BACKGROUND & AIMS: BACKGROUND CONTEXT:A potential correlation between surgery for symptomatic adjacent segment degeneration (sASD) and the development of degenerative disease of the lumbar spine or osteoarthritis of the musculoskeletal joints remains to be determined. PURPOSE:To assess the rate of sASD following anterior cervical discectomy and fusion (ACDF), the rate of lumbar discectomy (LD), and rate of surgery performed for osteoarthritis at the joints of the musculoskeletal in a long term follow-up. STUDY DESIGN/SETTING:Cohort study OUTCOME MEASURES: Repeat procedure for sASD, microsurgical LD (MSD), and/or the musculoskeletal joints (shoulder, knee, hip). PATIENT SAMPLE:Retrospectively, a total of 833 consecutive patients who underwent ACDF for degenerative disorders ≥20 years ago were identified. Charts were reviewed for preoperative neurological status, smoking status, physical labor, and repeat procedures. Missing data lead to exclusion from follow-up assessment. METHODS:At final follow-up the need for pain medication, Neck disability index (NDI), and Odoms criteria were evaluated. An MRI was performed to assess the grade of degeneration of the cervical spine via the segmental degeneration index (SDI). Patients without (group 1) and with (group 2) repeat procedure for sASD were compared. RESULTS:Collectively, 313 patients met inclusion criteria and 136 patients were evaluated. The mean follow-up was 26 years. Clinical success rate according to Odoms was 85.3%, mean NDI was 14.4%, the rate of regular intake of pain medication was 14.7%, the rate of repeated procedure for sASD was 10.3%. MSD was performed in 23.5%, surgery for osteoarthritis of the shoulder, the hip, and the knee were performed in 11.8%, 6.9%, and 27.7%, respectively. The rate of MSD (p=.018) was significantly higher in group 2 compared to group 1. Gender, smoking status, surgery of the musculoskeletal joints, and the grade of degeneration of the cranial and caudal adjacent segments were similar between group 1 and group 2. CONCLUSION:The overall clinical success following ACDF was 85.3%. The rate of repeat procedure for sASD was 10.3% within 26 years. Patients with sASD had a significantly higher rate of MSD and poorer clinical outcome compared to patients without sASD.

背景与目标： 背景技术：有症状的邻近节段性变性（sASD）手术与腰椎退行性疾病或肌肉骨骼关节骨关节炎发展之间的潜在相关性尚待确定。
目的：评估长期随访中颈椎前路椎间盘切除术和融合术（ACDF）后sASD的发生率，腰椎间盘切除术（LD）的发生率以及肌肉骨骼关节骨关节炎的手术率。
研究设计/设置：队列研究结果指标：对sASD，显微外科手术LD（MSD）和/或肌肉骨骼关节（肩，膝，髋）重复操作。
病人样本：回顾性地，共鉴定出833例接受ACDF≥20年前的变性疾病的连续患者。复查图表以了解术前神经系统状况，吸烟状况，体力劳动和重复手术。缺少数据导致无法进行后续评估。
方法：在最后的随访中，评估了止痛药的需求，颈部残疾指数（NDI）和Odoms标准。进行了MRI，以通过节段性变性指数（SDI）评估颈椎变性的程度。比较了没有（第1组）和有（第2组）重复进行sASD的患者。
结果：共有313例患者符合入选标准，对136例患者进行了评估。平均随访时间为26年。根据Odoms的临床成功率为85.3％，平均NDI为14.4％，常规服用止痛药的比率为14.7％，重复进行sASD的比率为10.3％。 MSD手术率为23.5％，肩部，髋部和膝盖骨关节炎的手术率分别为11.8％，6.9％和27.7％。与第1组相比，第2组的MSD发生率（p = .018）明显更高。第1组和第2组之间的性别，吸烟状况，肌肉骨骼关节手术以及颅骨和尾端相邻节段的退化程度相似。第二组
结论：ACDF术后总的临床成功率为85.3％。 sASD的重复手术率在26年内为10.3％。与没有sASD的患者相比，患有sASD的患者的MSD发生率明显更高，而临床结局也较差。

BACKGROUND & AIMS: :Coronavirus disease 2019 (COVID-19) is an emerging pandemic disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the majority of patients who become infected with SARS-CoV-2 are asymptomatic or have mild symptoms, some patients develop severe symptoms that can permanently detract from their quality of life. SARS-CoV-2 is closely related to SARS-CoV-1, which causes severe acute respiratory syndrome (SARS). Both viruses infect the respiratory system, and there are direct and indirect effects of this infection on multiple organ systems, including the musculoskeletal system. Epidemiological data from the SARS pandemic of 2002 to 2004 identified myalgias, muscle dysfunction, osteoporosis, and osteonecrosis as common sequelae in patients with moderate and severe forms of this disease. Early studies have indicated that there is also considerable musculoskeletal dysfunction in some patients with COVID-19, although long-term follow-up studies have not yet been conducted. The purpose of this article was to summarize the known musculoskeletal pathologies in patients with SARS or COVID-19 and to combine this with computational modeling and biochemical signaling studies to predict musculoskeletal cellular targets and long-term consequences of the SARS-CoV-2 infection.

背景与目标： ：冠状病毒病2019（COVID-19）是由严重的急性呼吸系统综合症冠状病毒2（SARS-CoV-2）引起的新兴大流行性疾病。尽管大多数感染SARS-CoV-2的患者无症状或症状较轻，但有些患者出现严重症状，可能永久性地降低其生活质量。 SARS-CoV-2与SARS-CoV-1密切相关，后者会导致严重的急性呼吸道综合症（SARS）。两种病毒都感染呼吸系统，并且这种感染对包括肌肉骨骼系统在内的多个器官系统都有直接或间接的影响。 2002年至2004年SARS大流行的流行病学数据将肌痛，肌肉功能障碍，骨质疏松和骨坏死定为中度和重度形式的该病患者的常见后遗症。早期研究表明，尽管尚未进行长期随访研究，但某些COVID-19患者也存在相当大的肌肉骨骼功能障碍。本文的目的是总结SARS或COVID-19患者的已知肌肉骨骼病理，并将其与计算模型和生化信号研究相结合，以预测肌肉骨骼细胞靶标和SARS-CoV-2感染的长期后果。

BACKGROUND & AIMS: PURPOSE:To investigate the prevalence of musculoskeletal symptoms, defined as aches, pains, discomfort, or numbness, by using a validated assessment tool among interventional radiologists. MATERIALS AND METHODS:A Web-based survey using the Nordic Musculoskeletal Questionnaire was disseminated to interventional radiologist members by email in November 2015. Musculoskeletal symptoms were evaluated in 9 body areas. Information regarding participant demographics, practice details, use of radio-protective equipment, and exercise routines was also gathered. Univariate and multivariate analyses were performed to determine risk factors associated with more severe symptoms. RESULTS:Of 4,096 SIR members at the time of the survey, 640 completed the questionnaire in its entirety (16% response rate). Respondents consisted of 69 females (11%) and 571 males (89%), with a mean age of 47.5 ± 10.2 years old, a mean body mass index of 25.5 ± 3.9 kg/m2, and a mean practice length of 17.1 ± 9.8 years. Prevalence of musculoskeletal symptoms was 88% in the 12 months preceding the survey. For those reporting musculoskeletal issues, 58% attributed the symptoms to work-related activities. Lower back (61%), neck (56%), and shoulder complaints (46%) were the most common. Symptoms prevented 21.2% of respondents from being able to work over the same time period. Multivariate analysis identified female gender, above-normal body mass index, and a practice length of 10 years or more as factors associated with a higher risk of moderate-to-severe symptoms. CONCLUSIONS:Musculoskeletal symptoms are prevalent among interventional radiologists, the majority of which are attributed to work-related causes.

背景与目标： 目的：通过在放射介入医师中使用经过验证的评估工具，调查肌肉骨骼症状（定义为疼痛，疼痛，不适或麻木）的患病率。
材料与方法：2015年11月，通过电子邮件将基于北欧肌肉骨骼问卷的网络调查通过电子邮件散发给介入放射科医生。对9个身体部位的骨骼骨骼症状进行了评估。还收集了有关参与者的人口统计信息，练习细节，使用无线电防护设备以及锻炼程序的信息。进行单因素和多因素分析以确定与更严重症状相关的危险因素。
结果：在调查时有4,096名SIR成员中，有640名完成了调查问卷（答复率为16％）。受访者包括69位女性（11％）和571位男性（89％），平均年龄为47.5±10.2岁，平均体重指数为25.5±3.9 kg / m2，平均练习时长为17.1±9.8年。在调查前的12个月内，肌肉骨骼症状的患病率为88％。对于那些报告肌肉骨骼问题的人，有58％将症状归因于与工作有关的活动。下背部（61％），颈部（56％）和肩部不适（46％）是最常见的。症状使21.2％的受访者无法在同一时间工作。多变量分析确定女性性别，高于正常的体重指数和10年或更长时间的练习时长是与中度至重度症状的较高风险相关的因素。
结论：介入放射科医师中普遍存在肌肉骨骼症状，其中大部分是与工作有关的原因。

BACKGROUND & AIMS: :There is increasing concern about the emerging global non-communicable diseases (NCDs) burden. The focus has mainly been on NCDs in adults but it is important that MSK morbidity in both children and adults is included in strategic planning. There have been considerable advances in the understanding and treatment options for children and young people (CYP) and clinical outcomes are improving for those who can access such high quality care. However vast inequity exists and there are many CYP who live in areas of the world with high burden of health care challenges, compounded by paucity of specialist care and limited access to treatments. The Paediatric Global Musculoskeletal Task Force aims to raise awareness about unmet needs for CYP with MSK conditions, promotion of MSK health through lifestyle and the avoidance of injury. We aim to leverage change through 'working together better'.

背景与目标： ：人们越来越关注新兴的全球非传染性疾病（NCD）负担。重点主要放在成年人的非传染性疾病上，但重要的是将儿童和成年人的MSK发病率纳入战略规划中。对于儿童和年轻人（CYP）的理解和治疗选择已经有了长足的进步，并且对于那些可以获得这种高质量护理的人来说，临床结果正在改善。但是，存在着巨大的不平等现象，世界上有许多CYP居住在医疗保健挑战众多的地区，而专科护理的匮乏和获得治疗的机会也很有限。儿科全球肌肉骨骼工作队旨在提高人们对未满足MSP条件的CYP需求的认识，通过生活方式和避免伤害来促进MSK健康。我们的目标是通过“更好地合作”来利用变化。

BACKGROUND & AIMS: INTRODUCTION:It is well known that foot massage is a very prevalent stress relief method in China. Literatures have reported various massage-inducted peripheral nerve injuries. However, massage-inducted lateral plantar nerve (LPN) injury is very rare. Here, we represent an unusual case of massage-inducted LPN damage, and we also report the diagnostic method of this patient using musculoskeletal ultrasonography combined with electromyography (EMG). PATIENT CONCERNS:A 21-year-old woman presented symptoms of redness, swelling, pain and numbness in the medial right ankle joint for 2 days. DIAGNOSIS:The results of musculoskeletal ultrasonography and EMG provide great help for doctors to make accurate diagnosis. The patient was eventually diagnosed with LPN injury. INTERVENTIONS:No further foot massage was allowed. Vitamin B12 was taken orally for 2 months. Conservative therapy, including electrical stimulation therapy and infrared therapy, was conducted. Besides, active rehabilitation training was also performed. OUTCOMES:The discomfort symptoms were relieved significantly after 2 months conservative treatment. Clinical symptoms and EMG examination illustrated satisfactory result during follow up time. CONCLUSION:The report showed that the masseur should be very careful when doing foot massage to prevent nerve damage. Besides, musculoskeletal ultrasonography combined with EMG can provide important evidence for accurate and effective diagnosis of LPN injury.

背景与目标： 简介：众所周知，足部按摩在中国是一种非常普遍的缓解压力的方法。文献报道了各种按摩引起的周围神经损伤。然而，按摩引起的足底外侧神经（LPN）损伤非常罕见。在这里，我们代表了按摩引起的LPN损伤的罕见情况，我们还报告了使用肌肉骨骼超声检查结合肌电图检查（EMG）对该患者的诊断方法。
患者担忧：一名21岁的女性在右踝内侧关节出现发红，肿胀，疼痛和麻木的症状，持续了2天。
诊断：肌肉骨骼超声检查和肌电图检查的结果为医生进行准确的诊断提供了很大的帮助。该患者最终被诊断出患有LPN损伤。
干预措施：不允许进一步的足部按摩。口服维生素B12，持续2个月。进行了保守疗法，包括电刺激疗法和红外线疗法。此外，还进行了积极的康复训练。
结果：保守治疗2个月后，不适症状明显缓解。临床症状和肌电图检查显示随访期间结果令人满意。
结论：该报告表明，按摩师在进行足部按摩时应非常小心，以防止神经损伤。此外，肌肉骨骼超声检查结合肌电图检查可为准确，有效地诊断LPN损伤提供重要依据。

BACKGROUND & AIMS: BACKGROUND:Evidence points to clinicians' beliefs and practice behaviours related to low back pain (LBP), which are discordant with contemporary evidence. While interventions to align beliefs and behaviours with evidence among clinicians have demonstrated effectiveness, a more sustainable and cost-effective approach to positively developing workforce capacity in this area may be to target the emerging workforce. The aim of this study was to investigate beliefs and clinical recommendations for LBP, and their alignment to evidence, in Australian university allied health and medical students. METHODS:Final-year students in chiropractic, medicine, occupational therapy, pharmacy and physiotherapy disciplines in three Western Australian universities responded to a survey. Demographic data, LBP-related beliefs data [modified Health Care Providers Pain and Impact Relationship Scale (HC-PAIRS) and the Back Pain Beliefs Questionnaire (BBQ)] and activity, rest and work clinical recommendations for an acute LBP clinical vignette were collected. RESULTS:Six hundred two students completed the survey (response rate 74.6%). Cross-discipline differences in beliefs and clinical recommendations were observed (p > 0.001). Physiotherapy and chiropractic students reported significantly more helpful beliefs compared with the other disciplines, while pharmacy students reported the least helpful beliefs. A greater proportion of chiropractic and physiotherapy students reported guideline-consistent recommendations compared with other disciplines. HC-PAIRS and BBQ scores were strongly associated with clinical recommendations, independent to the discipline of study and prior experience of LBP. CONCLUSIONS:Aligning cross-discipline university curricula with current evidence may provide an opportunity to facilitate translation of this evidence into practice with a focus on a consistent, cross-discipline approach to LBP management.

背景与目标： 背景：证据表明临床医生的信念和与下腰痛（LBP）有关的行为，与现代证据不符。尽管在临床医生中采取干预措施使信念和行为与证据保持一致的做法已证明是有效的，但积极地发展该领域劳动力能力的更具可持续性和成本效益的方法可能是针对新兴劳动力。这项研究的目的是调查澳大利亚大学相关健康和医学专业学生对LBP的信念和临床建议，以及它们与证据的一致性。
方法：西澳大利亚州三所大学的脊骨疗法，医学，职业治疗，药学和物理疗法学科的大四学生对此进行了调查。收集了人口统计学数据，与LBP相关的信念数据[经修改的卫生保健提供者疼痛和影响关系量表（HC-PAIRS）和腰痛信念问卷（BBQ）]以及针对急性LBP临床小插图的活动，休息和工作的临床建议。
结果：602名学生完成了调查（回答率为74.6％）。观察到信念和临床建议的跨学科差异（p> 0.001）。与其他学科相比，理疗和脊骨疗法学生报告的帮助信念明显要多，而药学专业的学生报告的帮助信念最少。与其他学科相比，脊椎治疗和物理治疗学生中有更大比例的人报告了指南一致的建议。 HC-PAIRS和BBQ评分与临床建议密切相关，而与研究学科和LBP的既往经验无关。
结论：使跨学科的大学课程与当前的证据保持一致，可能会提供一个机会，以侧重于一致，跨学科的LBP管理方法为重点，将这一证据转化为实践。

BACKGROUND & AIMS: OBJECTIVES:The primary objective of the present study was to examine the role of sex as a moderator of the relation between depression and activity-related pain. METHODS:The study sample consisted of 83 participants (42 women, 41 men) with musculoskeletal conditions. Participants were asked to lift a series of 18 canisters that varied in weight (2.9 kg, 3.4 kg and 3.9 kg) and distance from the body. Participants were asked to rate their pain while they lifted each canister and estimate the weight of the canisters. RESULTS:Consistent with previous research, the relations among depression, pain intensity and disability were stronger for women than for men. ANOVA revealed that depression was associated with more intense activity-related pain in women only. For both women and men, the intensity of pain increased with each trial, although the weight of the objects lifted remained constant. Neither sex nor depression had an effect on participants' weight estimates. CONCLUSIONS:The present discussion addresses the mechanisms through which depression may differentially affect pain in women and men. It also addresses the potential clinical implications of pain-augmenting effects of depression in women.

背景与目标： 目的：本研究的主要目的是检验性别作为抑郁症和与活动有关的疼痛之间关系的调节者的作用。
方法：本研究样本由83位参与者（42名女性，41名男性）患有肌肉骨骼疾病组成。要求参与者提起一系列18个不同重量（2.9公斤，3.4公斤和3.9公斤）以及与身体的距离不同的罐。要求参与者在举起每个滤罐时评估他们的疼痛程度，并估算滤罐的重量。
结果：与先前的研究一致，女性抑郁症，疼痛强度和残疾之间的关系比男性强。方差分析显示，抑郁症仅与女性的剧烈活动相关的疼痛有关。对于男性和女性，每次试验都增加了疼痛的强度，尽管举起的物体的重量保持恒定。性别和抑郁都不会影响参与者的体重估计。
结论：本讨论讨论了抑郁症可能通过不同的方式影响男女疼痛的机制。它还解决了女性抑郁症的疼痛增强作用的潜在临床意义。

BACKGROUND & AIMS: :Musculoskeletal conditions (MSC) are common throughout the world and their impact on individuals is diverse and manifold. Knowledge of the determinants for disability and of strategies for prevention and rehabilitation management according to the scientific evidence is critical for reducing the burden of MSC. The first section of this chapter reviews the evidence for common determinants of functioning and disability in patients with MSC. We have focussed on environmental factors (EF) and personal factors (PF) and have structured them according to the International Classification of Functioning, Disability and Health (ICF) framework. The second section discusses prevention strategies. Generally, prevention needs to address those EF and PF that were presented in the first section. The final section describes modern principles of rehabilitation and reviews the evidence for specific rehabilitation interventions.

背景与目标： ：骨骼肌肉疾病（MSC）在世界各地都很普遍，它们对个人的影响是多种多样的。根据科学证据了解残疾的决定因素以及预防和康复管理的策略对于减轻MSC的负担至关重要。本章的第一部分回顾了MSC患者功能和残疾的常见决定因素的证据。我们专注于环境因素（EF）和个人因素（PF），并根据国际功能，残疾与健康分类（ICF）框架进行了结构化。第二部分讨论预防策略。通常，预防需要解决第一部分中介绍的那些EF和PF。最后一部分描述了康复的现代原理，并回顾了具体康复干预措施的证据。

BACKGROUND & AIMS: BACKGROUND:North American indigenous populations experience higher rates of obesity and chronic disease compared with nonindigenous populations. Improvements in musculoskeletal fitness can mitigate negative health outcomes, but is not well understood among indigenous populations. This review examines musculoskeletal fitness measures among North American indigenous populations. METHODS:A total of 1632 citations were evaluated and 18 studies were included. RESULTS:Comparisons of musculoskeletal fitness measures between North American indigenous men and boys and women and girls were generally not reported. The greatest left and right combined maximal grip strength and maximal leg strength among Inuit boys and men and girls and women were observed among 20-29 years age group. Maximal combined right and left grip strength declined from 1970 to 1990, by an average of 15% among adults and 10% among youth. Maximal leg extension among Inuit has declined even further, averaging 38% among adults and 27% among youth from 1970 to 1990. Inuit men demonstrate greater grip strength and lower leg strength than Russian indigenous men, whereas Inuit women demonstrate greater leg strength. CONCLUSIONS:Further research is needed to better understand physical fitness among indigenous peoples and the potential for improving health and reducing chronic disease risk for indigenous peoples through physical fitness.

背景与目标： 背景：与非土著居民相比，北美土著居民的肥胖和慢性病发病率更高。肌肉骨骼适应性的改善可以减轻负面的健康后果，但在土著居民中尚未得到很好的理解。这项审查审查了北美土著人口中的肌肉骨骼适应措施。
方法：总共对1632篇文献进行了评估，包括18项研究。
结果：一般没有报道北美土著男子和男孩与妇女和女孩之间的肌肉骨骼健身措施的比较。在20至29岁年龄段的人群中，因纽特人男女中最大的左右最大握力和最大腿部力量相结合。从1970年到1990年，左右手的最大组合力量下降了，成年人平均下降15％，青年平均下降10％。因纽特人的最大伸腿幅度甚至进一步下降，从1970年到1990年，成年人平均平均伸腿38％，青年平均27％。因纽特人男性比俄罗斯土著男子表现出更大的握力和更低的腿部力量，而因纽特人女性则表现出更大的腿部力量。
结论：需要进行进一步的研究，以更好地了解土著人民的身体适应性，以及通过身体适应性改善土著人民健康和减少慢性病风险的潜力。

BACKGROUND & AIMS: :Brachial plexus birth injury (BPBI) is the most common nerve injury among children. The glenohumeral joint of affected children can undergo severe osseous deformation and altered muscle properties, depending on location of the injury relative to the dorsal root ganglion (preganglionic or postganglionic). Preganglionic injury results in lower muscle mass and shorter optimal muscle length compared to postganglionic injury. We investigated whether these changes to muscle properties over time following BPBI provide a mechanically-driven explanation for observed differences in bone deformity between preganglionic and postganglionic BPBI. We developed a computational framework integrating musculoskeletal modeling to represent muscle changes over time and finite element modeling to simulate bone growth in response to mechanical and biological stimuli. The simulations predicted that the net glenohumeral joint loads in the postganglionic injury case were nearly 10.5% greater than in preganglionic. Predicted bone deformations were more severe in the postganglionic case, with the glenoid more declined (pre: -43.8°, post: -51.0°), flatter with higher radius of curvature (pre: 3.0 mm, post: 3.7 mm), and anteverted (pre: 2.53°, post: 4.93°) than in the preganglionic case. These simulated glenoid deformations were consistent with previous experimental studies. Thus, we concluded that the differences in muscle mass and length between the preganglionic and postganglionic injuries are critical mechanical drivers of the altered glenohumeral joint shape.

背景与目标： ：臂丛神经损伤（BPBI）是儿童中最常见的神经损伤。患儿的盂肱关节可能会发生严重的骨变形和改变的肌肉特性，具体取决于损伤相对于背根神经节（神经节前或神经节后）的位置。与神经节后损伤相比，神经节前损伤导致较低的肌肉质量和较短的最佳肌肉长度。我们调查了BPBI之后这些随时间变化的肌肉特性是否为观察到的节前和节后BPBI之间的骨变形差异提供了机械驱动的解释。我们开发了一个计算框架，该框架集成了代表肌肉随时间变化的肌肉骨骼模型和有限元模型，以模拟对机械和生物刺激的骨骼生长。模拟预测神经节后损伤病例的盂肱关节净载荷比神经节前损伤高近10.5％。神经节后病例中预测的骨变形更为严重，关节盂下降更多（前：-43.8°，后：-51.0°），曲率半径更大（前：3.0mm，后：3.7mm），并且弯曲（前：2.53°，后：4.93°）。这些模拟的关节盂变形与先前的实验研究一致。因此，我们得出结论，神经节前和神经节后损伤之间的肌肉质量和长度差异是改变肱肱关节形状的关键机械驱动因素。

BACKGROUND & AIMS: :Musculoskeletal disorders are prevalent and a major burden on individuals and society. Information on relationships of patient involvement and responsibility to outcome is limited. This study aimed to explore relationships between self-reported outcome of physiotherapy treatment and attitudes toward responsibility for musculoskeletal disorders. A cross-sectional postal survey design was used. Patients (n=615) from an outpatient physiotherapy clinic, who had finished their physiotherapy treatment within the last 6 months were sent a questionnaire that included the Attitudes regarding Responsibility for Musculoskeletal disorders instrument (ARM), self-reported outcome of treatment and sociodemographic data. A total of 279 (45%) completed forms were returned. Multiple logistic regression analysis was used. The patients' scores on the four dimensions of ARM ("responsibility self active," "responsibility out of my hands," "responsibility employer," and "responsibility medical professionals"), controlled for age, sex, education, and physical activity as well as for number of treatments, main treatment, and physiotherapist, were associated with the patients' self-reported treatment outcome. Patients who attributed responsibility more to themselves were more likely (OR 2.37 and over) to report considerable improvement as the outcome of physiotherapy treatment. Because this study was conducted at only one physiotherapy outpatient clinic and had a cross-sectional design, the results should be replicated in other settings. Because patients' attitudes regarding responsibility for musculoskeletal disorders can possibly affect the outcome of physiotherapy treatment, it might be useful to decide whether to systematically try to influence the person's attitude toward responsibility for the management of the disorder or to match treatment to attitude.

背景与目标： ：骨骼肌肉疾病普遍存在，对个人和社会构成重大负担。关于患者参与和对结果的责任关系的信息有限。这项研究旨在探讨自我报告的理疗结果与对肌肉骨骼疾病责任感的态度之间的关系。使用横断面邮政调查设计。向门诊理疗诊所的患者（n = 615）过去6个月内完成理疗的患者发送了一份调查问卷，其中包括对肌肉骨骼疾病仪器的态度（ARM），自我报告的治疗结果和社会人口统计学数据。总共返回了279张（45％）已填写的表格。使用多元逻辑回归分析。患者在ARM的四个维度上得分（“责任自我活跃”，“失控责任”，“责任雇主”和“责任医务人员”）按年龄，性别，教育程度和体育锻炼进行控制以及就治疗次数而言，主要治疗方法和物理治疗师均与患者自我报告的治疗结果相关。归因于自己的责任更大的患者更有可能（OR 2.37及以上）报告其作为理疗治疗结果的显着改善。由于这项研究仅在一个理疗门诊诊所进行，并且具有横断面设计，因此该结果应在其他环境中复制。由于患者对肌肉骨骼疾病责任感的态度可能会影响理疗治疗的结果，因此决定系统地尝试影响患者对疾病管理责任的态度还是将治疗与态度相匹配可能会很有用。

BACKGROUND & AIMS: :There is a vacuum for a practice discipline of nursing that would enable nurses to articulate the significance of what they do as an essential thread of contemporary healthcare provision. This article is an effort to develop the meaning and possibilities of a practice discipline for nursing. Tuning into the general shift in thought about our human condition across disciplines and nations, we consider features of a participatory paradigm, which, when refocused on the humanness of the health circumstance, informs our approach to a practice discipline. Knowledge is personal and participatory, evolving in the here-and-now of health systems. Research integral to practice and service innovation illustrates the way of looking and talking about a new phase in discipline development. The discipline is relational and creative in practice, evolving in the forums for dialogue. Each one of us as nurses has responsibility in participation.

背景与目标： ：护理实践学科存在真空，使护士能够阐明他们所做的作为当代医疗保健必不可少的内容的重要性。本文旨在发展护理实践学科的意义和可能性。适应跨学科和跨国家的人类状况的思想的总体转变，我们考虑参与式范式的特征，当重新关注健康状况的人性时，该范式便为我们采用实践学科提供了依据。知识是个人和参与性的，并在当今和现在的卫生系统中不断发展。实践和服务创新不可或缺的研究说明了如何看待和谈论学科发展的新阶段。该学科在实践中具有关系性和创造性，并在对话论坛中不断发展。我们每个人作为护士都有责任参与。

BACKGROUND & AIMS: :A pair of ischiopagus tetrapus twins were successfully separated in Calcutta in 1986. The gastrointestinal tracts were separated at a preliminary operation, and the definitive operation was performed 3 months later. Four iliac osteotomies, division of symphysis pubes, and reconstruction of individual pelves with dissection and separation of pelvic organs alloted to individual twins were the procedures performed in the definitive operation. The musculoskeletal results have been excellent in the present case.

背景与目标： ：1986年在加尔各答成功分离出一对双足is虫双生双胞胎。在初步手术中分离了胃肠道，并在3个月后进行了最终手术。确定性手术的方法是进行四次骨截骨术，耻骨联合分离术，单个骨的重建以及解剖和分离分配给单个双胞胎的骨盆器官。在当前情况下，肌肉骨骼的效果非常好。

BACKGROUND & AIMS: INTRODUCTION:Noncombat injuries ("injuries") threaten soldier health and United States (U.S.) Army medical readiness, accounting for more than twice as many outpatient medical encounters among active component (AC) soldiers as behavioral health conditions (the second leading cause of outpatient visits). Noncombat musculoskeletal injuries (MSKIs) account for more than 80% of soldiers' injuries and 65% of medically nondeployable AC soldiers. This review focuses on MSKI risk reduction initiatives, management, and reporting challenges within the Army. The authors will summarize MSKI risk reduction efforts and challenges affecting MSKI management and reporting within the U.S. Army. MATERIALS/METHODS:This review focuses on (1) initiatives to reduce the impact of MSKIs and risk for chronic injury/pain or long-term disability and (2) MSKI reporting challenges. This review excludes combat or battle injuries. RESULTS:Primary risk reduction Adherence to standardized exercise programming has reduced injury risk among trainees. Preaccession physical fitness screening may identify individuals at risk for injury or attrition during initial entry training. Forward-based strength and conditioning coaching (provided in the unit footprint) and nutritional supplementation initiatives are promising, but results are currently inconclusive concerning injury risk reduction. SECONDARY RISK REDUCTION:Forward-based access to MSKI care provided by embedded athletic trainers and physical therapists within military units or primary care clinics holds promise for reducing MSKI-related limited duty days and nondeployability among AC soldiers. Early point-of-care screening for psychosocial risk factors affecting responsiveness to MSKI intervention may reduce risk for progression to chronic pain or long-term disability. TERTIARY RISK REDUCTION:Operational MSKI metrics enable commanders and clinicians to readily identify soldiers with nonresolving MSKIs. Monthly injury reports to Army leadership increase command focus on soldiers with nonresolving MSKIs. CONCLUSIONS:Standardized exercise programming has reduced trainee MSKI rates. Secondary risk reduction initiatives show promise for reducing MSKI-related duty limitations and nondeployability among AC soldiers; timely identification/evaluation and appropriate, early management of MSKIs are essential. Tertiary risk reduction initiatives show promise for identifying soldiers whose chronic musculoskeletal conditions may render them unfit for continued military service.Clinicians must document MSKI care with sufficient specificity (including diagnosis and external cause coding) to enable large-scale systematic MSKI surveillance and analysis informing focused MSKI risk reduction efforts. Historical changes in surveillance methods and injury definitions make it difficult to compare injury rates and trends over time. However, the U.S. Army's standardized injury taxonomy will enable consistent classification of current and future injuries by mechanism of energy transfer and diagnosis. The Army's electronic physical profiling system further enablesstandardized documentation of MSKI-related duty/work restrictions and mechanisms of injury. These evolving surveillance tools ideally ensure continual advancement of military injury surveillance and serve as models for other military and civilian health care organizations.

背景与目标： 简介：非战斗伤害（“伤害”）威胁着士兵的健康，而美国（美）军的医疗状况也好，占活动成分（AC）士兵中门诊医疗遭遇的两倍多，是行为健康状况（门诊的第二大诱因）访问）。非战斗型肌肉骨骼伤害（MSKI）占士兵伤害的80％以上，在医疗上无法部署的AC士兵中占65％。此次审查的重点是陆军内部MSKI风险降低计划，管理和报告挑战。作者将总结减少MSKI风险的努力以及影响美军内部MSKI管理和报告的挑战。
材料/方法：这篇综述着重于（1）减少MSKI的影响和减少慢性伤害/疼痛或长期残疾风险的举措，以及（2）MSKI报告面临的挑战。此评论不包括战斗或战斗伤害。
结果：降低主要风险遵循标准化的锻炼计划，可以减少受训人员的受伤风险。入组前的体能筛查可以识别在初次进入训练过程中有受伤或磨损风险的个人。前瞻性力量和条件教练（在单位占地面积中提供）和营养补充计划很有希望，但是就减少伤害风险而言，目前尚无定论。
降低二次风险：由军事单位或初级保健诊所内的嵌入式运动培训师和物理治疗师提供的基于MSKI护理的前向访问方式有望减少与MSKI相关的有限工作日和AC士兵的不可部署性。对影响MSKI干预反应性的社会心理风险因素进行早期医疗点筛查，可以降低发展为慢性疼痛或长期残疾的风险。
降低三级风险：MSKI作战指标使指挥官和临床医生能够轻松识别出具有无法解决的MSKI的士兵。向陆军领导层提交的每月伤害报告将命令重点放在使用未解决MSKI的士兵上。
结论：标准化的运动计划降低了学员的MSKI率。降低次级风险的举措显示出有望减少与ACKI相关的职责限制和AC士兵的不可部署性；及时识别/评估以及适当，早期地管理MSKI至关重要。降低第三级风险倡议显示出潜力，可以识别出那些慢性肌肉骨骼疾病可能使其不适合继续服兵役的士兵。临床医生必须以足够的特异性记录MSKI护理（包括诊断和外部原因编码），以进行大规模的系统MSKI监视和分析，从而使重点关注MSKI降低风险的努力。监视方法和伤害定义的历史变化使得很难比较伤害率和随时间变化的趋势。但是，美国陆军的标准化伤害分类法将通过能量转移和诊断机制对当前和将来的伤害进行一致的分类。陆军的电子物理配置文件系统进一步实现了与MSKI相关的职责/工作限制和伤害机制的标准化记录。这些不断发展的监视工具可以理想地确保军事伤害监视的持续发展，并可以作为其他军事和平民医疗保健组织的模型。

BACKGROUND & AIMS: :Musculoskeletal conditions are a major cause of morbidity and evidence-based strategies--such as the European Action Towards Better Musculoskeletal Health--have been developed to reduce their incidence and impact on individuals and on society. This issue is based around that report. These strategies are inclusive of all major musculoskeletal conditions with recommendations for prevention and management, stratified for degree of risk in the population. The development of these strategies required a framework that would enable the integration of evidence and expert opinion and the development of this is discussed. Implementation must be addressed if these strategies are to be effective and the actions required of, and implications for, different stakeholders are considered. In that report, we find evidence to support the need for an integrated approach for improving musculoskeletal health, by an improvement by the whole population in lifestyle with increasing physical activity, avoidance of obesity, smoking and excess alcohol along with prevention of accidents and musculoskeletal injuries. However, the individual health gain will be small and, in addition, specific interventions need to be targeted at those with most to gain--i.e. those at highest risk or those with the early features of a musculoskeletal condition.

背景与目标： ：骨骼肌肉疾病是发病的主要原因，基于证据的策略（例如，欧洲旨在改善骨骼肌肉健康的行动）已被开发出来，以减少其发病率以及对个人和社会的影响。此问题基于该报告。这些策略包括所有主要的肌肉骨骼疾病，并针对人群的风险程度进行了分层的预防和管理建议。这些策略的制定需要一个框架，以使证据和专家意见的整合成为可能，并对此进行了讨论。如果要使这些策略有效，并且必须考虑到不同利益相关者需要采取的行动以及对不同利益相关者的影响，则必须解决实施问题。在该报告中，我们找到了证据来证明有必要采取综合方法来改善肌肉骨骼健康，这是通过改善整体生活方式，增加体育锻炼，避免肥胖，吸烟和过量饮酒以及预防事故和骨骼肌肉受伤来改善整体肌肉骨骼健康。但是，个人的健康收益将很小，此外，还需要针对那些受益最多的人采取具体的干预措施。那些处于最高风险中或具有肌肉骨骼疾病早期特征的人。