Patients with worse disability respond best to cognitive functional therapy for chronic low back pain: a pre-planned secondary analysis of a randomised trial.

Question: Do five baseline moderators identify patients with chronic low back pain who respond best to cognitive functional therapy (CFT) when compared with usual care?

Design: Secondary analysis of the RESTORE randomised controlled trial.

Participants: A total of 492 adults with low back pain for > 3 months with at least moderate pain-related activity limitation.

Intervention: Participants were allocated to CFT alone or CFT plus biofeedback; these two groups were combined for this secondary analysis.

People with painful knee osteoarthritis hold negative implicit attitudes towards activity.

Negative attitudes/beliefs surrounding osteoarthritis, pain, and activity contribute to reduced physical activity in people with knee osteoarthritis (KOA). These attitudes/beliefs are assessed using self-report questionnaires, relying on information one is consciously aware of and willing to disclose. Automatic (ie, implicit) assessment of attitudes does not rely on conscious reflection and may identify features unique from self-report.

Co-development and evaluation of the Musculoskeletal Telehealth Toolkit for physiotherapists.

Introduction: In-person physiotherapy services are not readily available to all individuals with musculoskeletal conditions, especially those in rural regions or with time-intensive responsibilities. The COVID-19 pandemic highlighted that telehealth may facilitate access to, and continuity of care, yet many physiotherapists lack telehealth confidence and training. This project co-developed and evaluated a web-based professional development toolkit supporting physiotherapists to provide telehealth services for musculoskeletal conditions.

Broken Machines or Active Bodies? Part 3. Five Recommendations to Shift the Way Clinicians Communicate With People Who Are Seeking Care for Osteoarthritis.

In parts 1 and 2 of this series, we highlighted the dominant impairment way of talking about osteoarthritis: talking that frames osteoarthritis as a disease of cartilage worsened by physical activity that can only be "cured" by replacing the joint. An alternative understanding that counters common misconceptions about osteoarthritis, and links physical activity and healthy lifestyles to improvements in symptoms is likely a prerequisite for sustainable behavior change. It is insufficient to tell people with osteoarthritis that regular physical activity is important; people need to understand and experience physical activity can help.

Process of change for people with knee osteoarthritis undergoing cognitive functional therapy: a replicated single-case experimental design study.

Purpose: To examine the applicability and process of change of Cognitive Functional Therapy (CFT) in the management of pain and disability in people with knee osteoarthritis who were offered knee replacement surgery and had risk factors for poor response to surgery.

Methods: Single-case experimental design with a mixed-methods, repeated measures approach was used to investigate the process of change through CFT in four participants. Qualitative interviews investigated beliefs, behaviours and coping responses, and self-reported measures assessed pain, disability, psychological factors, and function at 25 timepoints.

Broken Machines or Active Bodies? Part 2. How People Talk About Osteoarthritis and Why Clinicians Need to Change the Conversation.

How people talk about osteoarthritis may impact outcomes, including uptake of guideline recommendations related to activity-based lifestyles and interventions. In this editorial, we describe 2 key ways of talking, based on findings from our systematic review of 62 qualitative studies exploring the perceptions of people with knee osteoarthritis (n = 1208), their carers (n = 28), and clinicians (n = 2403). Among raw quotes extracted from the studies, we observed a dominant impairment-based way of talking and a participatory based way of talking.

Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial.

Background: Low back pain is the leading cause of years lived with disability globally, but most interventions have only short-lasting, small to moderate effects. Cognitive functional therapy (CFT) is an individualised approach that targets unhelpful pain-related cognitions, emotions, and behaviours that contribute to pain and disability. Movement sensor biofeedback might enhance treatment effects.

Broken Machines or Active Bodies? Part 1. Ways of Talking About Health and Why It Matters.

This editorial series raises awareness among clinicians about how ways of talking about orthopaedic conditions can influence what people who are seeking health care (1) think about their health and (2) what they do to manage their health. In part 1, we introduce you to ways of talking about health, using osteoarthritis as a case study. In part 2, we describe 2 contrasting ways of talking about osteoarthritis and how changing the way you share information and ideas with people seeking care may impact clinical decisions.

Understanding Discrepancies in a Person's Fear of Movement and Avoidance Behavior: A Guide for Musculoskeletal Rehabilitation Clinicians Who Support People With Chronic Musculoskeletal Pain.

Generic self-report measures do not reflect the complexity of a person's pain-related behavior. Since variations in a person's fear of movement and avoidance behavior may arise from contextual and motivational factors, a person-centered evaluation is required-addressing the cognitions, emotions, motivation, and actual behavior of the person. Most musculoskeletal rehabilitation clinicians will recognize that different people with chronic pain have very different patterns of fear and avoidance behavior.

Left Atrial Myxoma Infected With Fusobacterium Nucleatum.

Cardiac myxomas are the most common primary cardiac tumours in adults. Clinical presentation is variable, with few cases of infected myxomas reported in the literature. We describe a rare case of a 63-year-old patient who presented with splenic abscesses and a left atrial mass suggestive of emboligen myxoma.

Person-centered care for musculoskeletal pain: Putting principles into practice.

Person-centered care specifically focuses on the whole person and is an important component of contemporary care for people with musculoskeletal pain conditions. Evidence suggests however, that some clinicians experience difficulties with integrating person-centered care principles into their clinical practice. Therefore, the purpose of this masterclass is to provide a framework that enables clinicians to incorporate person-centered principles in their management of people with musculoskeletal pain conditions.

What Are the Mechanisms of Action of Cognitive-Behavioral, Mind-Body, and Exercise-based Interventions for Pain and Disability in People With Chronic Primary Musculoskeletal Pain?: A Systematic Review of Mediation Studies From Randomized Controlled Trials.

Objectives: This systematic review examined studies that used mediation analysis to investigate the mechanisms of action of cognitive-behavioral, mind-body, and exercise-based interventions for pain and disability in people with chronic primary musculoskeletal pain.

Materials And Methods: We searched 5 electronic databases for articles that conducted mediation analyses of randomized controlled trials to either test or estimate indirect effects.

Results: We found 17 studies (n=4423), including 90 mediation models examining the role of 22 putative mediators on pain or disability, of which 4 had partially mediated treatment effect; 8 had mixed results, and 10 did not mediate treatment effect.

"There's definitely something wrong but we just don't know what it is": A qualitative study exploring rowers' understanding of low back pain.

Objectives: Low back pain is highly prevalent in rowing and can be associated with significant disability and premature retirement. A previous qualitative study in rowers revealed a culture of concealment of pain and injury due to fear of judgement by coaches or teammates. The aim of this study was to explore rowers' perspectives in relation to diagnosis, contributory factors, and management of low back pain.

Predicting Knee Joint Kinematics from Wearable Sensor Data in People with Knee Osteoarthritis and Clinical Considerations for Future Machine Learning Models.

Deep learning models developed to predict knee joint kinematics are usually trained on inertial measurement unit (IMU) data from healthy people and only for the activity of walking. Yet, people with knee osteoarthritis have difficulties with other activities and there are a lack of studies using IMU training data from this population. Our objective was to conduct a proof-of-concept study to determine the feasibility of using IMU training data from people with knee osteoarthritis performing multiple clinically important activities to predict knee joint sagittal plane kinematics using a deep learning approach.

From Fear to Safety: A Roadmap to Recovery From Musculoskeletal Pain.

Contemporary conceptualizations of pain emphasize its protective function. The meaning assigned to pain drives cognitive, emotional, and behavioral responses. When pain is threatening and a person lacks control over their pain experience, it can become distressing, self-perpetuating, and disabling.

Shoulder pain across more movements is not related to more rotator cuff tendon findings in people with chronic shoulder pain diagnosed with subacromial pain syndrome.

Introduction: People with chronic shoulder pain commonly report pain during arm movements in daily-life activities. Pain related to movement is commonly viewed as an accurate representation of tissue damage. Thus, when a person reports pain across a variety of movements, this is often understood as indicative of greater damage.

An investigation of implicit bias about bending and lifting.

Objectives: Previous studies in a high-income country have demonstrated that people with and without low back pain (LBP) have an implicit bias that bending and lifting with a flexed lumbar spine is dangerous. These studies present two key limitations: use of a single group per study; people who recovered from back pain were not studied. Our aims were to evaluate: implicit biases between back posture and safety related to bending and lifting in people who are pain-free, have a history of LBP or have current LBP in a middle-income country, and to explore correlations between implicit and explicit measures within groups.

The Relationship Between Changes in Movement and Activity Limitation or Pain in People With Knee Osteoarthritis: A Systematic Review.

Objective: To report whether changes in knee joint movement parameters recorded during functional activities relate to change in activity limitation or pain after an exercise intervention in people with knee osteoarthritis (OA).

Design: Etiology systematic review.

Literature Search: Four databases (MEDLINE, Embase, CINAHL, and AMED) were searched up to January 22, 2021.

Patient-centered care in musculoskeletal practice: Key elements to support clinicians to focus on the person.

Musculoskeletal rehabilitation, including physiotherapy, needs to move towards a broader biopsychosocial understanding of musculoskeletal conditions and the delivery of high-value care for people with persistent pain conditions, in which a patient-centered approach is a key feature. However, it has been reported that clinicians experience difficulties with integrating patient-centered care principles into their clinical practice. Based on a focused symposium about patient-centered care for patients with musculoskeletal conditions, held during the online 2021 World Physiotherapy Congress, the purpose of this article is to share key elements of the content of this symposium with a wider audience, aimed at enabling clinicians to enhance patient-centeredness in their current practice.

Human Activity Recognition for People with Knee Osteoarthritis-A Proof-of-Concept.

Clinicians lack objective means for monitoring if their knee osteoarthritis patients are improving outside of the clinic (e.g., at home).

2021 consensus statement for preventing and managing low back pain in elite and subelite adult rowers.

Purpose: To synthesise evidence on low back pain (LBP) in adult rowers and to create a consensus statement to inform clinical practice.

Methods: There were four synthesis steps that informed the consensus statement. In step one, seven expert clinicians and researchers established the scope of the consensus statement and conducted a survey of experienced and expert clinicians to explore current practice.

'It's not hands-on therapy, so it's very limited': Telehealth use and views among allied health clinicians during the coronavirus pandemic.

Background: Telehealth services have helped enable continuity of care during the coronavirus pandemic. We aimed to investigate use and views towards telehealth among allied health clinicians treating people with musculoskeletal conditions during the pandemic.

Methods: Cross-sectional international survey of allied health clinicians who used telehealth to manage musculoskeletal conditions during the coronavirus pandemic.

Treating low back pain in athletes: a systematic review with meta-analysis.

Objective: To summarise the evidence for non-pharmacological management of low back pain (LBP) in athletes, a common problem in sport that can negatively impact performance and contribute to early retirement.

Data Sources: Five databases (EMBASE, Medline, CINAHL, Web of Science, Scopus) were searched from inception to September 2020. The main outcomes of interest were pain, disability and return to sport (RTS).

Prevalence and risk factors for back pain in sports: a systematic review with meta-analysis.

Objectives: We aimed to determine the prevalence of low back pain (LBP) in sport, and what risk factors were associated with LBP in athletes.

Design: Systematic review with meta-analysis.

Data Sources: Literature searches from database inception to June 2019 in Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus, supplemented by grey literature searching.

'You're the best liar in the world': a grounded theory study of rowing athletes' experience of low back pain.

Objectives: Low back pain (LBP) is common in rowers and leads to considerable disability and even retirement. The athlete voice can help clinicians to better understand sport-related pain disorders. We aimed to capture the lived experience of LBP in rowers.