RESUMEN
OBJECTIVE: To compare the effects of personalized, supervised group-based programs (ie, group physical therapy programs) and usual one-on-one physical therapy care (ie, usual physical therapy care) on disability for military personnel suffering from low back pain, rotator cuff-related shoulder pain, patellofemoral pain syndrome, or lateral ankle sprain. Secondary outcomes were pain severity, pain-related fear, health-related quality of life, and patients' satisfaction with their condition and care. DESIGN: Non-inferiority pragmatic randomized clinical trial. METHODS: One hundred twenty military personnel from the Canadian Armed Forces, experiencing 1 of 4 targeted musculoskeletal disorders, were consecutively recruited and randomly assigned to group physical therapy programs or usual physical therapy care. Disability, pain severity, pain-related fear, and health-related quality-of-life outcomes were measured at 6, 12, and 26 weeks after baseline. Satisfaction with treatment was evaluated at the end of the intervention. Intention-to-treat analyses using linear mixed models with random effects were used to compare the effects of interventions. Chi-square tests were used to compare satisfaction. RESULTS: There were no significant Time × Group interactions for any of the primary and secondary outcomes (Time × Group: P>.67). Satisfaction with treatment also did not differ between groups (P>.05). Statistically significant and clinically important improvements were observed in both groups for all outcomes after 12 weeks (Time effect: P<.01), except for health-related quality of life (P = .13). CONCLUSION: Group physical therapy programs were not inferior to usual physical therapy care for managing pain, functional capacity, and patients' satisfaction with care of military personnel presenting with various musculoskeletal disorders. Both interventions led to clinical and statistical improvement in pain and function in the mid and long term. Group physical therapy could be an effective strategy to enhance access to care. J Orthop Sports Phys Ther 2024;54(6):1-10. Epub 26 Mar 2024. doi:10.2519/jospt.2024.12342.
Asunto(s)
Personal Militar , Enfermedades Musculoesqueléticas , Satisfacción del Paciente , Modalidades de Fisioterapia , Calidad de Vida , Humanos , Masculino , Adulto , Femenino , Enfermedades Musculoesqueléticas/rehabilitación , Enfermedades Musculoesqueléticas/terapia , Persona de Mediana Edad , Adulto Joven , Dimensión del DolorRESUMEN
OBJECTIVE: To synthesize the current evidence on the incidence of running-related injuries (RRIs) and their association with training parameters (distance, duration, frequency, intensity), as well as recent changes in training parameters. DATA SOURCES: Searches were conducted in MEDLINE/Ovid, CINAHL, Embase, and SPORTDiscus from their inception through July 7, 2020. STUDY SELECTION: Included articles had to report prospective data on RRIs and training parameters or any changes in parameters and be published in English or French. Two reviewers independently screened the titles, abstracts, and full texts. DATA EXTRACTION: Two independent raters performed data extraction and quality assessment using QualSyst, a quality appraisal tool. DATA SYNTHESIS: A total of 36 articles that involved 23â047 runners were included. Overall, 6043 runners (26.2%) sustained an RRI (incidence range = 8.8%-91.3%). The incidence of RRI was 14.9% in novice runners (range = 9.4%-94.9%), 26.1% in recreational runners (range = 17.9%-79.3%), and 62.6% in competitive runners (range = 52.6%-91.3%). The 3 most frequently injured body parts were the knee (25.8%), foot/ankle (24.4%), and lower leg (24.4%). Overall, evidence about the association between weekly running distance, duration, frequency, intensity, or specific changes in training parameters and the onset of RRIs was conflicting. CONCLUSIONS: Despite high rates of RRIs, current evidence does not consistently link RRIs with specific training parameters or recent changes in training parameters. Therefore, caution should be taken when recommending optimal parameters or progressions. Given the multifactorial nature of RRIs, future studies also need to consider the interactions between training parameters as well as psychosocial, hormonal, lifestyle, and recovery outcomes to better understand the onset of RRIs.
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Traumatismos en Atletas , Carrera , Humanos , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/etiología , Estudios Prospectivos , Carrera/lesiones , Extremidad Inferior/lesiones , IncidenciaRESUMEN
CONTEXT: Two-dimensional (2D) video-based analysis is often used by clinicians to examine the foot strike pattern (FSP) and step rate in runners. Reliability and validity of 2D video-based analysis have been questioned. OBJECTIVE: To synthesize the psychometric properties of 2D video-based analysis for assessing runners' FSP and step rate while running. DATA SOURCES: Medline/PubMed, Science Direct, Embase, EBSCOHost/CINAHL, and Scielo were searched from their inception to August 2018. STUDY SELECTION: Studies were included if (1) they were published in English, French, Portuguese or Spanish; (2) they reported at least 1 psychometric property (validity and/or reliability) of 2D video-based analysis to assess running kinematics; and (3) they assessed FSP or step rate during running. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 2. DATA EXTRACTION: Studies were screened for methodological (MacDermid checklist) and psychometric quality (COSMIN checklist) by 2 independent raters. RESULTS: Eight studies, with a total of 702 participants, were included. Seven studies evaluated the reliability of 2D video to assess FSP and found very good to excellent reliability (0.41 ≤ κ ≤ 1.00). Two studies reported excellent reliability for the calculation of step rate (0.75 ≤ intraclass correlation coefficient [ICC] ≤ 1.00). One study demonstrated excellent concurrent validity between 2D and 3D (gold standard) motion capture systems to determine FSP (Gwet agreement coefficient [AC] > 0.90; ICC > 0.90), and another study found excellent concurrent validity between 2D video and another device to calculate step rate (0.84 ≤ ICC ≤ 0.95). CONCLUSION: Strong evidence suggests that 2D video-based analysis is a reliable method for assessing FSP and quantifying step rate, regardless of the experience of the assessor. Limited evidence exists on the validity of 2D video-based analysis in determining FSP and calculating step rate during running.