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Musculoskeletal Rehabilitation: Current Challenges and New Perspectives

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Rehabilitation".

Deadline for manuscript submissions: closed (25 February 2024) | Viewed by 35050

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Dr. Andrea Perna

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Department of Orthopedics and Traumatology, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
Interests: total disc replacement; cervical spine; physiotherapy; musculoskeletal pain; osteomyelitis; infection

Dr. Raffaele Vitiello

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Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli—IRCCS, Largo Agostino Gemelli 8, Rome, Italy
Interests: foot and ankle; bone and soft tissue tumor; bone and soft tissue infection; prosthetic joint infection; traumatology
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Dr. Anna Maria Martone

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Department of Aging, Orthopedic and Rheumatologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
Interests: frailty; frail elderly; geriatric assessment; cachexia; sarcopenia
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Musculoskeletal diseases play a leading role in modern health systems due to their high prevalence in the general population and the progressive course they take. Furthermore, they often cause disability and absence in the workplace, with a high economic burden.

Musculoskeletal rehabilitation nowadays represents a discipline in continuous evolution, due to scientific and technological advances.

Rehabilitation must be part of the integrated care process in orthopedic patients, especially if they are elderly and frail.

Musculoskeletal rehabilitation has a wide range of applications, from surgically treated patients, to the patient who presents difficulties in the activities of daily life.

Another application of musculoskeletal rehabilitation, often underestimated, refers to the treatment of chronic muscular and skeletal pain. Other fields of interest directly related to musculoskeletal rehabilitation and of increasing interest are pre-operative rehabilitation protocols and orthopedic regenerative medicine.

The objectives of a correct rehabilitation approach should be to restore the patient with good autonomy and improve their quality of life.

In this Special Issue, we focus on the new musculoskeletal rehabilitation techniques, protocols, and treatments for orthopedic and chronic pain patients.

We would invite researchers to share their recent findings in these contexts by inviting original clinical and basic research articles, meta-analyses, and systematic reviews focusing on the global aspects of musculoskeletal rehabilitation.

Dr. Andrea Perna
Dr. Raffaele Vitiello
Dr. Anna Maria Martone
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

musculoskeletal diseases
rehabilitation
ERAS
chronic pain
disability
regenerative medicine
personalized medicine

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Published Papers (11 papers)

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Editorial

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3 pages, 195 KiB

Open AccessEditorial

Editorial on: Musculoskeletal Rehabilitation: Current Challenges and New Perspectives

by Andrea Perna and Luca Proietti

J. Clin. Med. 2023, 12(12), 3981; https://doi.org/10.3390/jcm12123981 - 12 Jun 2023

Cited by 5 | Viewed by 2204

Abstract

Musculoskeletal disorders are among the leading causes of disability and chronic pain worldwide, and their impact is expected to increase in the coming years [...] Full article

(This article belongs to the Special Issue Musculoskeletal Rehabilitation: Current Challenges and New Perspectives)

Research

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11 pages, 1474 KiB

Open AccessArticle

Effects of Pain Neuroscience Education and Physiotherapy on Chronic Low Back Pain, Fear of Movement and Functional Status: A Randomised Pilot Study

by Eglė Lendraitienė, Barbora Styraitė, Rasa Šakalienė, Gabija Misytė and Indre Bileviciute-Ljungar

J. Clin. Med. 2024, 13(7), 2081; https://doi.org/10.3390/jcm13072081 - 3 Apr 2024

Cited by 2 | Viewed by 3117

Abstract

Background: Chronic non-specific low back pain is a non-harmous condition often found in the general population. It is one of the most significant disabilities and needs different treatment modalities. This study investigates the effects of pain neuroscience education and physiotherapy on pain intensity, fear of movement and functional status in a Lithuanian cohort with non-specific low back pain. Methods: The study was performed at the primary health care unit in Kaunas, Lithuania. The key inclusion criterion was persistent non-specific low back pain longer than three months and which affects daily life functions. Thirty participants (mean 33.47, SD 4.38 years age, 70% women) were randomised into two training groups with and without pain neuroscience education (for a total of 60 min of teaching). Physiotherapy was performed twice per week during 45 min/session for a period of 10 weeks with exercises which strengthen, stabilize, and stretch the spinal cord muscles. Outcomes included pain intensity, kinesiophobia and disability and these were measured by self-scored questionnaires (numeric rating scale, Tampa scale for kinesiophobia-11, Oswestry disability index and the Roland–Morris questionnaire, respectively). Results: The results indicate that both groups improved in the measured outcomes, with the only difference between them being a better improvement in kinesiophobia in the group receiving physiotherapy and pain neuroscience education. Conclusions: The results of this study confirm that a relatively short intervention of pain neuroscience education enhances the effects of physiotherapy and should be implemented in clinical practice. Full article

(This article belongs to the Special Issue Musculoskeletal Rehabilitation: Current Challenges and New Perspectives)

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13 pages, 632 KiB

Open AccessArticle

Effectiveness of a Web-Guided Self-Managed Telerehabilitation Program Enhanced with Outdoor Physical Activity on Physical Function, Physical Activity Levels and Pain in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

by Maria Moutzouri, George A. Koumantakis, Michael Hurley, Aggeliki Georgia Kladouchou and George Gioftsos

J. Clin. Med. 2024, 13(4), 934; https://doi.org/10.3390/jcm13040934 - 6 Feb 2024

Cited by 2 | Viewed by 2180

Abstract

Background: Telerehabilitation to guide self-management has been shown to be a feasible care strategy for knee osteoarthritis (KOA). The aim of this study was to explore the effectiveness of a blended web-based rehabilitation program enhanced with outdoor physical activity (BWR-OPA) and consultation versus an OPA (usual care) program in KOA patients. Methods: Forty-four KOA participants were prescribed to follow the programs five times/week for 6 weeks. The primary outcome was self-reported physical function, measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS). The secondary outcomes were pain, PA, function (timed up-and-go (TUG) test, 30 s chair rise test (30 s CRT)), psychological functioning and QoL. Results: There was a significant difference between the groups’ KOOSs for pain and symptom subscales at the 6- and 12-week post-intervention assessments compared to baseline (p < 0.005) favoring the BWR-OPA group. There was a superior improvement in PA in the BWR-OPA training group (p < 0.05). Statistical and clinical improvements were found (p < 0.001) with effect sizes over 2.0 for objective measures of function. Similar improvements were recorded over time (p < 0.005) at 12 weeks for QoL, KOOS subscales for ADL, QoL and sports/recreation and psychological functioning for both groups. Conclusions: A blended web-based self-managed care program with outdoor PA was superior in many respects to usual care in KOA participants. Full article

(This article belongs to the Special Issue Musculoskeletal Rehabilitation: Current Challenges and New Perspectives)

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10 pages, 1528 KiB

Open AccessArticle

Musculoskeletal Rehabilitation: New Perspectives in Postoperative Care Following Total Knee Arthroplasty Using an External Motion Sensor and a Smartphone Application for Remote Monitoring

by Mirjam Victoria Neumann-Langen, Björn Gunnar Ochs, Jörg Lützner, Anne Postler, Julia Kirschberg, Khosrow Sehat, Marius Selig and Thomas M. Grupp

J. Clin. Med. 2023, 12(22), 7163; https://doi.org/10.3390/jcm12227163 - 18 Nov 2023

Cited by 5 | Viewed by 1729

Abstract

Background: The number of total knee replacements performed annually is steadily increasing. Parallel options for postoperative care are decreasing, which reduces patient satisfaction. External devices to support physical rehabilitation and health monitoring will improve patient satisfaction and postoperative care. Methods: In a prospective, international multicenter study, patients were asked to use an external motion sensor and a smartphone application during the postoperative course of primary total knee arthroplasty. The collected data were transferred to a data platform, allowing for the real-time evaluation of patient data. Results: In three participating centers, 98 patients were included. The general acceptance of using the sensor and app was high, with an overall compliance in study participation rate of up to 76%. The early results showed a significant improvement in the overall quality of life (p < 0.001) and significant reductions in pain (p < 0.01) and depression (p < 0.001). Conclusions: The early results of this clinical and multicenter study emphasize that there is a high interest in and acceptance of digital solutions in patients’ treatment pathways. Motion sensor and smartphone applications support patients in early rehabilitation. Full article

(This article belongs to the Special Issue Musculoskeletal Rehabilitation: Current Challenges and New Perspectives)

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10 pages, 257 KiB

Open AccessArticle

The Effects of Ultrasound-Guided Intra-Articular Injections with Hyaluronic Acid and Corticosteroids in Patients with Hip Osteoarthritis: A Long-Term Real-World Analysis

by Gianpaolo Ronconi, Sefora Codazza, Maurizio Panunzio, Fabiana La Cagnina, Mariantonietta Ariani, Dario Mattia Gatto, Daniele Coraci and Paola Emilia Ferrara

J. Clin. Med. 2023, 12(20), 6600; https://doi.org/10.3390/jcm12206600 - 18 Oct 2023

Cited by 6 | Viewed by 2654

Abstract

Intra-articular (IA) ultrasound-guided hip injections are currently considered a cornerstone of the conservative management of symptomatic hip osteoarthritis (HOA), although their effect on clinical outcomes has not been fully elucidated.The purpose of this study is to investigate the effectiveness of ultrasound-guided IA hip injections of hyaluronic acid (HA) with or without corticosteroids (CS) on pain relief and functional improvement in patients with HOA. In total, 167 patients with HOA were assessed at baseline (T0) and 12 months after injection (T1) using the VAS and GLFS scores. The sample consisted mainly of female subjects (58.1%), presenting an average age of 70.6 ± 12.2 years and grade 3 HOA (63.9%) according to the Kellgren–Lawrence classification. Most of the patients (76.2%) underwent unilateral hip injection with a combination of medium-high molecular weight HA (1500–2000 kDa) and CS. At T1, lower use of anti-inflammatory drugs, an increase in the consumption of chondroprotectors, and an overall reduction of instrumental physical therapies and therapeutic exercise were recorded. In addition, a statistically significant intragroup and between-group decrease observed at T1 for both the VAS and GLFS. Study results suggested that intra-articular hip injections with HA alone and with CS could represent a useful therapeutic tool for pain reduction and functional improvement for patients with hip osteoarthritis. Full article

(This article belongs to the Special Issue Musculoskeletal Rehabilitation: Current Challenges and New Perspectives)

19 pages, 538 KiB

Open AccessArticle

Exploratory Study of Associations and Agreement between Prognostic Patient-Registered Factors, Physiotherapists’ Intuitive Synthesis, and Patient-Reported Factors in Whiplash-Associated Disorders

by Rob A. B. Oostendorp, Gwendolyne G. M. Scholten-Peeters, Jan Mulder, Emiel Van Trijffel, Geert M. Rutten, Margot De Kooning, Marjan Laekeman, Nathalie Roussel, Jo Nijs and J. W. Hans Elvers

J. Clin. Med. 2023, 12(6), 2330; https://doi.org/10.3390/jcm12062330 - 16 Mar 2023

Cited by 1 | Viewed by 2386

Abstract

Background: A large proportion of people who sustain a whiplash injury will have persistent pain, disability, and participation problems. Several prognostic factors for functional recovery have been reported in the literature but these factors are often evaluated based on differing implementations in clinical practice. Additionally, physiotherapists also rely on their clinical intuition to estimate the functional prognosis of their patients, but this is seldom measured in experimental research. Furthermore, no study to date has explored the associations between clinical intuition, clinically estimated factors, and objectively measured factors for functional recovery of patients with Whiplash-Associated Disorders (WAD). Aim: The aim of this exploratory study is to evaluate associations between prognostic factors for functional recovery, based on routinely collected data in a specialized primary care physiotherapy practice in a consecutive sample of patients (n = 523) with WAD. Methods: Three sources of prognostic factors were selected: (1) physiotherapists’ synthesis of clinical intuition in terms of high-risk, inconclusive risk, or low-risk for functional recovery, (2) patient-registered factors from history taking, and (3) patient-reported prognostic factors derived from questionnaires. Prognostic factors were selected based on the literature, recommendations in Dutch clinical practice guidelines, and consensus between experts. Spearman’s rank correlation coefficients were calculated to explore the associations between sources of prognostic factors, using a cutoff ≥0.25 for acceptable association. Results: Associations between physiotherapists’ intuitive synthesis and patient-registered variables were substantial (r_s = 0.86), between patient-registered variables and patient-reported variables fair (ranging from 0.30 to 0.41) to substantial (ranging from 0.69 to 0.73), and between physiotherapists intuitive synthesis and patient-reported variables fair (ranging from 0.30 to 0.37). Conclusion: When estimating prognosis for functional recovery using clinical reasoning, physiotherapists should integrate patients’ registered experience of their course of recovery, as well as the timeline after an accident, with their own synthesis of clinical intuition regarding prognostic factors in patients with WAD. Full article

(This article belongs to the Special Issue Musculoskeletal Rehabilitation: Current Challenges and New Perspectives)

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10 pages, 941 KiB

Open AccessArticle

Effectiveness of a 3-Week Rehabilitation Program Combining Muscle Strengthening and Endurance Exercises Prior to Total Knee Arthroplasty: A Non-Randomized Controlled Trial

by Takamasa Hashizaki, Yukihide Nishimura, Takahiro Ogawa, Chigusa Ohno, Ken Kouda, Yasunori Umemoto, Takaya Taniguchi, Hiroshi Yamada and Fumihiro Tajima

J. Clin. Med. 2023, 12(4), 1523; https://doi.org/10.3390/jcm12041523 - 15 Feb 2023

Cited by 4 | Viewed by 2944

Abstract

We evaluated the effectiveness of a high-intensity preoperative resistance and endurance training program in improving physical function among patients scheduled for total knee arthroplasty. This non-randomized controlled trial included 33 knee osteoarthritis patients scheduled to undergo total knee arthroplasty at a tertiary public medical university hospital. Fourteen and nineteen patients were non-randomly assigned to intervention and control groups, respectively. All patients underwent total knee arthroplasty and a postoperative rehabilitation program. The intervention group participated in a preoperative rehabilitation program comprising high-intensity resistance and endurance training exercises to increase lower limb muscle strength and endurance capacity. The control group received only exercise instruction. The primary outcome was the 6-min walking distance, which was significantly higher in the intervention group (399 ± 59.8 m) than in the control group (348 ± 75.1 m) 3 months post-surgery. There were no significant differences between the groups 3 months post-surgery in muscle strength, visual analog scale, WOMAC-Pain, range of motion of knee flexion, and extension. A 3-week preoperative rehabilitation program combining muscle strengthening and endurance training improved endurance 3 months after total knee arthroplasty. Thus, preoperative rehabilitation is important for improving postoperative activity. Full article

(This article belongs to the Special Issue Musculoskeletal Rehabilitation: Current Challenges and New Perspectives)

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Review

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11 pages, 234 KiB

Open AccessReview

Functional and Rehabilitative Outcomes of Patients Affected by Bone Cancer of the Upper Limb Treated with MUTARS Prosthesis: A Narrative Review

by Sefora Codazza, Paola Emilia Ferrara, Adelaide Aprovitola, Mariantonietta Ariani, Fabiana La Cagnina, Daniele Coraci, Giorgio Ferriero and Gianpaolo Ronconi

J. Clin. Med. 2024, 13(6), 1651; https://doi.org/10.3390/jcm13061651 - 13 Mar 2024

Viewed by 1577

Abstract

Megaprostheses are well-known, reliable, and effective reconstruction prostheses used in oncologic surgery for limb salvage in patients affected by primary or metastatic bone tumors. Rehabilitation plays a major role after MUTARS replacement, with the aim of improving function after surgery and maintaining the highest possible quality of life. Only a few studies have been published about the use of megaprostheses for the upper limb. The aim of this narrative review is to describe the results of functional and rehabilitative outcomes of patients affected by bone primary or metastatic bone cancer of the upper limb and surgically treated with MUTARS prostheses. A comprehensive search was conducted on PubMed and Scopus using the following MESH terms: “Mutars”, “Megaprosthesis”, “bone”, “tumors”, “metastasis”, “upper limb”, “rehabilitation”, “outcome”, “quality of life”, and 10 studies were included. The most frequent oncological pathology was found to be metastases of the proximal humerus treated with modular endoprosthesis or modular reverse implants. Outcome measures used were ROM, MSTS, ASES, DASH, Constant-Murley score, Enneking score, VAS, MEP, TESS, and WOSI. Reconstruction of the proximal humerus with the MUTARS system seemed to be a valid treatment option after bone tumor resection. Rehabilitation after MUTARS surgery is very relevant, but currently, functional and rehabilitative outcomes are inadequately represented in the literature. Hence, further studies are needed to define standardized rehabilitation protocols after oncological orthopedic surgery that can be applied routinely in clinical practice. Full article

(This article belongs to the Special Issue Musculoskeletal Rehabilitation: Current Challenges and New Perspectives)

Other

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13 pages, 480 KiB

Open AccessSystematic Review

Current Evidence Using Pulsed Electromagnetic Fields in Osteoarthritis: A Systematic Review

by Luigi Cianni, Emidio Di Gialleonardo, Donato Coppola, Giacomo Capece, Eugenio Libutti, Massimiliano Nannerini, Giulio Maccauro and Raffaele Vitiello

J. Clin. Med. 2024, 13(7), 1959; https://doi.org/10.3390/jcm13071959 - 28 Mar 2024

Cited by 2 | Viewed by 7947

Abstract

(1) Background: Osteoarthritis (OA) significantly impacts patients’ quality of life and negatively affects public healthcare costs. The aim of this systematic review is to identify the effectiveness of pulsed electromagnetic fields (PEMFs) in OA treatment across different anatomical districts, determining pain reduction and overall improvement in the patient’s quality of life. (2) Methods: In this systematic review following PRISMA guidelines, PubMed and Google Scholar were searched for randomized controlled trials involving patients with osteoarthritis undergoing PEMF therapy. Seventeen studies (1197 patients) were included. (3) Results: PEMF therapy demonstrated positive outcomes across various anatomical districts, primarily in knee osteoarthritis. Pain reduction, assessed through VAS and WOMAC scores, showed significant improvement (60% decrease in VAS, 42% improvement in WOMAC). The treatment duration varied (15 to 90 days), with diverse PEMF devices used. Secondary outcomes included improvements in quality of life, reduced medication usage, and enhanced physical function. (4) Conclusions: Diverse PEMF applications revealed promising results, emphasizing pain reduction and improvement in the quality of life of patients. The variability in the treatment duration and device types calls for further investigation. This review informs future research directions and potential advancements in optimizing PEMF therapies for diverse osteoarthritic manifestations. Full article

(This article belongs to the Special Issue Musculoskeletal Rehabilitation: Current Challenges and New Perspectives)

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13 pages, 1689 KiB

Open AccessCase Report

Complex Regional Pain Syndrome after Distal Radius Fracture—Case Report and Mini Literature Review

by Michał Świta, Paweł Szymonek, Konrad Talarek, Agnieszka Tomczyk-Warunek, Karolina Turżańska, Agnieszka Posturzyńska and Anna Winiarska-Mieczan

J. Clin. Med. 2024, 13(4), 1122; https://doi.org/10.3390/jcm13041122 - 16 Feb 2024

Viewed by 4032

Abstract

This study explores the impact of the complex regional pain syndrome (CRPS) on the lives and mobility of patients, with a particular focus on its emergence as a late complication of distal radius fractures (DRFs), a common occurrence, especially among an aging population. The absence of a standardized treatment for the CRPS and the challenge of predicting its occurrence make it a complex medical issue. This research aims to shed light on the effects of treating the CRPS through a case study involving a 75-year-old woman with untreated osteoporosis who experienced a Colles fracture after a fall. The initial management involved repositioning and stabilizing the fractured forearm with a plaster cast, followed by an operation using percutaneous pinning via a Kirschner wire. Subsequently, the patient developed CRPS symptoms and was admitted to the rehabilitation department three months post-fracture. The affected forearm exhibited swelling, warmth, pain, and severely limited range of motion. Treatment involved a combination of medications, physiotherapy, and kinesiotherapy. Significantly, the patient experienced notable improvement following these interventions. This study underscores the absence of a definitive standard for CRPS treatment but suggests that proper rehabilitation and pharmaceutical interventions can contribute positively to patient outcomes. The case further highlights the potential association between DRF and CRPS development, emphasizing the need for continued research in this field. Full article

(This article belongs to the Special Issue Musculoskeletal Rehabilitation: Current Challenges and New Perspectives)

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17 pages, 643 KiB

Open AccessStudy Protocol

Effect of a Multicomponent Intervention with Tele-Rehabilitation and the Vivifrail© Exercise Programme on Functional Capacity after Hip Fracture: Study Protocol for the ActiveFLS Randomized Controlled Trial

by Bernardo Abel Cedeno-Veloz, Irache Casadamon-Munarriz, Alba Rodríguez-García, Lucia Lozano-Vicario, Fabricio Zambom-Ferraresi, María Gonzalo-Lázaro, Ángel María Hidalgo-Ovejero, Mikel Izquierdo and Nicolás Martínez-Velilla

J. Clin. Med. 2024, 13(1), 97; https://doi.org/10.3390/jcm13010097 - 23 Dec 2023

Cited by 1 | Viewed by 2785

Abstract

Introduction: Hip fractures are the most common fracture leading to hospitalization and are associated with high costs, mortality rates and functional decline. Although several guidelines exist for preventing new fractures and promoting functional recovery, they tend to focus on osteoporosis treatment and do not take into account the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. Moreover, most health systems are fragmented and are incapable of providing appropriate management for frail and vulnerable individuals who are at risk of experiencing fragility fractures. Multicomponent interventions and physical exercise using tele-rehabilitation could play a role in the management of hip fracture recovery. However, the effectiveness of exercise prescription and its combination with a comprehensive geriatric assessment (CGA) is still unclear. Methods: This randomized clinical trial will be conducted at the Hospital Universitario de Navarra (Pamplona, Spain). A total of 174 older adults who have suffered a hip fracture and fulfil the criteria for inclusion will be randomly allocated to either the intervention group or the control group. The intervention group will receive a multicomponent intervention consisting of individualized home-based exercise using the @ctive hip app for three months, followed by nine months of exercise using Vivifrail. Additionally, the intervention group will receive nutrition intervention, osteoporosis treatment, polypharmacy adjustment and evaluation of patient mood, cognitive impairment and fear of falling. The control group will receive standard outpatient care according to local guidelines. This research aims to evaluate the impact of the intervention on primary outcome measures, which include changes in functional status during the study period based on the Short Physical Performance Battery. Discussion: The findings of this study will offer valuable insights into the efficacy of a comprehensive approach that considers the complexity of frailty in older adults and geriatric syndromes, which are important factors in individuals at risk of suffering from frailty fractures. This study’s findings will contribute to the creation of more effective strategies tailored to the requirements of these at-risk groups. Full article

(This article belongs to the Special Issue Musculoskeletal Rehabilitation: Current Challenges and New Perspectives)

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