Best practice guidelines recommend access to psychological support within routine musculoskeletal care, but this remains limited. This mixed methods study aimed to explore the feasibility and acceptability of adding an online psychologically informed pain management program to usual care provided by musculoskeletal clinicians. Australian-based musculoskeletal clinicians recruited patients with persistent musculoskeletal pain. Clinicians screened, recruited and invited patients to complete an online, psychologically informed pain management program provided by an Australian digital psychology clinic. Feasibility was determined via calculating patient recruitment rate, retention in the study and adherence to the online psychologically informed pain management program. Perspectives of clinicians and patients were explored through semi-structured interviews, which were audio-recorded, and transcribed verbatim. Qualitative analyses used a reflexive thematic approach with themes then mapped to the Theoretical Domains Framework. N = 168 patients were screened, n = 60 patients recruited n = 40 completed an application and n = 29 enrolled in a psychologically informed pain management program. Thematic analysis from clinicians and patients identified a range of skills, attitudes and beliefs regarding the addition of psychological care and identified individual, systemic and practice-level barriers and enablers to engagement. Lending support to initial feasibility and acceptability, musculoskeletal clinicians could screen and recruit patients into the study. Subsequently, 66% of these patients applied, 48% enrolled and 36% completed an online psychologically informed pain management program. Qualitative results suggest the need for targeted clinician education, streamlined referral processes, and supportive practice environments to enhance digital psychology adoption.
Migrant live-in caregivers play an important role in home-based long-term care, yet their working and living conditions remain largely underregulated. Despite increasing evidence of precarious employment and health risks among live-in caregivers internationally, little is known about their occupational health risks and access to occupational health care. This qualitative interview study is part of the project Live-In Health and reports findings from 16 semi-structured interviews with Polish live-in caregivers (15 females and one male) working in German private households. Interviews were conducted in Polish, transcribed, translated into German, and analyzed using qualitative content analysis following an inductive-deductive approach. Identified work-related strains and risks were structured in four main domains according to established occupational risk assessment frameworks from the German care sector. Participants reported extensive occupational health risks across the four main domains: physical strain (e.g., musculoskeletal strain from patient transfers), psychological strain (e.g., social isolation, conflicts with agencies, emotional burden), occupational safety and health including working hours (e.g., long working hours, insufficient recovery time, lack of preparation and insurance coverage), and exposure to biological and hazardous substances (e.g., wound care, unhygienic living conditions). Access to occupational and general health care in Germany was largely absent. Preventive services, occupational medical examinations, and accident insurance coverage were inconsistently available or missing altogether. Live-ins described substantial barriers related to legal ambiguity, agency practices, lack of information, and unclear responsibilities. At the same time, informal support from families, ambulatory care services, and peer networks emerged as partial coping resources. Polish live-in caregivers in Germany are exposed to considerable occupational health risks while remaining largely excluded from occupational health care structures. The findings highlight substantial gaps in the implementation of existing occupational safety and health regulations for caregivers in private households. Strengthening occupational health protection for live-in caregivers requires enforceable working time regulations, reliable insurance coverage, accessible occupational health services, and clearer oversight of intermediary agencies. Tailored, low-threshold occupational health approaches are urgently needed to address the structural vulnerabilities of this workforce and to ensure healthy and sustainable care provision for the growing demand in home-based care for older people in Germany.
Point-of-care ultrasound (POCUS)-guided hydrodissection is the intentional injection of fluid under real-time ultrasound guidance to separate a peripheral nerve or another defined tissue plane from adjacent structures. The role of hydrodissection in emergency care remains uncertain. We conducted a structured narrative review. PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE) was searched from database inception through July 23, 2026, using a reproducible query covering ultrasound-guided hydrodissection of peripheral nerves and muscular, fascial, tendon-sheath, and peritendinous targets. Citation tracking supplemented the database search. Two authors performed the primary screening, and three additional authors evaluated the included records; disagreements were resolved by discussion with final adjudication by the lead author. Of 138 PubMed records and seven records identified through citation tracking, 32 publications were retained for narrative synthesis. Acute-care reports were appraised with design-appropriate Joanna Briggs Institute (JBI) tools. Eight acute-care hydrodissection reports involving 23 patients were identified: four perineural reports, three non-perineural muscular or fascial reports, and one mixed nerve-adjacent/fascial report. One additional emergency department (ED) sciatic nerve-block series was retained only as related procedural context because intentional tissue-plane separation was not documented. The acute-care evidence comprised four case reports, three case series, and one retrospective observational cohort. Reports described short-term pain or functional improvement, but the evidence was limited by uncontrolled designs, heterogeneous targets and injectates, brief or incomplete follow-up, confounding co-interventions, selective reporting, and incomplete adverse-event ascertainment. JBI appraisal identified generally adequate descriptions of patients and procedures but recurrent uncertainty regarding consecutive or complete inclusion, standardized case identification, and adverse-event assessment. Small uncontrolled reports suggest that POCUS-guided hydrodissection is technically feasible in selected acute-care presentations and may be followed by short-term symptom improvement. They do not establish efficacy, comparative benefit, durability, or safety. Perineural, non-perineural, and related non-hydrodissection procedures should be interpreted separately. At present, POCUS-guided hydrodissection should be considered an investigational procedural approach rather than routine emergency care.
Ayurveda represents one of the oldest structured healthcare systems and continues to gain attention within contemporary integrative medicine because of its emphasis on prevention, individualized care, lifestyle regulation, and health maintenance. Despite growing global use, its wider clinical acceptance remains limited by inconsistent evidence quality, heterogeneous formulations, variable treatment protocols, insufficient safety reporting, and challenges in aligning traditional diagnostic concepts with modern biomedical standards. This review critically examines the therapeutic relevance of Ayurveda in modern healthcare, with attention to its applications in metabolic, cardiovascular, gastrointestinal, hepatobiliary, musculoskeletal, inflammatory, mental health, respiratory, immune-related, reproductive, geriatric, and preventive care. A comprehensive narrative approach was used to synthesize evidence from clinical studies, pharmacological investigations, traditional frameworks, and integrative healthcare literature. The review indicates that specific Ayurvedic interventions, including herbal formulations, Panchakarma, Rasayana, yoga, dietary regulation, and lifestyle medicine, may offer supportive value in selected conditions through measurable outcomes such as cardiometabolic risk markers, gastrointestinal symptom scores, pain and functional indices, stress and sleep measures, respiratory symptom control, reproductive-metabolic parameters, and quality-of-life outcomes. Many claims remain insufficiently validated due to methodological weaknesses, limited standardization, and inadequate pharmacovigilance. Emerging Ayurgenomics may help bridge traditional Prakriti-based constitutional assessment with genomic profiles, molecular biomarkers, metabolic phenotypes, inflammatory signatures, and individualized risk stratification. Artificial intelligence and machine learning may further support modernization by digitizing Ayurvedic clinical records, standardizing diagnostic criteria, improving pharmacovigilance, and predicting response to polyherbal therapy. Ayurveda may contribute meaningfully to modern healthcare when applied as complementary and preventive care within regulated, evidence-based, and interdisciplinary systems. Future advancement depends on rigorous trials, validated biomarkers, quality-controlled formulations, transparent safety monitoring, and reproducible digital-clinical datasets.
Older adults are frequent users of outpatient services, increasing their vulnerability to high healthcare expenditures. This study aimed to investigate the outpatient cost burden among older adults while considering socioeconomic and geographic variations from a rural urban standpoint. The study included 34,801 Indian older adults (45 years and older) who sought outpatient care within a year before the Longitudinal Ageing Study in India, 2017-2018 survey. Rural-urban distributions by background characteristics and healthcare responsiveness were analyzed using a bivariate Chi-square test. Generalized linear models were used to examine the various factors associated with out-of-pocket expenditure. The habitat of urban areas reported a higher proportion of females and private healthcare usage as compared to rural areas. Cardiovascular and endocrine diseases are prevalent in urban regions, while musculoskeletal and respiratory diseases are prevalent in rural regions, but the most expensive is cancer. Wealthier individuals, females, and private healthcare users reported higher healthcare expenditures. Certain geographical barriers, such as longer distances to facilities, significantly increase the healthcare costs. The study highlights the high reliance on private outpatient care by older Indians and identifies education, wealth status, insurance, and geographical access as critical determinants of healthcare expenditure. In this context, strengthening public healthcare infrastructure, integrating telemedicine, and integrating outpatient care in insurance are essential to mitigate these costs. Further research is necessary to examine how women and the rural population perceive healthcare expenditures, as well as their experiences and coping mechanisms.
Background/Objectives: Degenerative musculoskeletal diseases represent a major cause of chronic pain and disability worldwide and are increasingly associated with dysregulated oxidative stress and impaired redox signaling. Conventional therapeutic strategies are often limited to symptomatic management, prompting interest in adjunctive approaches that target underlying biological mechanisms. Among these, medical ozone therapy has been proposed as a redox-modulating intervention in various musculoskeletal conditions. Methods: A narrative clinical-mechanistic review of the literature was conducted using PubMed/MEDLINE, Scopus, and Google Scholar to identify experimental and clinical studies examining oxidative stress, redox signaling, and the application of medical ozone therapy in degenerative musculoskeletal disorders. Preclinical models published between 2000 and 2025 and randomized controlled trials published between 2020 and 2025 were critically evaluated and synthesized qualitatively, with attention to biological plausibility, clinical outcomes, and methodological limitations. A PRISMA-style flow diagram was used to document study selection. Results: Evidence from experimental studies supports a role for controlled oxidative stimuli in activating adaptive cellular defense pathways, including redox-sensitive signaling mechanisms involved in inflammation and tissue homeostasis. Clinical studies across conditions such as intervertebral disc disease, knee osteoarthritis, and other degenerative or overuse-related disorders report short- to mid-term improvements in pain and function following ozone therapy. However, substantial heterogeneity in study design, treatment protocols, and outcome measures limits comparability. Critically, many trials report statistically significant differences that do not consistently exceed the minimal clinically important difference (MCID) for pain and disability indices, and no trial has validated the proposed Nrf2-mediated mechanism in human tissue at clinically administered doses. Conclusions: Current evidence suggests that ozone therapy may exert biologically plausible effects through hormetic redox modulation and may provide symptomatic benefit in selected patients with degenerative musculoskeletal diseases. Nonetheless, the lack of standardized protocols, high-quality long-term data, and mechanistic biomarker validation warrants cautious interpretation. Ozone therapy should be regarded as an investigational adjunct rather than a disease-modifying or standalone standard of care. Further rigorous clinical trials integrating mechanistic biomarkers, sham-controlled designs, and standardized methodologies are needed to clarify the therapeutic role and safety profile of ozone therapy in musculoskeletal medicine.
Congenital musculoskeletal and limb anomalies disproportionately affect people living in low-income countries. However, comprehensive data on their distribution is scarce in Ethiopia. This study aimed to assess fatal and non-fatal health outcomes among Ethiopian infants from 1990 to 2023 using the Global Burden of Diseases 2023 estimates. The study utilized data and methodologies of the Global Burden of Diseases 2023 estimates. To estimate non-fatal health outcomes, a Bayesian meta-regression tool for disease modeling was employed, whereas a cause of death ensemble model was applied to quantify the fatal health outcomes. All estimates were smoothed and presented with 95% uncertainty intervals. All rates were computed per 100,000 population. The overall change in the rates between 1990 and 2023 was determined by comparing values at the baseline and end of the study period. In 2023, the study estimated 2078 incident cases (95% UI: 460, 2988) and 1549 prevalent cases (95% UI: 1072, 2231) of congenital anomalies per 100,000 infants, with 5 deaths (95% UI: 2, 11). The corresponding rates of health losses were 628 disability-adjusted life years per 100,000 infants (95% UI: 336, 1224), 394 years of life lost per 100,000 infants (95% UI: 154, 950), and 234 years lived with disability per 100,000 infants (95% UI: 134, 402). Fatal outcomes were more prevalent among females, while non-fatal outcomes showed no sex disparities. Except for a reduction in the incidence rate by 19% (95% UI: -26, -11), the rates remained stable nationally between 1990 and 2023. The Addis Ababa, Dire Dawa, Harari, and Tigray regions experienced a decline in both the prevalence and incidence rates, while Amhara, Oromia, Benishangul-Gumuz, and Gambella declined the incidence rate. Moreover, there was a decline in the rate of years lived with disability in Addis Ababa. The findings highlight a significant burden of congenital anomalies among Ethiopian infants, particularly affecting females. To address this, strategies should focus on improving maternal and child healthcare access, raising community awareness, implementing preconception care, establishing birth defect registries, enhancing screening methods, providing rehabilitation services, and designing gender-sensitive interventions. Birth defects affecting muscles, bones, and limbs are more common in lower-income countries; yet, detailed information on their impact in Ethiopia has been limited. This study used data from the Global Burden of Disease 2023 report to track how these conditions affected Ethiopian infants from 1990 to 2023. Using advanced statistical models, we found that in 2023, there were approximately 2,078 new cases and 1,549 total cases of congenital musculoskeletal and limb anomalies for every 100,000 infants. While the death rate was relatively low (5 per 100,000), the overall “health loss”—a measure combining early death and years lived with disability—was 628 for every 100,000 infants. This included about 394 years of life lost and 234 years lived with disability per 100,000 infants. Interestingly, deaths were more frequent among baby girls, though long-term disability affected both sexes equally. These health conditions have remained largely the same nationally for over thirty years, with variable subnational progress in the non-fatal outcomes. The findings highlight that these birth defects remain a persistent challenge in Ethiopia. To improve outcomes, the country needs better access to maternal and infant healthcare, early screening programs, and community-based support. Raising public awareness and creating registries to track birth defects are also vital steps. Finally, because these conditions can affect boys and girls differently, healthcare strategies must be designed to be gender-sensitive and inclusive of all children’s needs.
Chronic low back pain (CLBP) is clinically heterogeneous and generates substantial symptom burden, functional limitation, psychological distress, work disability, and health-care utilization. Existing phenotyping approaches often describe subgroups but do not specify how subgroup assignment changes routing, conservative-care dose, imaging, interventional escalation, surgical evaluation, or outcome monitoring. The objective of this narrative review was to define operational phenotyping as a practical method for developing routable, auditable spine-care pathways and to distinguish this methodology from descriptive subgrouping, Subgroups for Targeted Treatment Back Screening Tool (STarT Back)-style risk stratification, and machine-learning phenotyping. We conducted a narrative review using structured methods. PubMed/MEDLINE was the primary database, supplemented by Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus/Web of Science when available, guideline and trial-registry review, and reference-list screening. Searches covered January 2000 through January 2026. Studies were synthesized using an Inputs-Decision-Pathway-Outcome (IDPO) framework. The Berlin deep-phenotyping program was used as a contextual exemplar of multidomain measurement, not as evidence of treatment efficacy. The synthesis yielded five operational findings. First, phenotype labels are implementation-ready only when linked to explicit pathway decisions. Second, minimal universal inputs should be separated from targeted add-ons. Third, escalation gates require illustrative thresholds and safety overrides rather than open-ended care drift. Fourth, diagnostic procedures, including diagnostic medial branch blocks, may themselves define a pain generator phenotype and should not be treated only as downstream treatment. Fifth, surgical referral should be framed as entry into shared decision-making evaluation rather than an automatic indication for surgery. Operational phenotyping is best understood as a methodology for developing a field guide rather than a completed field guide for all settings. It translates deep phenotyping and stratified-care concepts into locally deliverable pathways by requiring the same four elements for each phenotype: feasible inputs, explicit decision logic, an actionable pathway, and measurable outcomes.
This systematic review and meta-analysis aimed to assess the effect of behavioural interventions that include goal setting on pain, disability, and physical activity in people with chronic musculoskeletal pain. Five electronic databases (PubMed, CENTRAL (Cochrane Library), PEDro, PsycINFO, CINAHL) and three clinical trial registers (ClinicalTrials.gov, ANZCTR, ISRCTN) were searched from inception to August 2025 for randomised controlled trials of behavioural interventions with goal setting compared to matched comparators without goal setting, usual care, or wait-list. Screening, data extraction, risk of bias (RoB2), and certainty of evidence assessments (GRADE) were conducted in duplicate. We performed random-effects meta-analyses to estimate effects on pain, disability, and physical activity. Thirty-six trials involving 7,275 participants (mean age 57.29.2 y; 61.6% female) were included. Compared to matched comparators at post-intervention, behavioural interventions that include goal setting may reduce pain (SMD -0.32, 95%CI: -0.58 to -0.06, very low certainty) and disability (SMD -0.52, 95% CI: -0.90 to -0.15; low certainty) and increase physical activity (SMD 0.88, 95% CI: -0.32 to 2.07), but the effect is imprecise and very uncertain. Usual care and wait-list comparisons found varied effects on outcomes post-intervention, based on moderate to very low certainty evidence. Behavioural interventions that include goal setting may produce small improvements in pain and disability in adults with chronic musculoskeletal pain, but effects on physical activity are unclear. If clinicians choose to include goal setting within a behavioural intervention, they should consider how it could be best implemented to guide behaviour change and support evidenced-based management.
Background/Objective: The Patient-Specific Functional Scale (PSFS) is a patient-centered outcome measure that captures limitations in activities that are personally meaningful to patients. Although the Arabic PSFS has demonstrated acceptable validity and reliability, its responsiveness in individuals with lower extremity musculoskeletal disorders has not been established. This study aimed to examine the responsiveness of the Arabic PSFS in detecting changes in lower extremity function over time. Methods: A prospective cohort study was conducted in three outpatient physical therapy clinics in Riyadh, Saudi Arabia. Seventy-two adults with lower extremity musculoskeletal disorders receiving physical therapy care completed the Arabic PSFS, RAND-36, and Numeric Pain Rating Scale (NPRS) at baseline and follow-up. At the follow-up, participants also completed the Global Rating of Change (GRC). Responsiveness was evaluated using eight a priori hypotheses following COSMIN recommendations. Change scores were analyzed using correlation coefficients, paired t-tests, effect size (ES), and standardized response mean (SRM). Results: Sixty participants (83.3%) reported improvement in the GRC. PSFS scores improved significantly (mean difference = 1.66; p < 0.001), demonstrating a large magnitude of improvement (ES = 0.80; SRM = 0.92). PSFS change scores correlated moderately with RAND-36 physical functioning (r = 0.51) and GRC (r = 0.55) and weakly with emotional well-being (r = 0.26) and showed smaller-than-expected associations with pain measures. Six out of eight (75%) predefined hypotheses were confirmed. Conclusions: The Arabic PSFS demonstrates sufficient responsiveness in detecting improvement in lower extremity function and is suitable for monitoring rehabilitation outcomes in Arabic-speaking adults with lower extremity musculoskeletal disorders receiving outpatient physical therapy.
A self-management app, Urika, was developed to remotely monitor and support patients when initiating urate-lowering therapy (ULT). The objective was to test the overall feasibility of a future randomized controlled trial of a digital treat-to-target gout-care approach using Urika in secondary care. Feasibility was tested among patients with gout in specialized healthcare over 3 months. The predefined set of feasibility criteria included aspects of technical, operational, and trial feasibility, as well as the feasibility of collecting clinical outcomes. Overall feasibility would be deemed acceptable if ≥ 70% of the predefined criteria were achieved. Patient participants entered their measured serum urate, ULT medication, start dose, and flare medication into the app. The app provided instructions about dose escalations. Patient characteristics and patient-reported outcome measures were collected by digital questionnaires, and app experiences were collected in semi-structured telephone interviews. The study included 21 males aged 29-71 years. In total, 27/31 (87%) of the predefined feasibility criteria were achieved, 85% of patients rated their satisfaction with the app ≥ 8 on a 0-10 numeric rating scale, and 90% reported being satisfied/very satisfied with the gout treatment. Ten patients were interviewed, giving mainly positive feedback on the Urika app. No safety issues were identified in this small sample. The overall feasibility of the Urika app and the study logistics were satisfactory. The study results have been used to improve the app functions and decide study logistics in an ongoing randomized controlled trial of a digital treat-to-target gout-care approach.Trial Registration Number: ClinicalTrials.gov: NCT06211322, registered 18 January 2024.
Background: Work-related musculoskeletal disorders (WMSDs) have been reported to be very common among hospital workers and particularly nurses. They are assumed or found to be a result of physical workload or poor posture at work and only secondarily a consequence of (general) stress. Due to the increasing workload, more and more digestive endoscopy nurses have WMSDs, but there is still a lack of comprehensive research on the specific factors and patterns of WMSDs in China. Methods: A cross-sectional study was conducted among 400 digestive endoscopy nurses from 35 cities across 10 provinces in China. Data were collected using the Nordic Musculoskeletal Questionnaire (NMQ) and analyzed using multivariable logistic regression and latent class analysis (LCA) to identify associated factors and WMSD occurrence patterns. Results: The overall 12-month prevalence of WMSDs was high (82.5%), particularly in the neck, shoulder, and lower back. Frequent participation in complex endoscopic procedures (adjusted OR range 1.6-1.7) and 6-10 years of work experience (adjusted OR range 1.7-2.5)-rather than daily procedure volume alone-were independently associated with an increased likelihood of WMSDs (p < 0.05). BMI, analyzed using three categories (<24, 24-27.9, ≥28 kg/m2), was not significantly associated with WMSDs in any body region. The LCA revealed three distinct WMSD patterns characterized by multisite pain: a Full-body Pain group (19.0%), a Neck-Shoulder-Lower Back-Upper Back Pain group (42.25%), and a Mild Pain group (38.75%). Conclusions: This study found that digestive endoscopy nurses were at high risk for WMSDs, mainly due to repetitive physical strain and ergonomic challenges. As this was a cross-sectional study, the reported associations should not be interpreted as causal. Ergonomic training, improved workstation design, and workload optimization are important measures to ensure nurses' health and improve the quality of care.
The symbiotic relationship between industrial advancement and healthcare delivery has fundamentally shaped modern medicine. This comprehensive review article explores the historical and technological trajectory from the First Industrial Revolution (Industry 1.0) to the rapidly emerging Sixth Industrial Revolution (Industry 6.0), meticulously mapping distinct industrial milestones to their concurrent evolutions in clinical practice. An exhaustive electronic search was conducted across multiple premier academic and clinical databases, including PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library using specific technological enablers, clinical application domains and reported barriers to implementation. While Industry 1.0 through 3.0 focused on mechanization, mass production, and rudimentary automation, resulting in the institutionalization and digitization of medicine, the advent of Industry 4.0 introduced cyber-physical systems and the Medical Internet of Things/Internet of Medical Things. Subsequently, Industry 5.0 emerged to address the depersonalization of hyper-automation by reintegrating human-centricity, ethical governance, and mass personalization. This review posits that the global ecosystem is now transitioning into Industry 6.0, an era characterized by antifragile manufacturing, quantum computing, deep digital twins, and autonomous cognitive systems. By examining specific applications across diagnosis, treatment, screening, monitoring, prevention, and rehabilitation--with a particular focus on hightechnology fields such as orthopaedics--this paper illustrates a paradigm shift from reactive, standardized interventions to proactive, hyper-personalized, and autonomous healthcare delivery models.
Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized the treatment of hematologic malignancies but is associated with significant neuromusculoskeletal toxicities, including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), fatigue, myopathy, arthralgia, and avascular necrosis. These complications profoundly impact functional status, mobility, and quality of life (QoL), yet structured rehabilitation remains inconsistently integrated into CAR-T care pathways. To develop the first comprehensive, consensus-based recommendations outlining the role of rehabilitation team across the CAR-T treatment continuum, from pre-treatment assessment through long-term survivorship. A systematic literature search of PubMed, Embase, Science Direct, Taylor & Francis, and CINAHL Ultimate was conducted for publications from 2015 to 2025. International expert consensus was obtained through collaboration with the Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) Group and the Rehabilitation Association for Hematopoietic Cell Transplant, specialist from a diverse clinical background including physical therapy, nurse practitioner and transplant consultants. Post CAR-T treatment patients can suffer from various neuromusculoskeletal manifestations including ICANS (20-60%), CRS-related musculoskeletal symptoms (up to 90%), persistent fatigue (up to 90%), cytokine-induced myopathy, peripheral neuropathies, arthralgias, and avascular necrosis. Pre-existing sarcopenia is associated with higher toxicity rates and reduced survival. A tiered rehabilitation model is proposed comprising: (1) comprehensive pre-CAR-T baseline assessment including functional, neurological, and QoL measures; (2) dynamic inpatient rehabilitation adapting to daily fluctuations in CRS/ICANS severity and cytopenias; and (3) structured outpatient follow-up for at least 12-18 months. Three service delivery levels (minimum essential, intermediate, and advanced/model care) are outlined, with recommendations for embedding rehabilitation services within multidisciplinary CAR-T teams and developing Advanced Clinical Practitioner (ACP) roles. Neuromusculoskeletal rehabilitation is an essential, yet underutilized, component of CAR-T therapy care. Systematic integration of rehabilitation across the treatment continuum, supported by specialized practitioner roles, has the potential to reduce morbidity, improve functional outcomes and QoL, and optimize healthcare resource utilization. Prospective trials validating these recommendations remain a priority.
This narrative review synthesizes current evidence on extracorporeal shock wave therapy for pain management in musculoskeletal rehabilitation, emphasizing its analgesic mechanisms, clinical applications, and safety. As a noninvasive physical therapy, extracorporeal shock wave therapy is increasingly used for pain relief in conditions such as chronic low back pain, plantar fasciopathy, knee osteoarthritis, rotator cuff injury, and myofascial pain syndrome. Its analgesic effects arise through multiple pathways, including peripheral neuroregulation characterized by degeneration and subsequent regeneration of sensory nerve fibers, reduction of pro-inflammatory mediators, improved local blood flow, and, according to emerging functional magnetic resonance imaging data, modulation of central pain networks. Evidence from randomized controlled trials and meta-analyses supports the efficacy of extracorporeal shock wave therapy in reducing pain intensity and improving function across these disorders. The safety profile of extracorporeal shock wave therapy is favorable, with most adverse events being mild and transient local reactions. Nonetheless, standardized treatment parameters are lacking, and data on vulnerable populations remain sparse. This review aims to serve as a scientific reference for extracorporeal shock wave therapy in musculoskeletal pain management and to identify priorities for future research.
Professional bus drivers are exposed to occupational hazards leading to chronic disease, including musculoskeletal disorders and joint pain. Here, we investigated factors associated with joint pain among Swiss bus drivers. We used data from the Transport Personnel Health Cohort (TRAPHEAC-N=549), a Swiss bus driver cohort, and the Swiss Health Study (SHeS-N=1,364), a population-based study. Joint pain was assessed using the Nordic questionnaire. Exposures included vibrations, ergonomics, work organization, stress, BMI, smoking, and physical activity. Associations were analyzed using logistic regression and random forest models. Joint pain was prevalent in TRAPHEAC, especially in the neck (67%), lower-back (59%), shoulders (54%), and upper-back (45%). Comparatively, back pain prevalence in SHeS was 11% (odds-ratios comparing TRAPHEAC with SHeS: 1.89). Logistic regression showed associations between seat and floor vibrations with neck, upper-back, and elbows (odds-ratios 1.1-1.5), while stress was associated with joint pain across all regions. BMI and ergonomics were associated with selected pain locations. Random forest models, using permutation importance, identified stress (shoulder, upper-back, lower-back, and knee pain) with seat vibrations and ergonomics (neck and ankle pain), as the most influential predictors of joint pain. Despite modern infrastructure, joint pain remains prevalent among Swiss bus drivers, supporting prevention targeting biomechanical and psychosocial factors.
The peptide supplement market has experienced rapid growth due to marketing claims of enhanced performance and accelerated recovery from musculoskeletal injury. These peptides are increasingly popular with patients and athletes and are often perceived as low risk, despite the absence of efficacy or safety data for many emerging peptides. To summarize existing peer-reviewed data on 6 emerging peptides (BPC-157, thymosin beta-4 or TB-500, CJC-1295, MK-677, ipamorelin, and GHK-Cu [copper peptide]) for musculoskeletal recovery and enhancement in animal and human models. Scoping review. Three independent reviewers searched the PubMed database using permutations of peptide search terms (BPC-157, TB-500, CJC-1295, MK-677 [ibutamoren], ipamorelin, and GHK-Cu) combined with musculoskeletal tissue search terms (bone, fracture, muscle, tendon, ligament, meniscus, and cartilage) following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Papers were independently screened by 2 reviewers, with a third serving as a tiebreaker. Papers examining these peptides for musculoskeletal treatment, tissue recovery, or performance in animal or human models were included. Overall, 67% of identified publications utilized preclinical animal models. In animal models, most commonly rats, each compound demonstrated unique mechanisms with promising but variable effects on tendon, muscle, bone, and ligament healing. Human clinical studies were limited to a handful of investigations, most lacking robust controls or rigorous study designs. Human data were heterogeneous and revealed modest improvements at best for metabolic bone health and degenerative knee pain. Some peptides such as MK-677 were associated with significant risks including congestive heart failure, and significant heterogeneity existed in dosing and route of administration. Despite promising findings in animal studies, the claimed benefits of emerging peptide supplements for musculoskeletal recovery and performance remain unsubstantiated by current human trials. Documented risks include cardiovascular complications and metabolic dysfunction such as insulin resistance. Because of the lack of robust efficacy and safety data, peptide supplements should not currently be recommended as a replacement or adjunct for existing orthopaedic standard of care.
Vitamin D is essential for musculoskeletal health, and deficiency is frequently linked to pain and weakness. While low vitamin D levels worsen acute Coronavirus disease 2019 (COVID-19) outcomes, their role in post-COVID symptom recovery remains unclear. The American Diabetes Association recommends diabetes screening from age 35, with earlier screening for overweight adults with risk factors. This case study aims to report an occult case of vitamin D deficiency among post-COVID-19 prediabetes patients through the lens of a case study using the three-stage family medicine approach following the CAse REport (CARE) checklist. A 50-year-old woman presented with right forearm pain for two weeks and intermittent numbness in the same arm for two months after recovering from COVID-19. Through clinical, individual, and contextual assessments, neurological and structural causes were excluded, revealing severe vitamin D deficiency (10 ng/mL) and incidental prediabetes (HbA1c 5.9%). Her symptoms were influenced by sedentary post-pandemic behaviour, emotional stress, and limited local healthcare access. Management included non-steroidal anti-inflammatory drugs for symptom relief, high-dose vitamin D supplementation (60,000 IU weekly for 8-12 weeks), lifestyle modification, and psychosocial support, demonstrating the value of holistic care in primary practice. This case illustrates how the three-stage family medicine approach aids in identifying metabolic and nutritional contributors to nonspecific musculoskeletal complaints, addressing patient concerns, and guiding shared management, especially in resource-limited settings. Despite being a single case, it highlights the importance of holistic, patient-centred care and early detection of modifiable risks such as vitamin D deficiency and prediabetes in post-COVID-19 patients.
Total knee and hip arthroplasty (TKA/THA) effectively alleviate chronic pain and improve joint function and quality of life. However, postoperative recovery is often hindered by pain, edema, restricted range of motion (ROM), and muscle weakness, necessitating structured physical rehabilitation. Photobiomodulation Therapy (PBMT) has been proposed as an adjunct modality to enhance rehabilitation outcomes. This systematic review evaluates the efficacy of PBMT in reducing postoperative pain and edema as well as improving ROM and functional performance compared with placebo or standard physical therapy in post-arthroplasty patients. A systematic search of PubMed, ProQuest, ScienceDirect, and Google Scholar was conducted from inception to May 31, 2025. Only prospective controlled trials assessing PBMT effects on postoperative pain, swelling, ROM, or functional performance following TKA or THA were included. Case reports, uncontrolled studies, and trials focusing on unrelated outcomes were excluded. Article selection involved title, abstract, and full-text screening, with additional studies identified through reference lists. The review is registered in PROSPERO (CRD420251123169). Four randomized controlled trials (RCTs; n = 133 participants) met the inclusion criteria, three studies focused on TKA, and one study examined THA. PBMT significantly improved postoperative pain and edema reduction in three trials, while two studies demonstrated enhanced ROM and functional outcomes compared with control or placebo interventions. PEDro scores ranged from 8 to 10, indicating moderate-to-high methodological quality. PBMT shows promising short-term benefits in reducing postoperative pain and swelling and improving functional performance after knee or hip arthroplasty. However, due to heterogeneity in treatment parameters and limited high-quality trials, conclusive evidence remains insufficient. Future large-scale RCTs with standardized PBMT parameters and extended follow-up are warranted to confirm its clinical efficacy.
The primary aim of this scoping review was to synthesise published research priorities for back pain, neck pain and osteoarthritis. The secondary aim was to compare these research priorities to the priority areas identified in the Global Strategy to Improve Musculoskeletal Health. Scoping review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Literature searches were performed in MEDLINE, EMBASE and the James Lind Alliance Priority Setting Partnership database from inception to March 2025. Peer-reviewed studies reporting the development of a prioritised ranking of research topics related to back pain, neck pain or osteoarthritis were included. Included research priority sets were described. All research priorities for back pain, neck pain and osteoarthritis were presented. Research priorities were categorised according to priority areas identified in the Global Strategy to Improve Musculoskeletal Health. 15 studies from 3721 citations and three from the James Lind Alliance were included. Eight priority sets related to back and/or neck pain identified 155 research priorities. 15 priority sets related to osteoarthritis identified 206 research priorities. Most priority sets (69.6%) included patients in the development process, but only 17.4% included policymakers. Just three priority sets included participants from outside Europe, North America or Australia.Most priorities were in the clinical and basic science research priority area (73.1%) followed by the health policy and systems research priority area (14.1%), health economics research priority area (4.7%), public health research priority area (4.4%), epidemiological and population health research priority area (1.9%) and the other priority area (1.7%). The majority of published back pain, neck pain and osteoarthritis research priorities fall within clinical and basic science and were developed in high income countries. Given the known high population burden of musculoskeletal conditions, a broader approach to research beyond clinical and basic science is likely required to achieve population-level health benefits. Future initiatives should include all relevant members of the global musculoskeletal health community, including from low- and middle-income countries, to help ensure the development of broad-based research priorities that address all research domains required to improve back and neck pain and osteoarthritis health globally.