BACKGROUND: Mobile technologies are increasingly being used in health care and public health practice for patient communication, monitoring, and education. Mobile health (mHealth) tools have also been used to facilitate adherence to chronic musculoskeletal pain (CMP) management, which is critical to achieving improved pain outcomes, quality of life, and cost-effective health care.
OBJECTIVE: The aim of this systematic review was to evaluate the 25-year trend of the literature on the adherence, usability, feasibility, and acceptability of mHealth interventions in CMP management among patients and health care providers.
METHODS: We searched the PubMed, Cochrane CENTRAL, MEDLINE, EMBASE, and Web of Science databases for studies assessing the role of mHealth in CMP management from January 1999 to December 2023. Outcomes of interest included the effect of mHealth interventions on patient adherence; pain-specific clinical outcomes after the intervention; and the usability, feasibility, and acceptability of mHealth tools and platforms in chronic pain management among target end users.
RESULTS: A total of 89 articles (26,429 participants) were included in the systematic review. Mobile apps were the most commonly used mHealth tools (78/89, 88%) among the included studies, followed by mobile app plus monitor (5/89, 6%), mobile app plus wearable sensor (4/89, 4%), and web-based mobile app plus monitor (1/89, 1%). Usability, feasibility, and acceptability or patient preferences for mHealth interventions were assessed in 26% (23/89) of the studies and observed to be generally high. Overall, 30% (27/89) of the studies used a randomized controlled trial (RCT), cohort, or pilot design to assess the impact of the mHealth intervention on patients\' adherence, with significant improvements (all P<.05) observed in 93% (25/27) of these studies. Significant (judged at P<.05) between-group differences were reported in 27 of the 29 (93%) RCTs that measured the effect of mHealth on CMP-specific clinical outcomes.
CONCLUSIONS: There is great potential for mHealth tools to better facilitate adherence to CMP management, and the current evidence supporting their effectiveness is generally high. Further research should focus on the cost-effectiveness of mHealth interventions for better incorporating these tools into health care practices.
BACKGROUND: International Prospective Register of Systematic Reviews (PROSPERO) CRD42024524634; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=524634.

OBJECTIVE: To evaluate the patient-reported expectations regarding cannabis for pain following musculoskeletal (MSK) trauma and patients\' perceptions and attitudes regarding its use.
METHODS:
METHODS: A cross-sectional retrospective survey-based study.
METHODS: Three orthopaedic clinics in Ontario (Level-1 trauma center, Level-2 trauma center, rehabilitation clinic).
UNASSIGNED: Adult patients presenting to the clinics from January 24, 2018, to March 7, 2018, with traumatic MSK injuries (fractures/dislocations and muscle/tendon/ligament injury) were administered an anonymous questionnaire on cannabis for MSK pain.
UNASSIGNED: Primary outcome measure was the patients\' perceived effect of cannabis on MSK pain, reported on a continuous pain scale (0%-100%, 0 being no pain, and 100 unbearable pain). Secondary outcomes included preferences, such as administration route, distribution method, timing, and barriers (lack of knowledge, concerns for side effects/addiction, moral/religious opposition, etc.) regarding cannabis use.
RESULTS: In total, 440 patients were included in this study, 217 (49.3%) of whom were female and 222 (50.5%) were male, with a mean age of 45.6 years (range 18-92 years, standard deviations 15.6). Patients estimated that cannabis could treat 56.5% (95% CI 54.0%-59.0%) of their pain and replace 46.2% (95% CI 42.8%-49.6%) of their current analgesics. Nearly one-third (131/430, 30.5%) reported that they had used medical cannabis and more than one-quarter (123/430, 28.6%) used it in the previous year. Most felt that cannabis may be beneficial to treat pain (304/334, 91.0%) and reduce opioid use (293/331, 88.5%). Not considering using cannabis for their injury (132/350, 37.7%) was the most common reason for not discussing cannabis with physicians. Higher reported pain severity (β = 0.2/point, 95% CI 0.1-0.3, P = 0.005) and previous medical cannabis use were associated with higher perceived pain reduction (β = 11.1, 95% CI 5.4-16.8, P < 0.001).
CONCLUSIONS: One in 3 orthopaedic trauma patients used medical cannabis. Patients considered cannabis could potentially be an effective option for managing traumatic MSK pain and believed that cannabis could reduce opioid usage following acute musculoskeletal trauma. These data will help inform clinicians discussing medical cannabis usage with orthopaedic trauma patients moving forward.

BACKGROUND: People with chronic musculoskeletal pain (CMSP) often have low physical activity. Various factors can influence the activity level. The aim of this study was to monitor physical activity, assessed by the number of steps per day, over time in people with CMSP and identify factors that could be associated with this activity feature.
METHODS: This prospective study involved people undergoing rehabilitation following an orthopedic trauma that had led to CMSP. At entry, participants completed self-reported questionnaires assessing pain, anxiety, depression, catastrophyzing, kinesiophobia, and behavioural activity patterns (avoidance, pacing and overdoing). They also underwent functional tests, assessing walking endurance and physical fitness. To determine daily step counts, participants wore an accelerometer for 1 week during rehabilitation and 3 months post-rehabilitation. The number of steps per day was compared among three time points: weekend of rehabilitation (an estimate of pre-rehabilitation activity; T1), weekdays of rehabilitation (T2), and post-rehabilitation (T3). Linear regression models were used to analyze the association between daily steps at T2 and at T3 and self-reported and performance-based parameters.
RESULTS: Data from 145 participants were analyzed. The mean number of steps was significantly higher during T2 than T1 and T3 (7323 [3047] vs. 4782 [2689], p < 0.001, Cohen\'s d = 0.769, and 4757 [2680], p < 0.001, Cohen\'s d = 0.693), whereas T1 and T3 results were similar (p = 0.92, Cohen\'s d = 0.008). Correlations of number of steps per day among time points were low (r ≤ 0.4). Multivariable regression models revealed an association between daily steps at T2 and pain interfering with walking, anxiety and overdoing behaviour. Daily steps at T3 were associated with overdoing behaviour and physical fitness.
CONCLUSIONS: Despite chronic pain, people in rehabilitation after an orthopedic trauma increased their physical activity if they were given incentives to do so. When these incentives disappeared, most people returned to their previous activity levels. A multimodal follow-up approach could include both therapeutic and environmental incentives to help maintain physical activity in this population.

BACKGROUND: Population studies show that musculoskeletal conditions are a leading contributor to the total burden of healthy life lost, second only to cancer and with a similar burden to cardiovascular disease. Prioritizing the delivery of effective treatments is necessary, and with the ubiquity of consumer smart devices, the use of digital health interventions is increasing. Messaging is popular and easy to use and has been studied for a range of health-related uses, including health promotion, encouragement of behavior change, and monitoring of disease progression. It may have a useful role to play in the management and self-management of musculoskeletal conditions.
OBJECTIVE: Previous reviews on the use of messaging for people with musculoskeletal conditions have focused on synthesizing evidence of effectiveness from randomized controlled trials. In this review, our objective was to map the musculoskeletal messaging literature more broadly to identify information that may inform the design of future messaging interventions and summarize the current evidence of efficacy, effectiveness, and economics.
METHODS: Following a prepublished protocol developed using the Joanna Briggs Institute Manual for Evidence Synthesis, we conducted a comprehensive scoping review of the literature (2010-2022; sources: PubMed, CINAHL, Embase, and PsycINFO) related to SMS text messaging and app-based messaging for people with musculoskeletal conditions. We described our findings using tables, plots, and a narrative summary.
RESULTS: We identified a total of 8328 papers for screening, of which 50 (0.6%) were included in this review (3/50, 6% previous reviews and 47/50, 94% papers describing 40 primary studies). Rheumatic diseases accounted for the largest proportion of the included primary studies (19/40, 48%), followed by studies on multiple musculoskeletal conditions or pain sites (10/40, 25%), back pain (9/40, 23%), neck pain (1/40, 3%), and \"other\" (1/40, 3%). Most studies (33/40, 83%) described interventions intended to promote positive behavior change, typically by encouraging increased physical activity and exercise. The studies evaluated a range of outcomes, including pain, function, quality of life, and medication adherence. Overall, the results either favored messaging interventions or had equivocal outcomes. While the theoretical underpinnings of the interventions were generally well described, only 4% (2/47) of the papers provided comprehensive descriptions of the messaging intervention design and development process. We found no relevant economic evaluations.
CONCLUSIONS: Messaging has been used for the care and self-management of a range of musculoskeletal conditions with generally favorable outcomes reported. However, with few exceptions, design considerations are poorly described in the literature. Further work is needed to understand and disseminate information about messaging content and message delivery characteristics, such as timing and frequency specifically for people with musculoskeletal conditions. Similarly, further work is needed to understand the economic effects of messaging and practical considerations related to implementation and sustainability.
UNASSIGNED: RR2-10.1136/bmjopen-2021-048964.

UNASSIGNED: When performed in unfavorable conditions, work can lead to the development of musculoskeletal disorders and decrease in work ability.
UNASSIGNED: To identify the differences between three groups of workers (professors, technicians and outsourced workers) as for the sociodemographic profile, work ability, prevalence of musculoskeletal disorders, activity restrictions, and the correlation between the presence of musculoskeletal disorders and activity restrictions with each domain of the Work Ability Index.
UNASSIGNED: The sample consisted of 67 university workers assessed by a Sociodemographic Data Questionnaire, the Nordic Musculoskeletal Symptoms Questionnaire and the Work Ability Index. Descriptive statistics and Kendall\'s Tau correlation coefficient were used.
UNASSIGNED: Professors presented more favorable sociodemographic and lifestyle aspects and higher work ability, while outsourced workers had less favorable sociodemographic and lifestyle aspects and lower work ability. The correlation between activity restrictions and work ability was found in only one domain of Work Ability Index among professors. Among outsourced workers were found correlations on presence of musculoskeletal disorders and activity restrictions with six domains of Work Ability Index. Technicians did not show significant correlation.
UNASSIGNED: Outsourced workers presented worse work ability and less favorable sociodemographic and lifestyle aspects among the workers in the study, requiring the maintenance and improvement of work ability in this population.
UNASSIGNED: O trabalho, quando realizado em condições desfavoráveis, pode levar ao desenvolvimento de distúrbios musculoesqueléticos e à diminuição da capacidade para o trabalho.
UNASSIGNED: Identificar diferenças entre três grupos de trabalhadores (professores, técnicos e terceirizados) em relação a perfil sociodemográfico, capacidade para o trabalho, presença de distúrbios musculoesqueléticos e restrição para atividades e correlacionar a presença de distúrbios musculoesqueléticos e a restrição para atividades com cada domínio do índice de Capacidade para o Trabalho.
UNASSIGNED: A amostra foi composta por 67 trabalhadores de uma universidade, os quais preencheram um questionário de dados sociodemográficos, o Questionário Nórdico de Sintomas Osteomusculares e o índice de Capacidade para o Trabalho. Foram utilizados estatística descritiva e o teste tau de Kendall para identificar possíveis correlações.
UNASSIGNED: Os professores apresentaram aspectos sociodemográficos e de estilo de vida mais favoráveis e maior capacidade para o trabalho, enquanto os terceirizados apresentaram aspectos sociodemográficos e de estilo de vida menos favoráveis, além de menor capacidade para o trabalho. Foi encontrada correlação entre restrição para atividades em apenas um dos domínios do Índice de Capacidade para o Trabalho entre professores. Entre os terceirizados, foram encontradas correlações entre a presença de distúrbios musculoesqueléticos e a restrição para atividades em seis domínios do índice de Capacidade para o Trabalho. Os técnicos administrativos não apresentaram correlações significativas.
UNASSIGNED: Os trabalhadores terceirizados apresentaram pior capacidade para trabalho e aspectos sociodemográficos e de estilo de vida menos favoráveis entre os trabalhadores do estudo, sendo necessárias a manutenção e a melhora da capacidade para o trabalho desta população.

Background: It is unclear why neck pain persists or resolves, making assessment and management decisions challenging. Muscle composition, particularly muscle fat infiltrate (MFI), is related to neck pain, but it is unknown whether MFI changes with recovery following targeted interventions. Methods: We compared muscle composition quantified from fat-water magnetic resonance images from the C3 to T1 vertebrae in individuals with and without chronic idiopathic neck pain at two times 6 months apart. Those with neck pain received six weeks of intervention (physiotherapy or chiropractic) after their baseline MRI; at 6 months, they were classified as recovered (≥3 on the 11-point Global Rating of Change scale) or not recovered. Results: At 6 months, both asymptomatic and recovered individuals had decreased MFI compared to baseline (asymptomatic estimated marginal mean difference -1.6% 95%; CI -1.9, -1.4; recovered -1.6; -1.8, -1.4; p < 0.001) whereas those classified as not recovered had increased MFI compared to baseline (0.4; 0.1, 0.7; p = 0.014), independent of age, sex and body mass index. Conclusions: It appears MFI decreases with recovery from neck pain but increases when neck pain persists. The relationship between cervical MFI and neck pain suggests MFI may inform diagnosis, theragnosis and prognosis in individuals with neck pain. Future development of a clinical test for MFI may assist in identifying patients who will benefit from targeted muscle intervention, improving outcomes.

Background/Objectives: The rising prevalence of musculoskeletal (MSK) conditions has not been balanced by a sufficient increase in healthcare providers. Scalability challenges are being addressed through the use of artificial intelligence (AI) in some healthcare sectors, with this showing potential to also improve MSK care. Digital care programs (DCP) generate automatically collected data, thus making them ideal candidates for AI implementation into workflows, with the potential to unlock care scalability. In this study, we aimed to assess the impact of scaling care through AI in patient outcomes, engagement, satisfaction, and adverse events. Methods: Post hoc analysis of a prospective, pre-post cohort study assessing the impact on outcomes after a 2.3-fold increase in PT-to-patient ratio, supported by the implementation of a machine learning-based tool to assist physical therapists (PTs) in patient care management. The intervention group (IG) consisted of a DCP supported by an AI tool, while the comparison group (CG) consisted of the DCP alone. The primary outcome concerned the pain response rate (reaching a minimal clinically important change of 30%). Other outcomes included mental health, program engagement, satisfaction, and the adverse event rate. Results: Similar improvements in pain response were observed, regardless of the group (response rate: 64% vs. 63%; p = 0.399). Equivalent recoveries were also reported in mental health outcomes, specifically in anxiety (p = 0.928) and depression (p = 0.187). Higher completion rates were observed in the IG (79.9% (N = 19,252) vs. CG 70.1% (N = 8489); p < 0.001). Patient engagement remained consistent in both groups, as well as high satisfaction (IG: 8.76/10, SD 1.75 vs. CG: 8.60/10, SD 1.76; p = 0.021). Intervention-related adverse events were rare and even across groups (IG: 0.58% and CG 0.69%; p = 0.231). Conclusions: The study underscores the potential of scaling MSK care that is supported by AI without compromising patient outcomes, despite the increase in PT-to-patient ratios.

While musculoskeletal pain (MSP) stands as the most prevalent health condition among Veterans, timely and high-quality care is often hindered due to access barriers. Team Red, White & Blue (Team RWB), a nonprofit organization dedicated to promoting a healthier lifestyle among Veterans, aimed to assess innovative approaches to veteran care. This is a single-arm pilot study investigating the feasibility, clinical outcomes, engagement, and satisfaction of a remote multimodal digital care program among Veterans with MSP. The impact of deployment experience on outcomes was explored as a secondary aim. From 75 eligible Veterans, 61 started the program, reporting baseline pain frequently comorbid with mental distress. Program acceptance was suggested by the high completion rate (82%) and engagement levels, alongside high satisfaction (9.5/10, SD 1.0). Significant improvements were reported in all clinical outcomes: pain (1.98 points, 95%CI 0.13; 3.84, p = 0.036); mental distress, with those reporting at least moderate baseline depression ending the program with mild symptoms (8.50 points, 95%CI: 6.49; 10.51, p = 0.012); daily activity impairment (13.33 points, 95%CI 1.31; 25.34, p = 0.030). Deployed Veterans recovered similarly to their counterparts. Overall, the above results underscore the potential of a remote digital intervention to expand Veterans\' access to timely MSP care.

Posterior shoulder dislocations are relatively rare. When used by emergency medicine physicians, point-of-care ultrasound (POCUS) demonstrates higher sensitivity and specificity for diagnosing shoulder dislocation as compared to two-view plain films. A 49-year-old woman presented to the emergency department (ED) with left shoulder pain following a mechanical fall. Physical examination was remarkable for a gross shoulder deformity and tenderness over the left proximal humerus. POCUS of the left shoulder using a curvilinear probe and a posterior approach was performed and demonstrated posterior displacement of the humeral head relative to the glenoid. Anteroposterior and oblique shoulder X-rays were read as unremarkable by the radiologist; a computed tomography of the shoulder confirmed a posterior shoulder dislocation. Given its efficacy and efficiency as compared to X-ray radiography, POCUS should be strongly considered in the diagnosis and management of posterior shoulder dislocations in the ED setting.

BACKGROUND: Musculoskeletal (MSK) spinal pain encapsulates various conditions including lumbar (low back), cervical (neck), and thoracic pain that significantly impact individual and global health. While clinical aspects of spinal pain have been well-studied, understanding patients\' personal narratives and lived experiences remains essential for enhancing patient-centered care, improving treatment adherence, and informing healthcare policies. It provides deep insights into the impacts of spinal pain, guiding more effective and empathetic treatment approaches. This systematic review aims to synthesize qualitative evidence on patients\' experiences with MSK spinal pain, providing insight into the challenges faced, coping strategies, daily life impacts, and healthcare interactions. The objective of this review is to synthesize the qualitative evidence regarding the lived experiences of patients with MSK spinal pain.
METHODS: This systematic review will use a meta-aggregation approach to synthesize data from qualitative studies, that will be identified through a comprehensive search of electronic databases and supplemented by grey literature searches. Two independent reviewers will screen, identify, and extract data from eligible studies. In cases of disagreement, conflicts will be resolved by consulting a third reviewer. These same reviewers will then use the Joanna Briggs Institute (JBI) qualitative quality assessment tool to evaluate the methodological quality of the identified studies, with the derived scores informing the synthesis process, that will involve extracting each study\'s findings along with their supporting illustrations, then grouped into categories based on similarity in meaning. These categories will then be aggregated to form synthesized findings.
CONCLUSIONS: Synthesized findings on patients\' lived experiences with MSK spinal pain including key themes, patterns, and insights will be presented. By emphasizing patient narratives, the results of the review can contribute to the optimization of outcomes, and to enhance patient-provider relations and improve quality of care in MSK spinal health.