Rotator cuff (RC) muscles give the shoulder joint stability in addition to movement. The case report outlines the physical rehabilitation therapy, condition evaluation, and diagnostic testing that was given to a 62-year-old female field worker who had been complaining of pain in her left shoulder. To improve functional mobility and lessen discomfort, the patient underwent physiotherapy. In this instance, a physical therapy program was put in place to treat rotator cuff syndrome (RCS), enhance range of motion (ROM), and promote long-term recovery. Part of the assessment included a detailed examination of the biomechanics and potential mitigating variables for the persistent problems. The intervention plan\'s multimodal approach comprised physical therapy, stretching, and strengthening exercises, as well as patient counseling and health management education. Throughout the physiotherapy sessions, the patient\'s functional mobility improved and their level of discomfort gradually decreased. This case adds to the body of knowledge regarding successful physiotherapy techniques for RC injuries by emphasizing the value of a comprehensive approach to help patients with chronic shoulder pain achieve favorable outcomes. It also highlights how crucial it is to treat chronic RCS with a customized physical therapy program that takes into account the patient\'s unique preferences and characteristics that can exacerbate the problem.

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.
OBJECTIVE: Our analysis examined how waiting times and the number of treatments influenced physiotherapy outcomes for MSK conditions.
METHODS: 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.

Adults with shoulder pain often have partial rotator cuff injuries (RCIs) as the underlying cause. RC partial tears are one of the common conditions that can have a major influence on a wide range of people, including sportspeople, workers, and sedentary adults with rotator cuff syndrome (RCS). Any injury, disease, or deteriorating condition that affects the shoulder\'s RC muscles and tendons is recognized as RCS. Subacromial bursitis, RC tendonitis, subacromial impingement syndrome (SIS), rotator cuff tears (RCTs), etc., are a few disorders linked to RCS. For partial RCT, nonoperative treatment options include physical therapy, anti-inflammatories, analgesics, medication, rest or activity adjustments, and corticosteroid injections. We present the case of a 65-year-old male farmer by occupation, suffering from an RCI on the right side. Following a history of trauma to the right shoulder from a collision with a bull on his farm, the patient complained of pain and limitations in his right shoulder joint. The goal of the rehabilitation program was to maximize the patient\'s recovery through pain management, range-of-motion (ROM) restoration, muscle strength building, and functional activities. To improve muscular strength and preserve the ROM, strengthening exercises and isometrics were all incorporated into the rehabilitation regimen at the same time. The patient\'s progress was monitored at scheduled times during rehabilitation using the disabilities of arm, shoulder, and hand (DASH) score, visual analog scale (VAS), goniometer for normal ROM, and the upper extremity functional scale (UEFS). In this case study, the care and recovery of a patient with RC tendinopathy who received physical therapy are examined.

In response to the COVID-19 pandemic, face-to-face consultations within healthcare settings were suspended. Remote consultations became crucial for managing musculoskeletal conditions alongside Patient Initiated Follow-ups, leading to the development of the DiAL programme at a large National Health Service Community Trust. Previous research has focused on quantitative data, little is known about staff experiences with this programme.
To explore the perceptions and opinions of physiotherapy staff using DiAL, in order to highlight the benefits and challenges of this service with identification of areas for future development.
Qualitative focus groups.
Two virtual focus groups were conducted via Microsoft Teams, involving a purposive sample of physiotherapy staff in the musculoskeletal services known to have used DiAL. Thematic analysis was conducted.
Ten clinicians participated in the study, generating two main themes: Clinician Autonomy and Institutional Needs. These themes encompassed several subthemes.
Clinicians reported higher job satisfaction and improved accessibility for patients, attributing these positive outcomes to the autonomy and flexibility provided by the platform. While the programme met National Health Service targets for Patient Initiated Follow-ups, there was a desire for ongoing improvements and a recognition that previous audits failed to capture all the benefits. DiAL serves as a treatment choice, supporting evidence on the advantages of remote consultations and contributing to the National Health Services\' goal of reducing its carbon footprint. There is a collective desire for the platform to continue with future recommendations including expanding its use and exploring additional audit metrics.

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.
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.
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.
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.

BACKGROUND: Myogenic temporomandibular disorders (M-TMD) commonly involve occlusal splint (OS) therapy and musculoskeletal physiotherapy (MPT).
OBJECTIVE: To compare the effects of combining OS with MPT and education (EG) against OS and education (CG), in chronic M-TMD patients.
METHODS: In this double-blind randomised controlled trial, 62 participants were assigned to either EG or CG. The primary outcomes, pain levels at rest (VAS rest), maximum oral opening (VAS open) and during chewing (VAS chew), were measured by Visual Analogue Scale (VAS) in cm. The secondary outcome was the range of motion (ROM) for maximum oral opening. Both interventions lasted 3 months, with outcomes assessed at baseline (T0), post-treatment (T1) and 3 months post-treatment (T2).
RESULTS: Intention-to-treat analysis revealed significant improvements favouring EG (VAS rest = -1.50 cm [CI95%: -2.67, -0.32], p = .04; VAS open = -2.00 cm [CI95%: -3.23, -0.75], p < .01; VAS chew = -1.71 cm [CI95%: -2.90, -0.52], p = .01; ROM = 4.61 [CI95%: 0.93, 8.30], p = .04). Additionally, VAS measures were influenced by follow-up times (VAS rest = -0.73 cm [CI95%: -1.30, -0.17], p = 0.03; VAS open = -0.97 cm [CI95%: -1.57, -0.37], p < .01; VAS chew = -1.15 cm [CI95%: -1.73, -0.58], p < .01). At T1, EG demonstrated higher number of responders compared to CG for VAS open (χ2(1) = 4.39, p = .04) and VAS chew (χ2(1) = 11.58, p < .01).
CONCLUSIONS: Adding MPT to education and OS yields better outcomes in terms of pain reduction and ROM improvement, in chronic M-TMD.
BACKGROUND: NCT03726060.

Contextual factors such as patient expectations and financial pressures are overlooked challenges for Physiotherapists (PTs) and other rehabilitation professionals trying to implement evidence-based practice (EBP), particularly in private practice settings. In today\'s hypercompetitive pain management market, PTs may risk detrimental impacts to their reputation and livelihood if they do not give patients what they want, even if what they want does not align with clinical guidelines and research evidence. The aim of this professional practice paper is to shed light on these real-world challenges and encourage discussion among the PT community about strategies to increase uptake of EBP that involve multiple stakeholders such as PT training programs, professional organizations, researchers and clinic owners, which all have a role to play in supporting the translation of evidence into practice in our profession.

Musculoskeletal pain treatments are widespread in the clinical practice of physiotherapists. A multifaceted biopsychosocial approach should guide modern pain therapy. The study aimed to investigate the association of musculoskeletal problems with lifestyle behaviors. The study adopted a qualitative literature review methodology. About 200 papers have been reviewed for this study. The categories of the study had been classified according to the factors that are interconnected to the life intervention. The inclusion criteria of the selected literature depend upon the data received. This is a review-based study. The results of cross-sectional and correlational analysis dominated the literature on lifestyle implications on musculoskeletal health, which included pain and its correlated inflammation. Long-term prospective studies, however, are difficult to enroll in due to ethical concerns about denying patients\' therapies shown to benefit them, notably lifestyle behavior modification. By conducting intervention studies, it determines lifestyle modifications that determine the beneficial aspects. These aspects are avoiding and reducing pain by increasing exercise capacity. The study concluded that the quantity of beneficial health practices boosted the health-related quality of life. To achieve long-term health, the complexity of the behaviour change needs to be supported by the individual\'s lifestyle pattern and the support of the data. Therefore, in this century characterized by chronic lifestyle-related illnesses, various health behavior modifications may be claimed to be a primary therapeutic skill of health professionals (individually and collectively).

This qualitative study aimed to explore physiotherapists\' clinical reasoning when prescribing exercise for persons with musculoskeletal disorders.
A constructivist grounded theory inspired methodological approach was used. Six physiotherapists working in the United Kingdom were recruited via purposive sampling. Data collection and analysis included semi-structured interviews, memo writing, coding, and a constant comparative method.
A concept of \'building bespoke exercise\' has been generated to conceptualise the participants\' clinical reasoning when prescribing exercise.
The findings of this study highlight processes of co-designing and co-constructing exercise programmes in collaboration with persons receiving care. Physiotherapists can use this study to reflect on their own clinical reasoning to inform their own practice.

OBJECTIVE: There are approximately 9000 physiotherapy assistants/support workers in the UK. Many of them work in NHS physiotherapy outpatient services treating patients with musculoskeletal conditions, but their role(s) are relatively undefined and as such there is considerable variation in the duties and tasks they undertake. This study aimed to explore current practice of UK musculoskeletal physiotherapists in relation to delegation to physiotherapy assistants/support workers.
METHODS: An online cross-sectional descriptive survey was designed and collected data on delegation practice and training in delegation. The survey was piloted with 10 physiotherapists. The final questionnaire was distributed via the interactive Chartered Society of Physiotherapy\'s website and the authors\' professional networks via Twitter. Responses were collected over a five-week-period from October to November 2020.
RESULTS: Of 302 survey responses, 232 were analysed (46 incomplete, 24 ineligible). The majority of respondents (66.3%, 154/232) had worked as physiotherapists for over 10 years. Most respondents indicated they had neither formal training (84%, 195/232) nor informal training (60.3%, 140/232) regarding how to delegate tasks. The clinical tasks most commonly delegated by physiotherapists were supervision of exercises (81.0%, 188/232) and walking aid provision (78.5%, 182/232) whereas the least delegated clinical task was the application of electrotherapy (19.8%, 46/232).
CONCLUSIONS: These survey results provide evidence for the need to improve training in delegation for both physiotherapists and physiotherapy assistants, and to ensure clearer delegation processes to facilitate good delegation practice in the musculoskeletal setting.