoL), along with treatment mechanisms. These maps were aggregated into a meta-model comprising 142 Components and 1,161 weighted Connections. Centrality was used to quantify the relative contribution of each domain within the meta-model. Simulations with the meta-model based on expert knowledge (1) estimated the relative effectiveness of treatments on pain, disability, and QoL and (2) identified key Mediators and mediating Domains based on their relative contribution to mediating treatment effects. RESULTS:Psychological, biomechanical, and social/contextual Domains were central to expert conceptualizations of LBP. Simulation indicated cognitive behavioral therapy was considered the most effective among all interventions. Most interventions were mediated by Components across multiple Domains, with psychological factors frequently serving as mediators. The structure of the conceptual meta-model reflected both the multifactorial complexity of LBP and the diversity of expert perspectives regarding factors that influence treatment effectiveness. CONCLUSION:The developed meta-model provides a novel, systems-based representation of expert knowledge about LBP, enabling quantitative exploration of treatment effects and underlying mechanisms. This conceptual framework also offers a foundation for advancing research on multi-modal, personalized care.

BACKGROUND:Platelet-rich plasma (PRP) is increasingly used for treatment of knee osteoarthritis, but there is limited understanding regarding which patients will benefit most. The impact of lifestyle-related chronic diseases, which are linked to systemic inflammation, and behavioral factors, such as agreed-upon out-of-pocket costs, have been underevaluated as predictors of PRP response. OBJECTIVE:To investigate patient-specific factors for favorable response to intra-articular PRP injection in treating knee osteoarthritis, with a focus on lifestyle-related chronic disease burden (ie, hypertension, hyperlipidemia, type-2 diabetes, obstructive sleep apnea, anxiety/depression, gastroesophageal reflux disease, autoimmune disease, some cancers) and patients' agreed-upon out-of-pocket costs. DESIGN:Retrospective review. SETTING:Tertiary orthopedic institution. PATIENTS:Patients who underwent first-time, single, intra-articular PRP injections for symptomatic knee osteoarthritis. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Numerical rating scale or visual analog scale pain scores were collected at baseline and at 3-6 months post injection. Patients who achieved minimal clinically important reductions of 20% in pain score, or overall pain improvement of ≥60%, were classified as responders. RESULTS:Two hundred nine initial intra-articular PRP injections in 199 unique patients with symptomatic knee osteoarthritis were included. The mean age was 65 ± 11 years (113/209 [54%] female). A majority (91%) of the cohort had more than one lifestyle-related chronic disease, with the most common being hyperlipidemia; 74% had two or more lifestyle-related chronic diseases. Of the 209 injections, 85 (41% [95% confidence interval (CI): 34%-48%]) were classified as responders. Obstructive sleep apnea was more prevalent in nonresponders than responders (9% vs. 1%; p = .019). On multivariable logistic regression, having fewer than two lifestyle-related chronic diseases (odds ratio [OR]: 2.06 [95% CI, 1.01-4.16]; p = .046) or paying higher out-of-pocket procedure costs (OR: 1.28 [95%CI, 1.04-1.59] per $500-increase in out-of-pocket cost; p = .022) was associated with greater likelihood of positive response to PRP injection at 3-6 months. CONCLUSIONS:The effectiveness of PRP injections for knee osteoarthritis may be reduced in patients with higher cumulative disease burden of lifestyle-related chronic diseases, as well as in patients paying lower out-of-pocket procedure costs.

BACKGROUND:High-level competitive golfers often have access to interventions and support systems that include physical, nutritional, and behavioral health. Much focus has been directed to training on the course. There are limited studies describing what competitive golfers do off the course for performance optimization. OBJECTIVES:To describe the training, resources, and lifestyle modifications that competitive golfers use off the course in order to optimize performance on the golf course. DESIGN:Cross-sectional survey study. SETTING:Online survey. PARTICIPANTS:One hundred one high-level competitive golfers (56 collegiate, 45 touring professional; mean age: 25 ± 8 years; 55% male) completed the online survey and were included in the study. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Information on golf play, exercise, lifestyle (nutrition, sleep), and alternative interventions was collected from the survey. RESULTS:Participants averaged 4.1 ± 3.5 years of collegiate/professional golf play. Most golfers reported working with swing coaches (78.2%) and athletic trainers (71.3%), and 86.1% participated in golf-specific resistance training for 2.9 ± 2.0 days/week. Massage and Theragun were the most common alternative interventions used to optimize performance. Almost half of all golfers reported working with a sports psychologist. Furthermore, 64.4% of golfers reported changing diet to optimize golf performance, and 41.1% had consulted with nutrition experts. Most golfers reported ≥6 hours of sleep/night (92.1%), and 23.7% had consulted with sleep experts. Compared to collegiate golfers, touring professionals were more likely to make changes to diet, report <6 hours of sleep/night, consult with sleep experts, and use wearable devices to track sleep. CONCLUSIONS:Multiple golf-specific and lifestyle interventions were used by high-level competitive golfers off the course to optimize their performance.

Objective:To evaluate cumulative lifestyle-related chronic diseases and self-reported physical and mental health in low back pain (LBP) patients presenting to physiatrists and spine surgeons, and to assess outcomes following spine surgery in patients with and without lifestyle-related chronic disease(s). Design:This retrospective study included 4444 patients presenting for evaluation of LBP with physiatrists (n = 3282/4444) or spine surgeons (n = 1162/4444) from 4/1/2019-7/1/2021. Lifestyle-related chronic diseases and PROMIS-10 scores were collected. Length-of-stay (LOS), post-operative events, and persistent post-operative pain within 3 months were collected for surgical patients. Results:60.8% (n = 2704/4444) of patients had lifestyle-related chronic diseases; overweight/obesity was most common (56.8% [n = 2131/3755]). Patients evaluated by spine surgeons had more lifestyle-related chronic diseases than those evaluated by physiatrists. Increasing numbers of lifestyle-related chronic disease were associated with lower PROMIS-10 physical and mental health scores (P < .001). For surgical patients, LOS was greater for increasing numbers of lifestyle-related chronic diseases (P = .008). Post-operative events and persistent pain rates were similar in patients with and without lifestyle-related chronic disease. Conclusion:Lifestyle-related chronic diseases were common in this cohort and more prevalent in patients evaluated by spine surgeons, highlighting the need for pre-surgical health optimization. Future work should prospectively investigate lifestyle metrics, patient-reported outcomes, and post-operative events following standardized lifestyle medicine program implementation.

BACKGROUND:Although surgery provides symptomatic relief for many patients with nonarthritic hip-related pain, not all patients are ideal surgical candidates, are interested in pursuing surgery, or require surgery for symptomatic relief. Nevertheless, evidence is limited regarding patients' satisfaction with nonoperative management. OBJECTIVE:To identify the rate of satisfactory response to nonoperative management for nonarthritic hip-related pain at 12-month follow-up. A secondary purpose was to identify possible predictors of response to nonoperative management. DESIGN:Pragmatic, prospective cohort study. SETTING:Two U.S. tertiary medical centers. PATIENTS:Participants ranging in age from 15-40 years who were diagnosed by a surgical or nonsurgical orthopedic clinician with nonarthritic hip-related pain and were advised to initiate nonoperative management. INTERVENTIONS:Participants received brief instruction on movement pattern related activity modifications for hip-related pain. They otherwise followed the standard care treatment plan recommended by their treating clinician. MAIN OUTCOME MEASUREMENTS:The proportion of patients at 12-month follow-up who endorsed both (1) not having scheduled or undergone hip surgery and (2) answering "Yes" to "Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?" RESULTS:Among 88 patients (mean [SD] age 27 [8] years, 71 [81%] female), 59% (95% confidence interval [CI] 48%-70%) (n = 45/76) who completed follow-up reported satisfactory symptom response with nonoperative management at 12-month follow-up. Predictors of not achieving a satisfactory response included worse baseline symptom severity (odds ratio [OR] 1.04 per International Hip Outcome Tool-12 point [95% CI 1.01-1.07], p = .023) and a preference at baseline for procedural treatment such as injection or surgery (OR 0.13 [95% CI 0.04-0.46], p = .001). CONCLUSIONS:In a pragmatic analysis of patients presenting for tertiary orthopedic care, 59% of patients with nonarthritic hip-related pain were satisfied with their response to nonoperative management at 12-month follow-up. This information can be shared with patients to facilitate informed decision making. STUDY REGISTRATION:ClinicalTrials.gov, NCT04069507.

BACKGROUND:Eating a whole-food, plant-predominant diet reduces chronic systemic inflammation, which can improve pain in people with chronic musculoskeletal conditions. However, 85% of people have dietary perceptions that do not accurately reflect their actual dietary quality. OBJECTIVE:To determine whether patients' dietary perceptions align with dietary quality, assess correlations between dietary perception and lifestyle metrics, and evaluate how dietary perceptions relate to outcomes following Lifestyle Medicine (LSM) program completion. DESIGN:Retrospective review of repository data. SETTING:Tertiary orthopedic center. PATIENTS:Seven hundred eighty-three adults enrolled in the LSM program from March 2022-August 2024. INTERVENTIONS:Patients chose to participate in an intensive (multiple-visit) or selective (single-visit) track of the LSM program to treat musculoskeletal conditions and chronic diseases. MAIN OUTCOME MEASURES:Dietary perceptions were evaluated by asking patients if they had a healthy diet. Dietary quality was assessed by determining percentages of whole-food on a plate per meal (healthy diet: ≥50%). Lifestyle metrics included physical activity, sleep health, anxiety/depression, social connections, and smoking status. Program outcomes included the ability to attain goals to have hip or knee arthroplasty in a subset of 158 patients. RESULTS:Of the 783 patients (74.3% female, 60.3 ± 10.8 years), 60.4% (95% confidence interval [CI]: 56.9%-63.9%) had healthy dietary perceptions. Lifestyle metrics did not differ between patients with concordant versus discordant dietary perceptions (p > .05). Compared to patients with unhealthy dietary perceptions, patients with healthy dietary perceptions were more likely to be physically active (41.5% vs. 33.5% [p = .025]) and report good social connections (94.6% vs. 82.3% [p < .001]), with less sleep impairment (73.9% vs. 86.1% [p < .001]) and anxiety/depression (42.9% vs. 59.5% [p < .001]). Hip or knee arthroplasty rates did not differ by dietary perception status. CONCLUSION:Perceiving one's diet as healthy, rather than concordance with actual dietary quality, was associated with favorable lifestyle metrics. This suggests positive health perceptions may help predict engagement in other healthy behaviors.

Female athletes have long been under-represented in sports medicine research, and data on the association of surgical procedures on elite athletic careers remain limited. This study estimated career longevity and satisfaction among elite retired women football players. Data were collected via an anonymous online survey from a previously published cohort of 560 retired elite female football athletes, who provided information on playing history, surgical history, and assessments of long-term joint function, physical activity, and general health. Linear and ordinal regression analyses were used to evaluate factors associated with career longevity, career satisfaction, and post-career satisfaction. Higher competition level was associated with longer career duration (β = 2.57, p < 0.001), while more years since retirement was linked to shorter careers (β = -0.23, p = 0.018). Playing as a defender (OR: 1.71, p = 0.035), more years since retirement (OR: 1.03, p = 0.016), and better mental (OR: 1.05, p < 0.001) and physical health (OR: 1.04, p = 0.034) were associated with greater career satisfaction. Post-career satisfaction was higher with more years since retirement (OR: 1.05, p < 0.001) and better mental health (OR: 1.14, p < 0.001), while anterior cruciate ligament (ACL) reconstruction during the career was linked to lower post-career satisfaction (OR: 0.50, p = 0.034). Retired elite women football players with more years since retirement and better mental health reported greater career and post-career satisfaction. Those with a history of ACL reconstruction reported lower post-career satisfaction, potentially due to ongoing health issues.

BACKGROUND:Score cutoffs of clinically important outcome values such as the minimal clinically important improvement (MCII), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) are population and treatment specific. In patients with nonarthritic hip-related pain, numerous score cutoffs have been calculated for use after surgical treatment, but they have not been established for patients who pursue nonoperative care. PURPOSE:To determine the MCII, SCB, and PASS score cutoffs for the 12-item International Hip Outcome Tool (iHOT-12), the Hip Disability and Osteoarthritis Outcome Score (HOOS), and an 8-item abbreviated version of the HOOS (HOOSglobal) among patients with nonarthritic hip-related pain who were managed nonoperatively. STUDY DESIGN:Cohort study; Level of evidence, 4. METHODS:The cohort included 15- to 40-year-old patients who were diagnosed with nonarthritic hip-related pain by a surgical or nonsurgical orthopaedic clinician and were advised to pursue nonoperative management at the time of evaluation. At baseline and 12-month follow-up, patients completed the iHOT-12, HOOS, and HOOSglobal. Receiver operating characteristic curves were used to generate MCII, SCB, and PASS score cutoffs using an anchor-based approach as well as score changes between baseline and 12 months. The anchor question for the MCII and SCB utilized a 9-item global rating of change scale. The anchor question for the PASS was as follows ("yes"/"no" response): "Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?" RESULTS:Among 61 patients (mean age, 28 ± 8 years; 50 [82%] female), for the iHOT-12, the MCII score cutoff was 14, the SCB score cutoff was 18, and the PASS score cutoff was 63. For the HOOS subscales, the MCII score cutoffs ranged from 4 (Activities of Daily Living) to 13 (Sport and Recreation), the SCB score cutoffs ranged from 10 (Symptoms and Activities of Daily Living) to 25 (Quality of Life), and the PASS score cutoffs ranged from 50 (Quality of Life) to 87 (Activities of Daily Living). For the HOOSglobal, the MCII score cutoff was 5, the SCB score cutoff was 12, and the PASS score cutoff was 65. The models mostly had good responsiveness (area under the curve = 0.73-0.94). CONCLUSION:These clinically important outcome values can assist clinicians and researchers with interpreting patients' clinical change during nonoperative treatment for nonarthritic hip-related pain.

BACKGROUND:Nonarthritic hip-related pain can cause chronic pain and disability. Movement pattern training is an effective nonoperative treatment when delivered via formal physical therapy, but some patients have limited access to physical therapy. Discussion of movement pattern training during a patient's initial visit to a medical provider could be a valuable addition to first-line management of hip pain. However, the general acceptability of movement pattern related activity modification is not yet known. OBJECTIVE:To understand the real-world willingness of patients with nonarthritic hip-related pain to implement movement pattern modifications. A secondary goal was to explore adherence to movement pattern related activity modification after a single instructional session. DESIGN:Prospective cohort study. SETTING:Outpatient clinics of two U.S. tertiary care academic medical centers. PARTICIPANTS:Eighty-eight 15-40-year-old patients who were diagnosed by a musculoskeletal clinician with nonarthritic hip-related pain and advised to pursue nonoperative management. INTERVENTIONS:Participants received a single instructional session of movement pattern training principles, in addition to usual nonoperative care. MAIN OUTCOME MEASURES:The primary outcome was the proportion of participants who reported implementing one or more movement pattern related activity modifications during the 12-week follow-up period. The secondary outcome was participants' self-reported proportion of time that movement pattern related activity modifications were implemented. RESULTS:Eighty-eight participants enrolled (mean 27 [SD 8] years old, 81% (n = 71) female). By 12-week follow-up, 100% of the 80 retained participants implemented one or more movement pattern related activity modifications. Participants incorporated movement pattern modifications a median of 73% (interquartile range 50%-85%) of the time. CONCLUSIONS:Participants with nonarthritic hip-related pain demonstrated high willingness to engage in movement pattern related activity modification, even after a single instructional session. Instruction in movement pattern training principles during an initial medical visit for nonarthritic hip-related pain may be a valuable, well-received addition to traditional first-line management.

Diagnostic hip injections are used to confirm an intra-articular source of hip pain in adolescents and young adults in order to guide management. There is currently no data-driven consensus regarding what cutoff metric should be used to constitute a ‘positive’ response to injection. This study compared using either 50% or 75% immediate pain improvement to define a positive response to fluoroscopically-guided diagnostic hip injection to aid in management decision-making. Rates of surgical management and likelihood of satisfaction with care at 12+ months were then compared between the two groups. Amongst 56 hips, (mean age 18.5 (SD ± 5.2) years, 89% (50/56) female) there was no difference in the rate of progression to surgery amongst responders when using either a ≥50% or ≥75% cutoff of pain improvement (71% (29/41) versus 74% (20/27), between-group difference 3% [95% CI, −18% to 25%], P = .76). Amongst those undergoing surgery, there was no difference in patient-reported satisfaction, at 12+ months based on a ≥50% versus ≥75% pain improvement cutoff (74% (14/19) versus 69% (9/13) reporting ‘satisfied’ or ‘very satisfied’ on 5-point Likert Scale, between-group difference 4% [−27% to 36%], P = 0.78). Our findings suggest that a ≥50% cutoff could be considered a ‘positive’ response in a clinical setting and used to guide management decisions.

BACKGROUND:Enabling spine patients to access appropriate spine providers based on their course of care can enhance care outcomes. Physiatrists are trained to provide care throughout the continuum of low-back pain (LBP) symptoms and structural conditions that do not require urgent/emergent spine structural intervention. OBJECTIVE:To assess if patients triaged to a physiatrist for LBP based on where they are in their continuum of spine care will report better baseline physical and mental health than patients presenting to a spine surgeon. DESIGN:Retrospective study comparing physical and mental health (Patient-Reported Outcomes Measurement Information System [PROMIS]-10) in patients with LBP who are triaged for initial evaluations with physiatrists or spine surgeons. SETTING:Tertiary orthopedic hospital. PATIENTS:Adult patients presenting with chief concerns of nonemergent/nonurgent LBP to physiatry or spine surgery from April 1, 2019 to July 1, 2021. INTERVENTIONS:N/A. MAIN OUTCOME MEASURES:Initial-visit PROMIS-10 mental and physical health scores. RESULTS:A total of 2646 new patients presented to physiatrists (n = 1911 [72.2%]) and spine surgeons (n = 735 [27.8%]). Patients evaluated by physiatrists had higher mental health (physiatry 50.1 ± 8.5, spine surgery 46.7 ± 9.0; p < .001) and physical health scores (physiatry 43.7 ± 7.5, spine surgery 39.8 ± 7.2; p < .001) than those presenting to spine surgeons. Furthermore, patients evaluated by physiatrists were more likely to have mental and physical health scores >55 and less likely to have scores <45 (p ≤ .001). Patients with LBP + lower extremity (LE) pain had significantly lower mental and physical health scores than those with LBP alone (mental health 48.5 ± 8.6 [LBP + LE-pain], 49.9 ± 8.9 [LBP-alone]; physical health 41.5 ± 7.3 [LBP + LE-pain], 44.0 ± 7.7 [LBP-alone]; p < .001). CONCLUSIONS:Patients directed to spine surgeons via triage had worse PROMIS-10 mental and physical health, suggesting this subgroup of patients may especially need additional resources to address these issues in the course of their care. Physiatrists provided nearly two-thirds of nonurgent LBP evaluations in this tertiary orthopedic center, serving an important role in the initial evaluation and treatment of nonurgent LBP. The impact on patient outcomes, patient satisfaction, and associated health care costs requires further investigation.

Context: Surrounding the predictive value of clinical measurements and assessments for future athletic injury, most researchers have not differentiated between contact and non- contact injuries. Objectives: We assessed the association between clinical measures and questionnaire data collected before sport participation and the incidence of noncontact lower extremity (LE) injuries among Division III collegiate athletes. Design: Prospective cohort study. Setting: University setting, National Collegiate Athletic Association Division III. Patients or Other Participants: Here, 488 Division III freshmen athletes were recruited to participate in the study during their preseason physical examinations. Main Outcome Measure(s): Prospective incidence of non- contact LE injury. Athletes completed questionnaires to collect demographics and musculoskeletal pain history. Clinical tests, performed by trained examiners, included hip provocative tests, visual appraisal of a single-leg squat to identify dynamic knee valgus, and hip range of motion. Injury surveillance for each athlete's collegiate career was performed. The athletic training department documented each athlete-reported new onset injury and documented the injury location, type, and outcome (days lost, surgery performed). Univariable generalized estimating equation models were used to analyze the relationship between each clinical measure and the first occurrence of noncontact LE injury. An exchangeable correlation structure was used to account for repeated measurements within athletes (right and left limbs). Results: Of the 488 athletes, 369 athletes (75%) were included in the final analysis. Sixty-nine noncontact LE injuries were reported. Responding yes to, "Have you ever had pain or an injury to your low back?" was associated with an increased risk of noncontact LE, odds ratio = 1.59 (95% confidence interval = 1.03, 2.45; P = .04). No other clinical measures were associated with an increased injury risk. Conclusions: A history of prior low back pain or injury was associated with an increased risk of sustaining a noncontact LE injury while participating in National Collegiate Athletic Association Division III athletics.

Abstract:Single-point hand acupuncture with movement is a novel technique that can be used to provide immediate pain relief in the treatment of musculoskeletal disorders. It involves inserting just one needle along the second metacarpal bone, and then having the patient move through motions that were previously painful while retaining the needle. This study is a preliminary three-arm, single-blinded, randomized comparative trial looking at this technique compared with two control techniques. Abstract:Twenty-four patients were recruited in an outpatient musculoskeletal practice with neck, shoulder, low back, or hip pain. Patients were randomized to one of three treatment arms. The three treatment arms were verum single-point hand acupuncture with movement, single-point hand acupuncture without movement, and control acupuncture with movement. Range of motion (ROM) and numeric pain rating scale were recorded before and after treatment (about 10 min). Abstract:The combined results of all patients showed that the mean difference in post-treatment versus pretreatment ROM was 11.6 degrees and this was statistically significant (p = 0.0027). The mean difference in post-treatment versus pretreatment pain was -2.3 and this was statistically significant (p = 0.0000). There was no statistically significant mean difference between the single-point hand acupuncture with movement and the other two techniques. Also, there was no significant mean difference whether a de qi response was elicited or not. Abstract:Despite single-point hand acupuncture not being able to demonstrate superiority over the other techniques, it can still be a useful technique to learn, given its ease of use and wide applicability.

BACKGROUND:Knee osteoarthritis (OA) and its impairments affect patients' physical and mental health. Radiographically severe knee OA is believed to respond less to conservative treatments including physical therapy (PT) but has not been compared specifically with Patient-Reported Outcomes Measurement Information System (PROMIS)-10. OBJECTIVE:To correlate baseline PROMIS-10 physical and mental health scores in patients undergoing PT for knee OA, subgrouped by radiographic severity (Kellgren-Lawrence [KL] grade and number of knee compartments involved). Additionally, to describe the relationship between radiographic severity of knee OA and the change in PROMIS-10 scores post-PT. DESIGN:Retrospective review. SETTING:Outpatient musculoskeletal clinics at an orthopedic specialty hospital. PATIENTS (OR PARTICIPANTS):One hundred nine patients (age ≥ 18 years) who presented for evaluation of knee OA from April 1, 2019 to August 1, 2021, had baseline radiographs, underwent PT, and completed PROMIS-10 at baseline and follow-up. INTERVENTIONS:PT. MAIN OUTCOME MEASURE(S):PROMIS-10 physical and mental health scores. RESULTS:Participants were 60% female; average age was 66.6 ± 10.0 years. Baseline PROMIS-10 physical and mental health scores averaged 44.4 ± 7.2 and 52.8 ± 9.0. Post-PT PROMIS-10 physical and mental health scores averaged 44.7 ± 6.7 and 52.6 ± 8.7. Physical health scores improved in 39% of patients; mental health scores improved in 36% of patients (no statistical significance). There was no relationship between post-PT PROMIS-10 scores and radiographic severity of knee OA. Females exhibited osteoarthritic changes in all compartments in 72% of cases compared to 55% of males (p = .020). Females demonstrated a higher predisposition for lateral compartment involvement (83% vs. 64%; p = .021) and a higher proportion of severe OA, radiographically, with a KL grade 3-4 (92% vs. 80%; p = .051). CONCLUSIONS:More than one third of patients with knee OA reported improved physical and mental health post-PT. The degree of benefit did not relate to radiographic severity. Although OA is characterized by radiographic measurements, there are variables beyond the radiographic imaging that may affect patient outcomes.

Acetabular hip dysplasia patients experience chronic pain affecting daily activities. The STaRT MSK identifies patients at risk for persistent disabling pain, based on biopsychosocial factors. This study describes STaRT MSK risk group distribution in acetabular hip dysplasia patients and patient-reported one-year post-surgical outcomes among groups. This retrospective cohort study included 50 adult patients with acetabular hip dysplasia presenting for hip preservation surgery consultation. Data collected via chart review included: demographics, medical history, STaRT MSK, Patient-Reported Outcomes Measurement Information System (PROMIS)-10 mental health, PROMIS-10 physical health, International Hip Outcome Tool (iHOT)-12 questionnaires, treatment information, and post-surgical improvement. PROMIS-10 and iHOT-12 scores were stratified according to STaRT MSK risk groups. Post-surgical improvement was assessed across risk groups. Most patients (45/50; 90.0%) were female (mean age: 28.9±7.7 years); 11/50 (22.0%) had a history of anxiety or depression. STaRT MSK subgrouping distributions included 16/50 (32.0%) for low risk, 14/50 (28.0%) for medium risk, and 20/50 (40.0%) for high risk, which differed from validated tool measure distributions of 24.9%, 41.7%, and 33.4% for low, medium, and high risk, respectively. A lower percentage of patients in the medium-risk group (21.4%) had a history of anxiety/depression, compared to that in the low-risk (31.3%) and high-risk (55.0%) groups. Differences were significant in all patient-reported outcome tools, stratified by STaRT risk groups (p<0.05). High-risk patients had lower PROMIS-10 mental health (-10 points), physical health (-15 points), and iHOT-12 scores (-26 points), compared to low-risk patients (p<0.05). Treatments included periacetabular osteotomy, physical therapy, and medication. Post-surgery, the medium-risk group had fewer patients with self-reported improvement (40.0%), compared to the low- and high-risk groups (84.6% and 93.8%, respectively). The majority of patients with anxiety/depression reported improvement (93.3%). Patients with acetabular hip dysplasia have biopsychosocial risk for chronic persistent pain; with 68.0% classified as medium- or high-risk. The medium-risk group had the lowest percentage of patients reporting post-treatment improvement and the lowest prevalence of a history of anxiety and depression. Studies are needed to address biopsychosocial needs, especially for the medium- risk group where there is the greatest potential for intervention to improve outcomes and reduce health costs.

The concept of Equal Pay, Equal Health is motivated by the fact that women’s soccer players not only receive less pay than male players but are also under-represented in sports health research. The Women’s Soccer Health Study: From Head to Toe has collected data on 560 retired elite women’s soccer players in 5 health domains: General, Musculoskeletal, Reproductive, Post-Concussion, and Mental. Previous publications have reported on the high number of musculoskeletal injuries and post-concussion symptoms. Another key finding has been that players with ACL reconstruction have lower post-career satisfaction. To incorporate athlete voices, the players were asked to rank the 5 health domains in order of importance and to report other topics that were missing from the study. The top-ranked area was mental health, and nutrition topped the list of other health issues. Among the 99 written comments, 30% expressed appreciation for this research on female athlete health.

Recently, lifestyle medicine (LSM) application has shown feasibility for musculoskeletal pain patients with co-existing lifestyle-related chronic diseases. This study describes early results of a LSM program for musculoskeletal patients with goals to optimize health prior to orthopedic surgery. Fifty-four patients (age: 61 ± 11 years; 39 [72%] females) completed the program from 3/8/22-12/1/23. Data included patient goals, utilization, goal attainment, and patient outcomes. Most patients (41/54 [76%]) enrolled with established surgical dates. Mean BMI was 43.2 ± 5.3 kg/m2, and 89% had ≥2 lifestyle-related chronic diseases. The majority reported impaired sleep (79%) and zero cumulative minutes of physical activity/week (57%). Mean program duration was 13 ± 8 weeks involving 5 ± 4 visits with members of the interprofessional team. Fifty-two (96%) patients successfully attained pre-program goals, and 49/54 (91%) met their surgical goal. Of the patients enrolled without surgical dates, 11/13 (85%) optimized their health and proceeded to surgery. Forty-two (78%) patients reported decreases in weight and BMI, averaging 11 ± 7 lbs and 1.8 ± 1.3 kg/m2, respectively. Rates of improvement in pain, PROMIS-10 physical and mental health, and PHQ-4 were 52%, 37%, 45%, and 47%, respectively. These data demonstrate the feasibility and effectiveness of a LSM program to address whole-person health optimization and enable orthopedic patients to improve lifestyle behaviors and proceed to orthopedic surgery.

Interprofessional care improves outcomes for medically complex patients and may be a valuable addition to standard lifestyle medicine practice, but implementation barriers exist. The purpose of this study was to explore the key features, perceived impact, and implementation considerations related to holding interprofessional team meetings as part of an intensive lifestyle medicine program. In this mixed-methods study, focus groups were conducted with 15 lifestyle medicine clinicians from various healthcare disciplines who had participated in interprofessional team meetings. Quantitative descriptive statistics of the meeting minutes were also calculated. Clinician perceived benefits from participating in interprofessional team meetings included increased acquisition of knowledge, access to other clinicians, collaborative decision-making, patient satisfaction, and achievement of patient-centered goals. Participants described the importance of preparing an agenda for the interprofessional team meetings in advance, but a major implementation challenge was the time required to prepare for and conduct the meetings. Commitment and financial support by organization and program leadership were reported as key facilitators to implementing the meetings. Clinicians perceive significant value from incorporation of interprofessional team meetings into an intensive lifestyle medicine program, but successful implementation of meetings requires investment from all levels within a healthcare system.

BACKGROUND:Sleep health is linked to pain, function, and global health. Unfortunately, sleep health may not be consistently addressed as a part of musculoskeletal care. OBJECTIVE:To describe the frequency of sleep health documentation and intervention by musculoskeletal physiatrists. Additionally, patient-reported outcome measures were compared between patients with and without sleep impairment. We hypothesized that sleep health is documented and addressed in less than half of initial patient encounters and that patients with a sleep impairment have worse patient-reported outcomes scores compared to those without sleep impairment. DESIGN:Retrospective study. SETTING:Tertiary orthopedic hospital. INTERVENTIONS:None. MAIN OUTCOME MEASURES:Frequency of provider documentation of sleep health, frequency and characteristics of sleep health intervention provided, and Patient-Reported Outcome Measurement Information System (PROMIS)-10 mental health and physical health scores. RESULTS:Initial visits for a musculoskeletal condition of 39,452 patients from January 1, 2020 to October 1, 2022 were included. Documentation of sleep health was found in 33.0% (13,002/39,452) of patients. Of those with sleep health documentation, 59.2% (7697/13,002) were classified as having a sleep impairment. Only 19.0% of patients were provided with sleep-related education or other intervention. Patients with a sleep impairment had worse PROMIS-10 mental health and physical health scores (p < .001), as compared to those without a sleep impairment. CONCLUSIONS:Patients with sleep impairment had worse mental and physical health scores than those without sleep impairment, and only 19.0% received sleep health intervention. These data suggest that sleep impairment is common in patients presenting for evaluation of a musculoskeletal condition, and advanced provider education and tools to help patients improve their sleep health are needed.

Systemic inflammation is a root cause of lifestyle-related chronic diseases and may also play a role in the development and progression of osteoarthritis (OA). Lifestyle medicine seeks to treat, prevent, and reverse lifestyle-related chronic disease via 6 pillars: nutrition, sleep health, stress management, physical activity, social connections, and risky behavior avoidance/reduction. This article presents a review of the literature in which we assess the connections between the 6 pillars of lifestyle medicine, chronic systemic inflammation, and OA. We also discuss the whole-person approach that lifestyle medicine interventions can provide to reduce chronic systemic inflammation and affect the development or progression of OA.