Journal of Orthopaedic and Sports Physical Therapy

OBJECTIVES: To (1) determine how often home exercise programs (HEPs) are prescribed in supervised exercise trials for low back pain (LBP) and (2) describe characteristics of the HEP programs (design, purpose, dose, and adherence). DESIGN: Scoping review. LITERATURE SEARCH: PubMed, CINAHL, and Ovid MEDLINE were searched from January 1, 2010, to August 17, 2021. STUDY SELECTION CRITERIA: Randomized controlled trials that included adults with LBP who received exercise interventions. DATA SYNTHESIS: The presence or absence of a prescribed HEP and any details of the HEP including design, dose, and adherence were extracted and summarized...

OBJECTIVE: To describe the application and examine the influence of a continuous quality improvement intervention, which had a goal of standardizing care to reduce the proportion of patients who do not have a meaningful improvement in patient-reported outcomes following total knee arthroplasty (TKA). DESIGN: Continuous quality improvement. METHODS: A physical therapy (PT) care guideline was initiated in 2013 for patients following TKA. The Knee Outcome Survey - Activities of Daily Living (KOS-ADL) was measured at every visit, and scores were extracted from a clinical outcomes database to calculate the proportion of patients who did not achieve a minimal clinically important difference...

BACKGROUND: Decision rules (eg, Canadian computed tomography head rule [CCHR] for adults and Pediatric Emergency Care Applied Research Network [PECARN] rule for children/adolescents) are used in emergency settings (emergency room [ER] rules) to assess traumatic brain injuries (TBIs). The rules have a high-sensitivity and near-perfect negative predictive value that help to rule out more severe TBI. CLINICAL QUESTION: Which criteria should be added to the Sport Concussion Assessment Tool 5 (SCAT5) to reach the sensitivity of the ER rules and improve the utility of the SCAT5 for screening for higher-severity head and brain injuries? KEY RESULTS: We performed a comparative analysis of the SCAT5 with the CCHR and PECARN rules...

SYNOPSIS: Central sensitization is an umbrella-term for facilitated synaptic plasticity. This editorial explains wind-up, classical central sensitization, and long-term potentiation. Wind-up and LTP are generally considered homosynaptic, while classical central sensitization is classified as heterosynaptic. Wind-up is very short lived and unlikely to play a significant role in chronic musculoskeletal pain, however, both LTP and classical central sensitization could potentially be involved in chronic pain. J Orthop Sports Phys Ther 2023;53(2):55-58...

Recently, injury prevention experts developed a guideline for rehabilitation clinicians to use to help you avoid getting another knee injury. Here, we explain what the guidelines say about which exercises you should do to stay injury-free, how often to do the exercises, and when to do the exercises. J Orthop Sports Phys Ther 2023;53(2):105. doi:10.2519/jospt.2023.0503 .

SYNOPSIS: This editorial introduces JOSPT Open , a new gold open-access journal in the JOSPT stable. In 2023, JOSPT Open will publish its inaugural issue. The journal aims to cover all aspects of musculoskeletal rehabilitation and associated areas related to musculoskeletal health, including clinical biomechanics, diagnostic imaging, epidemiology, physical activity, sports science, and pain neuroscience. JOSPT Open welcomes diverse approaches to studying interesting and important clinical questions, and innovative approaches to translating knowledge to practice...

Knee and anterior cruciate ligament (ACL) injuries are common and can be severe. Some knee injuries carry long-term implications for the health of active people, including a risk of osteoarthritis and physical inactivity. Preventing injuries from occurring is critical to helping people stay active and healthy through their life. Here we present for clinicians, the most up-to-date information to guide their work to prevent knee and ACL injuries. J Orthop Sports Phys Ther 2023;53(2):103-104. doi:10.2519/jospt...

OBJECTIVE: To analyze the effect of trunkfocused exercise programs (TEPs) and moderator factors on chronic nonspecific low back pain (LBP). DESIGN: Systematic review with meta-analyses. LITERATURE SEARCH: We searched the PubMed, Scopus, Embase, SPORTDiscus, and CENTRAL databases from their inception to June 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials comparing TEPs to control or general exercises. DATA SYNTHESIS: We used random-effects models to calculate the standardized mean difference (SMD) plus confidence interval (CI) and heterogeneity ( I2 ) for pain, disability, quality of life, and trunk performance...

OBJECTIVES: To identify factors associated with nonresponse to neuromuscular training (NMT) warm-up programs among youth exposed to NMT warm-ups. METHODS: This is a secondary analysis of youth (aged 11-18 years) in the intervention groups of 4 randomized controlled trials in high school basketball, youth community soccer, and junior high school physical education. Youth who were exposed to NMT and who sustained an injury during the study were considered nonresponders . Odds ratios (ORs) were based on generalized estimating equations logistic regression controlling for clustering by team/class and adjusted for age, weight, height, balance performance, injury history, sex, and sport (soccer/basketball/physical education)...

SYNOPSIS: Neck pain, headache, and/or orofacial symptoms are potentially the first (nonischemic) symptoms of an underlying vascular pathology or blood flow limitation. If an underlying vascular pathology or blood flow limitation is not recognized by the musculoskeletal rehabilitation clinician, it can subsequently be aggravated by treatment, raising the risk of serious adverse events. We argue that clinicians can make an important, and potentially lifesaving, difference by providing specific information and advice...

OBJECTIVES: To (i) evaluate whether the defining characteristics of previously-reported Achilles tendinopathy subgroups were reproducible in a cohort with midportion Achilles tendinopathy and, (ii) compare recovery trajectories and outcomes. DESIGN: Prospective single cohort study METHODS: Participants (n=114, (Mean±SD) age 47±12, 57F) received the Silbernagel protocol and were evaluated at baseline, 8-, 16-, and 24 weeks. Subgroups were identified using mixture modeling. Main effects of group and time, and interaction effects were evaluated using linear mixed models for 23 outcome measures representing symptoms, lower extremity function, tendon structure, psychological factors, and patient-related factors...

Author response to the JOSPT Letter to the Editor-in-Chief "Leveraging the short-term benefits of manual therapy which includes exercise over exercise therapy alone appears justified for knee osteoarthritis" J Orthop Sports Phys Ther 2023;53(1):50-51. doi:10.2519/jospt.2023.0201-R .

The Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This guideline focuses on the exercise-based prevention of knee injuries and provides an update on the 2018 guideline, J Orthop Sports Phys Ther...

SYNOPSIS: Central sensitization is an umbrella term for facilitated synaptic plasticity. This editorial (1) explains the differences between homosynaptic and heterosynaptic plasticity, (2) explains the role of glia cells in dorsal horn neuroplasticity, and (3) briefly discusses the clinical relevance of central sensitization and nociplastic pain. Part 5 covers wind-up, classical central sensitization, and long-term potentiation. J Orthop Sports Phys Ther 2023;53(1):1-4. doi:10.2519/jospt.2023.11569 .

Letter to the Editor-in-Chief in response to JOSPT article "The Benefits of Adding Manual Therapy to Exercise Therapy for Improving Pain and Function in Patients with Knee or Hip Osteoarthritis: A Systematic Review with Meta-analysis" by Runge et al. J Orthop Sports Phys Ther 2023;53(1):49-50. doi:10.2519/jospt.2023.0201 .

Lateral elbow tendinopathy (LET) is an overuse injury of the common extensor tendon that occurs in active people. Modifiable risk factors include repetitive movements of the elbow, forearm, and hand, and tasks like handling heavy tools, which may overload the tendon. The clinical course of LET varies considerably. Some people experience a single, brief episode of symptoms, whereas others have persistent or recurring episodes of LET. J Orthop Sports Phys Ther 2023;53(1):5-6. doi:10.2519/jospt.2023.0501 .

OBJECTIVE: To investigate the effect of progressive resistance exercise compared with low-intensity home-based exercises on knee-muscle strength and joint function in people with anterior cruciate ligament (ACL) reconstruction and persistent hamstring strength deficits at 12-24 months after surgery. DESIGN: Randomized controlled superiority trial with parallel groups, balanced randomization (1:1), and blinded outcome assessment. METHODS: People with ACL reconstruction (hamstring autograft) and persistent hamstring muscle strength asymmetry were recruited 1 to 2 years postsurgery and randomized to either 12 weeks of supervised progressive strength training (SNG), or 12 weeks of home-based, low-intensity exercises (CON)...

BACKGROUND: Despite the rising burden of musculoskeletal (MSK) problems (MSK conditions, MSK pain and MSK injury and trauma) in most countries, actions to improve (strengthen) systems for supporting MSK health are often low on the priority list. Delivering effective, person-centred and equitable MSK health care requires strengthening systems for health, for example through policy, financing, service delivery and workforce initiatives. A critical but often overlooked component is genuine integration of lived experience perspectives to co-create care and systems that are responsive to people's needs and contexts...

OBJECTIVE: To describe the variation in outcomes and number of visits before and after implementing a care guideline for total knee arthroplasty (TKA) rehabilitation. DESIGN: Non-randomized intervention study METHODS: We compared 2,558 patients with TKA who received care that was not standardized (Non-Care Guideline [NCG] group) to 9,797 patients with TKA who received care according to the care guideline (CG). We fit two Bayesian hierarchical linear regression models using the Knee Outcome Survey - Activities of Daily Living (KOS) change score and number of physical therapy (PT) visits as the response variables, controlling for relevant predictor variables...

SYNOPSIS: Current injury-specific return-to-performance rehabilitation programs are not comprehensive, lack intensity, and need better tailoring to the demands of sport. The vast number of rehabilitation and return to sport protocols also reflects a lack of consensus about what the best program looks like, which hinders beginning practitioners from implementing best practices across the spectrum of injuries and sports. Backward design, which has underpinnings in educational research, can facilitate implementation by encouraging practitioners to begin with the end in mind before logically and intentionally working backwards to design transferable and context-specific rehabilitation plans that improve sports injury rehabilitation practices...