The Central Sensitization Inventory (CSI) assesses central sensitization-related symptoms, but its 25-item length may limit its use in large-scale research or routine clinical practice. Therefore, the aim was to develop a short version of the CSI, using a large international sample of 7862 participants across 23 countries. A multi-step Rasch analysis was applied to the 25-item version of the CSI using a training-validation paradigm to identify the subset of items that best fit a unidimensional model. Then, an expert committee reviewed the face-content validity of each item. A 7-item solution was ultimately developed (Chi-Square Value = 794.728, df = 20; p-value < 0.001; CFI = 0.96; TLI = 0.96; RMSEA = 0.09, 90%CI [0.09-0.10]; SRMR= 0.05). Internal consistency was adequate for both the CSI-25 (α = 0.93; ω = 0.93) and CSI-7 (α = 0.85; ω = 0.85). Both versions demonstrated strong discriminative validity in identifying subgroups with presumed different levels of central sensitization-related symptoms. As expected, CSI-25 and CSI-7 scores increased progressively from healthy control participants (who scored lowest) to single-site non-spinal chronic pain, chronic spinal pain, multi-site chronic pain, and fibromyalgia (who scored highest). CSI-7 Receiver Operating Characteristic curves showed excellent sensitivity and specificity, particularly in differentiating fibromyalgia from healthy control participants (area under the curve = 0.98; sensitivity of 92% and specificity of 93%). CSI-7 severity levels were empirically derived to aid clinical interpretation. To sum up, the CSI-7 offers an efficient, unidimensional, and internally consistent alternative to the CSI-25 for international use. PERSPECTIVE: The CSI-7 offers a brief, clinically useful screening tool for identifying central sensitization-related symptoms across diverse pain conditions. Derived from international data, it retains the psychometric strength of the full CSI while reducing patient burden, supporting efficient assessment in busy clinical and research settings.

BACKGROUND:Low back pain (LBP) is a major global burden expected to increase in the years to come. Clinical practice guidelines recommend diagnostic triage as a first step to differentiate specific from non-specific LBP, which might be challenging in clinical practice. OBJECTIVES:This exploratory study aimed to evaluate the ability of specialized musculoskeletal physiotherapists to recognize and manage cases of specific LBP. DESIGN:This study design is an online cross vignette-based-sectional study. METHODS:Physiotherapists (n = 105) with a post-graduate degree in musculoskeletal/orthopaedic manual therapy were recruited in Belgium to participate in an online study (Direct Physio trial). We evaluated their ability to recognize specific underlying spinal pathologies through two clinical vignettes describing the symptoms of a patient with lumbar spinal stenosis (LSS) and spondyloarthritis (SA). RESULTS:The majority of physiotherapists suspected a specific cause of LBP in both vignettes (i.e., 69% for the LSS and 94% for the SA case). The detection rate of the correct spinal pathology was 47% for the LSS case and 28% for the SA case. As a first clinical step, 31% of the physiotherapists chose to refer the LSS case for medical management, compared to 94% for the SA case. CONCLUSION:This exploratory study provides preliminary, condition-specific insights into the diagnostic triage performance of specialized physiotherapists. Although the majority of physiotherapists suspected a specific cause of LBP, recognition of the diagnosis and referral decisions remain variable across the conditions explored. Future efforts should focus on the evaluation of clinical and cost-effectiveness of direct access to physiotherapists in healthcare trajectories.

OBJECTIVE:To evaluate the efficacy of education and self-management (ED and SM) interventions delivered by a health care provider, either alone or in combination with other non-surgical interventions for improving pain, function, or health-related quality of life (HRQoL) in adults with temporomandibular disorders (TMDs). DESIGN:Systematic review with meta-analysis. LITERATURE SEARCH:Six databases were searched up to March 2025. STUDY SELECTION CRITERIA:Randomized clinical trials (RCTs) comparing the efficacy of ED and SM with any non-surgical other interventions such as splints, manual therapy, electrotherapy or multimodal approaches in adults with TMDs. Eligible studies had to report outcomes on pain, function or HRQoL. DATA SYNTHESIS:Risk of bias was assessed using the Cochrane RoB-1 tool. Pooled treatment effects were calculated using random-effects models with standardized mean differences. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS:Forty-seven RCTs (n = 3238 participants; 77% female; mean age: 34.4 ± 7.3 years) were included, and none had a low risk of bias. ED and SM interventions were generally delivered as standardized programs and often served as control conditions. Based on very low-certainty evidence, other non-surgical interventions may be more effective than ED and SM alone for short-term pain reduction (SMD = 0.67, 95% CI: 0.13-1.20, 6 studies, 323 patients) or HRQoL improvement (SMD = 0.61, 95% CI: 0.20-1.01, 2 studies, 124 patients). When combined with ED and SM, non-surgical interventions may also result in moderate additional HRQoL improvements (SMD = 0.50, 95% CI: 0.18-0.82, 3 studies, 154 patients). Other comparisons-such as ED and SM alone versus ED and SM combined with other non-surgical interventions-showed comparable effects between groups on pain, function and HRQoL over the short-, medium- and long-term. However, the certainty of evidence supporting these findings remains low to very low. CONCLUSION:The certainty of evidence supporting ED and SM interventions for TMDs is very low to low across all outcomes. While some short-term clinically relevant benefits may favour other non-surgical treatments, no consistent superiority or inferiority of ED and SM was found. Combining ED and SM with other interventions did not consistently improve outcomes. High-quality trials are needed to determine the effectiveness of ED and SM and their optimal delivery in TMD care. PROSPERO:CRD42024529862.

Pain in the arm could arise from a wide range of conditions, from non-specific musculoskeletal disorders to serious spinal pathology. Spine-related arm pain (SAP), i.e., pain that is best explained by processes in the spine or spinal nerves, poses a particular diagnostic challenge in primary care due to its diverse overlapping symptoms and evolving presentations. This paper proposes a structured, literature-informed, consensus-based guide to assist clinicians in classifying SAP according to predominant pain mechanisms and stratifying the level of clinical concern. The guide takes the form of a diagnostic algorithm derived from contemporary frameworks, including the terminology and mechanistic descriptors proposed by the International Association for the Study of Pain and the recommendations of the Neuropathic Pain Special Interest Group. It is illustrated through three hypothetical clinical scenarios that demonstrate how the algorithm can be applied to integrate subjective and objective findings, including a mandatory neurological examination and ongoing safety-netting. The algorithm is intended as a pragmatic knowledge-translation and educational tool to support mechanism-based reasoning, improve confidence in managing SAP in primary care, and help students and early-career clinicians navigate its diagnostic complexity.

Background Belgium's emergency services face several public health challenges, including increasing patient numbers and a shortage of medical staff. Against this backdrop, there is a risk that current organisational structures may not provide optimal responses to growing care demands. Countries facing similar challenges have adopted innovative care models that integrate advanced practice physiotherapists (APPs) into emergency teams. Belgium could draw inspiration from these successful models to improve its healthcare system. This exploratory study aims to assess the relevance of integrating APPs into emergency departments in French-speaking Belgium. Methods This study employed a descriptive qualitative approach following an iterative process: (1) focus groups to define the needs, roles and skills of APPs with 19 physicians and nurses from three Belgian emergency departments; (2) construction of care pathways integrating APPs for each hospital; and (3) elaboration of the final framework via NVivo software. The results are based on consensus among participants across all participating hospitals. Results The participants supported the integration of APPs into their emergency departments, believing this would improve care quality, optimise the use of available care resources, and enhance patient care pathway organisation. The two main care pathways incorporating APPs described were as follows: first-contact, autonomous management of patients with musculoskeletal disorders, and intervention as an expert in the multidisciplinary management of patients requiring respiratory care. The CanMEDS roles assigned to APPs include clinical expert, communicator, collaborator, leader, health promoter and scholar. The medical tasks and skills required to fulfil these roles include performing diagnostic and therapeutic procedures, providing autonomous guidance and coordinating patient care. Conclusion This study suggests the potential benefits of integrating APPs into several Belgian emergency departments. The results align with models used in other countries reporting APPs' ability to optimise emergency care through the management of non-critical patients. This study provides a theoretical basis for future research aimed at clarifying APPs' tasks, roles and skills, and evaluating the implementation of these new care models.

PurposeTo assess French- and Dutch-speaking physiotherapists' knowledge, practices, and acceptance of immersive virtual reality (VR) in clinical settings.Materials and methodsA cross-sectional online survey (NCT06252363) was conducted from February to July 2024, targeting French- and Dutch-speaking physiotherapists via non-probability sampling methods. Data were analyzed descriptively.ResultsA total of 155 physiotherapists from eight countries participated, mostly from Belgium. Most (75.5%) had never used immersive VR, while 12.25% were current users and 12.25% past users. Physiotherapists generally demonstrated satisfactory knowledge of immersive VR. Key facilitators and barriers to usage, reasons for discontinuation, and factors contributing to nonuse were identified. Half of the never-users showed interest in future use, a minority of past users planned to resume, and nearly all current users intended to continue. Attitudes toward immersive VR were mostly positive, though concerns about cost and value for money were noted. Immersive VR was generally perceived as clinically useful and not overly complex. Social influence did not appear to be a key factor in its adoption.ConclusionsThese findings provide insights into the perspectives of French- and Dutch-speaking physiotherapists regarding the use of immersive VR in clinical settings and may help inform the development of implementation strategies targeting physiotherapists.

Objective:To assess maladaptive beliefs about low back pain (LBP), valid and reliable measurement tools are required. Although some tools exist to assess them, the Low Back Pain-related Beliefs Screening Tool (LBP-BST) was developed in order to explore all different categories of misbeliefs in individuals chronic low back pain (CLBP). This study aimed to evaluate the main psychometric properties of both the short and long versions of the revised LBPBSTv2. METHODS:A total of 108 patients with CLBP completed the LBP-BSTv2 to assess its potential floor/ceiling effects, internal consistency, and construct validity. The latter was evaluated by comparing scores with the Back Beliefs Questionnaire (BBQ). Test-retest reliability was assessed in 47 of the participants one week later. RESULTS:No floor or ceiling effects were observed. The short and long versions of the LBPBSTv2 showed strong construct validity, with significant correlations with BBQ scores. Internal consistency was acceptable to good (Cronbach's alpha: 0.77-0.84), and test-retest reliability was high (intraclass correlation coefficient: 0.76-0.81). Conclusion:The LBP-BSTv2 is a valid and reliable tool for assessing maladaptive beliefs in patients with CLBP. Its integration into clinical practice could help healthcare professionals identify and address unhelpful beliefs that may hinder rehabilitation. Further research is needed to confirm its usefulness in tracking changes over time and guiding individualized interventions and to study other psychometric properties such as responsiveness.

PURPOSE:To summarize the evidence on the effectiveness of manual therapy (MT) and exercise targeted to the neck or jaw and neck (combined) in the management of orofacial pain (OFP). MATERIAL AND METHODS:The protocol was registered in PROSPERO (CRD42021227490). Electronic searches were conducted in MEDLINE, EMBASE, Cochrane Library, Web of Science, SCOPUS, and CINAHL. Two independent reviewers screened and extracted data. Studies involving adults with OFP treated with MT or exercise targeted to the neck or both the neck and jaw were eligible. Outcomes of interest were pain intensity, maximum mouth opening (MMO), and tenderness (i.e., pain pressure threshold - PPT). The Cochrane risk of bias (RoB) tool and the GRADE approach were used to determine RoB and certainty of the evidence, respectively. RESULTS:Thirty-seven studies were analyzed, mostly with a high RoB. Therapies (i.e., MT alone or combined therapy-MT plus exercise) targeting both the neck and jaw regions improved pain and tenderness (PPT). MT and combined treatment (i.e., MT plus exercise) targeting only the neck were clinically relevant for pain relief. No significant results were found for MMO. CONCLUSIONS:MT isolated and combined therapies targeting the neck alone or neck and jaw are promising for reducing pain and tenderness for individuals with OFP.

BACKGROUND AND PURPOSE:Despite evidence-based clinical guidelines promoting a biopsychosocial approach to managing low back pain, physiotherapists often fail to adhere to these recommendations, influenced by their attitudes. Therefore, this study aimed to explore Belgian physiotherapists' beliefs and attitudes toward low back pain management. METHODS:An observational, cross-sectional study was conducted in Belgium between 2014 and 2016. Physiotherapists' beliefs were evaluated using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), which contains a biomedical and psychosocial subscale, and Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS). A clinical vignette was used to assess physiotherapists' adherence to guidelines recommending physical activity and work for low back pain. Associations between physiotherapists' demographics, PABS-PT subscales and HC-PAIRS were assessed using Student T-tests and chi-square for group differences, and Pearson's R for correlations. RESULTS:A total of 565 physiotherapists participated. Out of 561 physiotherapists, 59.5 % provided guideline-adherent recommendations regarding physical activity and 33.9 % out of 560 regarding work. Physiotherapists with a stronger biomedical and weaker biopsychosocial orientation were less likely to adhere to guidelines concerning work and activity. Beliefs and adherence to guidelines were associated with years since graduation and socio-cultural differences. Sex-based differences were observed in guideline adherence related to activity, with male physiotherapists showing greater compliance. CONCLUSION:The study provides evidence that between 2014 and 2016, guideline adherence among physiotherapists in Belgium was low and related to their attitudes and beliefs about low back pain. These attitudes, beliefs and guideline adherence were associated with physiotherapists' graduation year and socio-cultural factors.

The assessment of running kinematics is essential for injury prevention and rehabilitation, including anterior cruciate ligament sprains. Recent advances in computer vision have enabled the development of tools for quantifying kinematics in research and clinical settings. This study evaluated the accuracy of an OpenPifPaf-based markerless method for assessing sagittal plane kinematics of the ankle, knee, and hip during treadmill running using smartphone video footage and examined the impact of clothing on the results. Thirty healthy participants ran at 2.5 and 3.6 m/s under two conditions: (1) wearing minimal clothing with markers to record kinematics by using both a smartphone and a marker-based system, and (2) wearing usual running clothes and recording kinematics by only using a smartphone. Joint angles, averaged over 20 cycles, were analysed using SPM1D and RMSE. The markerless method produced kinematic waveforms closely matching the marker-based results, with RMSEs of 5.6° (hip), 3.5° (ankle), and 2.9° (knee), despite some significant differences identified by SPM1D. Clothing had minimal impact, with RMSEs under 2.8° for all joints. These findings highlight the potential of the OpenPifPaf-based markerless method as an accessible, simple, and reliable tool for assessing running kinematics, even in natural attire, for research and clinical applications.

OBJECTIVE:The purpose of this study was to explore the experiences of individuals with persistent nonspecific neck pain who used immersive virtual reality (VR) serious games at home for 2 weeks. METHODS:In this descriptive qualitative study, semi-structured one-on-one interviews were conducted at the participant's home after the 2-week period. Interviews were analyzed using qualitative content analysis. Sample size was determined using the information power concept (where "information power" refers to the amount of relevant information the sample provides for addressing the research question). RESULTS:Eleven adults with continuous or recurrent nonspecific neck pain participated in the study. Three main categories were identified. The first revolves around the home environment, revealing that participants had mixed perceptions about being at home, yet held a positive perspective on the utilization of immersive VR in that setting. The second pertains to immersive VR as a novel technology, indicating its overall comfort, user-friendliness, and varying degrees of immersion and presence experienced by the participants. The third focuses on exercising in immersive VR, drawing comparisons with conventional exercises, exploring the facilitators and barriers to usage, and addressing various aspects of integrating this technology into rehabilitation. CONCLUSION:Immersive VR was deemed comfortable for almost all participants and easy to use. Participants found exercising in immersive VR motivating and enjoyable, compared to conventional exercises. The home environment proved suitable for using immersive VR, though challenges included autonomy and reduced human contact. Participants highlighted facilitators and barriers in using immersive VR serious games, as well as immersive VR's rehabilitation potential. They also underscored the crucial role of physical therapists for guidance, remote supervision, and personalized treatment. IMPACT:These findings could help clinicians to better understand the experiences of individuals with persistent nonspecific neck pain when using immersive VR, as well as its use at home. This understanding can improve patient care and optimize the effectiveness of immersive VR as a treatment method.

BACKGROUND AND PURPOSE:Mulligan's techniques, such as Sustained Natural Apophyseal Glides (SNAGs) and Natural Apophyseal Glides (NAGs), are commonly applied by physiotherapists when treating patients with non-specific neck pain (NP). However, there has been no comprehensive synthesis of their effects in NP. This review aimed to assess the effectiveness of Mulligan's techniques in reducing pain, improving disability, and enhancing cervical range of motion (CROM) in adults with acute, subacute, or chronic NP. METHODS:A systematic review with meta-analysis was conducted on randomized controlled trials (RCTs) comparing Mulligan's techniques with other interventions in adults with NP. Two reviewers independently conducted study selection, data extraction, and risk of bias (RoB) assessment. Meta-analyses were performed when clinical homogeneity was present; otherwise, a narrative synthesis was used. Certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS:Thirty-three studies were included. For acute and mixed (acute/subacute/chronic) NP, Mulligan's techniques were no more effective than other interventions for pain reduction, disability improvement, or CROM enhancement. However, in patients with chronic or uncertain chronicity NP, SNAGs combined with other interventions demonstrated superior outcomes-both statistically and sometimes clinically-compared to certain treatments like exercises and muscle-energy techniques, for reducing pain and disability and improving CROM. The certainty of evidence was rated very low. DISCUSSION:Mulligan's techniques appear to be safe, simple, and potentially beneficial for managing mixed or chronic NP when combined with other interventions, presenting results that may be comparable or occasionally superior to other standard techniques. IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE:Physiotherapists may consider incorporating Mulligan's techniques, especially SNAGs, within broader NP treatment strategies, as they offer a feasible, low-risk option for improving patient outcomes, particularly for chronic NP cases when used alongside other therapies.

BACKGROUND:The efficacy of conservative interventions targeting temporomandibular disorders (TMDs) in patients diagnosed with headaches has not been systematically reviewed. OBJECTIVE:To appraise the efficacy of conservative interventions targeting TMDs for adults with primary or secondary headaches. METHODS:Bibliographic searches were conducted up to September 2024 for randomised controlled trials in five databases: CINAHL, Cochrane CENTRAL, Embase, PEDro and PubMed. Outcomes collected were frequency, intensity and duration of headache episodes, and disability. Version 2 of the Cochrane Risk-of-Bias Tool and the GRADE approach were used for assessing the methodological quality and grading evidence. Results from trials with similar interventions and with similar outcome measures were pooled into separate meta-analyses. RESULTS:Five trials were included. Low-certainty evidence suggests that the occlusal stabilisation appliance did not reduce headache frequency (SMD episode/week: -1.57; 95% CI: -2.86 to -0.28; 3 RCTs; n = 145) and intensity (SMD VAS: -0.24 points out of 10; 95% CI: -0.67 to 0.20; 2 RCTs; n = 85) compared to non-specific appliance therapy or no treatment at 1-3 months post-intervention. At 4-9 months post-intervention, low-certainty evidence indicates that the occlusal stabilisation appliance therapy reduced headache frequency (SMD episode/week: 1.21; 95% CI: 0.06 to 2.36; 3 RCTs; n = 145), but not headache intensity (SMD VAS: -0.51 point out of 10; 95% CI: -1.01 to -0.02; 2 RCTs; n = 85). Very low-certainty evidence suggests that overall physiotherapy interventions reduced headache intensity compared to non-specific exercises at 1-3 months post-intervention (SMD NPRS: 4.44 points out of 10; 95% CI: -0.46 to 9.34; 2 RCTs; n = 67) and at 4-9 months post-intervention (SMD NPRS: 3.92 points out of 10; 95% CI: 0.75 to 7.09; 2 RCTs; n = 67). CONCLUSION:Our results suggest that clinicians may consider combining orofacial stabilisation appliance therapy and physiotherapy interventions without certainty of their effects for the criteria assessed. The heterogeneity of the interventions assessed and the populations studied means that caution must be exercised when interpreting the results obtained. TRIAL REGISTRATION:#CRD42023389507.

OBJECTIVE:To summarise the evidence on the effect of physiotherapy-led versus physician-led care on clinical outcomes, healthcare use, and costs in persons with low back pain. DATA SOURCES:PubMed, Web of Science, CINAHL, Embase, and PEDro were systematically searched with the latest search performed in July 2024. Reference lists of articles were hand-searched. REVIEW METHODS:Studies comparing clinical outcomes, healthcare use, or costs between adults with low back pain first consulting a physiotherapist and those first consulting a physician were included. Methodological quality was assessed with the Newcastle-Ottawa Scale. Study design, clinical setting, patient characteristics, and group effects were extracted. Findings on outcomes assessed in two or more studies were synthesised narratively. Certainty of evidence was determined using the GRADE approach. RESULTS:Eighteen studies comprising 1,481,980 persons with low back pain were included. Most studies were non-randomised retrospective or prospective cohort studies. In primary care (15 studies), consistent evidence, though of mostly very low certainty, indicated that physiotherapy-led care leads to higher patient satisfaction, less use of medication, injections and imaging, fewer physician's visits, lower total healthcare costs, and less sick leave compared to physician-led care, without increased harm. In emergency care (three studies), evidence of very low certainty showed that physiotherapy-led care leads to shorter waiting and treatment times, and fewer hospital admissions. CONCLUSION:Physiotherapy-led care is a clinically, time- and cost-effective care pathway for low back pain, although the certainty of evidence was overall very low. Further high-quality research with a greater focus on clinical outcomes is warranted.

Patients with anterior cruciate ligament reconstruction frequently present asymmetries in the sagittal plane dynamics when performing single leg jumps but their assessment is inaccessible to health-care professionals as it requires a complex and expensive system. With the development of deep learning methods for human pose detection, kinematics can be quantified based on a video and this study aimed to investigate whether a relatively simple 2D multibody model could predict relevant dynamic biomarkers based on the kinematics using inverse dynamics. Six participants performed ten vertical and forward single leg hops while the kinematics and the ground reaction force “GRF” were captured using an optoelectronic system coupled with a force platform. The participants are modelled by a seven rigid bodies system and the sagittal plane kinematics was used as model input. Model outputs were compared to values measured by the force platform using intraclass correlation coefficients for seven outcomes: the peak vertical and antero-posterior GRFs and the impulses during the propulsion and landing phases and the loading ratio. The model reliability is either good or excellent for all outcomes (0,845 ≤ ICC ≤ 0.987). The study results are promising for deploying the developed model following a kinematics analysis based on a video. This could enable clinicians to assess their patients’ jumps more effectively using video recordings made with widely available smartphones, even outside the laboratory.