Journal of Back and Musculoskeletal Rehabilitation

Meniscal injury is a common knee disorder that may alter lower-limb loading patterns during walking and contribute to functional impairment and secondary joint degeneration. However, whether gait kinetic alterations differ across MRI-defined Stoller grades remains unclear.

To investigate the effects of isolated meniscal injuries of different Stoller grades on gait kinetics, focusing on ground reaction forces (GRF) and joint moments in both affected and contralateral limbs.

A total of 114 participants were categorized into three groups based on MRI findings: normal, Grade I–II, and Grade III. Three-dimensional gait analysis recorded GRF components and sagittal-plane joint moments. Multivariate analysis of covariance, adjusting for age and body mass index (BMI), followed by Bonferroni post hoc tests, was used to compare intergroup differences.

There were significant differences in BMI and Lysholm scores between groups, and these factors were corrected in subsequent analyses. Compared with controls, patients with meniscal injury demonstrated altered GRF components (anterior, posterior, and lateral) and reduced ankle dorsiflexion, knee extension, and hip flexion/extension moments on the affected limb. Similar kinetic alterations were identified in the contralateral limb. Peak joint moments at the ankle, knee, and hip were significantly correlated with GRF parameters. No significant differences were detected between the Grade I–II and Grade III groups in any gait kinetic variables.

Gait kinetic alterations appear to be associated with the presence of meniscal injury rather than MRI-defined injury severity. These findings underscore the importance of functional gait assessment and support individualized rehabilitation strategies regardless of Stoller grade.

Despite the relation of the erector spinae and gluteus medius muscles to low back pain, only a few studies to date have attempted to quantify their dynamic function using ultrasound imaging.

To assess intra-rater reliability of ultrasound imaging measurement of erector spinae and gluteus medius muscle thickness, at rest and during submaximal contraction, and to compare the reliability of percent thickness change calculations with a novel method using linear regression analysis to estimate residualized thickness change.

Erector spinae and gluteus medius muscles of 30 participants were imaged at rest and during submaximal contraction. Intra-rater reliability of thickness measurements was estimated both based on a single measurement and on an average of three measurements, with intraclass correlation coefficients (ICCs), standard error of measurement (SEM) and minimal detectable change (MDC).

Reliability was high for all rested and contracted thickness measurements with ICCs ranging between 0.85 to 0.98, SEM 0.08 to 0.16 cm, and MDC 0.22 to 0.47 cm. Although less reliable than simple thickness measurements, reliability of residualized change measures was consistently higher than percent thickness change calculations.

Ultrasound imaging of the erector spinae and gluteus medius muscles is reliable. Measurement of simple resting and contracted thickness is highly reliable and can be based on a single measurement. Dynamic measures are less reliable and should be based on an average of three measurements. Measurements of residualized thickness change are consistently more reliable than percent thickness change calculations and its use should be explored in future dynamic ultrasound imaging research.

Recurrent hamstring strain injuries are associated with deficits in eccentric strength and altered muscle-tendon extensibility, which may persist and contribute to reinjury risk.

To examine the relationship between hamstring flexibility, assessed by Askling H-test, and isokinetic strength ratios; concentric-to-eccentric (Con:Ecc) and hamstring-to-quadriceps (H:Q) in elite soccer players with previous hamstring strain.

Fifty-two male professional players (27 ± 5 years) with clinically confirmed prior hamstring injury completed the Askling H-test and bilateral isokinetic testing at 60°·s⁻¹ (concentric) and 180°·s⁻¹ (eccentric). The mean of three maximal efforts was used to calculate peak torques. Pearson correlations and multiple linear regression examined the relationship between flexibility, age, and strength ratios (α = 0.05).

Mean ± SD Con:Ecc ratio was 86 ± 9% and H:Q ratio 63 ± 7%. Hamstring flexibility correlated inversely with the Con:Ecc ratio, moderately in the dominant limb (r = -0.65 [95% CI −0.78 to −0.46], p < 0.001) and weakly in the non-dominant limb (r = –0.34 [95% CI −0.56 to −0.06], p = 0.02). No significant correlation was observed between flexibility and the H:Q ratio (p = 0.38). Flexibility remained an independent predictor of the Con:Ecc ratio after adjusting for age (β = –0.61, p < 0.001; R² = 0.38).

Reduced hamstring flexibility is associated with a higher Con:Ecc ratio, indicating relatively reduced eccentric capacity, but is not related to H:Q balance. These findings highlight the role of flexibility in hamstring strength balance and warrant longitudinal investigation.

Hip extension exercises with knee flexion are used for individuals with weak hip extensors or hamstring (HAM)-dominant patterns. The relative contribution of the gluteus maximus (GM), semitendinosus (ST), and biceps femoris (BF) may be affected by the degree of knee flexion.

This study compared GM, ST, BF, and multifidus (MF) activation across three knee flexion angles during prone hip extension with reciprocal inhibition (PHERI) and examined GM/ST and GM/BF ratios to identify the angle most effective for selective GM activation.

Twenty healthy males performed PHERI via a non-elastic band at 60°, 90°, and 120° knee flexion. Electromyography recorded MF, GM, ST, and BF activation normalized to maximum voluntary isometric contraction. GM/ST and GM/BF ratios were calculated, and a repeated-measures ANOVA with Bonferroni adjustment analyzed differences among conditions.

GM activation was significantly higher at 90° than at 60° and 120° (p_adj < 0.017). BF activation was significantly lower at 90° than at 120° (p_adj < 0.017). GM/ST and GM/BF ratios were highest at 90° (p < 0.001). Overall differences were significant for all variables (p < 0.05); however, post-hoc analysis revealed no significant pairwise differences for right_MF, left_MF, or ST (p_adj > 0.017). Additionally, no significant pairwise differences were found for GM between 60° and 120°, nor for BF between 60° and 90° and between 60° and 120° (p_adj > 0.017).

PHERI at 90° knee flexion promotes selective GM activation while reducing HAM contribution, making it suitable for individuals with weak hip extensors or HAM-dominant patterns.

Plantar fasciitis (PF) is a leading cause of heel pain, impairing function and quality of life. While manual therapy is widely used, comparative evidence between specific techniques remains limited.

This study aimed to compare the effects of articulatory manual therapy (AMTG) and soft tissue massage based on the GDS muscle chains method (MCTG) on pain, function, and quality of life in individuals with PF.

A two-arm, parallel-group randomized pilot trial with assessor blinding was conducted at a university physiotherapy clinic in Spain. Seventeen adults (18–65 years) with unilateral PF ≥1 month were randomized to AMTG (n = 8) or MCTG (n = 9). Both groups received 8 sessions over 4 weeks, including plantar massage, myofascial trigger point inhibition, and daily home exercises. AMTG included joint mobilizations; MCTG applied soft tissue massage based on GDS principles. The primary outcome was pressure pain threshold (PPT). Secondary outcomes included ankle dorsiflexion, dynamic balance, foot health (FHSQ), pain/disability (FFI), and quality of life (SF-12).

Significant within-group improvements were observed in PPT (p < 0.001), dorsiflexion (p = 0.005), and FFI (p < 0.001). AMTG showed greater improvement in SF-12 physical role (p = 0.045) and physical component (p = 0.049).

Clinically, these findings suggest that both treatments can be considered valid options for reducing pain and improving function in patients with plantar fasciitis, although articulatory techniques offer an additional advantage in the physical component of quality of life. No adverse events were reported. Both treatments were effective; AMTG showed greater physical health benefits.

Adult degenerative scoliosis is a common condition in the aging population, and conservative treatment approaches are often used as the first-line management for symptom control.

To evaluate the efficacy of the erector spinae plane block, when administered in conjunction with physical therapy, on pain severity, disability, and quality of life in patients diagnosed with degenerative lumbar scoliosis.

A total of 26 patients aged 60 and older were randomized into two groups: Group 1 received physical therapy, while Group 2 received physical therapy plus an erector spinae plane block. The severity of pain was evaluated using the Numeric Rating Scale, while disability and quality of life were assessed using the Oswestry Disability Index and the SRS-22 questionnaire.

The severity of pain was statistically diminished in the 1st week, 1st month, and 3rd month after treatment in both groups (p < 0.01). Oswestry Disability Index and SRS-22 total scores showed notable improvements at each time point in both groups (p < 0.01). However, except for pain scores at 3 months, no statistically significant differences were observed between the two groups in terms of pain, disability, or quality of life scores.

Physical therapy is an effective method for controlling pain, improving functionality, and improving quality of life in patients with adult degenerative scoliosis. The rapid, short-term pain relief achieved through erector spinae plane block may encourage patient adherence to treatment and enhance the effectiveness of rehabilitation. Future studies with larger samples are needed to evaluate long-term effects of these interventions and personalized treatment strategies.

While TikTok's surge in health-related material creates valuable opportunities for patient education, the platform's absence of structured peer-review mechanisms raises concerns regarding the quality of available content. Increasingly, patients rely on social media for guidance on self-managing conditions such as Triangular Fibrocartilage Complex (TFCC) injuries; however, the quality of this information has not yet been rigorously evaluated.

The aim of this research was to systematically assess TikTok videos demonstrating rehabilitation exercises for TFCC injuries, specifically evaluating their quality, reliability, and educational value.

A cross-sectional study searched TikTok for “TFCC rehab”, “TFCC exercises”, and “TFCC training”. A final 123 videos were analyzed. Quality and reliability were assessed using DISCERN, Global Quality Scale (GQS), and JAMA criteria. Educational content was evaluated using an adapted TFCC Exercise Education Score (TFCCEES). Video characteristics, engagement metrics, and uploader types were recorded.

Overall quality was low (median DISCERN 28.00; 88.6% “poor” or “very poor”). Most videos (64.23%) were from non-health professionals. Health professionals scored higher on JAMA criteria (P < 0.001), but no significant differences were found in DISCERN, GQS, or TFCCEES between groups. Engagement metrics showed negligible correlations with quality scores. Video duration moderately correlated with DISCERN (ρ = 0.45).

TFCC rehabilitation content on the Chinese version of TikTok is predominantly poor, regardless of uploader status. Popularity is not an indicator of quality, which may limit patients’ ability to identify reliable rehabilitation guidance. Healthcare professionals should direct patients to validated resources and create high-quality social media content.

Tennis elbow is a common musculoskeletal condition that causes discomfort and functional limitations in the wrist extensors. Manual therapy techniques including neural mobilization, Mulligan, and Maitland mobilization are commonly used to relieve pain and improve upper limb function, but their relative usefulness is unknown.

To compare between three manual therapy approaches (radial nerve mobilization, Mulligan and Maitland mobilization) to find their effectiveness when they were added to eccentric exercises in patients with tennis elbow. Study Design: Single-blinded, randomized, controlled trial.

Forty-five tennis elbow participants were randomly allocated into three groups (n = 15 each): Group A received radial nerve neural mobilization, Group B received Mulligan mobilization (MWM), and Group C received Maitland mobilization. Interventions were implemented over six weeks. Pain intensity, Pressure Pain Threshold (PPT), functional disability, and hand grip strength were measured before and after intervention.

Between-group comparison showed no statistically significant differences in post-treatment scores for Pain intensity (p = 0.10), PPT (p = 0.45), functional disability (p = 0.16), and grip strength (p = 0.75). However, the radial nerve neural mobilization group had a greater mean reduction in pain intensity (Pre- post: 4.6–1.8) and improved grip strength (Pre-post:26.65–31.14 kg) compared to the other groups; this difference is numerically greater but statistically insignificant.

Maitland, Mulligan, and neural mobilization approaches are effective in reducing pain and enhancing upper limb function in patients with tennis elbow. Neural mobilization may provide numerically greater therapeutic benefits, but further research with larger sample size and long-term follow-up is needed.

Resting quadriceps muscle thickness (QMT) is known to be associated with muscle strength; however, the clinical relevance of contracted QMT in identifying muscle weakness has not been fully clarified.

This study aimed to investigate the relationship between resting and contracted QMT and isometric peak knee-extension torque (PT) and to evaluate the diagnostic value of contracted QMT in predicting probable sarcopenia (PS).

Forty-two individuals with PS and sixty-two healthy controls were evaluated. QMT and PT were compared between groups. Linear regression analyses examined the associations between QMT, handgrip strength (HGS), and appendicular skeletal muscle mass. Logistic regression and receiver operating characteristic (ROC) analyses assessed the diagnostic performance of contracted QMT.

Individuals with PS had lower contracted QMT and knee-extension strength than controls (all p < 0.01). Contracted QMT, rather than relaxed measurements, showed positive associations with HGS and appendicular skeletal muscle mass (ASMM) (all p < 0.05). Contracted QMT independently predicted PS (OR = 0.90, 95% CI: 0.82–0.99), and ROC analysis indicated moderate discriminatory performance (AUC range: 0.62–0.77).

While both measurements were reduced in PS, contracted QMT showed a stronger association with muscle mass and strength. These findings suggest that contraction-based ultrasound parameters may serve as a preliminary and exploratory adjunct for identifying early functional decline. However, given the moderate discriminatory power, further standardization and external validation are required before routine clinical adoption.

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive pain therapy with few adverse events (AEs) reporting. Despite updated CONSORT Harms 2022 standards, no study has evaluated AE documentation quality using it in TENS research.

This meta-epidemiological study aimed to (1) assess the safety profile of TENS, (2) evaluate the quality of AE reporting in randomized controlled trials (RCTs), (3) identify factors associated with reporting quality, and (4) examine changes in reporting practices following the publication of the CONSORT Harms 2022 guideline.

We searched PubMed, CENTRAL, and Cochrane Library for RCTs reporting TENS-related adverse events. Quality was assessed using the CONSORT Harms 2022 checklist. Mann–Whitney U test was used to investigate whether there was a significant difference between the reporting quality of AE before and after the publication of the checklist. Multivariable linear regression identified factors associated with overall CONSORT score (OCS) and AE documentation quality.

Seventy four studies were included with a mean AE reporting compliance of 64.2%. Higher OCS (p < 0.001), larger sample size (p < 0.05), governmental funding (p < 0.05), and diverse funding sources (p < 0.05) were significantly associated with better AE reporting quality. Studies published after the release of the CONSORT Harms 2022 guideline had significantly higher reporting scores than those published earlier (p < 0.05).

The CONSORT Harms 2022 guideline has had a measurable impact on AE reporting quality in TENS trials. The observed frequency of AEs underscores the need for robust safety monitoring protocols in this therapy.

Recurrent lateral ankle sprain (RLAS) often results in persistent symptoms, functional limitations, and reduced health-related quality of life (HRQOL). However, psychosocial and behavioral factors influencing recovery, particularly in Saudi Arabia, remain underexplored.

To identify demographic, clinical, and behavioral predictors of HRQOL among adults with RLAS, focusing on fear-avoidance beliefs (FABs) and physical activity levels.

A cross-sectional, web-based survey was conducted among 461 adults who reported ≥2 lateral ankle sprains within the previous 12 months or persistent symptoms consistent with recurrent injury. HRQOL was assessed using the Arabic version of the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L), and FABs were measured using the Arabic Fear-Avoidance Beliefs Questionnaire (FABQ-Arabic). Internal consistency of the FABQ-Arabic in the present sample was high (Cronbach's α = 0.89). Participants self-reported physical activity levels, demographics, and clinical characteristics. Multiple linear regression was used to identify independent predictors.

Higher FABQ-Arabic scores were strongly associated with lower HRQOL (standardized β = –0.328, p < 0.001). Additional factors predicting reduced HRQOL included age ≥45 years (β = –0.091, p = 0.017), being retired or unemployed (β = –0.082, p = 0.024), and the presence of foot deformity (β = –0.069, p = 0.043). Engagement in moderate (β = 0.112, p = 0.011) and high (β = 0.141, p = 0.001) levels of physical activity was independently associated with higher HRQOL.

Psychological factors (fear), age, employment status, physical activity, and foot deformities influence HRQOL. Rehabilitation should target FABs and promote physical activity to enhance recovery.

Chronic neck pain is a prevalent source of disability worldwide, and existing reviews report limited certainty due to heterogeneous methodologies and outdated trials.

To update and strengthen the evidence on the effectiveness and safety of cupping therapy for chronic neck pain by incorporating recent high-quality randomized controlled trials (RCTs).

In accordance with PRISMA 2020 and PROSPERO registration (CRD42025633104), major databases were searched through January 2025 for RCTs comparing various cupping modalities to control interventions in adults with chronic neck pain (≥3 months). Primary outcomes were pain intensity (Visual Analogue Scale, VAS/ Numeric Rating Scale, NRS) and functional disability (NDI); secondary outcomes included quality of life, range of motion, and adverse events.

Nine RCTs involving 401 participants met inclusion criteria. Meta-analysis revealed that cupping significantly reduced pain intensity (Cohen's d = 1.17; 95% CI 0.26–2.09; p = 0.002) and produced consistent functional improvements (Cohen's d = 0.77; 95% CI 0.63–0.91; p < 0.001; I² = 0%). Secondary outcomes favored cupping, with enhanced quality of life and range of motion. No serious adverse events were reported.

Cupping therapy provides consistent, clinically meaningful improvements in functional disability and significant pain relief for adults with chronic neck pain, within an overall evidence base that is stronger for function than for pain and is tempered by methodological limitations in several included trials. This updated synthesis elevates the evidence base, supporting cupping as a function-enhancing adjunct in multidisciplinary management and guiding its integration into clinical practice.

Body awareness is an important protective factor that helps individuals cope with negative situations and learn from positive movement experiences. Therefore, tools that assess postural habits and awareness are of great importance.

This study aims to examine the validity and reliability of the Postural Habits and Awareness Scale (PHAS) in individuals with chronic low back pain.

The study was prospectively designed, and face-to-face assessments were performed. The PHAS, Fremantle Back Awareness Questionnaire (FBAQ), and Oswestry Disability Index (ODI) were used as assessment parameters. All assessments except the PHAS were conducted only once, while the PHAS was repeated 7–10 days after the initial assessment for retest analyses.

Confirmatory factor analysis showed that the model had an acceptable fit with the data (CMIN/df = 1.46, RMSEA = 0.056, CFI = 0.92, GFI = 0.90). The scale's internal consistency was assessed using Cronbach's alpha, which was found to be α = 0.721 for the total scale. Test–retest reliability was evaluated using the Intraclass Correlation Coefficient (ICC) for the subdimensions and the total score. The ICC values were 0.878, 0.629, 0.739, and 0.844 for the subdimensions, respectively, and 0.877 for the total score.

In this study, the scale demonstrated satisfactory results in terms of both construct validity and reliability. The analysis findings indicate that the scale has a multidimensional structure consistent with the theoretical framework and shows an acceptable fit with the data. Overall, the scale is considered sufficiently valid and reliable, and it is an effective tool for assessing postural habits and awareness.

Neuromuscular electrical stimulation (NMES) for the treatment of hemiplegic shoulder pain (HSP) remains controversial. This study aims to clarify the efficacy of NMES in treating HSP.

PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang Data were searched from database inception to May 31, 2025. Randomized controlled trials (RCTs) on NMES for treating HSP were included, and subgroup analyses were performed based on follow-up duration. The National Institutes of Health Quality Assessment Tool (NIH-QAT) was employed to assess risk of bias, and data were analyzed using Stata 15. This study protocol was registered with PROSPERO (CRD420251070156).

Five studies involving 290 patients were included. NMES was found to alleviate shoulder pain (SMD = –0.49; 95% CI: −0.86 to −0.11), enhance upper limb motor function (WMD = 4.47; 95% CI: 2.85 to 6.09), and increase the range of motion (ROM) in shoulder forward flexion (WMD = 11.82; 95% CI: 6.13 to 17.50) and shoulder external rotation (WMD = 5.41; 95% CI: 2.48 to 8.34). Except for shoulder flexion, all of these findings were influenced by a single study with low methodological quality. No significant effects were observed for shoulder abduction or activities of daily living. The subgroup analyses indicated that the analgesic effect of NMES was sustained over the long term.

NMES is shown to mitigate shoulder pain over the long term and significantly increase the ROM in shoulder forward flexion. The short-term effect on alleviating shoulder pain is marginally significant, and NMES may be beneficial for enhancing upper limb motor function and increasing the ROM of shoulder external rotation. Nevertheless, due to potential bias, the findings should be interpreted with caution.

Neuropathic pain secondary to lumbar spinal pathology is often refractory to conventional treatments, prompting interest in ozone therapy because of its anti-inflammatory and neuromodulatory effects. However, treatment outcomes vary, and factors influencing remission duration remain unclear.

To assess the influence of demographic variables and ozone therapy parameters on symptom remission duration in patients with lower-limb peripheral neuropathic pain treated with subcutaneous oxygen–ozone injections.

This retrospective study included 304 patients with lower-extremity neuropathic pain who achieved initial symptom remission after subcutaneous O₂/O₃ injections. The primary outcome was time to pain recurrence up to 18 years. Variables analyzed included age, sex, number of treatment sessions, and ozone concentration. All patients received a constant total ozone dose of 800 μg. Statistical analysis included two-way ANCOVA, Kruskal–Wallis testing, and Spearman correlation analysis.

Recovery duration differed significantly according to patient age and ozone concentration. An optimal ozone concentration of approximately 21 μg O₃/mL O₂ was identified. Increasing ozone concentration was associated with a reduction in recovery duration of approximately 1.8% per unit increase. Age demonstrated a significant negative correlation with recovery duration (p < 0.01), with an estimated 0.2% decrease per additional year of age. No association was found between age and ozone concentration. Sex and number of treatment sessions were not significantly associated with outcome duration. Lower-to-middle ozone concentrations were associated with longer recovery duration.

Subcutaneous oxygen–ozone therapy provided sustained clinical benefit in patients with peripheral neuropathic pain secondary to lumbar spinal disorders. Demographic outcomes highlight the importance of individualized dose selection.

Subacromial pain syndrome (SAPS) is a common cause of shoulder pain and is frequently managed with exercise-based rehabilitation. In clinical practice, interventions such as dry needling (DN) and kinesiology taping (KT) are often used alongside exercise programs, although their short-term effectiveness remains unclear.

To compare the effectiveness of DN, KT, their combination and physical therapy modalities (PTM) when applied alongside exercise therapy in patients with SAPS.

Eighty adults with SAPS were included in this four-arm randomized controlled trial. Group 1 received KT plus exercise, Group 2 received DN plus exercise, Group 3 received combined DN and KT plus exercise, and Group 4 received PTM plus exercise. Interventions were applied over 3 weeks. Pain intensity and functional disability were assessed at baseline, week 1 and week 3, and kinesiophobia at baseline and week 3. Data were analyzed using Kruskal-Wallis, Friedman, and Wilcoxon signed-rank tests.

Significant within-group improvements in pain, functional disability and kinesiophobia were observed in all groups (p < 0.01). At week 3, reductions in pain were greater in the combined DN and KT group than in the PTM group, while kinesiophobia showed a similar pattern, although improvement in the KT group was comparable to that of the combined group; functional disability improved similarly across groups.

All evaluated interventions were associated with improvement when used as adjuncts to exercise-based rehabilitation. The combination of DN and KT was associated with greater reductions in pain and kinesiophobia than PTM, whereas functional improvement was similar across groups.

To map existing research on adjunctive psychological approaches in exercise-based randomized controlled trials (RCTs) involving children with chronic musculoskeletal diseases (CMD).

We conducted a scoping review, following Joanna Briggs Institute methodology and a prospectively registered protocol. Medline, Embase, PsycInfo, CINAHL, Cochrane CENTRAL and Scopus databases were searched in February 2024 and September 2025.

RCTs involving children with CMD, exploring therapeutic exercises with psychological approaches, were included. Four independent reviewers screened the studies; data were extracted by one reviewer and verified by another using standardized previously piloted forms. Covidence was used for all review steps. PRISMA extension for Scoping Reviews recommendations was followed for synthesis and reporting.

Of 6793 screened studies, 21 were assessed for full-text eligibility, and five RCTs (223 children, 80% female, mean age 14.2 years) were included from two countries (USA [n = 4], Sweden). Conditions included chronic musculoskeletal pain (n = 2), complex regional pain syndrome, patellofemoral pain syndrome, and juvenile fibromyalgia. Outcomes focused on pain, psychological, and clinical findings. Psychological approaches (motivational interviewing, behavior modification, pain psychoeducation) were delivered by psychologists and physiotherapists. Exercise interventions included neuromuscular exercises (n = 3), usual physiotherapy (n = 1), and tailored physiotherapy (n = 1).

Managing children with CMD is complex requiring multidisciplinary care, with psychological approaches potentially enhancing exercise-based rehabilitation. Although this integration appears promising, progress is limited by the lack of standardized protocols, scarce long-term evidence, and barriers such as accessibility, caregiver engagement, and therapist training.

The improvement following arthroscopic rotator cuff repair (ARCR) is associated with biopsychosocial factors, including emotional well-being, health beliefs, and patient engagement.

This prospective study aimed to investigate the relationship between musculoskeletal health literacy (MHL) and physical and psychological outcomes in patients with ARCR.

A total of 44 patients were divided into two groups: low (n = 24) and high (n = 20) MHL using the Turkish Health Literacy Scale-32. The patients received a standardized rehabilitation program composed of 30 treatment sessions (five days per week) lasting between 45 and 60 min. The primary outcomes included pain (Visual Analog Scale) and disability-function (Shoulder Pain and Disability Index and The Disabilities of the Arm, Shoulder and Hand Questionnaire). Secondary outcomes included pain catastrophizing (Pain Catastrophizing Scale-PCS), anxiety/depression (Hospital Anxiety and Depression Scale), kinesiophobia (Tampa-Scale of Kinesiophobia-TSK), and quality of life (12-Item Short-Form Health Survey). The outcomes were assessed pre- and post-treatment.

Both MHL groups showed significant improvements in pain, disability, and function over time (p < 0.001), with no group-by-time interaction for physical outcomes. However, higher MHL was associated with greater improvements in PCS (p = 0.029) and TSK scores (p = 0.041), indicating significant group-by-time interactions for psychological outcomes.

Higher MHL was associated with improved psychological outcomes, but not physical outcomes, after ARCR. The MHL may be more strongly related to psychological adaptation rather than physical recovery. Interventions targeting MHL may have the potential to influence rehabilitation outcomes. Further randomized trials are required to assess the clinical benefits of MHL-targeted educational interventions in terms of causality.

Artificial intelligence (AI)-based chatbots are increasingly used as sources of medical information. Given the high prevalence of neck pain as a musculoskeletal symptom, patients may commonly consult such tools for health-related guidance.

To evaluate and compare the performance of ChatGPT 4.0 and Google Gemini in addressing commonly asked patient questions and clinical case scenarios related to neck pain, focusing on their accuracy, quality, understandability, readability, reliability, and usability.

Twenty-four patient-oriented questions and four clinical case scenarios regarding neck pain were submitted to ChatGPT 4.0 and Google Gemini. Responses were evaluated using validated tools: modified DISCERN (mDISCERN) for reliability, Global Quality Scale (GQS) for quality, PEMAT-P for understandability and actionability, and Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) for readability. Case-based responses were assessed for accuracy, safety, and usability on a 7-point Likert scale by two experienced physicians.

Gemini demonstrated significantly higher reliability (mDISCERN, p < 0.001), whereas ChatGPT 4.0 had slightly higher, though statistically insignificant, GQS and PEMAT-P scores. Readability metrics were similar: ChatGPT's FRE was 48.78 and FKGL 9.08; Gemini's FRE was 47.12 and FKGL 9.11. Both models’ outputs were considered difficult to read. In clinical scenarios, both chatbots showed comparable accuracy, safety, and usability, with minor omissions noted.

ChatGPT 4.0 and Google Gemini provided similar performance in addressing neck pain-related queries. While both may support patient.

This study aimed to investigate the associations of multi-dimensional lipid metabolism indicators, comprising serum lipid profiles and the degree of fatty infiltration in the musculoskeletal system, with bone mineral density (BMD) and bone turnover markers (BTMs), and to identify independent risk factors for the occurrence and severity of osteoporotic vertebral compression fractures (OVCFs) in postmenopausal women.

This retrospective study included a total of 133 postmenopausal women from January 2023 to July 2024. Participants were stratified by fracture status and vertebral compression severity. Clinical data, including bone and lipid metabolic indicators and BMD, were retrieved from electronic medical records and MRI reanalysis. Pearson correlation analyzed associations between lipid metabolic indicators and BTMs/BMD. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for OVCFs, with multicollinearity among variables assessed using the variance inflation factor (VIF), and ordinal logistic regression was applied to assess lipid metabolic indicators’ impact on vertebral compression severity. Statistical analyses included Student's t-test or Mann-Whitney U test for group comparisons and one-way analysis of variance (ANOVA) for multiple-group comparisons.

This study included 133 participants: 34 controls, 32 with mild, 38 with moderate, and 29 with severe fractures. Age, BMI, BMD, vertebral bone quality (VBQ), the fatty infiltration ratio of the paraspinal muscles (FIR), and lipoprotein(a) [Lp(a)] differed significantly between fracture and control groups (all p < 0.05). VBQ and FIR were negatively correlated with total BMD (r = -0.466, p < 0.05; r = -0.455, p < 0.05) and positively correlated with the ratio of the fractured vertebra compressed sagittal cross-sectional area (RCSA) (r = 0.344, p < 0.05; r = 0.320, p < 0.05) and age (r = 0.615, p < 0.05; r = 0.283, p < 0.05). Univariate and multivariate regression analyses indicated that VBQ (p = 0.043; OR = 4.260, 95% CI: 1.046–17.345), FIR (p = 0.047; OR = 2.372, 95% CI: 1.010–5.572), and Lp(a) (p = 0.048; OR = 1.002, 95% CI: 1.002–1.799) were independently associated with an increased risk of OVCFs. Ordinal logistic regression confirmed VBQ (p = 0.006; OR = 3.168, 95% CI: 1.378–7.282) and FIR (p = 0.034; OR = 1.156, 95% CI: 1.009–1.325) were associated with increased fracture severity.

VBQ and FIR were independently associated with osteoporotic fractures in postmenopausal women and were further linked to fracture severity, suggesting their potential value in risk stratification and fracture severity assessment. Although Lp(a) showed a statistically significant association with OVCFs, the association was relatively weak, and its clinical significance requires further validation.