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 AND PURPOSE:Degenerative Diseases of the Lumbar Spine (DDLS) are typically managed with conservative treatments, while surgery is reserved for cases with severe motor and/or sensory deficits. Preoperative physiotherapy has been shown to improve postoperative outcomes in shoulder, hip, and knee surgeries. However, its effects on the lumbar spine have been poorly investigated. This systematic review aimed to evaluate the efficacy of preoperative physiotherapy on pain, disability, and hospitalisation in individuals with DDLS. METHODS:A literature search was conducted in MEDLINE, Cochrane CENTRAL, Scopus, PEDro and EMBASE. Two reviewers independently screened the studies, extracted the data, and assessed the risk of bias. We included randomised controlled trials (RCTs) in which preoperative interventions were delivered by physiotherapists and compared to usual care or other interventions. We conducted meta-analyses on primary outcomes. RESULTS:We screened 9.803 studies and included 6 with 5 different study populations. All studies were RCTs that evaluated the efficacy of preoperative physiotherapy compared with usual care in pain and disability. The preoperative interventions were heterogeneous, varying between therapeutic exercise, cognitive-behavioural therapies, and multimodal interventions. The meta-analyses showed no difference between interventions. All studies had a high risk of bias. CONCLUSION:The effects of preoperative physiotherapy, compared with usual care, on pain, disability, and hospitalisation among patients with DDLS, are minimal. However, the risk of bias of the included studies and the certainty of evidence, based on the GRADE approach, were very low. Future high-quality, low-bias trials are needed to clarify its effectiveness and identify patient subgroups that may benefit the most.

IMPORTANCE:Ethical and bioethical issues are central to the identity and practice of physical therapy. A comprehensive overview of how these issues are addressed in the literature is essential for advancing education, clinical practice, and professional reflection. OBJECTIVE:The objective was to systematically map ethical and bioethical issues in the physical therapy literature, describe the methodologies employed, and identify key gaps to inform education, practice, and policy. DATA SOURCES:Medline (via PubMed), Embase, Cochrane Central, CINAHL, PsycINFO, PEDro, grey literature sources, and academic library resources were searched from inception to October 2024. The review protocol was prospectively published on medRxiv. STUDY SELECTION:Studies addressing ethical or bioethical issues in physical therapy were included, encompassing both normative and descriptive (empirical) approaches. After screening titles, abstracts, and full texts, 108 studies met the inclusion criteria. DATA EXTRACTION AND SYNTHESIS:Data were extracted using a modified Joanna Briggs Institute standardized form. A narrative synthesis was conducted to map ethical themes and characterize methodological approaches across studies. MAIN OUTCOMES AND MEASURES:Identification and mapping of ethical and bioethical themes and characterization of research methodologies applied. RESULTS:A total of 15,464 records were identified; 3223 duplicates were removed. Of 12,241 titles and abstracts screened, 385 full texts were assessed, and 108 studies were included. Major themes included ethical reasoning (n = 33), ethical reasoning and education (n = 19), ethical theories (n = 12), care relationships (n = 15), justice and equity (n = 8), perception of ethical issues (n = 13), and codes of ethics (n = 8). Key challenges involved physical touch, informed consent, professional boundaries, and moral distress. Structural barriers, cultural contexts, and disparities in ethics education were recurring concerns. Ethical reasoning was often situational and intuitive, whereas formal codes were frequently perceived as disconnected from clinical practice. CONCLUSIONS AND RELEVANCE:Ethical complexities in physical therapy arise from its embodied, relational, and context-sensitive nature. The literature reveals variability in how ethics is taught and applied across settings and highlights underexplored areas, including oncology, end-of-life care, digital health and artificial intelligence, and equity, diversity, and inclusion. Findings emphasize the need to strengthen ethics education, reinforce the application of existing codes of ethics, and provide organizational support for ethical deliberation. This synthesis provides a foundation for future research and can inform curricular development, clinical practice, and policy initiatives in physical therapy ethics.

Objective To estimate the associations of diabetes and/or hypertension with (i) initiating opioid therapy and (ii) progressing to long-term opioid use, after an osteoarthritis (OA) diagnosis. Methods Population-based open cohort study using Swedish registers. We followed 48,778 opioid-naïve individuals, aged 35-75, with incident OA between 2008 and 2019 in the Skåne region. The associations of diabetes and hypertension with first opioid dispensation (ATC: N02A) and long-term opioid use (≥90 Defined Daily Doses in one year) were analysed using flexible parametric survival models. Associations were adjusted for sociodemographic characteristics, comorbidities, and prior healthcare use. Results At OA diagnosis, 26% of individuals had hypertension alone, 3% diabetes alone, and 6% both; 3% developed diabetes during follow-up time, 8% hypertension. Compared to metabolically healthy individuals, the risk of a first opioid dispensation was higher only for those with hypertension alone (RR: 1.16 [95% CI 1.12; 1.20]) and both conditions (RR: 1.15 [1.10; 1.21]). All metabolic conditions were associated with a higher risk of long-term opioid use: diabetes alone (RR: 1.63 [1.21; 2.20]), hypertension alone (RR: 1.32 [1.14; 1.52]), and both (RR: 1.69 [1.42; 2.02]). The instant risk peaked in the first year post-diagnosis, and the cumulative risk was highest in comorbid groups for both outcomes (47.5% and 4.6% with both conditions vs 39.0% and 2.5% with none). Conclusion After OA diagnosis, hypertension and/or diabetes were associated with an increased risk of initiating opioid therapy and progressing to long-term use. Our findings underscore the need to develop safer OA management strategies for individuals with comorbidities.

Parkinson's disease (PD) is a growing neurological challenge. The Sit-to-Stand (STS) transition is a key proxy for functional independence and fall risk. While sensor technology offers objective STS assessment, the methodological landscape is highly heterogeneous, lacking standardized protocols. This scoping review systematically maps the literature on the technological assessment of the STS transition in PD, focusing on sensors, tasks, settings, and variables. Additionally, the review details device accessibility and ecological validity in home-based settings, as these are two important elements for large-scale application and implementation in standardised protocols for both clinical assessment and real-world monitoring. A scoping review following Joanna Briggs Institute and PRISMA-ScR guidelines. Five major databases (PubMed, Embase, CINAHL, Scopus, Web of Science) and citation tracking were used to identify studies from 2015 to 2025. Eligibility criteria included studies with PD patients of any stage undergoing instrumental STS transition assessment. We mapped data according to sensors, tasks, settings, and variables. We performed specific subanalyses on Inertial Measurement Units (IMUs)—distinguishing research-grade 'kinematic' sensors from consumer 'Mobile' devices—and assessed ecological validity (unsupervised vs. supervised) in home-based settings. From 7,368 records, 77 studies were included. Four dominant trends emerged: (1) Technology: IMUs were used in 87

Background One of the most common ways to assess the sense of position is the Joint Position Reproduction (JPR) task, where a person reproduces a memorized joint position. While useful, this method is limited because it focuses on static positions and does not fully reflect the dynamic nature of real movements. New methods This study investigated the test-retest reliability of the Dynamic JPR (D-JPR) task, during Concentric and Eccentric muscle contractions. Twenty-eight participants were recruited and received a tactile stimulus indicating the position cue at Initial (INI), Intermediate (INT), and Final (FIN) phases of movements, during either the concentric or eccentric phases. After the movement, they replicated the position where they received the stimulus. Angular error (AE) was analysed. Intraclass Correlation Coefficient (ICC) was used to assess relative reliability; Standard Error of Measurement (SEM) and Bias were used to assess absolute reliability. Results The relative reliability was good in most conditions (ICC > 0.75), with moderate values only for some phases. Absolute reliability showed a variable SEM between conditions, with higher values in the initial eccentric contraction phase. The Bland-Altman plots showed low bias between test and retest. The best reliability was obtained by averaging movement phases and muscle contractions (ICC = 0.89, SEM = 1.35°, Bias = 0.91°). Comparison with existing methods The D-JPR provides a more suitable way to assess joint position sense during movement compared to existing methods. Conclusion The D-JPR task is a reliable method for assessing joint position sense in dynamic conditions.

Understanding how young people interact with health apps and wearables might help develop innovative strategies to support health management and improvement adopting a technology they are already familiar with. This study aimed to investigating the user experience of young adults who use apps or wearables for health purposes. A qualitative study using focus groups was conducted. Participants were eligible if they were between 18 and 26 years old and used an app or wearable to track at least one health variable (e.g., physical activity, diet, mental health). Transcripts were analysed using Reflexive Thematic Analysis (RTA) to identify themes grounded in the data. Sixteen people participated (mean age: 24.3 ± 1.9 years; men/women: 9/7) and five themes were generated: I) My health easily all in one place: one click away; II) Exploring and learning health through catchy, personalised and user-friendly graphics; III) From monitoring my variables to empowerment: road to healthy habits; IV) Collecting achievements and connecting with others to improve my health; and V) Be careful in managing and giving too much weight to health variables!. Young adults viewed apps and wearables as useful and powerful tools for managing their health, helping them gain a clear overview of different health aspects and how they interact. Features such as user-friendliness, personalisation, and achievement-based feedback were widely appreciated. In contrast, educational and community features were mentioned less often. Preventive and emergency functions were also valued, even among this young population. Despite these benefits, participants raised concerns about data accuracy and the potential negative impact of overly detailed information on people who are sensitive to tracking.

Teaching clinical reasoning and communication skills is a fundamental component of physiotherapy education. Integrating theoretical knowledge with practical application remains a core challenge, particularly in an evolving educational landscape increasingly shaped by digitalisation and inter-institutional collaboration. This study evaluates the feasibility and student-level educational impact of a national, digitally mediated, case-based simulation—the Case-Based Learning Challenge (CBLC)—designed to support clinical reasoning and decision-making in third-year physiotherapy students across multiple Italian universities. A one-group quasi-experimental design with repeated measures was adopted. The intervention consisted of a national, digitally mediated simulation, structured around the presentation and peer discussion of a complex cardiorespiratory case. Students from two universities acted as active presenters (Challenger Universities), while those from 23 additional institutions participated as guided observers (Observer Universities). University affiliation was collected only at the level of these categories (Challenger vs. Observer). The session included three phases: case presentation, peer review, and collaborative Q A. All students completed a competence questionnaire before and immediately after the intervention, and a satisfaction survey post-intervention. Descriptive and inferential statistics were applied, including paired-sample t-tests to assess changes in competence and Cronbach’s alpha to evaluate internal consistency. A total of 399 students completed the baseline assessment, and 256 completed the post-intervention survey. Statistically significant improvements were observed in general clinical knowledge (mean score increase from 3.59 to 4.02; p < 0.001), and in the total competence score (from 7.05 to 7.47; p < 0.001). No significant change was detected in case-specific knowledge. Student satisfaction ratings were generally favourable across domains, with higher scores related to content relevance and inter-university exchange, and lower ratings associated with organisational and technical aspects. The satisfaction survey demonstrated excellent internal consistency (Cronbach’s alpha = 0.913), while the competence questionnaire showed suboptimal reliability. The CBLC represents a feasible national digital format for delivering case-based, peer-discussion learning across multiple physiotherapy programmes and was associated with small improvements in general knowledge alongside favourable student perceptions. As outcomes were assessed at the student level and institution-specific identifiers were not collected for observer participants, these findings should be interpreted as evidence of feasibility and short-term educational impact rather than demonstrated standardisation across programmes. Future evaluations should incorporate predefined institution-level benchmarking metrics, process measures of inter-university collaboration, and delayed or performance-based assessments.

Background:Recently, mobile health and mobile apps have been proposed as a potential tool to improve different outcomes (eg, daily steps, blood glucose) in both people with and without chronic conditions. In particular, healthy people could benefit from these tools by improving health variables and for prevention. Previous evidence investigated different types of health interventions adopting apps in various settings and populations, but evidence of their effectiveness is still unclear. Objective:The aim was to assess the effectiveness of mobile apps in improving health variables (eg, daily steps, maximal aerobic capacity) in healthy adults, involving an intervention regarding physical activity, diet, or their combination thereof. Evidence would suggest if apps could be effectively adopted in health interventions aiming toward prevention. Methods:A systematic review was performed using Medline via PubMed, Cochrane Library-CENTRAL, and Embase. Only randomized controlled trials comparing the same intervention provided with and without a mobile app or a treatment and a mobile app compared with the treatment only were included in this systematic review. The Risk of Bias tool 2.0 was used to assess the risk of bias, and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was adopted for rating the certainty of evidence. Results:Considering studies up to June 2025, only 2 studies were included in the review of mobile apps for physical activity, and none were included for mobile apps for diet and none for mobile apps for physical activity and diet combined. The quality of evidence of the 2 studies included was low due to a high risk of bias, several missing data, and deviation from the original interventions, suggesting a scarce rigor in the methodology adopted. Therefore, mobile apps' effectiveness in improving diet, physical activity, or their combination cannot be assessed. Conclusions:Despite the widespread use of mobile apps for health and the large number of relative publications, the results of this systematic review did not allow us to ascertain the effectiveness of mobile apps for health, but they provided fundamental insights for future research. Hence, it is not possible to state if apps for health might be used as supporting tools for health interventions aiming toward prevention and health improvements in healthy people. There is an urgent need to develop stronger evidence of apps' effectiveness in addressing different populations and types of interventions for different health domains.

Introduction:Cancer rehabilitation is increasingly recognized as a core component of cancer care, yet little is known about how people with cancer perceive its ethical dimensions. This study explored how patients experience autonomy, safety, equity, and relational care within physiotherapy-led cancer rehabilitation. Methods:We conducted a qualitative interview study using reflexive thematic analysis (RTA). Twenty adults with a previous cancer diagnosis who had received physiotherapy related to cancer rehabilitation within the past three years were purposively sampled to maximize variation in age, gender, diagnosis, stage, care setting, and geographical area. Interviews were conducted online, audio-recorded, transcribed verbatim, anonymized, and analyzed inductively from a constructionist, experiential perspective. Results:Five themes captured ethically salient aspects of rehabilitation experiences: (1) struggles for meaningful participation, where involvement in decisions was sometimes limited despite rhetoric of autonomy; (2) balancing safety and control, where professional caution was experienced as both protective and at times over-restrictive; (3) unequal access as systemic injustice, with geography, logistics, and poor information affecting access to services; (4) empathy and emotional presence, which fostered trust, dignity, and motivation; and (5) limits of standardized care, where rigid protocols and time pressure risked depersonalization unless offset by flexibility. Participants did not view rehabilitation as a merely technical intervention, but as an ethically charged practice shaped by everyday interactions, organizational contexts, and opportunities for agency. Conclusions:People with cancer experience rehabilitation as an ethical as well as clinical practice. Flexible, dialogic, and equitable models of care may better support dignity, participation, and shared decision-making.

Some Italian regions have the oldest population and considering the European ageing trend, it is necessary to foster active ageing interventions that could help the population age in a more active way. This study aimed to gather older adults’ preferences and expectations about a multidisciplinary health intervention, also adopting a wearable device. Health domains such as physical activity, diet and mental health were addressed. Online individual interviews using a semi-structured protocol were conducted between April 12 and 30, 2024. Participants were eligible if older adults (+60), and no other restrictions were set. At the beginning of each interview, a detailed multidimensional health intervention was described to the participant and then questions were asked about it. The Reflexive Thematic Analysis approach was adopted to analyse data. Twenty volunteers were interviewed (mean age±SD: 71,2±5,3 years; men/women: 6/14) and from their transcriptions, 4 themes were created: 1) “Empower to Flourish: Senior-Defined Key Focus Areas for Active Ageing Programs”, 2) “Silver Expectations: Revealing the Needs and Desires of Seniors for Active Ageing”, 3) “Optimal Setup: Best Practices for Designing and Implementing Senior Active Ageing Programs” and 4) “Tech-Enabled Ageing: Wearables Impact on Senior Health”. A practical guide for crafting and developing the ideal active ageing intervention for older adults, adopting a wearable device was created. Interventions should address health spheres (e.g., physical activity, sleep, social aspects), hobbies and cultural aspects, emphasising long-lasting cooperation with local institutions to have sustainable and effective interventions. Moreover, adopting a completely autonomous wearable device could enhance the intervention’s effectiveness.

Eye-height is a reliable metric that help us scaling the surrounding world, understanding objects’ dimensions, how they move, and their distance from us. Previous studies have shown that inaccuracies in how people perceive their own eye-height can lead to significant errors in spatial estimation within immersive virtual reality (IVR). This study investigated how the visual context influences people's estimation of their own eye-height in IVR. Forty-eight healthy adults participated in a series of experiments that examined how two different factors influenced their eye-height estimation error: the environmental context of three virtual scenarios (Experiment 1), the visibility of body representations (Experiment 2), and the combined effect of these two factors (Experiment 3). Our results suggest that both the environmental context and the visibility of body representations are important to improve people’s eye-height estimation in IVR. Moreover, our findings are compatible with the idea of a weighted integration of multiple visual cues. In contextually enriched environments depth and spatial cues played a major role in the estimation process. In contrast, in contextually sparse environments, the visibility of body references became crucial to attain an accurate self-perception of eye-height. These results are consistent with cue weighting theoretical frameworks, in which the perceptual system dynamically adjusts the relative importance of different visual cues based on their reliability to obtain more precise eye-height estimates.

Introduction:Chronic non-specific low back pain is a leading cause of disability worldwide. While resistance training using external loads is common in rehabilitation, its added value over unloaded exercise remains uncertain, particularly across physical and psychological variables. Method:This systematic review and meta-analysis, registered on PROSPERO (CRD42022366975), included randomized controlled trials comparing externally loaded resistance training to unloaded exercise in adults with chronic non-specific low back pain. Primary outcomes were pain intensity and disability. Secondary outcomes included back muscle endurance, maximal strength, fear-avoidance beliefs, and pain catastrophizing. Random-effects meta-analyses were conducted, stratified by follow-up duration. Results:Thirteen randomized trials (778 participants) were included. At follow-up periods beyond seven weeks, externally loaded resistance training showed a small but statistically significant reduction in pain compared to unloaded exercise (mean difference = -0.52 on a 0-10 scale; 95% confidence interval [-0.92, -0.08]). No significant differences were found at short-term or post-washout follow-ups. Effects on disability were inconsistent and highly variable. Resistance training was associated with improvements in back muscle endurance and suggested a possible effect on long-term maximal strength, although wide prediction intervals prevent definitive conclusions. No meaningful differences were found for psychological variables, and pain catastrophizing was assessed in only one trial, limiting conclusions. Conclusion:Externally loaded resistance training is safe and feasible for chronic non-specific low back pain, but its effects on pain, disability and psychosocial outcomes are comparable to unloaded exercise. In line with the multifactorial nature of chronic pain, improvements appear driven more by exposure, adherence and therapeutic context than by load intensity alone. Exercise prescription should therefore remain individualized and embedded within a biopsychosocial framework.

Introduction: Literature on bioethics in physiotherapy, particularly in cancer management, is limited. This study explores the perceived bioethical issues in cancer rehabilitation by Italian physiotherapists. Participants: Thirty-one physiotherapists (Age: 42 ± 10.5 years; 20 women, 11 men) with expertise in cancer rehabilitation were purposefully selected. Data Collection: Six online focus groups were conducted, guided by a focus group guide based on existing literature and refined by experts in cancer rehabilitation and bioethics. Data Analysis: Sessions were recorded, transcribed, and analyzed using Braun and Clarke’s ‘Reflexive Thematic Analysis’. Results: Four primary themes emerged: 1) Challenges of (Non)-Disclosure in Diagnosis and Prognosis – ethical difficulties around withholding diagnosis or prognosis information; 2) Balancing Hope and Realism in Patient and Caregiver Expectations – navigating hope versus realistic rehabilitation goals; 3) Weighing Efficacy and Safety in Cancer Rehabilitation – balancing ­treatment outcomes with patient safety; 4) Decisions on Withdrawing Treatment – ethical considerations in discontinuing treatment. Discussion: These themes highlight common ethical dilemmas faced by physiotherapists in cancer rehabilitation, mirroring broader healthcare challenges. Addressing them requires a nuanced understanding of ethical principles within the cancer rehabilitation context. Conclusions: The study provides insights into the bioethical issues in cancer rehabilitation, stressing the need for a patient-centered approach to navigate these challenges effectively.

BACKGROUND:Persistent shoulder pain is common, and it is associated with substantial morbidity and healthcare costs. Approximately 21 to 50 % of people with shoulder pain treated in primary healthcare recover within six months. It is not known why at least half do not recover. One possibility is the manner underlying mechanisms related to persistent shoulder pain are managed. Being able to determine the predominant pain phenotype in people with persistent shoulder pain (i.e., nociceptive, neuropathic, or nociplastic pain) together with their underlying mechanism and tailoring management accordingly may improve outcomes for people seeking care for persistent shoulder pain. The International Association for the Study of Pain (IASP) recently developed clinical criteria and a grading system for the identification of nociplastic pain. OBJECTIVE:In this paper, we aim to provide suggestions to clinicians to assist in the evaluation of pain phenotypes, underlying mechanisms, and their causal relationships. DISCUSSION:Based on the IASP clinical criteria and grading system for nociplastic pain, we outline pain phenotype evaluation and provide a clinical reasoning framework. To facilitate this, three case studies involving people living with persistent shoulder pain are presented.

Introduction Body image disturbance (BID) is a complex construct that includes cognitive-affective, perceptual and behavioural characteristics, influencing how people perceive and feel about their bodies. An accurate assessment of BID is important for identifying and treating eating disorders (EDs), debilitating psychiatric conditions that compromise individuals’ well-being, leading to high death rates. Methods used to quantify BID in people with EDs vary widely, making it difficult to establish a gold standard measure. Hence, this scoping review will aim at summarising the literature on the methods to assess BID in people with EDs, providing a clearer overview of the topic.Methods and analysis The scoping review will map and synthesise the BID in individuals with EDs, exploring: (1) Which methods and tools are used to assess BID in individuals with EDs, and are they self-reported or evaluated by clinicians? (2) Which components of BID are assessed? (3) What are the main outcomes measured by these methods and tools? What is their validity, reliability and sensitivity? The population of interest will include individuals of all ages diagnosed with one of the main EDs: anorexia nervosa, bulimia nervosa and binge ED (BED). Hence, the concept of this review will revolve around the methods and tools for measuring BID in EDs focusing on research conducted either in experimental or clinical settings. Records will be screened by two independent reviewers and any discrepancies will be resolved by a third reviewer. Results will be synthesised and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search is planned to be conducted from November 2025 to September 2026 through multiple databases, including PubMed, PsycINFO, ScienceDirect, Web of Science, PubMed Central and Scopus.Ethics and dissemination Formal ethical approval is not required for this review. The results will provide a clear overview of the assessment methods for BID in EDs. Findings will be disseminated through publication, and presentations at relevant scientific conferences and sharing with professional networks.

ABSTRACTPurposeTo compare treatment utilisation for osteoarthritis (OA) and satisfaction with OA management between individuals with and without comorbid metabolic conditions (e.g., diabetes, obesity, dyslipidaemia, hypertension).MethodsSecondary analysis of a cross‐sectional international survey study (Italy, Russia, Sweden) on people ≥ 40 years old with knee/hip OA. Metabolic comorbidity was self‐reported. We used direct standardisation with prevalence ratios and mixed‐effect models to estimate the associations between comorbidity with treatment utilisation and satisfaction (score 0–100).ResultsWe analysed 401 individuals (48% Sweden, 28% Italy, 24% Russia; 53% with ≥ 1 metabolic condition). Those with and without comorbid metabolic conditions showed similar prevalence for first‐line interventions (exercise, education, and weight management). Metabolically unhealthy individuals showed higher use of opioids (prevalence ratio [95% CI] 1.9 [1.3–2.4]), antidepressants (1.8 [1.1–2.5]), corticosteroid injections (1.4 [1.0−1.8]), and homoeopathic products (2.1 [1.2–3.0]). Satisfaction with care (adjusted difference: −3.9 [95% CI: −8.5 to 2.4]) and information received about treatments (−4.0 [−9.7 to 1.7]) were similar.ConclusionsWhile first‐line OA interventions were similarly used, those with metabolic conditions relied more on second‐line and non‐recommended treatments, showing comparable satisfaction. More effort is needed to increase the adoption of lifestyle‐focused treatments in OA and to minimise the use of less recommended options among individuals with metabolic comorbidities.

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.

OBJECTIVES:To investigate the association of diabetes, hypertension and overweight/obesity with physical activity (PA), self-efficacy for pain and self-efficacy for other symptoms before and after a 6- week exercise and education intervention for knee and hip osteoarthritis (OA), and to assess outcome disparities based on metabolic health. METHODS:Register-based cohort study using the Swedish Osteoarthritis and Diabetes cohort. We used Body Mass Index, medical records and medication dispensation to define overweight/obesity, hypertension and diabetes at baseline (exposures). PA was self-reported (weekly minutes), and self-efficacy was measured using the 'Arthritis Self-Efficacy Scale' (ASES) (score 10-100) (outcomes). We used linear mixed-effect models to estimate associations between exposures and outcomes, adjusted for confounders. RESULTS:We included 80 893 individuals with knee or hip OA. Those with metabolic conditions consistently showed lower PA and self-efficacy, with baseline disparities persisting after the intervention, particularly when all three conditions coexisted (PA difference: baseline 107 min [95% CI: 97; 118], 3-month 97 [86; 108], 12-month 109 [95; 123]; ASES-pain difference: baseline 5.6 [3.9; 7.3], 3-month 5.9 [4.1; 7.7], 12-month 8.2 [6.1; 10.4]; ASES-other symptoms difference: baseline 6.1 [4.6; 7.7], 3-month 6.4 [4.8; 8.0], 12-month 8.2 [6.3; 10.1]). CONCLUSIONS:Metabolic conditions were associated with lower PA and self-efficacy, with differences increasing with the number of co-existing conditions. The baseline disparities associated with metabolic conditions persisted after the intervention, with both groups showing improvement at 3 months but reverting to baseline by 12 months. This suggests that current guideline-based interventions for OA may not reduce long-term disparities related to metabolic conditions.