Pathogenic variants affecting the TB5 domain of the fibrillin-1 protein: not only in geleophysic/acromicric dysplasias but also in Marfan syndrome

BACKGROUND

Marfan syndrome (MFS) is a multisystem disease with a unique combination of skeletal, cardiovascular and ocular features. Geleophysic/acromicric dysplasias (GPHYSD/ACMICD), characterised by short stature and extremities, are described as 'the mirror image' of MFS. The numerous FBN1 pathogenic variants identified in MFS are located all along the gene and lead to the same final pathogenic sequence. Conversely, in GPHYSD/ACMICD, the 28 known heterozygous FBN1 pathogenic variants all affect exons 41-42 encoding TGFβ-binding protein-like domain 5 (TB5).

METHODS

Since 1996, more than 5000 consecutive probands have been referred nationwide to our laboratory for molecular diagnosis of suspected MFS.

RESULTS

We identified five MFS probands carrying distinct heterozygous pathogenic in-frame variants affecting the TB5 domain of FBN1. The clinical data showed that the probands displayed a classical form of MFS. Strikingly, one missense variant affects an amino acid that was previously involved in GPHYSD.

CONCLUSION

Surprisingly, pathogenic variants in the TB5 domain of FBN1 can lead to two opposite phenotypes: GPHYSD/ACMICD and MFS, suggesting the existence of different pathogenic sequences with the involvement of tissue specificity. Further functional studies are ongoing to determine the precise role of this domain in the physiopathology of each disease.

A bibliometric study on trends in chiropractic research from 1920 to 2023

OBJECTIVE

An increasing body of evidence suggests a positive role of chiropractic in the treatment of neuro-musculoskeletal disorders. This study aims to explore current research hotspots and trends, providing insights into the broad prospects of this field.

METHODS

A bibliometric review was conducted on all chiropractic articles included in the Web of Science Core Collection before December 31, 2023.

RESULTS

Over the past century, the volume of research in the field of chiropractic has been fluctuating annually, with four peaks observed in total. The United States, Canada, Australia, and the United Kingdom are leading countries. Chu, Eric Chun-Pu is the author with the most publications, while Bronfort, Gert has the highest total citation count. The University of Southern Denmark has produced the most publications, while Queens University - Canada is the most central institution. The Journal of Manipulative and Physiological Therapeutics is the journal with the most publications and citations, while the Journal of the American Medical Association is the most central journal. The two most-cited articles were both authored by Eisenberg DM. Emerging keywords include "chronic pain" and "skills". The theoretical mechanisms and scientific basis of chiropractic, its clinical practice and safety, education and training, integration with other disciplines, and patient experiences and satisfaction are the frontiers and hotspots of research.

CONCLUSION

This study integrates bibliometric analysis to summarize the current state of research and global network centers in the field of chiropractic, further highlighting the hotspots and trends in this field. However, Individual and national rankings should be interpreted with caution due to our focus on Web of Science rather than PubMed.

Genetic complexity of diagnostically unresolved Ehlers-Danlos syndrome

BACKGROUND

The Ehlers-Danlos syndromes (EDS) are heritable disorders of connective tissue (HDCT), reclassified in the 2017 nosology into 13 subtypes. The genetic basis for hypermobile Ehlers-Danlos syndrome (hEDS) remains unknown.

METHODS

Whole exome sequencing (WES) was undertaken on 174 EDS patients recruited from a national diagnostic service for complex EDS and a specialist clinic for hEDS. Patients had already undergone expert phenotyping, laboratory investigation and gene sequencing, but were without a genetic diagnosis. Filtered WES data were reviewed for genes underlying Mendelian disorders and loci reported in EDS linkage, transcriptome and genome-wide association studies (GWAS). A genetic burden analysis (Minor Allele Frequency (MAF) <0.05) incorporating 248 Avon Longitudinal Study of Parents and Children (ALSPAC) controls sequenced as part of the UK10K study was undertaken using TASER methodology.

RESULTS

Heterozygous pathogenic (P) or likely pathogenic (LP) variants were identified in known EDS and Loeys-Dietz (LDS) genes. Multiple variants of uncertain significance where segregation and functional analysis may enable reclassification were found in genes associated with EDS, LDS, heritable thoracic aortic disease (HTAD), Mendelian disorders with EDS symptomatology and syndromes with EDS-like features. Genetic burden analysis revealed a number of novel loci, although none reached the threshold for genome-wide significance. Variants with biological plausibility were found in genes and pathways not currently associated with EDS or HTAD.

CONCLUSIONS

We demonstrate the clinical utility of large panel-based sequencing and WES for patients with complex EDS in distinguishing rare EDS subtypes, LDS and related syndromes. Although many of the P and LP variants reported in this cohort would be identified with current panel testing, they were not at the time of this study, highlighting the use of extended panels and WES as a clinical tool for complex EDS. Our results are consistent with the complex genetic architecture of EDS and suggest a number of novel hEDS and HTAD candidate genes and pathways.

Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review

Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.

The effect of corrective exercises on musculoskeletal disorders among the older adults residing in a nursing home in Rasht, Guilan, Iran

BACKGROUND

Ageing causes changes in the function of musculoskeletal systems and disability, and injury among older adults. This study aimed to determine the effect of corrective exercises on musculoskeletal disorders among older adults residing in a nursing home in Iran.

METHOD

This controlled clinical trial study was conducted on 58 older adults (29 samples in each group). The intervention group performed corrective exercises for 8 weeks and three sessions per week and each session lasted for one hour. The pre-test was performed one week before intervention and the post-test one week after the 8-week intervention. The research instruments included Nordic Musculoskeletal Questionnaire (NMQ), and the pain visual analog scale (VAS). Descriptive and inferential (Chi-square, Mann-Whitney, Wilcoxon, and McNemar test) statistics were used to analyze the data using SPSS software version 19.

RESULTS

the majority of the participants were males (67.2%) and in the age range of 60-74 years (82.8%). The mean age of samples in intervention and control groups was 68.45 (SD = 5.38) and 69.17 (SD = 5.86), respectively. The results showed that the prevalence of musculoskeletal disorders (MSDs) was decreased in the intervention group after the intervention (%Δ = -34.68, p < .05). The results also showed a statistically significant decrease in pain intensity of musculoskeletal in the intervention group, after the intervention (%Δ = -68.34, p < .001).

CONCLUSIONS

Corrective exercises reduce the prevalence of MSDs and the pain intensity among older adults. It is recommended to pay attention to these exercises to improve physical health and reduce the prevalence of MSDs among older adults.

Comparing Outcomes of Musculoskeletal Radiographs from In-Person and Telemedicine Primary Care Cohorts, April 2019-June 2021

PURPOSE

Musculoskeletal conditions are a common reason for primary care visits, and they are being increasingly addressed at televisits. We therefore examined outcomes of musculoskeletal radiographs ordered at in-person and telemedicine primary care visits, which have implications for patient care and the economic impact of telemedicine.

METHODS

We performed a retrospective cohort study of musculoskeletal radiograph orders placed April 1, 2019-March 31, 2021 at a major academic health system. Radiology reports were classified as normal or abnormal based on the radiologist's impression. Findings were compared using c2 tests.

RESULTS

The main outcome was radiographic abnormalities. A secondary outcome was the effect of social determinants of health and medical comorbidities on telemedicine utilization. A total of 1580 radiographs were reviewed. Compared with televisits occurring after onset of the SARS-Cov2-19 pandemic, radiographs ordered at in-person visits had higher odds of being abnormal (OR 2.51, 95% CI 1.33-4.75; P = .004). When comparing radiographic outcomes at in-person visits before and after the pandemic's onset, those ordered afterward had higher odds of being abnormal (OR 1.88, 95% CI 1.30-2.71; P < .001). Social determinants of health and medical comorbidities were not associated with telemedicine utilization.

CONCLUSIONS

After the onset of the SARS-Cov2-19 pandemic, radiographs ordered at in-person visits had higher odds of being abnormal compared with televisits. These findings indicate that prudence should be applied to ordering musculoskeletal radiographs in telemedicine encounters.

Effectiveness of psychosocial interventions for pediatric patients with scoliosis: a systematic review

Background

Pediatric patients affected by scoliosis have complex psychological and social care needs, and may benefit from psychosocial interventions. We therefore aimed to summarize evidence of the efficacy of psychosocial interventions for this patient population.

Methods

Literature was identified by searching Medline, PsycINFO, Embase, EBSCO Cumulated Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) from database inception to 20 March 2022. Articles that evaluated the effectiveness of psychosocial interventions for pediatric patients diagnosed with scoliosis and reported at least one quantitative outcome were included. Article eligibility, data extraction, and quality assessment (using the Cochrane Collaboration's Risk of Bias Tool and Methodological Index for Non-Randomized Studies) were performed by two independent researchers. Findings are presented using narrative synthesis.

Results

We identified ten studies, all of which focused on adolescent idiopathic scoliosis. Studies included a total of 1007 participants, most of whom were female. Three studies focused on patients undergoing bracing, six on patients undergoing spinal surgery, and one on patients broadly. Brace compliance monitoring and counseling were found to significantly improve brace compliance quality and quantity. Proactive mental healthcare delivery by nurses after spinal surgery was similarly found to improve outcomes. Several studies examined the efficacy of brief educational interventions; most did not report clear evidence of their efficacy. The methodological quality of studies was often unclear due to limitations in articles' reporting quality.

Conclusions

Research on the efficacy of psychosocial interventions for pediatric patients with scoliosis is limited, with interventions involving frequent patient-provider interactions showing the most promise. Future clinical and research efforts should focus on developing and testing psychosocial interventions for this patient population, with emphasis on multidisciplinary teams delivering holistic care.

Trial registration number

PROSPERO number CRD42022326957.

Ergonomic Risk Factors of Fourth- and Fifth-Year International Medical University Dental Students

Objective

The purpose of this study was to identify and compare the ergonomic risk factors of year 4 and year 5 dental students attending International Medical University.

Methods

This was an exploratory, observational study evaluating ergonomic risk factors among year 4 and year 5 dental students, with a total of 89 participants. The students' ergonomic risk components were evaluated using the Rapid Upper Limb Assessment (RULA) worksheet. Descriptive statistics were used to analyze the RULA scores, and the Mann-Whitney U test served to determine the difference of ergonomic risk between year 4 and year 5 dental students.

Results

The descriptive analysis showed that the participants' (N = 89) median final RULA score was 6.00 (standard deviation = 0.716). One-year difference in the years of clinical practice did not produce a significant difference in the final RULA score (U = 913.0, P = 0.49). The final RULA scores showed year 4 dental students had a higher mean ranking (year 4 = 46.65, year 5 = 43.23). Furthermore, the Mann-Whitney U test indicated that this was not statistically significant (U = 913.0, P = 0.49).

Conclusion

The descriptive analysis showed that the final RULA score of the participants indicated that the participants were in a high-risk category for experiencing work-related musculoskeletal disorders due to poor ergonomics. Contributing physical factors included working in asymmetric, awkward, and static positions in a confined workspace, infrequent use of dental loupes, and utilization of dental chairs that were not ergonomically appropriate.

Effects of Postural Shifting Frequency on Perceived Musculoskeletal Discomfort During 1-Hour Sitting in Office Workers

OBJECTIVE

The purpose of this study was to evaluate the effects of postural shifting frequency on perceived musculoskeletal discomfort during 1 hour of sitting in healthy office workers.

METHODS

An experimental study comparing 3 different postural shifting frequencies was conducted on 60 healthy office workers who were asked to sit for an hour. The effects of 3 postural shifts (ie, 10, 20, and 30 times/h) on discomfort, measured by Borg's CR-10 scale, were compared. A seat pressure mat was used to confirm an individual's postural shift.

RESULTS

Postural shifting frequency of 10 to 30 times/h had significant effects on perceived discomfort in the neck, shoulder, and upper and lower back during 1-hour sitting. At the neck and shoulder, a postural shifting frequency of 30 times/h significantly reduced perceived discomfort compared to a postural shifting frequency of 10 times/h during 1-hour sitting. At the upper and lower back, a postural shifting frequency of 20 to 30 times/h significantly reduced perceived discomfort compared to a postural shifting frequency of 10 times/h.

CONCLUSION

Postural shifts of 30 times/h provided buffering effects on perceived musculoskeletal discomfort at the neck, shoulder, and upper and lower back.

Clinical Outcomes of COVID‑19 Patients with Rheumatic and Musculoskeletal Diseases: A Single Centre Cohort Study

N/a.

Applying patient-reported outcome measures (PROMs) in physiotherapy: an evaluation based on the QUALITOUCH Activity Index

BACKGROUND

Patient-reported outcome measures (PROMs) are tools to screen a population, to monitor the subjective progress of a therapy, to enable patient-centred care and to evaluate the quality of care. The QUALITOUCH Activity Index (AI) is such a tool, used in physiotherapy. This study aimed to provide reference values for expected AI outcomes.

METHODS

A large data set uniting clinical routine data and AI outcomes was generated; it consisted of data of 11,948 patients. For four defined diagnoses, i.e. chronic lower back pain, tibia posterior syndrome, knee joint osteoarthritis and shoulder impingement, the AI responses related to the dimensions "maximum pain level" and "household activity" were analyzed. Reference corridors for expected AI outcomes were derived as linear trend lines representing the mean, 1st and 3rd quartile.

RESULTS

Reference corridors for expected AI outcomes are provided. For chronic lower back pain, for example, the corridor indicates that the initial average AI value related to maximum pain of 49.3 ± 23.8 points on a visual analogue scale (VAS multiplied by factor 10) should be improved by a therapeutic intervention to 36.9 ± 23.8 points on a first follow-up after four weeks.

CONCLUSIONS

For four exemplary diagnoses and two dimensions of the AI, one related to pain and one related to limitations in daily activities, reference corridors of expected therapeutic progress were established. These reference corridors can be used to compare an individual performance of a patient with the expected progress derived from a large data sample. Data-based monitoring of therapeutic success can assist in different aspects of planning and managing a therapy.

Conclusion of diagnostic odysseys due to inversions disrupting GLI3 and FBN1

Many genetic testing methodologies are biased towards picking up structural variants (SVs) that alter copy number. Copy-neutral rearrangements such as inversions are therefore likely to suffer from underascertainment. In this study, manual review prompted by a virtual multidisciplinary team meeting and subsequent bioinformatic prioritisation of data from the 100K Genomes Project was performed across 43 genes linked to well-characterised skeletal disorders. Ten individuals from three independent families were found to harbour diagnostic inversions. In two families, inverted segments of 1.2/14.8 Mb unequivocally disrupted GLI3 and segregated with skeletal features consistent with Greig cephalopolysyndactyly syndrome. For one family, phenotypic blending was due to the opposing breakpoint lying ~45 kb from HOXA13 In the third family, long suspected to have Marfan syndrome, a 2.0 Mb inversion disrupting FBN1 was identified. These findings resolved lengthy diagnostic odysseys of 9-20 years and highlight the importance of direct interaction between clinicians and data-analysts. These exemplars of a rare mutational class inform future SV prioritisation strategies within the NHS Genomic Medicine Service and similar genome sequencing initiatives. In over 30 years since these two disease-gene associations were identified, large inversions have yet to be described and so our results extend the mutational spectra linked to these conditions.

Analysis of Spin in the Reporting of Studies on Electroanalgesia for Musculoskeletal Pain

OBJECTIVE

The purpose of this study was to analyze the quality of reporting and presence of spin in abstracts of randomized clinical trials (RCTs) on the use of electroanalgesia for musculoskeletal pain.

METHODS

The Physiotherapy Evidence Database (PEDro) was searched from 2010 to June 2021. Inclusion criteria were RCTs using electroanalgesia in individuals with musculoskeletal pain, written in any language, comparing 2 or more groups, and with pain as 1 of the outcomes. Two blinded, independent, and calibrated evaluators (Gwet's AC1 agreement analysis) performed eligibility and data extraction. General characteristics, report of outcomes, quality of reporting (Consolidated Standards of Reporting Trials for Abstracts [CONSORT-A]), and spin analysis (7-item spin checklist and spin analysis per section) were extracted from abstracts.

RESULTS

Of 989 studies selected, 173 abstracts were analyzed after screening and eligibility criteria. Mean risk of bias on the PEDro scale was 6.02 ± 1.6 points. Most abstracts did not report significant differences for primary (51.4%) and secondary (63%) outcomes. Mean quality of reporting was 5.10 ± 2.4 points in the CONSORT-A, and spin was 2.97 ± 1.7. Abstracts had at least 1 type of spin (93%), and the conclusion presented the greatest number of spin types. More than 50% of abstracts recommended an intervention without significant differences between groups.

CONCLUSION

This study found that the majority of RCT abstracts on electroanalgesia for musculoskeletal conditions in our sample had a moderate to high risk of bias, incomplete or missing information, and some type of spin. We recommend that health care providers who use electroanalgesia and the scientific community be aware of spin in published studies.

Clinical, radiological, pedobarographic, and quality of life outcomes of the Ponseti treatment for clubfoot: a prospective study

BACKGROUND

Talipes equinovarus, also known as clubfoot, is a congenital anomaly that affects one newborn per 1000 live births. Its standard treatment strategy is Ponseti casting management. This study aims to report the long-term outcomes of the Ponseti treatment in Iran.

METHODS

A prospective cohort study was enrolled to evaluate clinical outcomes, radiological results, pedobarographic measurements, and quality of life after the Ponseti treatment in patients with clubfoot who were followed for at least five years.

RESULTS

In this study, 25 clubfeet of 18 patients were included. Significant reductions in Pirani, Dimeglio, and CAP scores, improved ankle dorsiflexion, and acceptable pedobarographic indices were observed in this study. From the radiological evaluation indices, the calcaneal pitch and lateral talus-first metatarsal angles were significantly reduced. After five years of treatment, patients' quality of life was favorable, which was better in females. This study showed that the results of the Ponseti treatment remained acceptable after five years.

CONCLUSIONS

The Ponseti management for clubfoot in the long term appears to maintain significant improvements. However, the recurrence rate - albeit without disruption to daily activities - cannot be ignored.

Reliability of the Joint Position Sense Error Test for Women With Neck Pain and Asymptomatic Men and Women

OBJECTIVE

The purpose of this study was to evaluate the intra-rater between-days reliability of the joint position sense error (JPSE) test in asymptomatic men and women, as well as in women with neck pain.

METHODS

Fourteen asymptomatic men and 27 women (14 asymptomatic and 13 with neck pain) participated. The JPSE test was performed during right and left cervical rotation (10 trials for each side) in 2 sessions, with at least 7 days between them. The head repositioning error during the JPSE test (in degrees) was measured and used to calculate the intra-rater between-days reliability of the test, evaluated through the intraclass correlation coefficient and Bland-Altman analyses. Independent t tests were calculated to compare the head repositioning errors of asymptomatic women and men. The minimal detectable change was also calculated.

RESULTS

The neck pain group showed higher intraclass correlation coefficient values (0.866 and 0.773, good reliability) compared to the asymptomatic men (0.478 and 0.403, poor reliability) and to the asymptomatic women (-0.161 and 0.504, poor and moderate reliability, respectively) for both right and left cervical rotation, respectively. Considering Bland-Altman analyses, the neck pain group showed better agreement between the measurements for right cervical rotation than the asymptomatic groups.

CONCLUSION

The results indicate that the methodology used to perform the JPSE test in this study may be a reliable way to assess the proprioception of women with neck pain in clinical settings.

Low back pain among nurses in Italy: a review

Low back pain is a deeply felt problem among the world's population, and it causes distress for health care workers, especially in nurses. Therefore, it is important to investigate the incidence of low back pain in Italian nurses. Methods. A search has been conducted on the main international databases, only studies conducted in Italian nurse have been considered. Results. Results are various: 13.7% - 20% of annual incidence and 17% - 63.7% of prevalence; working night shifts, insufficient training, frequent patient handling, lack of devices, work department, obesity, age, work-related stress and no physical activity represent a greater risk to incur in low back pain. Conclusions. There is a need to improve devices, training and lifestyle to reduce chronic situations.

A multiple linear regression approach to extimate lifted load from features extracted from inertial data

Work-related musculoskeletal disorders are among the main occupational health problems. Substantial evidence has shown that work-related physical risk factors are the main source of low back complaints, particularly affecting heavy and repetitive manual lifting activities. The aim of the study is, during load lifting tasks, to explore the correlation between the time domain features extracted from the acceleration and angular velocity signals of the performing subject and the load lifted, and to explore the feasibility of a multiple linear regression model to predict the lifted load. The acceleration and angular velocity signals were acquired along the three directions of space by means of an inertial sensor placed on the subject's chest, during lifting activities with load gradually increased by 1 kg from 0 kg to 18 kg. Successively three time-domain features (Root Mean Square, Standard Deviation and MinMax value) were extracted from the acquired signals. First a correlation analysis was carried out between each individual feature and the load lifted (calculating r); then the time-domain features that proved most representative (strong correlation) were used to create a multiple linear regression model (calculating R-square). The statistical analysis was carried out by means of the Pearson correlation and multiple linear regression model was fed with the most informative time-domain features according to the correlation analysis. The correlation analysis showed a strong correlation (r > 0,7) between six features (three extracted from z-axes acceleration and three extracted from y-axes angular velocity) and the lifted load. The predictive multiple linear regression model, fed with these six features achieved a Rsquare greater than 0,9.The study demonstrated that the proposed combination of kinematic features and a multiple regression model represents a valid approach to automatically calculate the load lifted based on raw signals obtained by means of an inertial sensor placed on the chest. The results confirm the potential application of this methodology to indirectly monitor the load lifted by workers during their activity.

Scoping Review of Telehealth for Musculoskeletal Disorders: Applications for the COVID-19 Pandemic

OBJECTIVE

The purpose of this scoping review was to identify information about telehealth and rehabilitation for the evaluation and management of musculoskeletal disorders, patient satisfaction, cost, and access as may be applicable during the COVID-19 pandemic.

METHODS

We searched MEDLINE for studies published between January 1, 2000, and June 1, 2019. Search terms consisted of MEDLINE medical subject headings and other words relevant to this review, including "telerehabilitation," "musculoskeletal," "telemedicine," "therapy," "chiropractic," "ergonomics," and "exercise." This review targeted studies of people aged 18 years and older with musculoskeletal concerns. Articles on diagnostic tests, effectiveness of treatment, patient satisfaction, access to care, and cost were included.

RESULTS

Eleven studies were included in this review. Interrater reliability and agreement were moderate to high for several assessment procedures for the lower limb, elbow, and low back. Two clinical trials demonstrated that provider and patient simultaneous telehealth were equally as effective as in-office care. Patient and provider satisfaction with telehealth were reported to be equal to or higher than for conventional rehabilitation. We found no studies reporting cost or access.

CONCLUSION

In the COVID-19 pandemic environment, telehealth is feasible for health care providers to provide rehabilitation services for their patients with various musculoskeletal conditions. Current evidence suggests that for some musculoskeletal disorders, telehealth evaluation may be reliable, treatment may be effective, and patient satisfaction may be good or better than for in-office care. Results from this study may help physiatry, physical therapy, and chiropractic health care providers in their decisions to implement telehealth during and after the COVID-19 pandemic.

The Impact of Childhood Obesity on Joint Alignment: A Systematic Review and Meta-Analysis

OBJECTIVE

It has been suggested that overweight/obesity (OW/OB) impairs the normal alignment of children and adolescents' musculoskeletal system. However, to date, no study has systematically reviewed or quantified the effect of OW/OB on the development of joint malalignments in children and adolescents. The purpose of this study was to systematically review the association between OW/OB and joint alignment in children and adolescents and to quantify the evidence on whether children and adolescents with OW/OB have a higher risk of developing joint malalignments than their peers of normal weight.

METHODS

PubMed and Web of Science databases were systematically searched from inception to March 9, 2020. Studies investigating the association between OW/OB and joint alignment in children and adolescents were selected. Nonoriginal articles, participants with movement pattern diseases, and adolescents studied while pregnant were excluded. Two independent reviewers conducted the study selection and data extraction. Qualitative synthesis of evidence and random effect meta-analyses (risk ratio [RR]) were performed.

RESULTS

Seventy-three studies (5 longitudinal and 68 cross-sectional) met the inclusion criteria involving 1,757,107 children and adolescents. There was consistent evidence supporting associations of OW/OB with rounded shoulder, lumbar hyperlordosis, genu valgum, and flatfoot. Our meta-analysis showed that children and adolescents with OW/OB had a significantly higher risk of lumbar hyperlordosis (RR = 1.41), genu valgum (RR = 5.92), flatfoot (RR = 1.49), and any joint malalignment (RR = 1.68) when compared with their peers of normal weight. The presence of genu valgum and flatfoot were the most robust results.

CONCLUSION

Based on these findings, OW/OB is associated with the presence of joint malalignments in children and adolescents.

IMPACT

This is the first study that has systematically reviewed the effect of OW/OB on the development of joint malalignments in children and adolescents.

Mobile Health Applications for Rehabilitation of Musculoskeletal Diseases of the Shoulder: A Systematic Analysis

Rehabilitation of musculoskeletal diseases (MSD) of the shoulder is a multifaceted long-term process, which is often not transparent to affected patients. Mobile health applications (apps) have the potential to support this complex process by improving patients' self-management skills. However, there seems to be a lack of apps providing a holistic approach to motivate and guide patients during the whole rehabilitation process. Therefore, a systematic analysis of apps on Google Play Store was conducted by two independent reviewers. A total of 3227 apps were identified, of which 64 met the eligibility criteria for the qualitative analysis. The majority of analyzed apps were developed generally for patients with MSD of the shoulder, rarely for specific diseases (individual needs of patients). The majority of apps focus on the provision of information, exercise training, and alternative medicine. Apps for diagnostics, inpatient treatment, and self-management, especially for multiple rehabilitation phases, are rare or even not existent. Game design elements are seldom used. If there are any, then simple to implement ones, e.g. messages and progress bars. The (psychological) effects of individual game design elements on patients seem to be neglected, when selecting and implementing game-components.

Assessment of knowledge of junior doctors and non-specialists about musculoskeletal medicine

Objectives:

To assess the knowledge and confidence of junior doctors and non-specialists in examining and making a diagnosis of patients with musculoskeletal (MSK) diseases.

Methods:

This was a Cross-sectional study of 121 doctors working in medical clinics at a tertiary hospital between October and December 2019. Data were collected using a questionnaire. Doctor’s awareness regarding different MSK examination methods including gait, arms, leg, spine (GALS), pediatric gait, arms, leg, spine (pGALS) and regional examination of musculoskeletal system (REMS) was noted. Undergraduate teaching of these methods and use in their daily practice was surveyed.

Results:

Majority of the doctors lacked awareness about different MSK examination techniques. Awareness about GALS, REMS and pGALS was 44.6%, 59.5% and 18.2% respectively. There was significant correlation of GALS/REMS awareness with the undergraduate teaching and doctor’s clinical experience (p-value <0.05). Confidence level of doctors in diagnosing patients with adult MSK pathologies was 55%. Only few doctors were satisfied with their musculoskeletal education (29%).

Conclusion:

The GALS examination is a useful screening tool for junior doctors and non-specialists in a direct access setting to rule out musculoskeletal problems.

[Factors related to the one-month retention of 8507 employees declared medically unfit in Hauts-de-France companies between 2014 and 2018]

BACKGROUND

Given the low rate of retention in a company after an employee has been found unfit for the job, our aim was to determine the factors related to employees being kept by their company one month after being declared unfit for the job due to either a musculoskeletal disease (MSD) or a mental health disorder (MHD).

METHODS

This study was based on all employees declared unfit for the job by the occupational physicians in the "Unfitness" survey in the French "Hauts-de-France" region between 2014 and 2018. For each of the two groups of workers, factors related to the employees being kept by their company one month after being declared unfit for the job were studied by logistic regression.

RESULTS

Only 6.9% of the 5352 workers declared unfit for the job due to MSD were kept in their company whereas 3.6% of the 3155 workers declared unfit for the job due to MHD were kept in theirs. For the two groups of workers, the proportion of employees kept by their company decreased with female gender (OR=0.63 95%CI [0.47-0.84] for MSD and OR=0.50 [0.32-0.78] for MHD for female vs. male), long sick-leave (OR=0.26 [0.18-0.40] for MSD and OR=0.22 [0.11-0.45] for MHD for sick-leave>6 months vs. no sick leave), small size of the company (<50 employees) and working in the construction field or services sector (vs. industry or administration). Concerning the employees declared unfit due to MSD alone, the proportion of employees kept by their company decreased for seniors (>50 years old) and for those with low seniority (<5 years).

CONCLUSION

"Retention in a company" as a tool for "maintenance of employment" is a little-discussed subject, lending further credence to the current recommendations for reduction of inequalities in working conditions and vocational training of employees according to age and socio-occupational category, and also for reduction of inequalities in occupational pathways according to gender.

Effectiveness of a 12-Week Physical Exercise Program on Lower-Limb Malalignment in School-age Rugby: A Randomized Clinical Trial

OBJECTIVE

We sought to assess the effectiveness of 12 weeks of a physical exercise program (PEP) in child rugby players with lower-limb overpronation during gait.

METHODS

This was a randomized clinical trial. A total of 123 young athletes (mean ± standard deviation age, 10.35 ± 1.22 years) were evaluated, 20 of whom had lower-limb overpronation (n = 40 extremities). Participants were randomly assigned to 2 groups: the experimental group, who performed their normal training and a PEP for 12 weeks, and the control group, who continued with their normal training for the same time. The PEP was focused on stretching the hypertonic muscle and potentiating the weakened muscles of the lower body. All participants underwent biomechanical analysis including the Helbing angle, the femorotibial angle, and the Fick angle in both limbs.

RESULTS

All participants (n = 20) completed the study. Baseline measurements showed no significant differences between groups in any of the variables tested. After 12 weeks, there were significant differences between groups (P < .001 for all angles). No improvement was found in the control group; however, meaningful improvement was found in all variables in the experimental group: Helbing angle (175°, P < .001, effect size [ES] = 1.94), femorotibial angle (173°, P < .001, ES = 1.77), Fick angle (12°, P < .001, ES = 1.55). The number needed to treat was 2 for femorotibial angle and Helbing angle, and 3 for Fick angle.

CONCLUSION

A 12-week PEP produced significant improvements in these 3 biomechanical variables. We also conclude that young athletes with a pathological gait pattern reached a normal gait pattern.

Low-Level Laser Light Therapy Dosage Variables vs Treatment Efficacy of Neuromusculoskeletal Conditions: A Scoping Review

OBJECTIVE

The purpose of this scoping review was to identify and synthesize literature on dosage variables on the efficacy of low-level laser therapy (LLLT) for neuromusculoskeletal conditions.

METHODS

A scoping literature review was conducted by searching the following databases: the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, Medline, the Physiotherapy Evidence Database, the Index to Chiropractic Literature, manufacturer websites, and online guidelines. The search was modeled after STARLITE criteria. The reporting used Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR). Articles were included if LLLT was used in any treatment group for a neuromusculoskeletal complaint with dosage and effectiveness reported. This was tabulated by source, dosage variables, conditions, outcome measures, and conclusions. Data were charted in Excel format. Frequency counts were performed on ordinal data. Descriptive statistics were computed for the continuous data.

RESULTS

A total of 86 articles were included in the review. They revealed a broad range of musculoskeletal conditions and diverse dosage parameters. Seven individual parameters were found that would alter the dosage. Although duration of application is an independent clinical factor, the negative-outcome studies were inconsistent in duration. There was lack of statistical difference between the studies with improved vs unimproved outcomes. No statistical differences were noted between the dosage parameters and efficacy.

CONCLUSION

Although many articles were found on LLLT for neuromusculoskeletal conditions, the studies had amorphous parameters. A heterogeneity of reported doses precluded the synthesis of sufficient evidence to correlate dosage variables with improved or unimproved outcomes. Therefore, based on the current literature, dosage variables for the efficacy of LLLT for neuromusculoskeletal conditions are uncertain at this time.

The negative effects of anterior cruciate ligament injury during stroke rehabilitation

Musculoskeletal problems are commonly reported after stroke resulting in abnormal gait biomechanics, pain, and limitation in performing activities of daily living. Anterior circulate ligament is the most frequently injured knee ligament accounting for approximately 50% of all ligament injuries; however, post stroke anterior cruciate ligament injury is rarely reported. We present a case of a 58-year-old female admitted for inpatient stoke rehabilitation after a left middle cerebral artery stroke. After gaining considerable functional recovery, she was planned to be discharged in two weeks’ time when she tripped resulting in a torn anterior cruciate ligament on the hemiperetic side. This resulted in increase in the length of stay and loss of functional gains. We discuss the possible mechanisms and the management plan. Patients with stroke should be monitored for musculoskeletal complications and preventive strategies should be devised to protect from possible ligamentous injuries of the knees.

A Vision Utilizing Gamification to Enhance Patients' with Chronic Shoulder Diseases Adherence to Rehabilitation

Although adherence is a key factor for successful treatment of chronic diseases, only about 50% of patients achieve good adherence. However, health enabling technologies and gamification offer new possibilities to enhance patient's motivation. In physical rehabilitation, various applications exist. As these often stress a specific part of the rehabilitation process, we introduce a six-step new holistic approach to apply game design elements in the entire rehabilitation process, while focusing on patients with musculoskeletal diseases of the shoulder.

Prediction Model for Choosing Needle Length to Minimize Risk of Median Nerve Puncture With Dry Needling of the Pronator Teres

OBJECTIVE

The aim of this study was to relate forearm anthropometric measures to ultrasound pronator teres depth to determine the necessary needle length to prevent median nerve (MN) injury during pronator teres dry needling.

METHODS

We conducted a study employing a diagnostic accuracy prediction model (NCT03308279) at a Spanish university center. The study recruited 65 participants to predict the depth of the MN (measured with ultrasound) in the pronator teres using a decision tree algorithm to reduce the risk of MN puncture using 2 needle lengths (13 mm or 25 mm). The decision tree was developed by automatically selecting a cutoff for body mass index, forearm length and circumference, and pronator teres thickness.

RESULTS

For forearm circumferences ≤27.5 cm, the predictive value for the 13-mm needle was 92%. For forearm circumferences >27.5 cm and forearm lengths ≤26.75 cm, the predictive value for the 25-mm needle was 100%.

CONCLUSION

Based upon the findings of this study, we suggest that needle length should be selected according to forearm anthropometric measures to prevent MN injury during pronator teres dry needling.

Playing-Related Musculoskeletal Disorders of Professional Orchestra Musicians from the North of Portugal: Comparing String and Wind Musicians

INTRODUCTION

It is well known that musicians are a group prone to suffer from playing-related musculoskeletal disorders. Professional orchestra musicians play for several hours a week and have to fight against pain caused by their profession. The aim of this study was to explore and describe self-reported complaints among professional orchestra musicians and to compare its intensity and the prevalence between string and wind instruments.

MATERIAL AND METHODS

Hundred and twelve professional orchestra musicians from the three main professional orchestras from the North of Portugal were individually interviewed about the prevalence and the intensity (measured by verbal numerical scale for pain) of their playing-related musculoskeletal disorders.

RESULTS

About two third (62.5%) of the interviewed musicians presented playing-related musculoskeletal disorders during the time of the interview. Despite there are no significant statistic values between groups, results suggested that playing-related musculoskeletal disorders are more common in string players and more intense in wind players.

DISCUSSION

Referring to the prevalence of playing-related musculoskeletal disorders, our data is in line with other studies from different countries. More than half of professional orchestra musicians in the North of Portugal are playing with a mild to moderate pain.

CONCLUSION

Future studies focusing on working-related problems among professional orchestra musicians in Portugal would be useful to better describe the problem of occupational diseases among performing artist.

[Occupational Exposure to Psychosocial Factors and Presence of Musculoskeletal disorders in Nursing Staff: A review of Studies and Meta-Analysis]

BACKGROUND

There is scientific evidence that psychosocial factors are significantly associated with discomfort and / or pain musculoskeletal complaints in nursing staff. The objective of the research was to analyze the association between occupational exposure to psychosocial factors at work and musculoskeletal damage in nursing staff.

METHODS

Systematic review and meta-analysis of studies published up to 2015 in English, French, Italian, Portuguese or Spanish evaluating the association between musculoskeletal disorders and psychosocial factors in the work of nursing staff. A search was made using the same strategies in the bibliographic databases Web of Science, MEDLINE (Pubmed), NIOSHIC and CINAHL. We assessed the quality of eligible studies, heterogeneity, and sensitivity analyzes.

RESULTS

64 studies were reviewed and quality criteria were accepted, accepting those of medium and high quality (n = 47). In a second screening, those that did not meet inclusion criteria were eliminated, with 36 studies being included in the meta-analysis. Statistically significant associations were found between high demands with discomfort and / or pain neck (OR 1.55, IC95%: 1.39-1.72). And between the effort-reward imbalance with discomfort and / or pain in any body region (OR 2.56, IC95%: 1.59-4.11). Heterogeneity was generally average and low for most subsets of the meta-analysis.

CONCLUSIONS

Occupational exposure to psychosocial factors is associated with discomfort and / or pain in different body areas. Therefore, the improvement of the psychosocial environment has an impact on the reduction and prevention of musculoskeletal disorders.

The Prevalence and the Determinants of Musculoskeletal Diseases in Emiratis Attending Primary Health Care Clinics in Dubai

OBJECTIVES

To estimate the prevalence of rheumatic diseases in the Emiratis attending primary health care (PHC) clinics in Dubai. The secondary objective was to study the relationship between age, gender, and body mass index (BMI) and rheumatic diseases in the general population. .

METHODS

The Prevalence of Rheumatic Diseases and Osteoporosis (PRO) in Dubai study was a cross-sectional study, which randomly enrolled Emiratis' aged between 18-85 years old who attended one of 13 PHC clinics between 2 January 2009 and 31 December 2009. Demographic and health data for all participants was obtained via a questionnaire. Participants that indicated positive answers had their responses validated by a rheumatologist and underwent a thorough locomotor examination. .

RESULTS

The study included 3,985 participants with a mean age of 42.1±15.8 years. The majority (77.4%) were female. Lower back pain was the most prevalent problem in our study population (32.9%). Knee osteoarthritis (OA) was the most common form of arthritis seen in our cohort (25.8%). Overall, the prevalence of inflammatory arthritis was 3.1%. Age and BMI were associated with increased risk of knee OA and lower back pain. .

CONCLUSIONS

Rheumatic diseases are quite common in Emirati patients attending PHC clinics. Lower back pain and knee OA were the most common musculoskeletal diseases seen in our cohort. There is a need for more population-based studies in the Middle East to have a better understanding of the epidemiology of rheumatic diseases in this region.

Quality of Life Impact Related to Foot Health in a Sample of Older People with Hallux Valgus

Hallux Valgus (HV) is a highly prevalent forefoot deformity in older people associated with progressive subluxation and osteoarthritis of the first metatarsophalangeal (MTP) joint and it is believed to be associated with varying degrees of HV effect on the quality of life related to foot health. The aim of this study is to compare the impact of varying degrees of HV on foot health in a sample of older people. The sample consisted of 115 participants, mean age 76.7 ± 9.1, who attended an outpatient center where self-report data were recorded. The degree of HV deformity was determined in both feet using the Manchester Scale (MS) from stage 1 (mild) to 4 (very severe). Scores obtained on the Foot Health Status Questionnaire (FHSQ) were compared. This has 13 questions that assess 4 health domains of the feet, namely pain, function, general health and footwear. The stage 4 of HV shown lower scores for the footwear domain (11.23 ± 15.6); general foot health (27.62 ± 19.1); foot pain (44.65 ± 24.5); foot function (53.04 ± 27.2); vigour (42.19 ± 16.8); social capacity (44.46 ± 28.1); and general health (41.15 ± 25.5) compared with stage 1 of HV (P<0.05) and there were no differences of physical activity (62.81 ± 24.6). Often, quality of life decreases in the elderly population based in large part on their foot health. There is a progressive reduction in health in general and foot health with increasing severity of hallux valgus deformity which appears to be associated with the presence of greater degree of HV, regardless of gender.

Evaluation of the usefulness of 2 prediction models of clinical prediction models in physical therapy: a qualitative process evaluation

OBJECTIVE

The purposes of this study were to (1) evaluate the usefulness of 2 prediction models by assessing the actual use and advantages/disadvantages of application in daily clinical practice and (2) propose recommendations to enhance their implementation.

METHODS

Physical therapists working in 283 practices in the area of Breda (the Netherlands) were invited to participate in this study. Two prediction models were presented: (1) to predict persistent shoulder pain and (2) to predict the preferable treatment in nonspecific neck pain. Participants were asked to apply both models in practice. After 2 months, their opinions about the usefulness of both models were gathered during a focus group meeting or by using an online questionnaire in order to identify the most important advantages/disadvantages of each prediction model.

RESULTS

In total, 46 physical therapists (13.8%) of 39 practices participated. Evaluative data were available from 32 participants who used the shoulder model 102 times and the neck model 126 times. For the shoulder model, the most frequent advantage (mentioned 14 times) was that it enabled physical therapists to estimate a motivated prognosis, that is, a prognosis based on the score of the model. The most frequent mentioned disadvantage was that participants expressed their doubts about the validity of the model because the model initially was developed for usage in a general practice setting. For the neck model, the most frequently mentioned advantage (29 times) was that the model was easy to interpret. The most important disadvantage (mentioned 14 times) was that the model only takes a few treatment options into account.

CONCLUSIONS

The physical therapists participating in this study reported that both models evaluated in this study were not easy to use in daily practice. Based on the findings of this study, we recommend that these models are modified to meet the practical needs of the therapist, before assessing their impact on daily clinical care and patient outcomes.

Development of a neck pain risk score for predicting nonspecific neck pain with disability in office workers: a 1-year prospective cohort study

OBJECTIVE

The purpose of this study was to develop a neck pain risk score for office workers (NROW) to identify office workers at risk for developing nonspecific neck pain with disability.

METHODS

A 1-year prospective cohort study of 559 healthy office workers was conducted. At baseline, risk factors were assessed using questionnaires and standardized physical examination. The incidence of neck pain was collected every month thereafter. Disability level was evaluated using the neck disability index. Logistic regression was used to select significant factors to build a risk score. The coefficients from the logistic regression model were transformed into the components of a risk score.

RESULTS

Among 535 (96%) participants who were followed up for 1 year, 23% reported incident neck pain with disability (≥5). After adjusting for confounders, the onset of neck pain with disability was significantly associated with history of neck pain, chair adjustability, and perceived muscular tension. Thus, the NROW comprises 3 questions about history of neck pain, chair adjustability, and perceived muscular tension. The NROW had scores ranging from 0 to 4. A cut-off score of at least 2 had a sensitivity of 82% and specificity of 48%. The positive and negative predictive values were 29% and 91%, respectively. The area under the receiver operating characteristic curve was 0.75.

CONCLUSION

The risk score for nonspecific neck pain with disability in office workers was developed, and it contained 3 items with scores ranging from 0 to 4. This study shows that the score appears to have reasonable sensitivity, specificity, positive predictive value, and negative predictive values for the cut-off point of at least 2.

Prevalence and clinical picture of musculoskeletal sarcoidosis

Background:

Sarcoidosis is a multisystem disease affecting different organs with different frequency rates depending on geographical location. Musculoskeletal abnormalities includes osseous lesions (small and large bone sarcoidosis), sarcoidal arthropathy, and sarcoidal myopathy. Musculoskeletal involvement is reported in a significant number of patients.

Objectives:

This study aimed to determine the prevalence and clinical picture of musculoskeletal sarcoidosis in Iranian cohort of patients with sarcoidosis.

Patients and Methods:

We designed a descriptive cross-sectional study including 30 patients with sarcoidosis who had hospitalized in the Rheumatology Department at Ghaem Hospital, Mashhad, Iran. The patients were evaluated for musculoskeletal symptoms using history, physical examination, and paraclinical data.

Results:

Of the 30 studied patients, 24 were female (80%) and six were male (20%). The mean age at diagnosis was 38 years. Sarcoidal arthropathy (arthritis and periarthritis) was observed in 26 patients (86.6%). Furthermore, the initial presentation was associated with joint symptoms in 19 cases (63.3%); acute arthritis developed in 17 (65%) while bone and muscle involvements each occurred in 2 (6.6%).

Conclusions:

Sarcoidosis is a common disease in women aged 20 to 40 years. The most common involved joint were consecutively ankles, knees, and wrists, reaching a accumulated frequency of 86.6%; however, bone and muscle involvements were uncommon.

Role of occupational stress and burnout in prevalence of musculoskeletal disorders among embassy personnel of foreign countries in iran

Background:

Occupation is one of the major parts of our daily lives that might cause a great amount of stress. Stress and job burnout are linked together. The association between musculoskeletal disorders (MSD) and burnout syndrome as a psychosocial factor was investigated previously.

Objectives:

The aim of this study was to identify the role of occupational stress and burnout in musculoskeletal complaint among diplomatic employees of different embassies in Iran.

Materials and Methods:

In a cross-sectional study, we assessed 200 employees of the foreign countries embassies in Iran. The participants were selected randomly from all the embassy personnel. Study questionnaires were delivered to the participants and finally 161 questionnaires were returned to the researchers (response rate: 80.5%). An assessment of burnout and MSD were made using the Maslach Burnout Inventory (MBI) and Nordic questionnaires. The work place stress was measured by the work place stress questionnaire.

Results:

Mean occupational stress was significantly higher among embassy personnel with MSD than among the personnel without this syndrome during the preceding week (17.18 ± 3.42 and 16.06 ± 2.19, respectively; P = 0.02) and the preceding year (17.17 ± 3.11 and 16.74 ± 3.03, respectively; P < 0.01) to the study. Only smoking and occupational stress were identified as independent predictors of MSD among embassy personnel.

Conclusions:

It seems that association between musculoskeletal complaints and burnout syndrome was more complex than being attributed to only occupation stress. Further studies are recommended to determine other related factors to this association.

Occupational diseases in Korea

Korea has industrialized since the 1970s. Pneumoconiosis in coal miners was the most common occupational disease in the 1970s to 1980s. With the industrialization, the use of many chemicals have increased since the 1970s. As a consequence, there were outbreaks of occupational diseases caused by poisonous chemicals, such as heavy metal poisoning, solvent poisoning and occupational asthma in the late 1980s and early 1990s with civil movement for democracy. Many actions have been taken for prevention by the government, employers and employees or unions. In the 1990s most chemical related diseases and pneumoconiosis have rapidly decreased due to improving work environment. In the late 1990s, cerebro-cardiovascular diseases related to job stress or work overloads have abruptly increased especially after the economic crisis in 1998. After the year 2000, musculoskeletal disorders became a major problem especially in assembly lines in the manufacturing industry and they were expanded to the service industry. Mental diseases related to job stress have increased. Infectious diseases increased in health care workers and afforestation workers. Occupational cancers are increasing because of their long latency, although the use of carcinogenic substances are reduced, limited, and even banned.

Characteristics of work-related musculoskeletal disorders in Korea and their work-relatedness evaluation

Work-related musculoskeletal disorders (WMSDs) can be compensated through the Industrial Accident Compensation Insurance Act. We looked at the characteristics of WMSDs in worker's compensation records and the epidemiological investigation reports from the Occupational Safety and Health Research Institute (OSHRI). Based on the records of compensation, the number of cases for WMSDs decreased from 4,532 in 2003 to 1,954 in 2007. However the proportion of WMSDs among the total approved occupational diseases increased from 49.6% in 2003 to 76.5% in 2007, and the total cost of WMSDs increased from 105.3 billion won in 2004 to 163.3 billion won in 2007. The approval rate of WMSDs by the OSHRI accounted for 65.6%. Ergonomic and clinical characteristics were associated with the approval rate; however, the degenerative changes had a minimal affect. This result was in discordance between OSHRI and the Korea Workers' Compensation & Welfare Service. We presumed that there were perceptional gaps in work-relatedness interpretation that resulted from the inequality of information in ergonomic analyses. We propose to introduce ergonomic analysis to unapproved WMSDs cases and discuss those results among experts that will be helpful to form a consensus among diverse groups.