搜索结果：The Journal of orthopaedic and sports physical therapy

OBJECTIVE: To (1) examine Malawian physical therapists' knowledge and beliefs about osteoarthritis (OA), and their perceived capabilities to deliver an OA management program to people with knee and hip OA, and (2) identify barriers and facilitators for an OA management program in Malawi. DESIGN: Two-phased mixed-methods formative evaluation. METHODS: In phase 1, Malawian physical therapists participated in the Good Life with osteoArthritis in Denmark (GLA:D) Australia training course and answered quantitative precourse and postcourse questions that were descriptively summarized, and analysed using McNemar's test, where appropriate. In phase 2, semistructured focus groups generated qualitative data that were thematically analyzed and mapped to the Consolidated Framework for Implementation Research. Mixed-methods data were integrated through triangulation. RESULTS: Eleven Malawian physical therapists (9 [82%] female, 10 [91%] with 5-10 years of clinical experience) participated. From pretraining to posttraining course, participants' knowledge of OA management (percentage change) increased regarding the benefits of therapeutic exercise (91%), importance of weight management (82%), and acceptable symptoms profile (73%). Participants' confidence and beliefs in managing knee and hip OA also increased. Implementation barriers included program costs, current medical management of OA with painkillers, and infrastructure challenges. Implementation facilitators included the content and organization of GLA:D, adaptability of the program, and OA awareness and education among other health professionals. CONCLUSION: Knowledge, confidence, and beliefs in managing knee and hip OA improved post-GLA:D training in Malawian physical therapists. Increasing education of physical therapists, other health professionals, and the public about evidence-based OA management and making contextual adaptions to the GLA:D training and program structure may facilitate implementation of OA management program, such as GLA:D, in low- and-middle-income countries. J Orthop Sports Phys Ther 2026;56(3):193-208. Epub 4 February 2026. doi:10.2519/jospt.2026.13317.

OBJECTIVE: To evaluate the cost-utility of a single session compared with multiple sessions of physical therapy care for adults with spinal disorders. DESIGN: Economic evaluation based on a pragmatic randomized controlled trial. METHODS: Patients with spinal disorders who were referred for a spinal surgery consultation and triaged as nonsurgical cases by an advanced practice physical therapist were randomized to either a single session of education and exercise prescription (n = 52) or multiple sessions (6 sessions) of a multimodal physical therapy intervention (n = 54). Patients answered questionnaires on the health care resources used and related costs, as well as the EuroQol 5-dimension 5-level questionnaire at baseline and at 6, 12, and 26 weeks. Total health care costs and quality-adjusted life years (QALYs) were calculated. A cost-utility analysis comparing both groups was conducted using an intention-to-treat approach with multiple imputation to handle missing data. Nonparametric bootstrapping with 1000 resamples was performed. The incremental cost-effectiveness ratio (ICER) was subsequently calculated. Sensitivity analyses were performed. RESULTS: Compared to the single-session group, the multiple-session group incurred a significantly higher total health care costs of CA$368 (95% confidence interval [CI], $327 to $412) and achieved an additional 0.013 QALY (95% CI, 0.009 to 0.018). The ICER for the multiple-session approach was CA$29 787 per QALY gained compared to the single-session approach. Excluding private costs leads to similar results, while the complete-case analysis suggested that the multiple-session approach was not cost-effective. CONCLUSION: A multiple-session approach may be considered cost-effective compared to a single session of physical therapy for adults with spinal disorders in an advanced practice physical therapy model of care. J Orthop Sports Phys Ther 2025;55(11):1-8. Epub 29 September 2025. doi:10.2519/jospt.2025.13468.

OBJECTIVE: To evaluate the effects of shockwave therapy (SWT) for Achilles tendinopathy compared to sham-SWT as a monotherapy or co-intervention or no treatment. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: AMED, CINAHL, Web of Science, MEDLINE, EMBASE, SPORTDiscus, Cochrane CENTRAL, clinical trial registries, and gray literature were searched between February 14 and February 24, 2025. STUDY SELECTION CRITERIA: Criteria included RCTs assessing radial or focused SWT (with or without co-interventions) in adults with Achilles tendinopathy. DATA SYNTHESIS: We conducted a random-effects meta-analysis. We assessed risk of bias using the Cochrane Risk of Bias 2 tool and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. RESULTS: Nine RCTs (n = 557) were included. For insertional Achilles tendinopathy, SWT showed no clinically meaningful benefit over sham (low-moderate certainty), with consistent findings across all outcomes and sensitivity/subgroup analyses. For midportion Achilles tendinopathy, all meta-analyses (very low and moderate certainty) showed no significant differences in disability or pain between SWT and control interventions at all timepoints. There was very low-certainty evidence of a clinically meaningful effect of radial SWT on short- and long-term improvements in disability and pain compared to sham or wait-and-see controls. One trial (midportion Achilles tendinopathy) showed benefit over sham-SWT but did not report success of participant blinding. Subgroup analyses revealed no clear advantage for either radial or focused SWT. Two Achilles tendon ruptures were reported following focused SWT. CONCLUSION: There was no clinically meaningful benefit of SWT in pain and disability for Achilles tendinopathy, with evidence ranging from very low to moderate certainty. Because most effect estimates are based on very low- and low-certainty data, the true effects may change with future high-quality trials. At present, SWT should not be considered a routine treatment for either insertional or midportion Achilles tendinopathy, and alternative treatments should be prioritized. J Orthop Sports Phys Ther 2026;56(5):282-299. Epub 27 March 2026. doi:10.2519/jospt.2026.13985.

OBJECTIVE: To describe the core elements of therapeutic patient education programs for adults with subacute and chronic MSK conditions. DESIGN: Scoping review to identify specific components of therapeutic patient education programs. LITERATURE SEARCH: Five databases were searched from 2005 to 2025. STUDY SELECTION CRITERIA: Randomized clinical trials evaluating any types of therapeutic patient education in adults with MSK conditions, compared to rehabilitation interventions. DATA SYNTHESIS: A descriptive synthesis was conducted based on 3 core elements of therapeutic patient education: the themes (activity modification, behavioral approaches, exercise intensity and pain response, pain biology, pain self-management, pathoanatomical/diagnosis, and posture), their delivery methods (contextual examples, education sessions, group interaction, personalized sessions, self-reflection, video, and written materials), and the intervention parameters (duration/session, number of sessions, number of sessions/week, and duration of follow-up). RESULTS: Seventy therapeutic patient education programs were identified across 62 randomized clinical trials. The most frequently addressed themes were pain biology and pathoanatomical/diagnostic. Education was most frequently delivered through education sessions with verbal explanation, personalized sessions, and written materials. Intervention parameters varied depending on whether the education program was implemented as a stand-alone intervention or combined with other approaches. The general trend observed was 3 to 4 sessions of 40 to 60 minutes over a period of 1 month and an average of 2.5 topics covered. CONCLUSION: Despite variability in program components, our review provides a foundation for clinicians and underscores the need for future research to identify key elements of therapeutic patient education. J Orthop Sports Phys Ther 2026;56(4):248-260. Epub 6 March 2026. doi:10.2519/jospt.2026.13784.

OBJECTIVE: To determine the effect on Shoulder Pain and Disability Index (SPADI) scores of adding dry needling to a program of exercise and manual therapy in individuals with subacromial pain syndrome (SAPS). DESIGN: Three-arm randomized trial involving 121 participants with SAPS. METHODS: Participants were randomized to physical therapy (PT) treatment (PT Only), PT and sham dry needling (PT+SDN), or PT and dry needling (PT+DN) groups. The primary outcome was the SPADI at 1 year. Secondary measures included the Physical Function and Pain Interference subscales from the PROMIS-57, the Patient Acceptable Symptom State (PASS), and self-reported shoulder-related health care use. Linear marginal models and generalized estimating equations were used to identify differences between groups at each follow-up. Logistic regression was used to determine differences in health care use between groups at 1 year. RESULTS: Differences (95% confidence interval) in SPADI scores at 1 year between the PT+DN and PT Only (-7.51 [-16.57, 1.54]) and the PT+DN and PT+SDN (-9.85 [-18.98, 0.73]) groups did not reach statistical significance. Differences in the percentage of "yes" responses to the PASS were significant at 6 months between the PT+DN and PT Only groups (34% [14%-55%]) and the PT+DN and PT+SDN groups (24% [4%-45%]) and at 1 year between the PT+DN and PT+SDN groups (28% [7%-49%]). Participants in the PT+DN group were less likely to receive additional care for their shoulder in the year following enrollment (OR = 0.35 [0.13, 0.95]). CONCLUSION: Adding dry needling to a standard PT program did not result in greater improvements in SPADI scores at 1 year. Improvements in secondary outcomes and patient-perceived symptom acceptability may suggest potential clinical value. J Orthop Sports Phys Ther 2026;56(1):50-63. Epub 19 November 2025. doi:10.2519/jospt.2025.13460.

OBJECTIVE: To evaluate the efficacy of therapeutic patient education delivered by a health care provider, either alone or in combination with other rehabilitation interventions, for reducing pain and disability in adults with subacute and chronic musculoskeletal conditions. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Five databases were searched from 2005 to 2025. STUDY SELECTION CRITERIA: Randomized clinical trials (RCTs) evaluating the efficacy of therapeutic patient education in adults with subacute and chronic musculoskeletal conditions, compared to other interventions such as exercise programs. Outcomes included pain, disability, quality of life, kinesiophobia, and catastrophizing. DATA SYNTHESIS: Treatment effects were estimated using random-effects models with standardized mean differences. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Sixty-nine RCTs were included, and 56 contributed data to meta-analyses (n = 6773 participants; mean age, 43.1 ± 10.3 years; 63% female). Adding therapeutic patient education to other interventions likely reduced pain, disability, and catastrophizing in the short term (moderate-certainty evidence), may reduce pain and disability in the medium term (low-certainty evidence), and likely resulted in a large reduction in kinesiophobia in the short and medium terms (moderate-certainty evidence). The efficacy of therapeutic patient education as a stand-alone intervention was uncertain. CONCLUSION: Evidence supports using therapeutic patient education, in combination with other rehabilitation interventions, to reduce pain, disability, kinesiophobia, and catastrophizing in adults with subacute and chronic musculoskeletal conditions. The magnitude of the effects may vary from small to large. J Orthop Sports Phys Ther 2025;55(10):1-26. Epub 20 August 2025. doi:10.2519/jospt.2025.13247.

OBJECTIVES: To (a) estimate the association between socioeconomic position (SEP) and the use and frequency of physical therapy visits in the year preceding hip arthroscopic surgery for femoroacetabular impingement (FAI) syndrome in Denmark and (b) compare these associations before and after 2019, following international recommendations. STUDY DESIGN: Retrospective cohort study. METHODS: A cohort of 5739 patients with FAI syndrome and hip arthroscopy (2012-2024) was identified from the Danish Hip Arthroscopy Registry. Physical therapy use (yes/no) and visit frequency in the year preceding surgery were identified from national registries. SEP was categorized as low, medium, or high based on a composite score of educational attainment, income, and labor market affiliation. Binomial and negative binomial regressions were used to estimate relative risk ratios (RRs) and incidence rate ratios (IRRs). RESULTS: Overall, 35.1% of patients used physical therapy before hip arthroscopy, with lower use among those in the low-SEP group (29.3%) compared to the high-SEP group (36.0%) (directed acyclic graph [DAG]-adjusted RR = 0.83 [95% CI: 0.70, 0.98]) and no significant difference in visit frequency (DAG-adjusted IRR = 0.79 [95% CI: 0.59, 1.07]). Use declined from 38.9% before 2019 to 30.1% after (DAG-adjusted RR = 0.77 [95% CI: 0.72, 0.83]), with visits decreasing from 3.95 to 2.59 (DAG-adjusted IRR = 0.64 [95% CI: 0.56, 0.74]). CONCLUSION: One third of patients used physical therapy in the year before hip arthroscopy in Denmark, with one fifth having 6 or more visits. Patients in the lowest SEP group were less likely to use physical therapy, while differences in visit frequency were not statistically significant. Use of physical therapy declined from 39% before 2019 to 30% after. J Orthop Sports Phys Ther 2025;55(12):1-9. Epub 30 October 2025. doi:10.2519/jospt.2025.13558.

OBJECTIVE: To explore athletes' experiences of "reinjury concerns" in those with lived experience of anterior cruciate ligament (ACL) injury. DESIGN: Systematic review with qualitative evidence synthesis. LITERATURE SEARCH: CINAHL, SPORTDiscus, Scopus, MEDLINE, PsychINFO, and ProQuest Dissertations were searched until January 2025. STUDY SELECTION CRITERIA: Two reviewers independently and in parallel screened studies for inclusion if they were (1) qualitative or mixed-methods; (2) included participants who were athletes with lived experience of an ACL injury; (3) reported the phenomenon of interest, "reinjury concerns," within the findings; and (4) published in English. DATA SYNTHESIS: We applied thematic synthesis based on Thomas and Harden's approach aligned to a constructivist paradigm and followed relevant checklists for performing and reporting a systematic review and qualitative evidence synthesis. Confidence in the findings was evaluated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual). RESULTS: Forty-five studies were included, comprising 611 participants. Themes described how athletes assessed the threat of reinjury (theme 1), experienced reinjury concerns across a multidimensional spectrum (theme 2), and coped with reinjury concerns (theme 3). Confidence in the findings was mostly rated moderate-high according to the GRADE-CERQual assessment. CONCLUSION: Athletes' experiences of reinjury concerns after ACL injury were multidimensional and shaped by individual beliefs and contexts. Our findings support shifting from the narrow construct fear of reinjury toward a broader conceptualization of reinjury concerns that more accurately reflects athletes' lived experiences and may better inform assessment and clinical approaches after ACL injury. J Orthop Sports Phys Ther 2026;56(3):135-157. Epub 5 February 2026. doi:10.2519/jospt.2026.13852.

OBJECTIVE: To summarize the perceptions and experiences of patients living with whiplash-associated disorders (WADs). DESIGN: Qualitative evidence synthesis. LITERATURE SEARCH: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Embase, Physiotherapy Evidence Database (PEDro), PsycINFO, MEDLINE, Scopus, SPORTDiscus, and Web of Science databases were searched up to June 2024 and updated in October 2024. STUDY SELECTION CRITERIA: Inclusion criteria were (1) qualitative primary studies or mixed methods studies with clear identification of participants and findings from the qualitative methods, (2) published in English or Italian, (3) included participants aged ≥16 years, and (4) focused on participants' experiences with a diagnosis of WAD. DATA SYNTHESIS: Metasummary and metasynthesis processes were conducted following Sandelowski and Barroso's methodology. The confidence of the findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. RESULTS: Eighteen studies were included, comprising a total of 349 participants. Overall, 330 target findings were collected, analyzed, and grouped into 15 categories attributable to 5 main themes: (1) "WAD changed my body," (2) "WAD destabilized my daily life," (3) "WAD has consumed my thoughts," (4) "The recovery journey from WAD," (5) "Life goes on after WAD." The methodological quality of all studies revealed only minor concerns. The GRADE-CERQual assessment indicated moderate confidence in the findings, due to serious concerns regarding their relevance to the patient experience of WAD. CONCLUSION: People with WAD experienced a wide range of interconnected physical, emotional, cognitive, and social challenges. Addressing these multifaceted needs through a biopsychosocial approach can guide more effective management strategies and improve long-term outcomes for patients with WAD. J Orthop Sports Phys Ther 2025;55(9):1-19. Epub 25 July 2025. doi:10.2519/jospt.2025.13156.

OBJECTIVES: To (1) collate current practice, perceptions, and experience of patients and professionals to develop a patient-reported outcome measure (PROM) that assesses the severity of disability in patellar tendinopathy, and (2) evaluate the content validity (relevance, comprehensiveness, and comprehensibility) of the developed PROM. DESIGN: Mixed-methods PROM development and content validation study. METHODS: Using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, we performed 1 round of semistructured, one-on-one interviews with professional (n = 8: health care providers and research experts) and patient participants (n = 7) for initial item generation. To assess content validity, we collected 1 round of survey responses for professional participants (n = 33) and conducted 1 round of semistructured, one-on-one interviews with patient participants. RESULTS: Item generation resulted in 15 items in the subdomains of pain (general), function, and pain (with loading). The 15 items were sent to professional participants, and all items reached the 0.70 item-content validity coefficient cutoff for relevance. One item was substantially lower than others and excluded. The remaining 14 items met the criteria for comprehensibility; all items had a median comprehensibility of ≥6/7 and were comprehensible. Patient participants endorsed PROM content validity. Individual completion times ranged from 4 to 9 minutes. CONCLUSION: We established the content validity of the Tendinopathy Severity Assessment - Patellar (TENDINS-P) as a new PROM to assess the severity of patellar tendinopathy. The TENDINS-P assesses aspects of pain (general), function, and pain (with loading). TENDINS-P can now be used in clinical and research populations. J Orthop Sports Phys Ther 2026;56(5):300-309. Epub 9 April 2026. doi:10.2519/jospt.2026.13984.

OBJECTIVE: To evaluate the effectiveness of interventions using activity trackers and smartphone applications (apps) for increasing physical activity (steps per day) in people aged ≥60 years. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched 6 electronic databases (including EMBASE and MEDLINE) from inception to January 2025. SELECTION CRITERIA: We included randomized controlled trials that used activity trackers or smartphone apps to promote physical activity in people aged ≥60 years. DATA SYNTHESIS: Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Meta-analyses were conducted using random-effects models, and certainty of the evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. RESULTS: We included 29 trials with 3005 participants. In the short term (data point closest to the end of the intervention), activity trackers and apps may increase physical activity by about 1113 steps per day compared to minimal intervention (95% CI: 669, 1557; 20 trials; low-certainty evidence). When compared to other active interventions, activity trackers and apps may increase physical activity by 912 steps per day (95% CI: 412, 1413; 8 trials; very low-certainty evidence). Single trials reported intermediate (6 months) and long-term (12 and 24 months) effects, and suggested no sustained benefits. CONCLUSION: Activity tracker and app-based interventions may cause short-term increases in physical activity among older adults, but effects were not sustained. J Orthop Sports Phys Ther 2026;56(4):235-247. Epub 2 March 2026. doi:10.2519/jospt.2026.13825.

OBJECTIVE: To assess how different diagnostic labels affect treatment preferences and beliefs in people with musculoskeletal pain. DESIGN: Systematic review of randomized trials. LITERATURE SEARCH: PubMed, Web of Science, MEDLINE, CINAHL, SPORTDiscus, PsycINFO, ClinicalTrials.gov, and the Australian New Zealand Clinical Trials Registry (ANZCTR) (from inception to September 17, 2025). STUDY SELECTION CRITERIA: Randomized trials evaluating the impact of diagnostic labels for musculoskeletal pain on treatment preferences and beliefs. Studies using hypothetical vignettes were eligible. DATA SYNTHESIS: The primary outcomes were patient treatment preferences and beliefs. Due to heterogeneity of labels and accompanying explanations, a narrative synthesis approach was conducted. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Five vignette-based randomized trials involving 7575 participants were included. Risk of bias was rated as low to some concerns across all outcomes. Low-certainty evidence suggested that specific diagnostic labels may increase patient preferences for imaging and surgery and may increase the perceived seriousness of the condition. Non-specific labels may lead to more positive recovery beliefs and reduced perceived need for invasive treatments, and to lower patient satisfaction. The information accompanying these labels (eg, explanations, reassurance) may have influenced outcomes. CONCLUSION: Based on low-certainty evidence, specific diagnostic labels may increase demand for invasive care and foster more negative recovery expectations. Non-specific labels may encourage non-invasive management but can contribute to patient dissatisfaction. J Orthop Sports Phys Ther 2026;56(1):4-15. Epub 3 December 2025. doi:10.2519/jospt.2025.13759.

OBJECTIVE: To investigate the effectiveness and cost-effectiveness of an Internet-based self-management program compared with an online booklet for people with chronic musculoskeletal pain. DESIGN: Parallel-group, randomized controlled superiority trial with economic evaluation conducted in Brazil. METHODS: Patients with chronic musculoskeletal pain were randomly allocated to receive an Internet-based self-management program (ReabilitaDOR) or an online booklet. Participants were recruited from university- and community-based physical therapy clinics and through social media. The primary outcome was pain intensity at 8 weeks. The secondary outcomes were function; quality of life; kinesiophobia; global perceived effect; anxiety and depression; pain catastrophizing; pain-related attitudes and beliefs; self-efficacy; and adverse effects at 8 weeks, 6 months, and 12 months after randomization. The economic evaluation from the societal perspective was conducted for pain intensity and quality-adjusted life years (QALYs). RESULTS: We included 162 participants (ReabilitaDOR, n = 83; online booklet, n = 79). There was no statistically significant difference in pain intensity between groups at 8 weeks (mean difference: -0.74; 95% confidence interval: -1.5, 0.04), and no significant differences in the secondary outcomes. From a societal perspective, the intervention had a 0.98 probability of being cost-effective at a willingness-to-pay threshold of $200 per point of improvement in pain intensity and 0.63 at a willingness-to-pay threshold of $50 000 per QALY gained compared to the control group. CONCLUSION: An Internet-based self-management program was not superior to an online booklet for chronic musculoskeletal pain. The Internet-based self-management program seemed to be a cost-effective intervention for pain intensity, but not for QALYs. These findings should be interpreted with caution due to high dropout rates and the trial running during the COVID-19 pandemic. J Orthop Sports Phys Ther 2026;56(1):1-12. Epub 30 October 2025. doi:10.2519/jospt.2025.13418.

SYNOPSIS: The Moving Forward Together series was developed to inform, guide, and inspire musculoskeletal physical therapists to bring Indigenous health to the forefront of their work in clinical practice, research, and education and to strengthen their roles in allyship and advocacy for Indigenous Communities. In this, the second article of the series, we examine the clinical practice of individual physical therapists and physical therapy services. Our group-comprising Indigenous and non-Indigenous clinicians and/or academics from Aotearoa/New Zealand, Australia, Canada, and Samoa-reflected on current initiatives and explored future directions to offer suggestions on how physical therapists can contribute to positive change within Indigenous musculoskeletal clinical practice in order to improve the musculoskeletal health of Indigenous Peoples. Here, we take a practical, skills-based approach in describing ways to provide respectful and equitable musculoskeletal health care for Indigenous Peoples. J Orthop Sports Phys Ther 2026;56(3):128-134. doi:10.2519/jospt.2026.13739.

OBJECTIVE: To evaluate the cost utility of 2 emergency department (ED) care models: management by an emergency physician (EP; usual care), and management by a primary contact physical therapist (PT) and an EP (PT + EP; intervention). DESIGN: Cost-utility analysis based on data collected during a pilot pragmatic randomized clinical trial over a 3-month period (NCT04009369). METHODS: We measured health-related quality of life (HRQoL) and health resource use at baseline, and 1 and 3 months, using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) and a standardized health care resource use questionnaire. Responses to the EQ-5D-5L were transformed into utility scores (Canadian conversion algorithm), and then into quality-adjusted life years (QALYs) using area-under-the-curve analyses. Costs and QALYs were used to derive incremental cost-effectiveness ratios for each perspective. We conducted a complete case analysis (main analysis), and missing data were imputed using multiple imputation (sensitivity analysis). RESULTS: After 3 months, participants managed by the PT + EP had a QALY gain of 0.195 (95% confidence interval [CI]: 0.179, 0.209), compared to 0.182 (95% CI: 0.168, 0.195) for those managed by the EP alone. The average total cost in the PT + EP group for the public payer was $469.23/patient (95% CI: $269.30, $708.85) and $878.37/patient for society (95% CI: $559.72, $1208.23), compared with $804.70/patient (95% CI: $225.58, $1972.78) and $1288.76/patient (95% CI: $551.84, $2452.48), respectively, in the EP group (2019 CAD). PT + EP management was dominant for the public payer and Canadian society perspectives. CONCLUSION: The addition of PTs in EDs may reduce expenses for the public payer and society, while improving HRQoL. J Orthop Sports Phys Ther 2026;56(2):109-118. Epub 27 November 2025. doi:10.2519/jospt.2025.13429.

OBJECTIVE: To evaluate the effectiveness of nonsurgical interventions for work-related shoulder pain. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials. DATA SOURCES: Six databases and 2 clinical trial registries were searched, supplemented by manual searches and citation tracking. Eligible trials compared nonsurgical interventions for work-related shoulder pain. DATA SYNTHESIS: Outcomes of interest were pain intensity, physical functioning, return to work, and productivity loss. Risk of bias was assessed using the Cochrane Risk of Bias tool 2.0; certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. A random-effects meta-analysis and narrative synthesis were performed. RESULTS: Of 8608 records identified, 24 randomized controlled trials met the inclusion criteria. Four trials were included in meta-analysis. No trials were at low risk of bias. The evidence was very uncertain (GRADE) regarding the effect of exercises interventions (eg, strengthening, stretching, and endurance exercises) compared to no intervention on short-term pain intensity (standardized mean difference, -0.60; 95% confidence interval: -1.22, 0.03; 95% prediction interval: -1.83, 0.64; k = 4; n = 172). Reanalyzing using 3 alternative meta-analysis approaches for small-study meta-analyses yielded different results. The narrative synthesis provided no additional insights. CONCLUSION: The evidence was very uncertain about whether exercise interventions (strengthening, stretching, and endurance) provided a moderate short-term (<3 months) benefit for reducing pain compared with no intervention. These results should be interpreted cautiously due to the limited number of trials included in the meta-analysis and the inconsistent terminology for work-related shoulder pain. J Orthop Sports Phys Ther 2025;55(11):1-14. Epub 3 October 2025. doi:10.2519/jospt.2025.13360.

OBJECTIVE: To synthesize the literature and generate evidence and gap maps examining randomized controlled trial (RCT) interventions and outcome measures for patellofemoral pain (PFP). DESIGN: A systematic evidence and gap map. LITERATURE SEARCH: PubMed, CINAHL Complete via EBSCO, PEDro, Scopus, SPORTDiscus (EBSCO), Embase via Ovid, Cochrane Database of Systematic Reviews via Ovid, Web of Science, and CENTRAL. STUDY SELECTION CRITERIA: Peer-reviewed RCTs, pilot RCTs, and pilot feasibility RCTs evaluating interventions for PFP. DATA SYNTHESIS: Interventions were mapped against outcomes. The Cochrane Risk of Bias tool was used to assess risk of bias, and the PFP diagnosis checklist was used to assess the criteria used in each study to confirm a diagnosis of PFP. RESULTS: A total of 307 studies were included. The most frequently included intervention was physical intervention, particularly therapeutic exercises (n = 281, 82%); 59 studies (19%) included nonphysical interventions. Pain outcomes were included in 274 studies (89%), and patient-reported physical function in 216 (70%). Other outcomes, such as activity or movement-related psychological factors, quality of life, and sleep, were infrequently assessed (each <10%). Two hundred seven studies (67%) were at high risk of bias, and 45 studies (15%) met the recommended PFP diagnostic criteria checklist. CONCLUSION: Among 307 RCTs, with approximately three quarters published in the past 10 years, there was an uneven focus on physical interventions and pain and physical function outcomes. J Orthop Sports Phys Ther 2026;56(2):98-108. Epub 5 January 2026. doi:10.2519/jospt.2026.13511.

OBJECTIVE: To systematically review, map, and appraise the existing prospective evidence on risk factors for, and preventive strategies against, the development of patellofemoral pain (PFP), and to identify key gaps. DESIGN: The study design was a systematic evidence and gap map (EGM). LITERATURE SEARCH: Nine electronic databases (PubMed, CINAHL, PEDro, Scopus, SPORTDiscus, Embase, Cochrane, Web of Science, CENTRAL) were searched from inception to the end of March 2024. STUDY SELECTION CRITERIA: Published prospective observational studies and randomized controlled trials (RCTs) investigating the development of PFP in individuals without baseline PFP were included. Studies of other knee conditions, older adults (mean age > 45), or retrospective designs were excluded. DATA SYNTHESIS: Evidence was mapped across the following domains: sociodemographic, neurobiological, anthropometric, psychological, biomechanical, and behavioral. RESULTS: From 57,897 identified records, 36 studies were included: 24 prospective observational studies and 12 RCTs. Most studies focused on biomechanical risk factors (n=22), with limited exploration of psychological (n=1), behavioral (n=2), and neurobiological (n=1) domains. Preventive interventions involved orthoses (n=4), exercise (n=3), bracing (n=2), gait retraining (n=1), stretching (n=1), or running intensity/volume modification. Nonbiomechanical strategies such as education or graded exposure were rarely tested. Risk of bias was low to moderate for most prospective observational studies and moderate to high for most RCTs. CONCLUSION: This EGM reveals an overreliance on biomechanical perspectives within the context of PFP risk factor research, with limited attention to psychosocial, behavioral, and load-related risk factors. Preventive trials are few, often low in quality, and narrowly focused. Addressing these evidence gaps is essential for developing effective, multifactorial prevention strategies for PFP. J Orthop Sports Phys Ther 2026;56(2):85-97. Epub 15 December 2025. doi:10.2519/jospt.2025.13489.

SYNOPSIS: The Moving Forward Together series is a collective effort developed to inform, guide, and inspire musculoskeletal physical therapists to bring Indigenous health to the forefront of their work in clinical practice, research, and education and to strengthen their roles in allyship and advocacy for Indigenous Communities. In the fourth article of the "Moving Forward Together" series, we highlight how physical therapy education can influence, and have responsibility for, improving students' knowledge and skills to care for Indigenous Peoples who are living with musculoskeletal conditions. Through a collaborative process, our group-comprising Indigenous educators from Aotearoa/New Zealand, Australia, and Canada-has reflected on current initiatives, explored future directions, and offered suggestions on how physical therapists can contribute to positive change in Indigenous musculoskeletal education. An interconnected approach positions students to graduate as physical therapists, capable of demonstrating cultural humility to provide reflective, strengths-based, and relational, culturally safe health care to all people with musculoskeletal conditions. J Orthop Sports Phys Ther 2026;56(5):272-276. Epub 3 December 2025. doi:10.2519/jospt.2025.13740.