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Purpose: To explore what patients with rheumatic and musculoskeletal diseases (RMDs) need and receive of follow-up care after specialized rehabilitation, and whether received follow-up is associated with health outcomes after 1 year. Further, to compare these findings with patients' experiences to improve the understanding of how follow-up takes place., Methods: In a mixed methods study, patients received a rehabilitation programme designed to improve the continuity in rehabilitation across care levels. A total of 168 patients completed questionnaires, of which 21 were also interviewed., Results: At discharge, most patients reported needs for follow-up. These needs were largely met within 1 year, mainly resulting from patients' initiatives to re-connect with previous contacts. The degree of received follow-up was not associated with goal attainment, quality of life, or physical function. Factors related to providers (competence, communication skills), context (delays, limited access to care), and patients (motivation, life situation, preferences) seemed to be decisive for the progress of the rehabilitation process over time., Conclusions: The results provide evidence that access to follow-up care is crucial to patients with RMDs. However, it also highlights several factors that may influence its impact. These results can be used to optimise design and implementation of future follow-up interventions.

Background: Race/ethnicity and gender concordance between patients and providers is a potential strategy to improve health care interventions. In digital health, where human interactions occur both synchronously and asynchronously, the effect of concordance between patients and providers is unknown., Objective: This study aimed to evaluate the impact of race/ethnicity or gender concordance between patients and physical therapists (PTs) in engagement and the clinical outcomes following a digital care program (DCP) in patients with musculoskeletal (MSK) conditions., Methods: This secondary analysis of 2 prospective longitudinal studies (originally focused on assessing the acceptance, engagement, and clinical outcomes after a remote DCP) examined the impact of both race/ethnicity concordance and gender concordance between patients and PTs on outcomes for a digital intervention for MSK conditions. Outcomes included engagement (measured by the completion rate and communication, assessed by text interactions), satisfaction, and clinical outcomes (response rate, ie, percentage of patients achieving at least a minimal clinically important change in pain, measured by the Numerical Pain Rating Scale [NPRS]; anxiety, measured by the Generalized Anxiety Disorder 7-item scale [GAD-7]; depression, measured by the Patient Health Questionnaire 9-item [PHQ-9]; and daily activity impairment, measured by the Work Productivity and Activity Impairment [WPAI] questionnaire)., Results: Of 71,201 patients, 63.9% (n=45,507) were matched with their PT in terms of race/ethnicity, while 61.2% (n=43,560) were matched for gender. Concordant dyads showed a higher completion rate among White (adjusted odds ratio [aOR] 1.11, 95% CI 1.05-1.19, P<.001) and Hispanic (aOR 1.27, 95% CI 1.08-1.54, P=.009) groups, as well as women (aOR 1.10, 95% CI 1.06-1.18, P<.001), when compared to discordant dyads. High and similar levels of interaction between patients and PTs were observed across race/ethnicity and gender dyads, except for Asian concordant dyads (adjusted β coefficient 5.32, 95% CI 3.28-7.36, P<.001). Concordance did not affect satisfaction, with high values (>8.52, 95% CI 8.27-8.77) reported across all dyads. Response rates for pain, anxiety, and daily activity impairment were unaffected by race/ethnicity concordance. An exception was observed for depression, with White patients reporting a higher response rate when matched with PTs from other races/ethnicities (aOR 1.20, 95% CI 1.02-1.39, P=.02). In terms of gender, men had a slightly higher pain response rate in discordant dyads (aOR 1.08, 95% CI 1.01-1.15, P=.03) and a higher depression response rate in concordant dyads (aOR 1.23, 95% CI 1.05-1.47, P=.01)., Conclusions: Race/ethnicity and gender concordance between patients and PTs does not translate into higher satisfaction or improvement for most clinical outcomes, aside from a positive effect on treatment completion. These results highlight the importance of other PT characteristics, in addition to race/ethnicity or gender concordance, suggesting the potential benefit of experience, languages spoken, and cultural safety training as ways to optimize care., Trial Registration: ClinicalTrials.gov NCT04092946, NCT05417685; https://clinicaltrials.gov/study/NCT05417685, https://clinicaltrials.gov/study/NCT04092946., (©Anabela C Areias, Dora Janela, Maria Molinos, Virgílio Bento, Carolina Moreira, Vijay Yanamadala, Steven P Cohen, Fernando Dias Correia, Fabíola Costa. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.10.2024.)

Background: Musculoskeletal disorders are commonly treated in primary healthcare and may, if not treated adequately, entail a risk for long-term disability and sickness absence. A team-based rehabilitation intervention (PREVention of Sickness Absence for Musculoskeletal disorders, PREVSAM) was evaluated in a randomised controlled trial. The purpose of this study was to evaluate the process of implementing the PREVSAM model in primary care rehabilitation., Methods: This process evaluation was conducted alongside the trial, collecting quantitative and qualitative data to evaluate how the PREVSAM model was implemented, mechanisms of impact, and contextual factors. Acceptability, feasibility, appropriateness, adaptations, training and support, resources, recruitment, reach, retention, dose, fidelity, and readiness for change were investigated. Qualitative data were collected from healthcare professionals and patients., Results: Eight of 22 invited rehabilitation clinics (36%) and 28 of 54 healthcare professionals (52%) were included in the PREVSAM trial and this process evaluation. Of 507 eligible patients, 261 (51%) were included. Of those, 134 were randomised to the intervention and 129 (96%) were retained. Twelve healthcare professionals and 15 patients participated in the qualitative evaluations. The model's essential components; individual assessments and structured, team-based rehabilitation with clear division of responsibilities agreed in a joint health plan; were generally delivered according to protocol. The optional components early access to psychological treatment and workplace contact were delivered to a lesser extent. Perceived acceptability, feasibility, and appropriateness of the PREVSAM model were moderate to high. Several contextual barriers, in the form of missing prerequisites, affected the implementation. Qualitative data showed that the model, with its holistic view, was appreciated by both healthcare professionals and patients., Conclusions: This process evaluation suggests that PREVSAM is acceptable, feasible and appropriate for patients with MSDs reporting psychological risk factors associated with increased risk for sickness absence. While essential components were implemented with fidelity for most patients, optional components were not. This variability reflects the complexity of the model, its mandatory and optional components, contextual barriers, and the person-centred approach meeting individual patient needs. As all model components were not delivered to all patients, the intervention may have been too similar to treatment as usual to detect differences on a group level. A limitation of the study is that half of the participating rehabilitation clinics withdrew prematurely., (© 2024. The Author(s).)

Background: The incidence of musculoskeletal diseases is increasing in clinical practice, leading to a growing demand for rehabilitation medicine. However, education in musculoskeletal education is lacking in the training of physical medicine and rehabilitation students. This study aims to evaluate the impact of musculoskeletal education on medical students' learning of rehabilitation medicine and analyze the correlation between influencing factors and education., Objectives: The primary objective of this study is to evaluate the impact of musculoskeletal education on medical students' learning of rehabilitation medicine. Furthermore, the authors aim to analyze the correlation between various influencing factors and the effectiveness of this education, with the goal of informing future educational interventions and enhancing student outcomes., Methods: A comprehensive search was conducted across the Pubmed, Ovid, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for relevant articles published from January 2012 to September 2024. The search focused on medical students as the research subjects and musculoskeletal education as the intervention method. Both randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) were included. The selected studies underwent a systematic review, and meta-analysis was performed using R 3.4.4 software., Results: After a thorough search, 41 studies were included. The retrospective study indicated that the most common impacts were knowledge acquisition, self-confidence, and satisfaction. The subsequent meta-analysis revealed significant increases in students' knowledge acquisition [standardized mean differences (SMD) = 2.15, 95% confidence interval [CI] (1.36, 2.94), I 2  = 97%, random effect model] and self-confidence [SMD = 5.81, 95% CI (2.88, 8.75), I 2  = 97%, random effect model]. Compared with the general teaching control group, the knowledge acquisition of students in the observation group improved [SMD = 0.25, 95% CI (0.00, 0.51), I 2  = 83%, in the random effect model]; However, no significant difference in satisfaction occurred [SMD = 0.27, 95% CI (-0.47, 1.01), P > 0.05, I 2  = 89%, in the random effects model]., Conclusion: Musculoskeletal education primarily impacts knowledge acquisition self-confidence, and satisfaction among physical medicine and rehabilitation students. The meta-analysis further establishes that musculoskeletal education significantly enhances knowledge acquisition and confidence in these students., Trial Registration: CRD42024563899 (completed on July 17, 2024)., (© 2024. The Author(s).)

Purpose: Research indicates that the implementation of work-related medical rehabilitation (WMR) is characterized by pronounced heterogeneity and that the requirements defined by the German Pension Insurance are not consistently met. The study aimed to investigate the implementation of the WMR guideline in patients with musculoskeletal disorders with regard to the identification of a need for WMR as well as the assessment of the individual demands of work., Methods: 317 rehabilitation facilities authorized for WMR in patients with musculoskeletal disorders were invited to participate in a nationwide survey. 86 of 317 facilities responded to the self-developed questionnaire and met the inclusion criteria., Results: Although most facilities reported that nearly all patients receive WMR if they have a need for it, the proportion of WMR measures provided was below ten percent in the majority of cases. With regard to work demands, respondents demanded greater involvement of employers in order to strengthen validity., Conclusion: The findings indicate that WMR is largely implemented in accordance with the WMR guideline. The main challenges include meeting the need for WMR and strengthening the involvement of employers in the assessment of work requirements., Competing Interests: Die Autoren sind für das Institut für Qualitätssicherung in Prävention und Rehabilitation GmbH an der Deutschen Sporthochschule Köln tätig., (Thieme. All rights reserved.)

Rationale: Advanced practice physiotherapy roles (Advanced Physiotherapy Practitioners [APPs] and First Contact Physiotherapists [FCPs]) are pivotal in supporting patients to manage their musculoskeletal (MSK) conditions. Having a greater understanding of how decisions are made by these practitioners will inform competency frameworks and improve the provision of patient-centred care., Aim: To evaluate the current knowledge, views and use of shared decision-making in MSK advanced physiotherapy practice in the United Kingdom., Methods: A cross-sectional survey using an online questionnaire was used to collect demographic information, knowledge, views and self-reported use of shared decision-making (SDM) of APPs and FCPs who work with adults with MSK disorders in the United Kingdom., Results: Responses from 49 participants (25 APPs and 24 FCPs) were included in the study. In total, 80% of participants had received SDM training and overall high levels of knowledge were shown. Only 12% of participants used a communication model to facilitate SDM. In total, 80% of participants reported making decisions together with the patient either always or most of the time. FCPs favoured a more patient-led approach to decision-making compared to APPs who favoured collaborative decision-making. The most commonly reported barriers to SDM included lack of time, lack of patient education resources, lack of access to patient decision aids and treatment pathway restrictions., Conclusions: The responses in this study showed that overall APPs and FCPs have good knowledge of SDM and report routine use of collaborative and patient-led decision-making approaches., (© 2024 The Author(s). Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Chronic musculoskeletal conditions cause pain and disability and have significant impact on morbidity worldwide. Tele-rehabilitation is proposed as an alternative or complement to improve patient's muscle function, pain, and quality of life. However, the satisfaction of both patients and professionals must be assessed, together with the patient's daily life activity independence. A search of the literature was made to locate assessment reports, systematic reviews and reports from regulatory bodies with support from a documentarian from the Andalusian Health Technologies Assessment Area (AETSA). For this purpose, the following sources were used: Medline, EMBASE, INAHTA (international network of health technologies assessment) and PEDro (Physiotherapy Evidence Database) from 2014 onwards. Subsequently a secondary search was carried out on the articles selected in the initial search. A search of open clinical trials was also carried out in the database: www.ClinicalTrials.gov Initially 345 articles were identified. Duplicated articles (57) were excluded. By first analysing the title and abstract 238 articles were excluded. The full texts of the remaining 30 articles were analysed. Finally 18 articles were included., (Copyright © 2024 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: First contact physiotherapy practitioners (FCPPs) are embedded within general practice, providing expert assessment, diagnosis, and management plans for patients with musculoskeletal disorders (MSKDs), without the prior need for GP consultation., Aim: To determine the clinical effectiveness and costs of FCPP models compared with GP-led models of care., Design and Setting: Multiple site case-study design of general practices in the UK., Method: General practice sites were recruited representing the following three models: 1) GP-led care; 2) FCPPs who could not prescribe or inject (FCPPs-standard [St]); and 3) FCPPs who could prescribe and/or inject (FCPPs-additional qualifications [AQ]). Patient participants from each site completed outcome data at baseline, 3 months, and 6 months. The primary outcome was the SF-36 Physical Component Summary (PCS) score. Healthcare usage was collected for 6 months., Results: In total, 426 adults were recruited from 46 practices across the UK. Non-inferiority analysis showed no significant difference in physical function (SF-36 PCS) across all three arms at 6 months ( P = 0.667). At 3 months, a significant difference in numbers improving was seen between arms: 54.7% ( n = 47) GP consultees, 72.4% ( n = 71) FCPP-St, and 66.4% ( n = 101) FCPP-AQ ( P = 0.037). No safety issues were identified. Following initial consultation, a greater proportion of patients received medication (including opioids) in the GP-led arm (44.7%, n = 42), compared with FCPP-St (18.4%, n = 21) and FCPP-AQ (24.7%, n = 40) ( P <0.001). NHS costs (initial consultation and over 6-month follow-up) were significantly higher in the GP-led model (median £105.5 per patient) versus FCPP-St (£41.0 per patient) and FCPP-AQ (£44.0 per patient) ( P <0.001)., Conclusion: FCPP-led models of care provide safe, clinically effective patient management, with cost-benefits and reduced opioid use in this cohort., (© The Authors.)

Importance: Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy-oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors., Objective: To design, implement, and assess the potential of the Comprehensive Operating Room Ergonomics (CORE) program for surgeons, a holistic evidence-based ergonomics and wellness intervention grounded in occupational therapy principles., Design: Mixed-methods pilot study with the quantitative strand embedded in the qualitative strand., Setting: University-affiliated hospital., Participants: Six laparoscopic surgeons., Outcomes and Measures: CORE program outcomes were assessed using qualitative and quantitative data to indicate changes in posture, physical discomfort, sense of wellness, and operating room (OR) ergonomic performance. The Rapid Upper Limb Assessment (RULA) was used to quantify surgeons' WMSD risk level before and after intervention., Results: There were 12 baseline observations (two for each participant), and two or three post-CORE implementation observations. A statistically significant difference, F(1, 6) = 8.57, p = .03, was found between pre- and post-occupational therapy intervention RULA scores. Thematic analysis of surgeon feedback, which was overwhelmingly positive, identified five themes: postural alignment, areas of commonly reported physical pain or discomfort, setup of the OR environment, surgical ergonomics training, and ergonomics in everyday life., Conclusions and Relevance: The CORE program effectively decreased ergonomic risk factors to optimize surgeons' occupational performance in the OR. This study demonstrates a potential solution to how occupational therapists can holistically support surgeons and health care providers who are at risk for WMSDs. Plain-Language Summary: By 2025, a surgeon shortage is expected, partly because of the increase in surgeons' work-related musculoskeletal disorders, which affect their health and job continuity. This pilot study shows that the Comprehensive Operating Room Ergonomics program effectively addresses these problems. The study also serves as a framework for occupational therapy professionals to work with health care providers on ergonomics, benefiting population health. Results suggest that this approach could enhance surgeons' work conditions, supporting the American Occupational Therapy Association's Vision 2025 to improve health and quality of life., (Copyright © 2024 by the American Occupational Therapy Association, Inc.)

Purpose: To explore the intensity and variation of workers' worries, pain, psychosocial factors, and margin of manoeuvre before and after a return-to-work program, and identified the psychosocial factors associated with non-return to work at the end of the rehabilitation program., Methods: A pre-post study design was used. A convenience sample of 80 workers starting a return-to-work program and having a compensated musculoskeletal injury that caused an absence of more than three months from their regular work was recruited. Data were collected at baseline and at the end of the rehabilitation program on the nature of the worries and maintenance factors defined in Dugas' generalized anxiety and worry model, using validated questionnaires. The margin of manoeuvre was assessed by the treating occupational therapist. A series of descriptive analyses were performed, as well as Generalized Estimating Equations analyses., Results: Workers' worries were work-related or disability-related 83% of the time at baseline. These worries were essentially based on the situation then occurring at work 90% of the time. For the Generalized Estimating Equations analyses on work status, the final model was significant, explaining 54% of the variance in non-return to work (Pseudo R 2 = 0.54; p = 0.0001). Workers were 8.52 times less likely to return to work when the margin of manoeuvre was insufficient, and twice as likely not to return to work in the presence of intense worry. Worries were significantly associated with insufficient margin of manoeuvre., Conclusion: A strong association between workers' lack of margin of manoeuvre at work and their worries about their return to work, and poor work outcomes, supports the importance of the worker-environment interaction in rehabilitation programs., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: Exercise, support and advice are the key treatment strategies of musculoskeletal problems. The aims of this study were to determine patients', physiotherapists', and other stakeholders' perspectives about supported home physiotherapy for the management of musculoskeletal problems and to identify the barriers and facilitators to rolling out this model of physiotherapy service delivery., Methods: This study was conducted as part of a process evaluation run alongside a large trial designed to determine whether supported home physiotherapy is as good or better than a course of in-person physiotherapy. Forty interviews were conducted with 20 trial participants, 15 physiotherapists, and 5 other stakeholders. The interviews were semi-structured and based on interview guides. Each interview was transcribed and a three-tiered coding tree was developed., Results: Six key themes were identified. Supported home physiotherapy (i) is convenient for some patients, (ii) does not always align with patients' and therapists' expectations about treatment (iii) is suitable for some but not all, (iv) can reduce personal connection and accountability, (v) has implications for physiotherapists' workloads, and (vi) has barriers and facilitators to future implementation., Conclusions: Findings suggest that patients are far more accepting of supported home physiotherapy than physiotherapists assume. This model of service delivery could be rolled out to improve access to physiotherapy and to provide a convenient and effective way of delivering physiotherapy to some patients with musculoskeletal conditions if our trial results indicate that supported home physiotherapy is as good or better than in-person physiotherapy., Clinical Trial Registry Number: ACTRN12619000065190 CONTRIBUTIONS OF THIS PAPER., Competing Interests: Conflict of Interest None declared., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Musculoskeletal (MSK) conditions affect over 20.3 million people in the UK, presenting a substantial economic impact on health and social services. Physiotherapy can alleviate MSK conditions, especially if delivered in the acute or sub-acute period. However, patients often present after significant waiting times., Objectives: Our analysis examined how waiting times and the number of treatments influenced physiotherapy outcomes for MSK conditions., Design: Retrospective analysis of the Data for Impact, Physio First dataset., Methods: Logistic regression models assessed the effects of symptom duration, treatment frequency, and other variables on pain, Patient-Specific Functional Scores (PSFSs), and Goal Achievement (GA)., Results: Analysis of 15,624 patient records showed that patients treated within two weeks of symptom onset were more likely to have favourable outcomes in pain (odds ratio [OR] = 2.01, 95% Confidence Interval [95% CI] = 1.65-2.45), PSFS (OR = 1.80, 95% CI = 1.55-2.08), and GA (OR = 1.74, 95% CI = 1.51-2.01) compared to those treated after longer durations. Receiving four or more treatment sessions significantly improved outcomes compared with only one session (pain: OR = 4.64, PSFS: OR = 5.72, GA: OR = 1.94, all p's < 0.001), with no additional benefits beyond four sessions. Younger age was associated with better outcomes (approximately OR = 0.99 per year age difference). Other findings included better outcomes in males and in those with fewer previous episodes of the condition., Conclusions: Shorter waiting times, a greater number of treatments, and younger patient age are associated with better physiotherapy outcomes for MSK conditions., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Investigating how individual characteristics modify treatment effects can improve understanding, interpretation, and translation of trial findings. The purpose of this secondary analysis was to identify treatment effect modifiers of the MI-NAV trial, a 3 arm, parallel randomized controlled trial which compared motivational interviewing and stratified vocational advice intervention in addition to usual case management (UC), to UC alone. This study included (n = 514) participants with musculoskeletal disorders on sick leave for at least 50% of their contracted work hours for at least 7 consecutive weeks with the Norwegian Labour and Welfare Administration. Sickness absence days was the primary outcome, measured from baseline assessment date until the 6-month follow-up. Potential treatment effect modifiers, identified a priori and informed by expert consultation and literature, were evaluated using linear regression models and statistical interaction tests. For motivational interviewing versus UC, age (mean difference [MD] -.7, 95% confidence interval [CI] -1.5 to .2; P = .13) and self-perceived health status (MD -.3, 95% CI -.7 to .1; P = .19) were identified as potential effect modifiers (P ≤ .2). For stratified vocational advice intervention versus UC, analgesic medication use (MD -26.2, 95% CI -45.7 to -6.7; P = .009) was identified as a treatment effect modifier (P ≤ .05). These findings may assist in more targeted treatment adaptation and translation as well as the planning of future clinical trials. PERSPECTIVE: This secondary analysis of the MI-NAV trial found that analgesic medication use, age, and self-perceived health may modify the effect of 2 vocational interventions on reducing sickness absence in people with musculoskeletal disorders., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: Firefighters perform dangerous and physically demanding work, increasing their risk of musculoskeletal injuries that can lead to work absences. Return-to-work procedures can help firefighters return-to-work sooner and safely. The purpose of this study was to explore what firefighters understand about return-to-work procedures in their workplaces, and what firefighters believe the facilitators and barriers to return-to-work are., Methods: Thirty-eight Canadian career firefighters were recruited for semi-structured interviews. Qualitative descriptive methods were used to analyze the transcripts. Two researchers performed the inductive coding and thematic analysis., Results: Five themes were identified: 1. Variation in the return-to-work process knowledge among firefighters based on their experiences; 2. Accessible medical resources and treatments to support injury recovery; 3. Light duties must be meaningful and suitable; 4. Pressures to return-to-work too soon may lead to negative consequences; and 5. Heavy physical demands of firefighting may become a barrier for return-to-work. 'Factors affecting RTW depended on personal experiences and context' was the overarching theme identified, as many reported facilitators for return-to-work were also reported as barriers in different contexts. There was a variation in the experiences and understanding of return-to-work., Conclusion: There is a lack of knowledge of the return-to-work processes. Firefighters require access to clear return-to-work policies and procedures and treatments that are targeted to firefighting duties to support recovery from injuries and regain physical abilities after an injury. Firefighters must be able to perform all essential duties before returning to firefighting work, as returning to work too soon can lead to further injury., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: A comprehensive review of the literature on the time between the onset of symptoms and the first episode of care and its effects on important worker outcomes in compensated musculoskeletal conditions is currently lacking. This scoping review aimed to summarize the factors associated with time to service and describe outcomes in workers with workers' compensation accepted claims for musculoskeletal conditions., Methods: We used the JBI guidelines for scoping reviews and reported following the PRISMA-ScR protocol. We included peer-reviewed articles published in English that measured the timing of health service initiation. We conducted searches in six databases, including Medline (Ovid), Embase (Ovid), PsycINFO, Cinahl Plus (EBSCOhost), Scopus, and the Web of Science. Peer-reviewed articles published up to November 01, 2022 were included. The evidence was summarized using a narrative synthesis., Results: Out of the 3502 studies identified, 31 were included. Eight studies reported the factors associated with time to service. Male workers, availability of return to work programmes, physically demanding occupations, and greater injury severity were associated with a shorter time to service, whereas female workers, a high number of employees in the workplace, and having legal representation were associated with a longer time to service. The relationship between time service and worker outcomes was observed in 25 studies, with early access to physical therapy and biopsychosocial interventions indicating favourable outcomes. Conversely, early opioids, and MRI in the absence of severe underlying conditions were associated with a longer duration of disability, higher claim costs, and increased healthcare utilization., Conclusion: Existing evidence suggests that the time to service for individuals with compensated musculoskeletal conditions was found to be associated with several characteristics. The relationship between time to service and worker outcomes was consistently indicated in the majority of the studies. This review highlights the need to consider patient-centred treatments and develop strategies to decrease early services with negative effects and increase access to early services with better outcomes., (© 2024. The Author(s).)

Background: The majority of patients with musculoskeletal pain (62% to 64%) achieve their treatment goals upon completing rehabilitation. However, a high re-consultation rate after discharge is frequently reported. Numerous authors have recognized the necessity of secondary prevention programs (after-discharge strategy) to ensure that the gains are maintained or further pursued after the completion of a rehabilitation program. Little is known about the different strategies currently in use, and a detailed review of the existing strategies is needed for future integration into the healthcare systems., Objective: This review systematically scopes and synthesizes the after-discharge strategies reported in the literature following rehabilitation for individuals experiencing musculoskeletal pain., Methods: Four databases (OVID MEDLINE, EMBASE, Web of Sciences, and OVID PsycInfo) were screened from their inception until May 4, 2023. Literature search, screening, and extraction were performed according to the PRISMA extension for scoping review guidelines., Results: Different after-discharge strategies were identified and grouped into 2 main categories: (1) in-person and (2) remote strategies. In-person strategies included (1.1) in-person booster sessions and (1.2) the use of existing community programs after discharge. Remote strategies included remote strategies that (2.1) involve a health care professional service or (2.2) strategies that do not involve any health care professional service., Discussion: We identified various after-discharge strategies designed to sustain gains and improve patients' self-management skills following the completion of a rehabilitation program. The existence of numerous promising strategies suggests their potential suitability for various contexts., Competing Interests: H.M.A. and J.S.R. are supported by research scholars from Fonds de recherche du Québec – Santé (281961, 281654). F.D. received a grant from the Cirris Research Centre and is supported by a scholarship from the Canadian Institute of Health Research. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Social return on investment (SROI) may present a method for demonstrating the social value of healthcare interventions. It has not previously been measured in musculoskeletal (MSK) physiotherapy but is being used in the procurement and performance management of healthcare services. The aim of the study was to measure SROI in one provider of MSK physiotherapy in the United Kingdom's National Health Service (NHS)., Methods: A retrospective single arm online survey-based service evaluation was carried out to calculate the SROI of an NHS adult MSK physiotherapy service using the Housing Association's Charitable Trust Social Value Calculator., Results: 237 respondents (35.6%) completed the survey and a mean SROI of £4.13 for every £1 invested was demonstrated. There were sub-group variations based on symptom location and discharge location., Discussion: This is the first time SROI has been calculated in an MSK physiotherapy setting. This service evaluation raises new questions about the variations observed in subgroups and the applicability of this methodology in individuals with MSK conditions who receive physiotherapy., Conclusion: MSK physiotherapy is an intervention which offers a positive SROI across a range of MSK conditions and contributes towards improved wellbeing. This is the first study to use the HACT Social Value Calculator when evaluating a physiotherapy service and further research is required to validate the results., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Introduction: Worldwide, the unmet rehabilitation needs of adults with musculoskeletal disorders are high. Aquatic exercise is clinically effective in managing musculoskeletal disorders, but access to rehabilitative services is limited., Objective: To determine the feasibility of a community-based aquatic exercise and peer support intervention for patients with musculoskeletal disorders delivered via a multisector partnership between an NHS physiotherapy service, a leisure operator and a social enterprise that creates personalised exercise programmes delivered through an application on a tablet computer. Cost-sharing was implemented after an initial complimentary session., Methods: A mixed method service evaluation was undertaken. Patient demographics, attendance, and patient-reported outcomes were summarised using descriptive statistics. Semi-structured interviews and an online survey were employed to explore patient acceptability of the intervention., Results: Thirty four patients accessed the intervention during the 6-month pilot. Over half were from minority ethnic groups and nearly two thirds were in the bottom three deciles relating to low income. Patients exercised in a group of up to eight, supported by NHS rehabilitation professionals and volunteers. Provision of post-session refreshments encouraged connectivity between patients. Weekly attendance at the programme was high. Patient-reported outcome measures showed favourable changes in pain intensity and function following the intervention. Qualitative data suggest that the intervention was acceptable to patients., Conclusion: Implementation of a community-based aquatic exercise and peer support intervention for people with musculoskeletal disorders via a cross-sector partnership involving the NHS appears feasible and acceptable to patients. Further research is needed to assess the impact on musculoskeletal health and health inequalities., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Background: The COVID-19 pandemic had a substantial impact on healthcare systems globally, particularly in the public sector. To address the challenges posed by the pandemic, musculoskeletal (MSK) healthcare providers had to rapidly adopt virtual platforms for delivering care, representing a major shift in how healthcare was delivered., Objective: This manuscript aims to retrospectively evaluate a virtual MSK podiatry service offered by a private provider under a National Health Service commission, in terms of patient access, waiting times and patient-reported pain. This service was developed and implemented in response to the COVID-19 pandemic and the extended waiting times., Methods: A retrospective clinical service evaluation was conducted on MSK podiatry services delivered via telephone or virtual consultations. The evaluation covered a cohort of 574 referred patients over a 19-month period (July 2021 to January 2023). It analysed demographic data, initial and final visual analogue pain scores, pathology categories, orthoses prescriptions and exercise rehabilitation plans., Results: Data from a total of 492 patients (male = 152 and female = 340) were analysed, with 82 patients excluded for non-attendance. The average waiting time from referral-to-first appointment and referral-to-discharge was 35 and 91 days, respectively. Results showed statistically significant improvement (p < 0.001) in the mean visual analogue scale when patients received orthoses with and without a rehabilitation plan (4.12 ± 2.55 and 3.33 ± 2.88, respectively). Most patients (61.5%) were aged 40-69, with "foot pain" being the main reported pathology category. Patients had an average of two appointments. 56.5% of patients remained virtual throughout their journey and were successfully discharged to self-management. 43.9% were discharged to other face-to face services., Conclusions: The study provided evidence that the virtual MSK podiatry service achieved a statistically significant reduction in patient-reported pain for various pathologies with reasonable waiting times. The service delivered favourable outcomes and complemented traditional services at a time with limited access due to the COVID-19 pandemic., (© 2024 The Author(s). Journal of Foot and Ankle Research published by John Wiley & Sons Australia, Ltd on behalf of Australian Podiatry Association and The Royal College of Podiatry.)

Objective: This study aimed to co-design and develop a user-centred, theory-based eHealth-mediated self-management support follow-up prototype for adults with musculoskeletal disorders., Design: A three-step system development cycle was employed. Step 1 involved creating intervention features and content, with two focus groups reviewing prioritised eHealth intervention elements based on earlier research. Step 2 involved heuristic testing using Nielsen's 10 heuristic principles. Step 3 incorporated qualitative think-aloud interviews and the System Usability Scale., Setting: Republic of Ireland., Participants: Step 1 included adults with musculoskeletal disorders ( n  = 12). Step 2 involved five reviewers. Step 3 included people with musculoskeletal disorders ( n  = 5) and musculoskeletal physiotherapists ( n  = 5)., Results: Participants in step 1 approved four main intervention components, which map to recognised theoretical frameworks, and suggested increased use of visual and interactive elements. Heuristic testing in step 2 identified design and navigation issues. In Step 3, usability testing, additional navigation, content and design recommendations were identified. The overall median system usability score (interquartile range) was 75 (0) out of 100 for adults with musculoskeletal disorders and 77.5 (2.5) out of 100 for musculoskeletal physiotherapists, indicating good usability., Conclusion: A theory-based, user-centred eHealth-mediated follow-up self-management support prototype has been developed for people with musculoskeletal disorders, with the next steps focusing on feasibility testing in clinical practice, with a more diverse population., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The First Contact Physiotherapist (FCP) role offers patients direct access to musculoskeletal (MSK) specialists in primary care settings and is designed to reduce GP workload while providing high-quality care. Despite positive early evaluations of FCP services, there remains a need for up-to-date assessments of their impact., Aim: To evaluate the FCP model of care implemented in an NHS Primary Care Network (PCN) against pre-defined service objectives., Method: A service evaluation was conducted using data from April 2020 to March 2024. Key performance indicators were based on national FCP evaluation criteria. Data included appointment utilisation, wait times, referral patterns, patient and staff satisfaction surveys, and audit results from clinical data., Results: Over 4 years, 12,185 patients were seen. Of these, 69% of patients were seen as true first contacts. The majority of patients (86.4%) were managed within primary care, with a referral rate of 8.5% to outpatient physiotherapy and 5.1% to orthopaedics. Patient satisfaction was high, with 82% rating their FCP experience as excellent or outstanding., Discussion: The FCP service successfully met its objectives by reducing GP workload and providing effective care. However, there was an increase in outpatient physiotherapy referrals over the 4-year period. Staff satisfaction was generally positive, though some highlighted concerns about appointment duration and workload., Conclusion: This evaluation demonstrates that FCP services provide a viable solution for managing MSK conditions in primary care. Future research should explore the most effective MSK service delivery models and incorporate digital solutions for comprehensive outcome and experience measures., (© 2024 John Wiley & Sons Ltd.)

Background: Patients with multiple chronic conditions, for example, musculoskeletal conditions and comorbidities, often receive inadequate and sometimes even contradictory care. Physiotherapists are well qualified to manage patients with musculoskeletal conditions and comorbidities due to their education and experience with rehabilitation; however, it is unknown which challenges they face when treating these patients., Aim: To identify challenges, treatment strategies, and delineations of areas of responsibility among physiotherapists working in private physiotherapy practice when treating people with musculoskeletal conditions and comorbidities., Methods: Qualitative study using focus group discussions and participant observations of 13 physiotherapists working in Danish private physiotherapy clinics. Grounded theory was applied to guide the analysis., Results: Two major themes emerged from the focus groups and the observations (1) The necessity of adapting management to the patients and their treatment trajectory; (2) The dilemma of overall responsibility for coordinating care. The physiotherapists described different elements of adapting their management, including being challenged on time, taking extra care of the patient, and having to adjust to a fluctuating course of treatment. The dilemma in coordinating care concerned whether the responsibility should lie with the physiotherapist, other healthcare professionals, or the patients, and whether to treat only the condition on the referral or to treat all the conditions the patient had., Conclusion: Physiotherapists use adapted strategies for diagnosing and treating patients with musculoskeletal conditions and comorbidities and are uncertain about the overall responsibility for coordinating care and whether they should focus on the index condition alone or also the other comorbidities the patient has., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Purpose of Review: This review explores recent advances in using immersive virtual reality to improve bodily perception and motor control in rehabilitation across musculoskeletal and neurological conditions, examining how virtual reality's unique capabilities can address the challenges of traditional approaches. The potential in this area of the emerging metaverse and the integration of artificial intelligence in virtual reality are discussed., Recent Findings: In musculoskeletal rehabilitation, virtual reality shows promise in enhancing motivation, adherence, improving range of motion, and reducing kinesiophobia, particularly postsurgery. For neurological conditions like stroke and spinal cord injury, virtual reality's ability to manipulate bodily perceptions offers significant therapeutic potential, with reported improvements in upper limb function and gait performance. Balance and gait rehabilitation, especially in older adults, have also seen positive outcomes. The integration of virtual reality with brain-computer interfaces presents exciting possibilities for severe speech and motor impairments., Summary: Current research is limited by small sample sizes, short intervention durations, and variability in virtual reality systems. Future studies should focus on larger, long-term trials to confirm findings and explore underlying mechanisms. As virtual reality technology advances, its integration into rehabilitation programs could revolutionize treatment approaches, personalizing treatments, facilitating home training, and potentially improving patient outcomes across a wide variety of conditions., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To examine patients' use of primary healthcare (PHC) before and after specialized rehabilitation and its relation with self-reported health and functioning., Design: Longitudinal cohort study., Participants: 451 rehabilitation patients., Methods: Register data were used to measure the frequency of visits to the general practitioner (GP) and physiotherapist (PT) in PHC 3 years before and after rehabilitation. Patients reported health (EQ-VAS) and functioning (SF-36) before rehabilitation and at 1 and 3 years after. Data are described for the total study cohort and subgroups with musculoskeletal disease (MSD) and cardiovascular disease (CVD)., Results: There was an increase in GP and PT visits preceding rehabilitation and a gradual decrease thereafter. An exception was GP visits among patients with CVD, with few diagnosis-specific visits before but an increase after. Lower levels of health and functioning tended to be related to more frequent GP and PT visits. An indication of clinically important improvement was found among those with frequent GP visits in the MSD subgroup, and among those with 1-2 GP visits in the CVD subgroup., Conclusions: The diverse relationship between health and functioning, and the use of PHC services at follow-up, may imply that additional factors besides healthcare use explain long-term improvement following rehabilitation.

Purpose: Delegation of clinical tasks from physiotherapists to physiotherapy support workers varies considerably in musculoskeletal outpatient physiotherapy services leading to variation in patient care. This study aimed to develop consensus amongst physiotherapists, support workers and managers about what components should be included in a future framework to guide effective and safe delegation of clinical tasks to physiotherapy support workers in United Kingdom's National Health Service musculoskeletal outpatient physiotherapy services., Methods: A consensus study was carried out, using Nominal Group Technique. Seven physiotherapists, ten physiotherapy support workers and ten physiotherapy operational/clinical leads from 13 musculoskeletal physiotherapy services within United Kingdom's National Health Service were recruited through the Chartered Society of Physiotherapy's professional networks and social media. Three separate, role-specific consensus groups were convened, involving participants generating, discussing and rating on a Likert scale, components for inclusion in a future delegation framework., Results: 32 out of 38 generated items reached consensus of ≥70%, i.e. a mean of ≥4.9 on a 7-point Likert scale, across the three groups. Items were grouped under five main categories: 1) training/Continuous Professional Development for physiotherapists and support workers; 2) need for a clear delegation process; 3) competencies 4) defining the role of support workers and 5) safety net., Conclusion: Key stakeholder groups were able to reach consensus on five priority areas which will be developed into a best practice framework to standardise delegation and guide physiotherapists when delegating clinical tasks to support workers., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To validate the comprehensive ICF core set for post-acute musculoskeletal conditions from the perspective of patients in a primary care physiotherapy setting., Materials and Methods: A qualitative study was conducted with patients suffering from musculoskeletal problems. A phenomenological approach based on focus groups was used to identify the most relevant aspects related to physical therapy care in their condition. The data were analyzed using a meaning condensation procedure, identifying relevant themes and concepts. The identified concepts were linked to the ICF and compared to the ICF core set for post-acute musculoskeletal conditions., Results: Forty-three patients were included in eight focus groups. A total of 1281 relevant concepts were extracted and related to 156 ICF second-level entities. Entities in the ICF core set for post-acute musculoskeletal conditions were 95.7% confirmed. Eighty-nine additional second-level ICF entities were identified., Conclusions: Entities in the ICF core set for post-acute musculoskeletal conditions are relevant to patients seen in primary care physical therapy units. However, there are areas of functioning related to community health care not covered by this ICF-based tool.IMPLICATIONS OF REHABILITATIONAn ICF-based framework is feasible for the assessment of musculoskeletal conditions.Post-acute musculoskeletal ICF core set was confirmed in patient focus groups.Additional ICF categories emerged for a primary care physical therapy setting.Community features of functioning could be addressed by a tailored ICF core set.

Purpose: Home self-rehabilitation exercises for musculoskeletal conditions are a valuable complement to rehabilitation plans. Telerehabilitation systems using artificial intelligence can provide reliable solutions and empower patients by providing them with guidance and motivating them to engage in rehabilitation plans and activities. This study aims to understand the patient's and physiotherapist's perspective on the requirements of effective face-to-face physiotherapy sessions to inspire the design of a telerehabilitation platform to be used in home settings., Methods: The authors used an ethnography-informed approach through observation and semi-structured interviews with patients ( n  = 13) and physiotherapists ( n  = 10) in two outpatient rehabilitation clinics. The AEIOU framework was used to structure and analyse the observation. Thematic analysis was used to code and analyse the data collected from the observations and the interviews., Results: Patients' and physiotherapists' perspectives emphasise the need for exercise instruction clarity, evolution monitoring, and feedback. In the absence of the physiotherapist, in home settings, patients feel insecure and fear execution difficulties and limited exercise instructions, while physiotherapists struggle with controlling patients' home exercise performance. Telerehabilitation is seen as an opportunity to move further into home self-rehabilitation programs., Conclusions: Besides home exercise monitoring and guidance, telerehabilitation platforms must allow personalization and effective communication between patients and physiotherapists.

Background: The coronavirus (COVID-19) pandemic resulted in the rapid implementation of remote consultations to maintain musculoskeletal physiotherapy services. However, little is known about UK musculoskeletal physiotherapists' experiences of providing services during the COVID-19 pandemic., Objectives: To explore musculoskeletal physiotherapists' experiences of using remote consultations in one area of England during the COVID-19 pandemic., Design: Qualitative study using hermeneutic phenomenology based on the approach of Gadamer., Methods: Semi-structured interviews with twelve musculoskeletal physiotherapists were conducted online using Microsoft Teams. Data were analysed using frameworks based on the philosophical concepts of Gadamer's hermeneutics., Findings: Musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic was framed by three concepts: therapeutic relationship, transformational change, and uncertainty. These concepts are underpinned by four main themes capturing their experiences: (1) Disconnection: Difficulties building a rapport and reduced non-verbal communication affected building an effective therapeutic relationship, (2) Necessity: Transformation of services to remote consultations was positive, although technology and connectivity issues had a negative impact, (3) Loss of control: Diagnostic uncertainty, being unprepared, and experience affected physiotherapists' clinical practice, (4) Protection: Peer support and the use of technology facilitated a feeling of protection for physiotherapists., Conclusion: The findings of this study contribute to a better understanding of musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic. Implications for practice include the need to provide training for all musculoskeletal physiotherapists and undergraduates to enable the effective delivery of remote physiotherapy. Furthermore, digital infrastructure should be optimised to support future delivery of remote musculoskeletal physiotherapy services., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To evaluate the current evidence regarding the use of ultrasound elastography for assessing non-invasive, non-pharmacological interventions for eliciting changes in musculoskeletal stiffness., Methods: A systematic search of MEDLINE, CINAHL, EMBASE, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Information on measurement and intervention procedures was extracted. Bias was assessed using Cochrane Risk of Bias or Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tools for studies with true or quasi-experimental designs, respectively. Analyses were conducted for adequately powered subgroups based on intervention type, measurement site, and population assessed., Results: Twenty-one studies were included in the review. Overall risk of bias was low for true experimental studies and moderate for quasi-experimental studies. Subgroup analyses indicated a large overall effect for interventions involving manual physiotherapy and taping/splinting for reducing masseter muscle stiffness in patients with masticatory muscle disorders ( g  = 1.488, 95% CI = 0.320-2.655, p  = 0.013). Analyses for other intervention types and patient groups were underpowered., Conclusion: Ultrasound elastography demonstrates clinical applicability for assessing non-invasive, non-pharmacological interventions for musculoskeletal stiffness. However, the comparative efficacy of these interventions for modulating tissue stiffness remains inconclusive.

Musculoskeletal disorders challenge significantly the performance of many daily life activities, thus impacting the quality of life. The efficiency of the traditional physical therapy programs is limited by ecological parameters such as intervention duration and frequency, number of caregivers, geographic accessibility, as well as by subjective factors such as patient's motivation and perseverance in training. The implementation of VR rehabilitation systems may address these limitations, but the technology still needs to be improved and clinically validated. Furthermore, current applications generally lack flexibility and personalization. A VR rehabilitation game simulation is developed, which focuses on the upper-limb movement of reaching, an essential movement involved in numerous daily life activities. Its novelty consists in the integration of a machine learning algorithm, enabling highly adaptive and patient-customized therapeutic intervention. An immersive VR system for the rehabilitation of reaching movement using a bubble popping game is proposed. In the virtual space, the patient is presented with bubbles appearing at different locations and is asked to reach the bubble with the injured limb and pop it. The implementation of a Q-learning algorithm enables the game to adjust the location of the next bubble according to the performance of the patient, represented by his kinematic characteristics. Two test cases simulate the performance of the patient during a training program of 10 days/sessions, in order to validate the effectiveness of the algorithm, demonstrated by the spatial and temporal distribution of the bubbles in each evolving scenario. The results show that the algorithm learns the patient's capabilities and successfully adapts to them, following the reward policy dictated by the therapist; moreover, the algorithm is highly responsive to kinematic features' variation, while demanding a reasonable number of iterations. A novel approach for upper limb rehabilitation is presented, making use of immersive VR and reinforcement learning. The simulation suggests that the algorithm offers adaptive capabilities and high flexibility, needed in the comprehensive personalization of a rehabilitation process. Future work will demonstrate the concept in clinical trials., (© 2024. The Author(s).)

With the overall objective of providing implication for clinical and research practices regarding the identification and measurement of modifiable predicting factors for return to work (RTW) in people with musculoskeletal disorders (MSDs) and common mental disorders (CMDs), this study 1) systematically examined and synthetized the research evidence available in the literature on the topic, and 2) critically evaluated the tools used to measure each identified factor. A systematic search of prognostic studies was conducted, considering four groups of keywords: 1) population (i.e., MSDs or CMDs), 2) study design (prospective), 3) modifiable factors, 4) outcomes of interest (i.e., RTW). Studies showing high risk of bias were eliminated. Tools used to measure prognostic factors were assessed using psychometric and usability criteria. From the 78 studies that met inclusion criteria, 19 (for MSDs) and 5 (for CMDs) factors reaching moderate or strong evidence were extracted. These factors included work accommodations, RTW expectations, job demands (physical), job demands (psychological), job strain, work ability, RTW self-efficacy, expectations of recovery, locus of control, referred pain (back pain), activities as assessed with disability questionnaires, pain catastrophizing, coping strategies, fears, illness behaviours, mental vitality, a positive health change, sleep quality, and participation. Measurement tools ranged from single-item tools to multi-item standardized questionnaires or subscales. The former generally showed low psychometric properties but excellent usability, whereas the later showed good to excellent psychometric properties and variable usability. The rigorous approach to the selection of eligible studies allowed the identification of a relatively small set of prognostic factors, but with a higher level of certainty. For each factor, the present tool assessment allows an informed choice to balance psychometric and usability criteria., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Villotti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Musculoskeletal (MSK) pathologies significantly affect the rehabilitation course for patients admitted to an inpatient rehabilitation facility (IRF). The impact of a specialized inpatient MSK consult service has not been previously evaluated., Objective: To assess the demographics, pathologies, and impact on pain scores of patients who were evaluated by a specialized MSK consult service., Design: Retrospective descriptive analysis of patients at an IRF who were evaluated by the MSK consult service., Setting: Academic IRF., Participants: 230 patients evaluated by the MSK consult service over 4.5 years., Interventions: MSK consult service composed of sports medicine fellowship-trained physiatrists who use history, physical examination, point-of-care ultrasound, and specialized MSK knowledge to assess and address MSK barriers to functional improvement., Main Outcome Measures: Primary rehabilitation diagnosis, length of stay, discharge destination, reason for consult, MSK diagnosis, need for injection, change in Numerical Pain Rating Scale (NPRS) pain scores, change in Functional Independence Measures (FIM)., Results: A total of 230 consults met inclusion criteria for analysis. The most common symptoms were shoulder pain (47%), knee pain (30%), and hip/groin pain (10.4%). The MSK consult service made 82 different musculoskeletal and neuromuscular diagnoses. The most common primary rehabilitation diagnosis was stroke (28.3%). Injections were performed in 44.3% of consults, with an average reduction in NPRS pain score of 2.3 (SD 1.9) and a statistically significant reduction in average NPRS pain scores in patients who underwent injections compared to those who did not (p < .001)., Conclusions: This study is the first to examine the use of an innovative inpatient MSK physiatry consult service in an IRF. This promising consult service can play a pivotal role in patient care by reducing functionally limiting MSK pain to allow for better toleration of therapies and to optimize functional gains., (© 2023 The Authors. PM&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.)

Improving peak oxygen uptake (V̇O 2peak ) and maximal strength are key objectives of rehabilitation for patients with unspecific musculoskeletal disorders (MSDs). Although high-intensity training yield superior outcomes for these factors, patients with MSDs may not tolerate high-intensity due to pain and fear. Therefore, we examined the effect and feasibility of incorporating aerobic high-intensity intervals (HIITs) and maximal strength training (MST) in a standard clinical rehabilitation program for patients with unspecific MSDs. 73 patients (45 ± 10 years) with MSDs partaking in a standard, public, and 4-week rehabilitation program were randomized to high-intensity training (HG: 4 × 4 minutes intervals at ∼90% of maximal heart rate; HR max , and 4 × 4 repetitions leg press at ∼90% of 1 repetition maximum; 1RM, with maximal intended velocity) or keep todays treatment of low-to moderate-intensity training (MG: various cycling, walking, and/or running activities at ∼70%-80% of HR max and 3 × 8 - 10 repetitions leg press at ∼75% of 1RM without maximal intended velocity). HG improved V̇O 2peak (12 ± 7%) and leg press 1RM (43 ± 34%) more than moderate-intensity group (V̇O 2peak ; 5 ± 6%, 1RM; 19 ± 18%, both p < 0.001). We observed that no adverse events and no between-group differences in dropout rate or self-reported quality of life (both p > 0.05). There were positive correlations between improved V̇O 2peak and improved physical (p = 0.024) and emotional (0.016) role functioning. We conclude that both high-intensity interval training and MST are feasible and improve V̇O 2peak and maximal strength more than standard low-to moderate-intensity treatment of patients with unspecific MSDs. Our findings suggest that high-intensity training should be implemented as a part of standard clinical care of this patient population., (© 2024 The Author(s). European Journal of Sport Science published by Wiley‐VCH GmbH on behalf of European College of Sport Science.)

Study Design: This study was a scoping review., Background: Continued advances in musculoskeletal sonography technology and access have increased the feasibility of point-of-care use to support day-to-day clinical care and decision-making. Sonography can help improve therapeutic outcomes in upper extremity (UE) rehabilitation by enabling clinicians to visualize underlying structures during treatment., Purpose of the Study: This study aimed to (1) evaluate the growth, range, extent, and composition of sonography literature supporting UE rehabilitation; (2) identify trends, gaps, and opportunities with regard to anatomic areas and diagnoses examined and ultrasound techniques used; and (3) evaluate potential research and practice utility., Methods: Searches were completed in PubMed, CINAHL, SPORTDiscus, PsycINFO, and BIOSIS. We included data-driven articles using ultrasound imaging for upper extremity structures in rehabilitation-related conditions. Articles directly applicable to UE rehabilitation were labeled direct articles, while those requiring translation were labeled indirect articles. Articles were further categorized by ultrasound imaging purpose. Article content between the two groups was descriptively compared, and direct articles underwent an evaluation of evidence levels and narrative synthesis to explore potential clinical utility., Results: Average publication rates for the final included articles (n = 337) steadily increased. Indirect articles (n = 288) used sonography to explore condition etiology, assess measurement properties, inform medical procedure choice, and grade condition severity. Direct articles (n = 49) used sonography to assess outcomes, inform clinical reasoning, and aid intervention delivery. Acute UE conditions and emerging sonography technology were rarely examined, while tendon, muscle, and soft tissue conditions and grayscale imaging were common. Rheumatic and peripheral nerve conditions and Doppler imaging were more prevalent in indirect than direct articles. Among reported sonography service providers, there was a high proportion of nonradiologist clinicians., Conclusion: Sonography literature for UE rehabilitation demonstrates potential utility in evaluating outcomes, informing clinical reasoning, and assisting intervention delivery. A large peripheral knowledge base provides opportunities for clinical applications; however, further research is needed to determine clinical efficacy and impact for specific applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Musculoskeletal disorders (MSDs) impact people globally, cause occupational illness and reduce productivity. Exercise therapy is the gold standard treatment for MSDs and can be provided by physiotherapists and/or also via mobile apps. Apart from the obvious differences between physiotherapists and mobile apps regarding communication, empathy and physical touch, mobile apps potentially offer less personalized exercises. The use of artificial intelligence (AI) may overcome this issue by processing different pain parameters, comorbidities and patient-specific lifestyle factors and thereby enabling individually adapted exercise therapy. The aim of this study is to investigate the risks of AI-recommended strength, mobility and release exercises for people with MSDs, using physiotherapist risk assessment and retrospective consideration of patient feedback on risk and non-risk exercises. 80 patients with various MSDs received exercise recommendations from the AI-system. Physiotherapists rated exercises as risk or non-risk, based on patient information, e.g. pain intensity (NRS), pain quality, pain location, work type. The analysis of physiotherapists' agreement was based on the frequencies of mentioned risk, the percentage distribution and the Fleiss- or Cohens-Kappa. After completion of the exercises, the patients provided feedback for each exercise on an 11-point Likert scale., e.g. the feedback question for release exercises was "How did the stretch feel to you?" with the answer options ranging from "painful (0 points)" to "not noticeable (10 points)". The statistical analysis was carried out separately for the three types of exercises. For this, an independent t-test was performed. 20 physiotherapists assessed 80 patient examples, receiving a total of 944 exercises. In a three-way agreement of the physiotherapists, 0.08% of the exercises were judged as having a potential risk of increasing patients' pain. The evaluation showed 90.5% agreement, that exercises had no risk. Exercises that were considered by physiotherapists to be potentially risky for patients also received lower feedback ratings from patients. For the 'release' exercise type, risk exercises received lower feedback, indicating that the patient felt more pain (risk: 4.65 (1.88), non-risk: 5.56 (1.88)). The study shows that AI can recommend almost risk-free exercises for patients with MSDs, which is an effective way to create individualized exercise plans without putting patients at risk for higher pain intensity or discomfort. In addition, the study shows significant agreement between physiotherapists in the risk assessment of AI-recommended exercises and highlights the importance of considering individual patient perspectives for treatment planning. The extent to which other aspects of face-to-face physiotherapy, such as communication and education, provide additional benefits beyond the individualization of exercises compared to AI and app-based exercises should be further investigated.Trial registration: 30.12.2021 via OSF Registries, https://doi.org/10.17605/OSF.IO/YCNJQ ., (© 2024. The Author(s).)

The majority of patients following musculoskeletal rehabilitation are taking painkillers. However, apart from one recent observational study, there is a lack of data. The use of analgesics, particularly opioids, is associated with higher scores for pain, anxiety, depression, catastrophizing and disability, as well as poorer results in functional tests. Prescribing analgesic treatment with precise objectives (improving pain and function) should also include identifying psychosocial factors associated with a poor prognosis. Regular reassessment of the treatment should make it possible to limit side-effects and the risk of misuse and help patients to engage in an active rehabilitation programme and resume regular physical activity., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In the rapidly advancing field of regenerative medicine, relying solely on cell transplantation alone may be insufficient for achieving functional recovery, and rehabilitation before and after transplantation is crucial. Regenerative rehabilitation functions by synergizing the therapeutic effects of regeneration and rehabilitation to maximize tissue regeneration and patient function. We used the keywords "regenerative rehabilitation" to search across the database for published works; this review discusses the development of regenerative rehabilitation for the treatment of musculoskeletal injuries. Rehabilitation has become a crucial component of regenerative medicine because it can enhance patients' functional activity and facilitate their early return to society. Experimental data increasingly demonstrates that rehabilitation interventions support the regeneration of transplanted tissues.

Purpose: To synthesize common or differing perceptions of patients' and clinicians' that influence uptake of online-delivered exercise programmes (ODEPs) for chronic musculoskeletal (MSK) conditions., Methods: Eight databases were searched from inception to April 2023 for studies including (1) patients with and/or clinicians delivering ODEPs for chronic MSK conditions, and (2) synchronous ODEPs, where information is exchanged simultaneously (mode A); asynchronous ODEPs, with at least one synchronous feature (mode B); or no ODEPs, documenting past experiences and/or likelihood of participating in an ODEP (mode C). Critical Appraisal Skills Programme checklists were used to assess study quality. Perceptions of patients' and clinicians' influencing uptake of ODEPs were extracted. Quantitative and qualitative data were synthesised and integrated., Results: Twenty-one studies were included (twelve quantitative, seven qualitative, and two mixed-methods) investigating the perceptions of 1275 patients and 534 clinicians on ODEP mode A ( n  = 7), mode B ( n  = 8), and mode C ( n  = 6). Sixteen of the 23 identified perceptions related to satisfaction, acceptability, usability, and effectiveness were common, with 70% of perceptions facilitating uptake and 30% hindering uptake., Conclusions: Findings highlight the need to promote targeted education for patients and clinicians addressing interconnected perceptions, and to develop evidence-based perception-centred strategies encouraging integrated care and guideline-based management of chronic MSK conditions.

Objective: To compare single and multiple physiotherapy sessions to improve pain, function, and quality of life (QoL) in patients with musculoskeletal disorders (MSKDs)., Data Sources: AMED, Cinahl, SportsDiscus, Medline, Cochrane Register of Clinical Trials, Physiotherapy Evidence Database, and reference lists., Study Selection: Randomized controlled trials (RCTs) comparing single and multiple physiotherapy sessions for MSKDs., Data Extraction: Two reviewers extracted data and assessed risk of bias and certainty of evidence using Cochrane Risk of Bias tool 2.0 and Grading of Recommendation Assessment, Development, and Evaluation., Data Synthesis: Six RCTs (n=2090) were included (conditions studied: osteoporotic vertebral fracture, neck, knee, and shoulder pain). Meta-analyses with low-certainty evidence showed a significant pain improvement at 6 months in favor of multiple sessions compared with single session interventions (3 RCTs; n=1035; standardized mean difference [SMD]: 0.29; 95% CI: 0.05 to 0.53; P=.02) but this significant difference in pain improvement was not observed at 3 months (4 RCTs; n=1312; SMD: 0.39; 95% CI: -0.11 to 0.89; P=.13) and at 12 months (4 RCTs; n=1266; SMD: -0.05; 95% CI: -0.49 to 0.39; P=.82). Meta-analyses with low-certainty evidence showed no significant differences in function at 3 (4 RCTs; n=1583; SMD: 0.05; 95% CI: -0.11 to 0.21; P=.56), 6 (4 RCTs; n=1538; SMD: 0.06; 95% CI: -0.12 to 0.23; P=.53) and 12 months (4 RCTs; n=1528; SMD: 0.08; 95% CI: -0.08 to 0.25; P=.30) and QoL at 3 (4 RCTs; n=1779; SMD: 0.08; 95% CI: -0.02 to 0.17; P=.12), 6 (3 RCTs; n=1206; SMD: 0.03; 95% CI: -0.08 to 0.14; P=.59), and 12 months (4 RCTs; n=1729; SMD: -0.03; 95% CI: -0.12 to 0.07; P=.58)., Conclusions: Low certainty meta-analyses found no clinically significant differences in pain, function, and QoL between single and multiple physiotherapy sessions for MSKD management for the conditions studied. Future research should compare the cost-effectiveness of those different models of care., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: First Contact Physiotherapy Practitioners (FCPPs) provide expert care for patients with musculoskeletal (MSK) conditions in General Practice. Access to FCPPs can facilitate timely care and efficient use of health services. However, there is little evidence about patient experiences of accessing FCPP appointments., Objective: To explore the experiences of patients with MSK conditions who have accessed an FCPP appointment in a General Practice setting in the UK., Design: Exploratory qualitative design., Methods: Patients with MSK conditions who had experience of accessing FCPP appointments were recruited via social media. Semi-structured interviews were conducted and recorded via MS Teams. Data were analysed using thematic analysis., Results: Of 13 patients interviewed, there were 10 females and three males, with an age range between 20 and 80 years. The main themes identified were: (1) Awareness of FCPP, (2) Access routes, (3) Facilitators to access, (4) Barriers to access, (5) Likelihood of re-accessing FCPP. Awareness of FCPP was generally low amongst participants. There were a variety of routes to access FCPP appointments; some were felt to be sub-optimal by participants. Facilitators included quick/easy access to FCPP. Barriers included difficulty contacting General Practitioner (GP) surgeries and public perception of needing to see a GP initially. The likelihood of re-consultation with a FCPP was low when participants had disappointing care experiences., Conclusion: This study provides new evidence about patient experiences of accessing FCPP. It explores positive and negative aspects of access from patients' perspectives. It also highlights areas for improvement in terms of GP staff/patient awareness and understanding of FCPP., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Introduction: People living with a painful distal upper limb musculoskeletal disorder (DUL-MSD) often experience pain, difficulty in doing everyday tasks and a reduced quality of life. Currently, there are challenges in the treatment of DUL-MSDs, highlighting the need to develop innovative approaches to rehabilitation. A potential solution is to develop and implement a digital self-management rehabilitation programme focussing on optimising recovery, improving function and reducing pain. Before developing this programme, we aimed to identify the barriers and facilitators to using a digital health intervention (DHI) for self-management of DUL-MSDs., Objective: This study aimed to investigate the potential barriers and facilitators to using a DHI with people living with DUL-MSDs and healthcare professionals (HCPs)., Methods: A qualitative exploratory study was carried out with purposely selected participants consisting of 15 participants with DUL-MSDs and 13 HCPs. Three focus groups (FGs) and four semistructured interviews with DUL-MSD participants and semistructured interviews with 13 HCPs were conducted. FGs and interviews were digitally recorded, transcribed and analysed using reflexive thematic analysis., Results: To address challenges in the care and management of DUL-MSDs, both HCPs and people living with a DUL-MSD welcomed the development of a DHI. This study identified several barriers and facilitators that would influence engagement with a digital intervention. Findings suggest that in developing a DHI, attention needs to be paid to digital design features, usability, tailoring, personalisation and consideration of how well usual care could be replicated digitally without direct HCP involvement., Conclusion: The identified digital design features of importance to participants will inform the design of a digital self-management rehabilitation programme for people living with DUL-MSDs. Addressing the barriers and facilitators to engagement with a DHI is essential in ensuring its relevance and acceptability to those who will use it., Patient or Public Contribution: Patient and Public Involvement and Engagement (PPIE) was integral throughout the study. PPIE members contributed to the development and planning of this study, checked and confirmed the relevance of the findings and are involved in the dissemination plans., (© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: Musculoskeletal (MSK) First Contact Practitioners (FCP), diagnostic clinicians with expertise in the assessment and management of undifferentiated MSK conditions in primary care have been widely employed in the United Kingdom since 2020. The role aims to bring specialist clinical knowledge to patients at the first point of contact and reduce the burden on existing primary care services. Since the national adoption of the role, little has been published to support the effectiveness or acceptability of the role. This narrative synthesis review aims to highlight and summarise the current body of evidence., Methodology: An adapted systematic review was carried out to inform thematic reporting and narrative synthesis, under the sub-themes of clinical outcomes, patient satisfaction, acceptability and cost analysis., Results: Eight publications were included in the review, reporting improvements in clinical outcomes in patients seen by MSK FCP, patient satisfaction and general acceptability of the role. However, all data were collected from observational studies and qualitative sources, some of which were found to be of low methodological quality., Conclusion: Although the review identified consistent positivity relating to effectiveness, satisfaction and acceptability across the reviewed publications, conclusions are limited due to the relatively recent introduction of the FCP role leading to limited availability of relevant publications., (© 2024 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd.)

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 .

Importance: A response shift (RS) is a phenomenon in which there is an individual perceptual gap between pre and post assessments. RS effects were not considered in the Canadian Occupational Performance Measure (COPM) development process., Objective: To detect the effects of RS on the COPM., Design: Convergent mixed-methods research., Setting: Subacute rehabilitation hospital in Japan., Participants: Nineteen adult patients with a range of neurological and musculoskeletal conditions recruited from a subacute rehabilitation hospital., Outcomes and Measures: In the qualitative analysis, patients' perceptions regarding occupation identified by the COPM were compared between the initial assessment (Time 1 [T1]) and a reassessment (Time 2 [T2]). In the quantitative study, patients were asked to re-rate the occupations in which the RS had occurred, giving feedback on their perceptions at T1 (T2'). The difference between T2 and T2' was calculated to clarify the magnitude of the RS., Results: Of the 19 patients, 18 had an RS in at least one occupation. The RS effects were classified into five categories: Replacing, Adding, Reducing, Unspecified, and Embodiment. Ninety occupations were extracted from all the patients, and 46 (51.1%) were affected by RS. The percentages of occupations for which the change in score due to RS exceeded the minimal clinically important difference (±2 points) was 26.1% (12 of 46) for COPM-Performance scores and 30.4% (14 of 46) for COPM-Satisfaction scores., Conclusions and Relevance: Diverse RS effects have been identified in the COPM, which also affect score interpretation. Plain-Language Summary: The Canadian Occupational Performance Measure has a potential measurement bias that is due to a response shift in which there is an individual perceptual gap between pre and post assessments. The results of this study reveal a need to establish more accurate measurement methods to reduce the impact of response shifts on COPM scores., (Copyright © 2024 by the American Occupational Therapy Association, Inc.)

Objectives: To assess the confidence in the results of systematic reviews on the effectiveness of physiotherapy for musculoskeletal conditions in the past 10 years and to analyze trends and factors associated., Methods: This is a metaepidemiological study on systematic reviews (SRs) with meta-analysis of randomized controlled trials (RCTs). MEDLINE, Cochrane Database of Systematic Reviews, CINAHL, and PEDro were searched for SRs of RCT on physiotherapy interventions for musculoskeletal disorders from December 2012 to December 2022. Two researchers independently screened the records based on the inclusion criteria; a random sample of 100 studies was selected, and each journal, author, and study variable was extracted. The methodological quality of SRs was independently assessed with the AMSTAR 2 tool. Any disagreement was solved by consensus., Results: The confidence in SRs results was critically low in 90% of the studies, and it did not increase over time. Cochrane reviews are predominantly represented in the higher AMSTAR 2 confidence levels, with a statistically significant difference compared to non-Cochrane reviews. The last author's H-index is the only predictor of higher confidence among the variables analyzed (OR 1.04; 95% CI: 1.01, 1.06)., Conclusion: The confidence in SRs results is unacceptably low. Given the relevance of musculoskeletal disorders and the impact of evidence synthesis on the clinical decision-making process, there is an urgent need to improve the quality of secondary research by adopting more rigorous methods., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To determine the prospective association of pain coping strategies and symptoms of anxiety and depression with work absenteeism in people with upper limb musculoskeletal disorders., Data Sources: A systematic search of PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases was conducted from inception to September 23, 2022., Study Selection: Prospective observational studies of adults with upper limb musculoskeletal disorders were included. Included studies had to provide data on the association of pain coping strategies (catastrophizing, kinesiophobia, self-efficacy or fear avoidance) or symptoms of anxiety and depression with work absenteeism., Data Extraction: Study selection, data extraction, and assessment of methodological quality (Newcastle Ottawa Scale) were performed by 2 independent authors. Random-effects models were used for quantitative synthesis., Data Synthesis: Eighteen studies (n=12,393 participants) were included. Most studies (77.8%) reported at least 1 significant association between 1 or more exposure factors (pain coping strategies or symptoms of anxiety and depression) and work absenteeism. Meta-analyses showed a statistically significant correlation between the exposure factors of catastrophizing (r=0.28, 95% confidence interval [CI]: 0.15 to 0.40; P<.0001) and symptoms of anxiety and depression (r=0.23, 95% CI: 0.10 to 0.34; P=.0003) with work absenteeism. The correlation between self-efficacy and work absenteeism was non-significant (r=0.24, 95% CI: -0.02 to 0.47; P=.0747)., Conclusions: Rehabilitation teams should consider assessing catastrophizing and symptoms of anxiety and depression to identify patients at risk for work absenteeism. Addressing these variables may also be considered in return-to-work programs for individuals with upper limb disorders., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Abstract: In this dynamic scanning protocol, ultrasound examination of the ankle is described using various maneuvers to assess different conditions. Real-time patient examination and scanning videos are used for better simulation of daily clinical practice. The protocol is prepared by several/international experts in the field of musculoskeletal ultrasound and within the umbrella of European Musculoskeletal Ultrasound Study Group in Physical and Rehabilitation Medicine/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine., Competing Interests: USPRM: Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine (ISPRM). Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The relevance of the presented article is due to the lack of information on the impact of social work in the development of rehabilitation motivation in children with disorders of the musculoskeletal system. This research aimed to evaluate the role of social work in shaping rehabilitation motivation in children with musculoskeletal disorders. Using a questionnaire, the study involved 43 children and their carers who received social support and 20 who did not. Analysis revealed a significant correlation between the absence of social support and rehabilitation outcomes. The results underlined the value of rehabilitation, with a predominantly positive response to its methods and outcomes. The data also suggested that the absence of social work could increase the likelihood of unfavorable outcomes. By highlighting the need for comprehensive treatment and rehabilitation strategies, this research provides a basis for improving rehabilitation approaches. Addressing the challenges highlighted could pave the way for optimized public health strategies.