OBJECTIVE: To investigate the effectiveness of intervention strategies for primary and secondary prevention of knee osteoarthritis (OA). DESIGN: Intervention systematic review of randomized controlled trials (RCTs). DATA SOURCES: The Medline, EMBASE, CINAHL, PEDro, and The Cochrane Library databases were searched from inception to June 10, 2025. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: RCTs evaluating interventions for primary/secondary knee OA prevention. Eligible trials targeted populations at-risk of developing knee OA or population with knee OA, and the outcome of interest must not have been present at study entry. Primary outcomes were self-reported knee pain and associated disability. Secondary outcomes included imaging features of knee joint structure and the incidence of knee arthroplasty. Data were synthesized narratively and reported as relative risks (RRs) with 95% Confidence Intervals (CIs). RESULTS: Five published reports from three RCTs (1481 participants) were included. We found evidence that a self-management lifestyle program for community-based women with BMI ≥ 25 kg/m 2 may reduce the risk of developing pain associated with knee OA at 12-months, when compared to a single education session (RR: 0.27, 95%CI: 0.16-0.46). There was uncertain evidence from four reports to draw conclusions about the effects of diet & exercise, glucosamine supplements, diet & exercise plus glucosamine supplements, and intra-articular sprifermin interventions for preventing or reducing Knee OA progression or arthroplasty. CONCLUSION: A self-management lifestyle program may be effective for reducing the risk of developing pain associated with knee OA in women with a BMI ≥ 25 kg/m 2 . Evidence for other preventive interventions remains uncertain.

OBJECTIVE: To describe the prevalence and predictors for upper extremity injury in pickleball players. DESIGN: Cross-sectional study METHODS: Pickleball players aged ≥18 years from across the United States were invited to take a pre-validated survey. The primary outcome was self-reported upper extremity all-complaint injuries (time-loss and non-time-loss) in the past 12 months. Collected through a survey, potential predictor variables were sex, age, playing time (amount per week), and perception of injury prevention programs. Injury prevalence was reported with 95% confidence intervals (CIs) and injury predictors were analyzed using multivariable logistics regression. RESULTS: 1758 athletes responded. 689 (95% CI: 37.0%–41.6%) players reported experiencing at least one upper extremity injury (male 42.0%; female 37.0%). 285 (95% CI: 14.5%–18.0%) reported time-loss injuries and 527 (95% CI: 27.7–32.1) experienced non-time-loss injuries. The most frequently cited injury types were chronic overuse conditions (41%), sprains (24%), strains (20%). The significant predictors of injury were male sex, increased frequency of play during the week, shorter play history, and decreased perceived importance of injury prevention. CONCLUSION: Upper extremity injuries in pickleball players were common; 1 in 3 athletes reported injuries annually. Non-time-loss and chronic injuries were the most common injuries.

OBJECTIVE: To explore patients’ understanding of how manual therapy works. DESIGN: Qualitative interview study. METHODS: Patients receiving outpatient physical therapy for a musculoskeletal condition were interviewed using an interpretive description research approach, and their responses were analyzed and coded into themes. An online survey was used to gather demographic data. RESULTS: Twenty six participants (mean [standard deviation] age: 60.5 [8.8]) were interviewed. Three major themes emerged and centered largely around the perceived outcomes, not mechanisms, of manual therapy: mechanical, neurophysiological, and psychological. Eight subthemes were extracted, the most common of which included 1) increased mobility, 2) improved circulation, 3) decreased pain, and 4) realignment of the body. CONCLUSION: Patients’ understanding of how manual therapy works centered on mechanical, neurophysiological, and psychological effects. Patients believed that structural changes occurred during manual therapy treatment, ultimately impacting their overall outcomes. Providers should be aware of patients’ beliefs when using manual therapy interventions.

OBJECTIVE: To evaluate the 3D kinematics of the scapula and trunk during a kneeling anterior/posterior movement in asymptomatic adults, (a) without resistance and (b) with two complementary resistance arrangements integrating the kinetic chain. DESIGN: A controlled laboratory study using within-group comparisons. METHODS: Thirty-six healthy young adults of both sexes, and without shoulder or lower quadrant problems, participated in this study. Three-dimensional scapular kinematics were recorded with an electromagnetic tracking device during shoulder elevation for both the unloading (active) and loading (resisted) conditions. Data for scapular and trunk kinematics were analyzed at 15°, 30°, 60°, 90°, and 120° of humerothoracic elevation and lowering. A repeated measures ANOVA was conducted to investigate different interactions between resistance, phase, and humerothoracic elevation for scapular and trunk kinematics. RESULTS: There was an effect of resistance on internal/external rotation and anterior/posterior tilt, and an effect of phase on anterior/posterior tilt. Trunk motion and resistance influenced axial rotation and lateral flexion, while phase impacted lateral flexion and extension. The scapula exhibited an interaction between phase-by-humerothoracic elevation at 60° of internal rotation during the lowering phase and between resistance-by-humerothoracic elevation at 15° and 60° for upward rotation. Increased resistance induced an anterior tilt of the scapula during the arm raising phase. The trunk exhibited an interaction between phase-by-humerothoracic elevation range 15-30° of lowering phase. There were no significant differences in scapulohumeral rhythm. CONCLUSION: Increased resistance impacted scapular and trunk kinematics, significantly enhancing stability but not altering scapulohumeral rhythm.

OBJECTIVE: To determine the effectiveness of physical therapy (PT) management and pain neuroscience education (PNE) combined for patients with musculoskeletal pain while undergoing rehabilitation for substance use disorder (SUD). DESIGN: Quality improvement project using a quasi-experimental cohort design METHODS: Two female addiction recovery care (ARC) centers participated by completing 2 outcome measures: the Central Sensitization Inventory (CSI) and a novel questionnaire called the Recovery Exercise Program Index (REP Index). At ARC 1, participants received individualized and group PT and PNE interventions. ARC 2 participants received no additional interventions beyond the standard of care. Outcome measures were collected at baseline and 30 days later at both centers. A 2×2 repeated measure analysis of variance (ANOVA) model was used to compare group-by-time interactions to determine the effect the intervention had on each measure. RESULTS: The CSI ANOVA demonstrated a significant group-by-time interaction ( P<.001). The post hoc analysis at the follow-up assessment revealed improved and significantly lower scores at ARC 1 (31.0 ± 11.6) compared to ARC 2 (43.3 ± 13.6) ( P<.001). The REP Index ANOVA demonstrated a significant group-by-time interaction ( P = .002). The post hoc analysis at the follow-up assessment showed improved and significantly lower scores at ARC 1 (15.9 ± 6.4) compared to ARC 2 (31.1 ± 8.3) ( P<.001). CONCLUSION: Providing both individual PT management and PNE for 1 month to the unique patient population with chronic musculoskeletal pain undergoing SUD appears to have a positive effect during recovery by reducing CS. JOSPT Open 2025;3(3):354-361. Epub 24 April 2025. doi:10.2519/josptopen.2025.0111

To evaluate how initiating physical therapy (PT) early affected (1) case duration and (2) the number of PT visits, in patients with acute work-related musculoskeletal disorders (WMSDs). A retrospective cohort study of 83 846 patients with WMSDs who were receiving occupational health services between January 1, 2021, and December 31, 2022. Patients were categorized according to the time from injury to initiating PT (0-2 days, 3-7 days, 8-12 days, and 13+ days). Descriptive statistics were used to analyze case duration and PT visits across 7 diagnostic groups (lumbar spine, thoracic spine, cervical spine, shoulder/humerus, elbow/wrist/hand, knee, and ankle/foot). Kruskal-Wallis tests assessed the impact of PT timing on outcomes. Initiating PT early (0-2 days) was associated with significantly shorter case durations and fewer PT visits across all diagnostic groups. The median case duration for early PT was 14 days, compared to 28 days for initiating PT later (13+ days). Similarly, the early PT group required fewer PT visits (median: 4) than the late PT group (median: 5). These trends were consistent across all diagnostic groups. Initiating PT early, particularly within the first 2 days postinjury, was associated with shorter case durations and fewer PT sessions in people with acute WMSDs. Standardizing early PT protocols in occupational health settings could improve case durations and reduce health care use.

OBJECTIVE: To compare, during shoulder proprioceptive testing (kinesthesia, active and passive joint position sense), (1) proprioception acuity between participants with and without subacromial pain syndrome (SPS) and (2) proprioception acuity and pain intensity across various arm and body positions. DESIGN: Cross-sectional study. METHODS: Forty participants with SPS and forty asymptomatic participants were included. Proprioceptive testing was performed to assess passive and active joint position sense, as well as kinesthesia, during lateral and medial shoulder rotations using an isokinetic dynamometer. Testing was conducted in 2 positions: sitting with 60° of shoulder elevation in the scapular plane and supine with 90° shoulder abduction. Pain intensity was recorded after each test. RESULTS: The SPS group showed greater errors in passive joint position sense (lateral rotation) in the sitting position, as well as in kinesthesia in the sitting (for both medial and lateral rotations) and supine (for medial rotation) positions. The SPS group had greater errors in the sitting position, while the supine position was reported as more painful during kinesthesia tests for medial and lateral rotations. CONCLUSION: Certain subcategories of shoulder proprioception, such as passive joint position sense and kinesthesia, may be impaired in individuals with SPS. The position of the participant’s arm appeared to influence proprioceptive acuity. JOSPT Open 2025;3(2):1-8. Epub 17 January 2025. doi:10.2519/josptopen.2025.0064

These abstracts are presented here as prepared by the authors. The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract, OPL designates an Academy of Orthopaedic Physical Therapy platform presentation. JOSPT Open 2025;3(2):CSM1-CSM30. Epub 31 January 2025. doi:10.2519/josptopen.2025.AOPTCSM1

OBJECTIVES: To compare knee abduction moment (KAM) magnitudes between a generic 180° pivot turn (modified 505 change-of-direction test [m505]) and a handball-specific sidestep cut, to assess ranking consistency, and to examine the resultant ground reaction force (GRF) and its frontal plane moment arm to the knee to comprehend their contributions to KAM. STUDY DESIGN: Observational laboratory study. METHODS: High-level female handball players (n = 45) performed the m505 and the handball-specific sidestep cut. The resultant GRF and its frontal plane moment arm to the knee as well as KAM were obtained and subsequently compared between tasks. Rank correlation coefficients were employed to assess if the variables of both tasks were related. RESULTS: Peak KAM was similar for the m505 and the sidestep cut (median [range], 1.79 [0.95-3.53] Nm/kg vs 1.64 [0.34-3.60] Nm/kg; rb = .25; P = .14). The ranking of the players’ peak KAM differed substantially ( rs = .26; P = .084), suggesting that different tasks could classify the same player with different injury risk. The m505 generated lower resultant GRFs (24 ± 4 N/kg, 95% CI [23, 24] vs 33 ± 9 N/kg, 95% CI [31, 35]; d = 1.30; P<.001) but longer frontal plane moment arms (7.8 ± 1.8 cm, 95% CI [7.3, 8.4] vs 5.4 ± 1.5 cm, 95% CI [5.0, 5.8]; d = 1.36; P<.001) compared to those generated by the sidestep cut. CONCLUSION: A difference in individual anterior cruciate ligament injury risk assessment depending on movement type was revealed. While KAM magnitudes were similar across direction-change tasks, player rankings differed. The contributions of resultant GRF and frontal plane moment arms to peak KAM varied between tasks, underscoring the importance of task-specific and individualized injury prevention. JOSPT Open 2025;3(2):1-9. Epub 4 December 2024. doi:10.2519/josptopen.2024.0076

OBJECTIVE: To refine and evaluate the content validity of a bank of items representing the physical, social, and motivation behaviors associated with youth sport specialization. DESIGN: Qualitative analysis. METHODS: The conceptual framework for item generation involved an existing consensus-based definition of youth sport specialization. Purposive sampling recruited English-literate youth athletes who participated in at least 1 organized sport in the past 12 months to participate in individual cognitive interviews. Three rounds of interviews used a “read aloud, think aloud” strategy to evaluate the comprehension, relevance, and comprehensiveness of the items and their response structure. One reviewer conducted thematic analysis of verbatim transcripts following rounds 1 to 2; after round 3, 2 independent reviewers evaluated the content validity of all items. The full research team reviewed results and established consensus regarding item acceptance, revision, or removal. RESULTS: Twenty-two participants (64% male, 13.8±3.0 years) were interviewed. Participants were classified as low (59%), moderate (23%), and high (18%) specialization. Thirty-one items organized into participation volume, physical, motivation, and social domains were tested. Comprehension of 24 items in the physical (n = 6), motivation (n = 12), and social (n = 6) domains was acceptable. No participation volume items achieved content validity. Acceptable items were considered relevant to youth sport specialization, and the item bank was deemed comprehensive. Participants affirmed the response structure was easy to understand and use. CONCLUSION: Content validity was established for a bank of patient-reported items assessing youth sport specialization. An appropriate next step is to conduct psychometric evaluation and develop a youth sport specialization assessment. JOSPT Open 2025;3(1):22-29. Epub 02 October 2024. doi:10.2519/josptopen.2024.0065