Hasil untuk "Chiropractic"

Evan A. Katz, Seana B. Katz, Sophie F. Katz et al.

Background/Objectives: Cervical degenerative disc disease (DDD) is associated with decreased disc height, spinal arthrosis, decreased spinal stability, neck pain (NP), and increased years living with disability and global disease burden. Methods: A total of 64 patients (19 males, 45 females) between 23 and 77 years (mean age of 49.05 ± 3.34 years) presented to a private practice with NP and disability. Pre-treatment radiographs revealed decreased cervical curvature (ARA C2–C7) measuring −6.18 ± 3.06° (ideal is −42.0°), anterior head translation (Tz C2–C7) measuring 22.03 ± 2.39 mm (ideal is 0 mm), anterior cervical disc height (ADH C2–C7) measuring 3.68 ± 0.20 mm, and posterior cervical disc height (PDH C2–C7) measuring 3.21 ± 0.15 mm. Pre-treatment NP numeric rating scale (NRS) scored 6.66 ± 0.27, and neck disability index (NDI) scored 40.28 ± 1.42%, indicating moderate disability due to NP. Patients were treated using Chiropractic BioPhysics^® (CBP^®) Mirror Image^® spinal rehabilitation for mean values of 37.80 ± 2.44 treatment visits over 19.48 ± 3.89 weeks at a frequency of 2.89 ± 0.45 treatment visits per week. Results: Post-treatment radiographs revealed improvements in ARA C2–C7 to −19.95 ± 3.05°, Tz C2–C7 to 12.11 ± 2.34 mm, ADH C2-C7 to 5.19 ± 0.21 mm, and PDH C2-C7 to 4.36 ± 0.16 mm. Post-treatment patient-reported outcomes showed improvements in NP NRS to 1.52 ± 0.26 and NDI to 12.66 ± 0.96, indicating minimal NP and disability. Conclusions: CBP^® helps improve sagittal cervical spinal alignment and posture, which may help improve cervical disc height and NP and disability in adult patients with cervical DDD.

Sylvain Pigeon, Arnaud Lardon, André Bussières

Abstract Introduction Non-specific low back pain (NSLBP), with or without radiation, is a leading cause of global disability. International guidelines recommend that healthcare providers extend self-management support (SMS) to patients to alleviate pain and disability. However, the adoption of SMS strategies remains suboptimal. This study aimed to evaluate the levels of knowledge and confidence associated with adopting evidence-based practice (EBP) recommendations on SMS and identify related barriers and facilitators among interns and clinicians at the Franco-European Institute of Chiropractic (IFEC) outpatient clinic. Methods Methods:Using an explanatory sequential mixed-methods design (quantitative then qualitative), chiropractic interns and clinicians completed two self-reported questionnaires assessing 1) the levels of EBP endorsement (EBP Belief Scale) and application (EBP Implementation Scale), and 2) clinical practice orientation (Pain Attitude and Belief Scale). Semi-structured interviews underpinned by the Theoretical Domains Framework (TDF) were conducted among survey respondents to identify the key barriers and facilitators toward implementing SMS. Results A total of 48 interns and 23 supervising clinicians participated in the quantitative strand, while 10 interns and 10 clinicians took part in the qualitative strand.Despite positive beliefs towards EBP, interns and clinicians encountered various obstacles in practical implementation. Key TDF barriers included lack of time to apply SMS, familiarity with guideline recommendations, communication skills, and concerns over the potential impacts if patients failed to perform exercises. Additionally, confidence in delivering SMS and the recognition that providing SMS aligns with chiropractic duties emerged as important facilitators. Conclusion The data suggests that while practitioners demonstrate a solid level of knowledge regarding the use of EBP in patients with low back pain, their actual implementation of these strategies remains moderate. Qualitative analysis further highlights the presence of specific beliefs and attitudes that mirror those reported in other healthcare professions. Among the main barriers, significant challenges related to knowledge, skills, and resources—particularly the lack of time—appear to hinder the systematic application of SMS in clinical practice. 

Robert J Trager, Zachary A Cupler, Roshini Srinivasan et al.

<h4>Background</h4>Patients receiving chiropractic spinal manipulation (CSM) for spinal pain are less likely to be prescribed opioids, and some evidence suggests that these patients have a lower risk of any type of adverse drug event. We hypothesize that adults receiving CSM for sciatica will have a reduced risk of opioid-related adverse drug events (ORADEs) over a one-year follow-up compared to matched controls not receiving CSM.<h4>Methods</h4>We searched a United States (US) claims-based data resource (Diamond Network, TriNetX, Inc.) of more than 216 million patients, yielding data ranging from 2009 to 2024. We included patients aged ≥18 years with sciatica, excluding those post-spine surgery, prior anesthesia, serious pathology, high risk of ORADEs, and an ORADE ≤ 1-year prior. Patients were divided into two cohorts: (1) CSM and (2) usual medical care. We used propensity score matching to control for confounding variables associated with ORADEs. Comparative outcomes were analyzed by calculating risk ratios (RRs) and 95% confidence intervals (CIs) for the incidence of ORADEs and oral opioid prescription between cohorts.<h4>Results</h4>372,471 patients per cohort remained after matching. The incidence of ORADEs over 1-year follow-up was less in the CSM cohort compared to the usual medical care cohort (CSM: 0.09%; usual medical care: 0.30%), yielding an RR of 0.29 (95% CI: 0.25-0.32; P < .00001). CSM patients had a lower risk of receiving an oral opioid prescription (RR of 0.68 [95% CI: 0.68-0.69; P < .00001]).<h4>Conclusions</h4>This study found that adults with sciatica who initially received CSM had a lower risk of an ORADE compared to matched controls not initially receiving CSM, likely explained by a lower probability of opioid prescription. These findings corroborate existing practice guidelines which recommend adding CSM to the management of sciatica when appropriately indicated.

Joel Carmichael, Kent Stuber, Katherine A. Pohlman et al.

Abstract Objective This scoping review maps chiropractic-specific clinical outcomes registries. Introduction Clinical outcomes registries track patient outcomes to improve evidence-based practice and quality of care; however, their role in chiropractic remains unclear. Methods This research adhered to Joanna Briggs Institute’s scoping review outline and methodology, as well as the PRISMA-ScR guidelines. Five databases were searched on January 9, 2025, with subsequent search of grey literature and citation tracking. Sources were included if they described chiropractic-specific registries that reported clinical outcomes data. Two reviewers independently screened 604 citations, extracting data into Excel. Variables included registry characteristics and clinical outcomes collected. Results Only one dedicated chiropractic clinical outcomes registry was identified: Spine IQ, launched in 2016 in the US with approximately 50 chiropractors submitting data on over 2000 low back pain patients. Spine IQ collected patient-reported outcome measures including the Oswestry Disability Index, Bournemouth Questionnaire, and the PROMIS physical function measure. By 2018, Spine IQ had completed its pilot phase and planned expansion to 100 clinics. Three sources were excluded: one spine registry not collecting chiropractic outcomes and two databases that included chiropractic data in publications but did not qualify as registries. Conclusions This review identified only Spine IQ as a dedicated chiropractic clinical outcomes registry, revealing a significant gap in registry infrastructure within the profession globally. The profession should explore the development of registries to enhance care quality, societal impact, and opportunities for collaborative research.

Shannon Schueren, Dean L. Smith, Christopher A. Malaya et al.

Abstract Background Continuing education (CE) for chiropractors is mandated by state licensing boards to ensure ongoing learning and to maintain professional excellence. While incorporating research into CE programs is crucial for practitioners to remain dynamic and evidence-based, conducting research and academic pursuits is necessary for further development of the profession. We hypothesized that fewer U.S. states would provide CE credit for the completion of research or higher-education teaching activities within the chiropractic profession compared to other health professions. Methods Internet searches of publicly available state board websites for each profession was undertaken with a cross-sectional study design between 12/19/2024 and 03/01/2025. Data extraction focused on whether CE was granted for research (publication and/or peer review) as well as academic pursuits (higher education and/or CE instruction). Descriptive statistics determined the frequency of states allowing CE while Fisher’s Exact test and one-way ANOVA was performed to compare states granting CE credits for research and teaching as well as comparisons among the professions. Results Only 16 US states allow DCs to claim research activities for CE credit while 50% allow teaching for CE credit. This is significantly lower (p < 0.001) than ATs, DOs, and MDs where teaching and research activities are accepted for CE credit in all states. Conclusions Precluding research and higher-education teaching opportunities for CE presents a potential barrier to chiropractic academic and research development at present and in the future.

Rikke Krüger Jensen, Lisbeth Hartvigsen, Berit Schiøttz-Christensen et al.

Abstract Background Lumbar spinal stenosis (LSS) affects older people, leading to a decline in functional ability, and its prevalence is projected to rise with the aging population. Effective, affordable, and low-risk interventions are needed to maintain the function and quality of life for LSS patients. This study tested the feasibility of implementing a comprehensive conservative treatment program (Boot Camp Program) for LSS in Danish chiropractic clinics to inform a future randomised clinical trial. The objectives were to assess feasibility in terms of recruitment, adherence, data collection procedures, and completeness of outcomes, and to describe patient characteristics and investigate changes in outcomes over time. Method Using a prospective, single-arm, pretest–posttest design, this study sought to recruit 50 patients with LSS from six chiropractors in two primary care chiropractic practices. The program consisted of 12 visits and included patient education, manual therapy, and a progressive home exercise program. The impact of the program was assessed by measuring walking distance using a treadmill test at the 6- and 12-week follow-ups visits and self-reported pain and physical function at 6-, 12-, 20-, and 52-week intervals. Results In total, 147 patients were screened for eligibility and 38 (26%) were included. The mean age was 69 years (SD 10, range 47–89) and 61% were women. Thirty-four (90%) completed the 6-week program and 32 (84%) provided follow-up data. Almost 80% completed one daily exercise session 5 to 7 days a week. Overall, data collection procedures were feasible, except for paper patient diaries. Follow-up rates at 12, 20, and 52 weeks were 87%, 82%, and 74% respectively. Participants improved their walking distance on average by 45% and 53% at 6 and 12 weeks, respectively. Clinically relevant improvement was observed in secondary outcomes such as leg pain, back pain, and physical function at all follow-ups. Conclusions The Boot Camp Program for LSS was feasible to deliver in Danish chiropractic practice and patients improved on relevant outcomes. However, the recruitment procedure was ineffective. Logistics, awareness, incentives, timeframes, and patient motivation may have influenced enrolment and adherence. Recruitment in multiple settings and patient enrolment incentives will be considered.

Claire E O'Hanlon, Steven B Zeliadt, Rian DeFaccio et al.

<h4>Background</h4>Acupuncture and chiropractic care are evidence-based pain management alternatives to opioids. The Veterans Health Administration (VA) provides this care in some VA facilities, but also refers patients to community providers. We aimed to determine if patient-reported outcomes differ for acupuncture and chiropractic care from VA versus community providers.<h4>Materials and methods</h4>We conducted an observational study using survey outcome data and electronic medical record utilization data for acupuncture and chiropractic care provided in 18 VA facilities or in community facilities reimbursed by VA. Study participants were users of VA primary care, mental health, pain clinic, complementary and integrative therapies, coaching or education services in 2018-2019. Patients received 1) 4+ acupuncture visits (N = 201) or 4+ chiropractic care visits (N = 178) from a VA or community provider from 60 days prior to baseline to six-months survey and 2) no acupuncture or chiropractic visits from 1 year to 60 days prior to baseline. Outcomes measured included patient-reported pain (PEG) and physical health (PROMIS) at baseline and six-month surveys. Multivariate analyses examined outcomes at six months, adjusting for baseline outcomes and demographics.<h4>Results</h4>In unadjusted analyses, pain and physical health improved for patients receiving community-based acupuncture, while VA-based acupuncture patients experienced no change. Unadjusted analyses also showed improvements in physical health, but not pain, for patients receiving VA-based chiropractic care, with no changes for community-based chiropractic care patients. Using multivariate models, VA-based acupuncture was no different from community-based acupuncture for pain (-0.258, p = 0.172) or physical health (0.539, p = 0.399). Similarly, there were no differences between VA- and community-based chiropractic care in pain (-0.273, p = 0.154) or physical health (0.793, p = 0.191).<h4>Conclusions</h4>Acupuncture and chiropractic care were associated with modest improvements at six months, with no meaningful differences between VA and community providers. The choice to receive care from VA or community providers could be based on factors other than quality, like cost or convenience.

Bastien Couëpel, Bastien Couëpel, Catherine Daneau et al.

BackgroundIn patients with fibromyalgia, exercise and education are recommended to decrease pain level and improve pain management. The latest scientific evidence recommends to focus interventions on the upper limb. The aim of this pilot study was to compare the immediate effect of physical activity education vs. a control group on pain and muscle capacity in fibromyalgia patients.MethodFifty-six participants with fibromyalgia were randomized into an experimental group and a control group. The intervention consisted in watching a five-minute video that provided information about fibromyalgia, pain, kinesiophobia and physical activity. The control group watched a neutral five-minute video about beavers in Quebec. Following the video, participants performed a muscular fatigue task consisting of a repeated unilateral shoulder abduction task. At baseline and following the muscular fatigue task, maximal voluntary contraction (MVC) in shoulder abduction was assessed as well as pain level and pressure pain threshold (PPT) in the upper limb. Electromyographic activity was also assessed for upper trapezius and middle deltoid muscles. Two-way repeated measures analysis of variance was used to compare the MVC, PPT, and pain level before and after the muscular fatigue task between groups.ResultsThe experimental group showed a significantly lower increase in pain than the control group in the middle deltoid muscle (p = 0.002) when assessed by verbal pain rating scale. No significant interaction or main effect of Group and Time were observed for the pain level at the upper trapezius and elbow extensor muscles nor for any of the PPT measures. According to electromyographic data, the median frequency values indicate that neither group experienced muscle fatigue during the repeated contraction task.ConclusionsThe preliminary results suggest that a short physical activity education video positively influenced middle deltoid pain following repeated abduction in participants with fibromyalgia. Electromyographic analysis showed no evidence of objective muscle fatigue, suggesting that there might be a partial disconnection between the perception of muscle fatigue and the physiological biomarkers associated with muscle fatigue.

Josef Finsterer, Carla Alexandra Scorza, Fulvio Alexandre Scorza et al.

Silvano Mior, Dan Wang, Jessica J. Wong et al.

Abstract Background Despite increases in musculoskeletal disorders (MSD) in Canada, evidence suggests utilization of chiropractic services has remained relatively stable over time. Understanding the extent to which chiropractors are consulted and factors associated with their utilization may suggest factors related to accessing care. We assessed the change in prevalence and characteristics of Canadians seeking chiropractic care across two time periods 2001–2010 and 2015–2018. Methods We used national cross-sectional data from seven cycles of the Canadian Community Health Survey between 2001 and 2018. The survey included Canadians aged 12 years and older living in private dwellings in all provinces and territories. National annual weighted prevalence and age-standardized weighted prevalence (and 95% confidence intervals) of chiropractic utilization were calculated. We calculated prevalence of chiropractic utilization stratified by demographic, socioeconomic, lifestyle and health-related variables. Crude linear trends and change in prevalence from 2001 to 2010 were assessed using linear regression models. Results The national annual prevalence of Canadians consulting a chiropractor in the previous 12 months slightly increased from 11.0% (95% CI 10.8, 11.3) in 2001 to 11.4% (95%CI 11.1, 11.7) in 2010, and in those reporting receiving regular health care from a chiropractor from 7.5% (95%CI 7.2, 7.7) in 2015 to 7.9% (95%CI 7.7, 8.2) in 2018. Prevalence of utilization varied by province, highest in the Western provinces but lowest in Atlantic provinces. The age-specific prevalence of chiropractic utilization was highest in those aged 35–49 years and remained stable over time, except for slight increase in those aged 65–79 years. A higher percentage of Canadians identifying as white, Canadian-born, in the highest quintile of household income, overweight, physically active and in excellent health reported seeking chiropractic services. The most common reported chronic conditions measured in the survey among Canadians consulting chiropractors were chronic back problems, arthritis, fibromyalgia and headaches. Conclusion The national prevalence of utilization of chiropractic services among Canadians slightly increased over time but varied by province and respondents’ socioeconomic and health characteristics. Chronic back problems were the most common reported chronic condition. This comprehensive population-based study on chiropractic utilization in Canada can be used to inform decisions concerning health human resources and access to rehabilitation care for MSD.

Anita Meinke, Cinzia Maschio, Michael L. Meier et al.

BackgroundFear of movement is thought to interfere with the recovery from low back pain (LBP). To date, the relationship between fear of movement and postural balance has not been adequately elucidated. Recent findings suggest that more specific fears need to be assessed and put in relation to a specific movement task. We propose that the fear to bend the trunk in a certain direction is distinctly related to the amount of postural sway in different directions. Therefore, our aim was to investigate whether fear of movement in general and fear of bending the trunk in a certain plane is related to postural sway.MethodsData was collected from participants with LBP during two assessments ~3 weeks apart. Postural sway was measured with a force-platform during quiet standing with the eyes closed. Fear of movement was assessed with an abbreviated version of the Tampa Scale of Kinesiophobia (TSK-11) and custom items referring to fear of bending the trunk in the sagittal and the frontal plane.ResultsBased on data from 25 participants, fear of bending the trunk in the frontal plane was positively related to displacement in the sagittal and frontal plane and to velocity in the frontal plane (χ2 = 4.35, p = 0.04; χ2 = 8.15, p = 0.004; χ2 = 9.79, p = 0.002). Fear of bending the trunk in the sagittal plane was not associated with any direction specific measure of sway. A positive relation of the TSK-11 with velocity of the frontal plane (χ2 = 7.14, p = 0.008) was found, but no association with undirected measures of sway.DiscussionFear of bending the trunk in the frontal plane may be especially relevant to postural sway under the investigated stance conditions. It is possible that fear of bending the trunk in the frontal plane could interfere with balance control at the hip, shifting the weight from side to side to control balance.ConclusionFor the first time the directional relationship of fear of movement and postural sway was studied. Fear of bending the trunk in the frontal plane was positively associated with several measures of postural sway.

Catherine Daneau, Jacques Abboud, Andrée-Anne Marchand et al.

Up to 86% of pregnant women will have lumbopelvic pain during the 3rd trimester of pregnancy and women with lumbopelvic pain experience lower health-related quality of life during pregnancy than women without lumbopelvic pain. Several risk factors for pregnancy-related lumbopelvic pain have been identified and include history of low back pain, previous trauma to the back or pelvis and previous pregnancy-related pelvic girdle pain. During pregnancy, women go through several hormonal and biomechanical changes as well as neuromuscular adaptations which could explain the development of lumbopelvic pain, but this remains unclear. The aim of this article is to review the potential pregnancy-related changes and adaptations (hormonal, biomechanical and neuromuscular) that may play a role in the development of lumbopelvic pain during pregnancy. This narrative review presents different mechanisms that may explain the development of lumbopelvic pain in pregnant women. A hypotheses-driven model on how these various physiological changes potentially interact in the development of lumbopelvic pain in pregnant women is also presented. Pregnancy-related hormonal changes, characterized by an increase in relaxin, estrogen and progesterone levels, are potentially linked to ligament hyperlaxity and joint instability, thus contributing to lumbopelvic pain. In addition, biomechanical changes induced by the growing fetus, can modify posture, load sharing and mechanical stress in the lumbar and pelvic structures. Finally, neuromuscular adaptations during pregnancy include an increase in the activation of lumbopelvic muscles and a decrease in endurance of the pelvic floor muscles. Whether or not a causal link between these changes and lumbopelvic pain exists remains to be determined. This model provides a better understanding of the mechanisms behind the development of lumbopelvic pain during pregnancy to guide future research. It should allow clinicians and researchers to consider the multifactorial nature of lumbopelvic pain while taking into account the various changes and adaptations during pregnancy.

Mareike C. Janiak, Michael J. Montague, Catalina I. Villamil et al.

Abstract Background An individual’s microbiome changes over the course of its lifetime, especially during infancy, and again in old age. Confounding factors such as diet and healthcare make it difficult to disentangle the interactions between age, health, and microbial changes in humans. Animal models present an excellent opportunity to study age- and sex-linked variation in the microbiome, but captivity is known to influence animal microbial abundance and composition, while studies of free-ranging animals are typically limited to studies of the fecal microbiome using samples collected non-invasively. Here, we analyze a large dataset of oral, rectal, and genital swabs collected from 105 free-ranging rhesus macaques (Macaca mulatta, aged 1 month-26 years), comprising one entire social group, from the island of Cayo Santiago, Puerto Rico. We sequenced 16S V4 rRNA amplicons for all samples. Results Infant gut microbial communities had significantly higher relative abundances of Bifidobacterium and Bacteroides and lower abundances of Ruminococcus, Fibrobacter, and Treponema compared to older age groups, consistent with a diet high in milk rather than solid foods. The genital microbiome varied widely between males and females in beta-diversity, taxonomic composition, and predicted functional profiles. Interestingly, only penile, but not vaginal, microbiomes exhibited distinct age-related changes in microbial beta-diversity, taxonomic composition, and predicted functions. Oral microbiome composition was associated with age, and was most distinctive between infants and other age classes. Conclusions Across all three body regions, with notable exceptions in the penile microbiome, while infants were distinctly different from other age groups, microbiomes of adults were relatively invariant, even in advanced age. While vaginal microbiomes were exceptionally stable, penile microbiomes were quite variable, especially at the onset of reproductive age. Relative invariance among adults, including elderly individuals, is contrary to findings in humans and mice. We discuss potential explanations for this observation, including that age-related microbiome variation seen in humans may be related to changes in diet and lifestyle. Video abstract

Ali Raza Asif, Asim Waris, Syed Omer Gilani et al.

Electromyography (EMG) is a measure of electrical activity generated by the contraction of muscles. Non-invasive surface EMG (sEMG)-based pattern recognition methods have shown the potential for upper limb prosthesis control. However, it is still insufficient for natural control. Recent advancements in deep learning have shown tremendous progress in biosignal processing. Multiple architectures have been proposed yielding high accuracies (&gt;95%) for offline analysis, yet the delay caused due to optimization of the system remains a challenge for its real-time application. From this arises a need for optimized deep learning architecture based on fine-tuned hyper-parameters. Although the chance of achieving convergence is random, however, it is important to observe that the performance gain made is significant enough to justify extra computation. In this study, the convolutional neural network (CNN) was implemented to decode hand gestures from the sEMG data recorded from 18 subjects to investigate the effect of hyper-parameters on each hand gesture. Results showed that the learning rate set to either 0.0001 or 0.001 with 80-100 epochs significantly outperformed (p &lt; 0.05) other considerations. In addition, it was observed that regardless of network configuration some motions (close hand, flex hand, extend the hand and fine grip) performed better (83.7% &#177; 13.5%, 71.2% &#177; 20.2%, 82.6% &#177; 13.9% and 74.6% &#177; 15%, respectively) throughout the course of study. So, a robust and stable myoelectric control can be designed on the basis of the best performing hand motions. With improved recognition and uniform gain in performance, the deep learning-based approach has the potential to be a more robust alternative to traditional machine learning algorithms.

Julie C. Kendall, Dein Vindigni, Barbara I. Polus et al.

Abstract Introduction Chronic musculoskeletal pain is associated with reduced balance performance and falls risk. Manual therapies are commonly used interventions for musculoskeletal pain. There is emerging evidence that manual therapies may improve balance. The aim of this systematic review was to examine the effectiveness of manual therapies for musculoskeletal pain on measures of static and dynamic stability. Methods Six electronic databases were searched using pre-defined eligibility criteria and two independent reviewers assessed all identified records. Risk of bias was assessed using the 12-item Cochrane Risk of Bias assessment by two authors independently and any discrepancies resolved through consensus. Meta-analysis was conducted when three or more studies used the same outcome measures including gait speed, timed up and go test, step test and sit-to-stand test. Results Twenty-six studies were included in the analysis. Both spinal and extremity musculoskeletal pain conditions were represented. Manual therapies included manipulation, mobilisation and massage. The most common intervention compared to manual therapy was exercise. Outcome measures included both clinical and objective measures of stability. Overall the risk of bias was reported as generally low or unclear. Conclusion Improvement in stability measures were reported in studies comparing manual therapy in the short term, but not long-term follow-up. There was no clear association between significant pain reduction and measures of stability. Further prospective studies are recommended to investigate whether manual therapies should be part of an integrative healthcare plan for risk of falls management and when a transition from manual therapy to more active interventions should occur for long term management.

Pascale Gränicher, Thomas Stöggl, Sandro F. Fucentese et al.

Abstract Background The purpose of this study was to assess the effect of preoperative physiotherapy (PT) on functional, subjective and socio-economic parameters after total knee arthroplasty (TKA). Methods 20 patients (mean ± SD: age 67 ± 7 years) scheduled for TKA at Balgrist University Hospital between July 2016 and March 2017 were randomly assigned to a control (CG) or intervention (IG) group. 3 to 4 weeks prior to surgery the IG completed 5 to 9 sessions of PT containing proprioceptive neuromuscular facilitation (PNF) techniques, endurance training and individually indicated interventions. Measurements were executed at baseline, preoperative and 3 months after TKA. The primary outcome measure was the Stair Climbing Test (SCT), secondary outcome measures were the knee range of motion (ROM) and the level of physical activity using Lysholm Score (LS) and Tegner Activity Scale (TAS). The subjective and socio-economic parameters were the Patients’ Global Impression of Change (PGIC) scale, inpatient rehabilitation time, preoperative pain levels and metabolic equivalent (MET), postoperative intake of analgesics and overall costs. Results No difference between IG and CG was found for SCT (F (2/36) = 0.016, p = 0.984, η2 = 0.004). An interaction between group and time was shown for TAS (F (18/1) = 13.890) with an increase in the IG (p = 0.002, η2 = 0.536). The sub-item “pain” within the LS presented a higher pain-level in CG (F (18/1) = 4.490, p = 0.048, η2 = 0.974), while IG showed a higher preoperative MET compared to CG (p = 0.035). There were no other significant changes. The CG produced 21.4% higher overall costs, took more analgesics and showed higher preoperative pain levels than the IG. Conclusions Findings show that preoperative therapy improved the level of physical activity before and after TKA and resulted in a clinically relevant gain in TAS. Trial registration ClinicalTrials.gov Identifier; NCT03160534 . Registered 19 May 2017

Kelsey L. Lewis, Patrick J. Battaglia

Abstract Background Low back pain is a burden worldwide and biological, psychological, and social mechanisms play a role in its development and persistence. Current guidelines support care using the biopsychosocial model. However, biomedical constructs dominate clinician training, and it is unknown the extent to which health science students understand the psychosocial determinates of a patient’s low back pain. Therefore, the aim of this scoping review is to report health science students’ current knowledge of psychosocial factors associated with low back pain. Methods A scoping review framework was used to search electronic databases for research examining health science students’ knowledge of psychosocial factors associated with low back pain. The nature and findings of the studies are highlighted using the data charting tool. Each study was analyzed to determine the type of outcome measurement used. Scores were compared to minimum accepted scores, between disciplines, as education advanced, and after educational modules. Results Fourteen studies published between 2004 and 2019 were identified. Seven healthcare disciplines were represented. In total, 12 different measurement tools were utilized. In 9 studies students demonstrated inadequate knowledge of psychosocial factors associated with low back pain. Three tools compared disciplines and nationalities. Three tools were associated with practice behavior. Eight studies showed improvement as students’ education advanced, and 3 studies demonstrated improvements in knowledge after implementation of pain education modules of varied lengths. Of those, two showed significant improvement. Conclusions Health science students in these studies had substandard understanding of psychosocial factors associated with low back pain. Dedicated pain education has the potential to improve low back pain understanding, resulting in more guideline appropriate care recommendation.