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Primary Care Education in Musculoskeletal Disease
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Primary Care Education in Musculoskeletal Disease

A special issue of Rheumato (ISSN 2674-0621).

Deadline for manuscript submissions: closed (25 October 2024) | Viewed by 14946

Special Issue Editor

Prof. Dr. Bruce M. Rothschild

E-Mail Website
Guest Editor
Department of Medicine, Indiana University Ball, Memorial Hospital, Muncie, IN, USA
Interests: rheumatology; skeletal impact of disease; skeletal radiology; paleopathology; history of disease; examination of premises utilized in recognition of disease in skeletons
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Primary care physicians seem ill-trained and educated to address the preponderance of musculoskeletal problems that constitute up to 40% of clinical practice and usually lack timely access to specialists (e.g., rheumatologists). Medical school education and residency training programs have tremendous challenges related to incorporating advances in understanding new diseases and intervention approaches. They have generally not succeeded in this task. Addressing the increased information base is complex, especially in view of their artificial time limitations.  Post-residency education and training has fared little better. The bedside/office experiences specifically need to be organized to assure exposure to and participation in the full spectrum of that specialty’s or subspecialty’s practice and not relegated to the fortuitous problems inherent to routine patient appointments. Inpatient rotations typically provide a very biased prevue of rheumatologic diseases, providing little perspective of routine management approaches and their efficacy.

This Special Issue invites insights that may improve the ability of primary care physicians to at least provide initial evidence-based care for the preponderance of office-based rheumatologic challenges. Descriptions of designs for appropriate education/training and evaluation of their efficacy are invited. The resultant issue will provide unique guidance for the development of such programs.

Prof. Dr. Bruce M. Rothschild
Guest Editor

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. Rheumato is an international peer-reviewed open access quarterly 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 1000 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

  • primary care
  • rheumatoid arthritis
  • physical therapy
  • occupational therapy
  • mechanical forms of arthritis
  • recognition of systemic disease
  • recognition of how and when to consult

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Published Papers (6 papers)

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Editorial

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3 pages, 170 KiB  
Editorial
Replacing Surf and Turf Medical Care: A Clarion Call for the Incorporation of Rheumatology as an Integral Component of Primary Care Education
by Bruce Rothschild
Rheumato 2022, 2(4), 87-89; https://doi.org/10.3390/rheumato2040011 - 20 Sep 2022
Viewed by 1246
Abstract
The current time/experience allotted for rheumatology in primary care education seems like paying lip service to a medical education clinical approach consisting of: 1 [...] Full article
(This article belongs to the Special Issue Primary Care Education in Musculoskeletal Disease)

Research

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20 pages, 3297 KiB  
Article
Chronic Plantar Fasciitis Treatment: A Randomized Trial Comparing Corticosteroid Injections Followed by Therapeutic Ultrasound with Extracorporeal Shock Wave Therapy
by Nermeen Hassan A. Moneim, Mennatullah A. Hemed, Peter M. ten Klooster, Johannes J. Rasker and Nashwa K. El Shaarawy
Rheumato 2023, 3(3), 169-188; https://doi.org/10.3390/rheumato3030012 - 30 Jun 2023
Cited by 2 | Viewed by 3500
Abstract
This study aims to compare the effect of corticosteroid injection (CSI) followed by therapeutic ultrasound (TUS) with that of extracorporeal shock wave therapy (ESWT) in patients with chronic plantar fasciitis (PF) and to explore the impact of a sedentary lifestyle and obesity on [...] Read more.
This study aims to compare the effect of corticosteroid injection (CSI) followed by therapeutic ultrasound (TUS) with that of extracorporeal shock wave therapy (ESWT) in patients with chronic plantar fasciitis (PF) and to explore the impact of a sedentary lifestyle and obesity on treatment outcomes. Female patients with PF were randomly allocated to receive ESWT (group A, n = 25) or CSI + TUS (group B, n = 25). Interventions: Group A received four once-weekly sessions of ESWT (2000 shocks, 2.5 bar pressure, 10.0 Hz frequency). Group B received a local injection of 40 mg triamcinolone acetonide with 2 mL 1% xylocaine, followed by three sessions of TUS per week for two weeks. Pain visual analog scale (VAS pain), plantar fasciitis pain and disability scale (PFPDS), and fascia thickness using musculoskeletal ultrasound were all measured at baseline, 4 weeks, and 12 weeks after the end of treatment. VAS pain and PFPDS improved significantly in both groups after 4 and 12 weeks. In the ESWT group, the pain improved significantly more at 12 weeks (p = 0.004). In obese patients (BMI > 29.9 kg/m2), ESWT gave more long-term pain relief at 12 weeks follow-up. In both the ESWT and CSI + TUS groups, after 12 weeks, the VAS pain improved more in patients with a sedentary daily life than in those with active life (p = 0.021 and p = 0.014, resp.), as well as the PFPDS (p = 0.014 and p = 0.019, resp.). Plantar fascia thickness decreased in both groups at 12 weeks. In both groups, improvements in function (PFPDS) correlated significantly with decreased plantar fascia thickness at 4 and 12 weeks. In the CSI + TUS group only, the decrease in plantar fascia thickness was correlated with pain improvement at both follow-up visits. Echogenicity changed from hypoechoic to iso- or hyperechoic and improved significantly in both groups at 12 weeks follow-up, but changes were not different between the groups (p = 0.208). Both CSI + TUS and ESWT are effective treatments for female patients with chronic plantar fasciitis resulting in pain relief and improved function and fascia thickness. ESWT gave more pain relief at 12 weeks follow-up. CSI + TUS is effective as a rapid and short-term modality for relieving PF pain. According to previous studies, the addition of TUS does not appear to make CSI much more effective. Full article
(This article belongs to the Special Issue Primary Care Education in Musculoskeletal Disease)
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14 pages, 633 KiB  
Article
An Exploration of the Implications of Sequencing Order on Group Pain Interventions in Veterans
by David Cosio and Madison Simons
Rheumato 2022, 2(4), 98-111; https://doi.org/10.3390/rheumato2040014 - 17 Oct 2022
Viewed by 1654
Abstract
Background: Efforts to increase acceptance and reduce avoidance behaviors in patients who suffer from chronic pain are likely to have additional beneficial effects on pain management. The primary aim of the current study was to evaluate whether a sequential approach to treatment, where [...] Read more.
Background: Efforts to increase acceptance and reduce avoidance behaviors in patients who suffer from chronic pain are likely to have additional beneficial effects on pain management. The primary aim of the current study was to evaluate whether a sequential approach to treatment, where acceptance-based coping strategies are taught prior to problem-focused coping strategies using manualized group therapies, improves pain-related outcomes. Methods: The current investigation is a single-group, longitudinal ex post facto study. A sample of 168 Veterans participated in the current study at a midwestern VA medical center. All participants were administered a standard pre- and post-intervention assessment battery. The primary outcome analysis was a 4 × 2 repeated-measures multivariate analysis of variance. Results: The current study did not find a significant interaction effect for intervention x time but did find a significant main effect for time. All treatment conditions were associated with decreases in pain severity, pain interference, illness-focused coping strategies, catastrophizing behaviors, and global distress. Participation in both of the combined groups did not produce significantly different pain-related outcomes compared to participation in one group. Conclusion: These findings reinforce common factors theory in psychotherapy and provide insight into treatment dosage for patients who suffer from chronic pain. The current findings underline the importance of researching pain management, as it is a fundamental aspect of clinical practice, training, and research in rheumatology. Full article
(This article belongs to the Special Issue Primary Care Education in Musculoskeletal Disease)
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Review

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13 pages, 831 KiB  
Review
Subcutaneous Nodules as Manifestations of Systemic Disease
by Bruce Rothschild
Rheumato 2024, 4(2), 75-87; https://doi.org/10.3390/rheumato4020007 - 26 Apr 2024
Viewed by 2200
Abstract
The spectrum of disorders/phenomena encompassed in the practice of rheumatology is quite broad. In addition, our expertise is typically sought whenever other physicians encounter phenomena outside their knowledge base. While skin alterations typically prompt referrals to dermatology practices, alterations underlying the skin (e.g., [...] Read more.
The spectrum of disorders/phenomena encompassed in the practice of rheumatology is quite broad. In addition, our expertise is typically sought whenever other physicians encounter phenomena outside their knowledge base. While skin alterations typically prompt referrals to dermatology practices, alterations underlying the skin (e.g., subcutaneous) may well represent localization in “no man’s land” or an orphaned localization, with rheumatology thus referred as to the specialty of last resort—one of the roles that rheumatology has fulfilled for more than half a century. The current review addresses the cacophony of disorders producing or associated with variouslysized subcutaneous nodules. Their classifications, while necessarily artificial, encompass the full spectrum of pathologic processes. They are delineated in the current style to facilitate the consideration required to distinguish among them and to facilitate recognize the underlying processes for which we as rheumatologists are renowned. Full article
(This article belongs to the Special Issue Primary Care Education in Musculoskeletal Disease)
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Other

5 pages, 2553 KiB  
Case Report
Lipoma Arborescens Might Be an Unusual Cause of Knee Pain in Adolescents: A Case Report
by Lorenzo Moretti, Davide Bizzoca, Andrea Michele Abbaticchio, Alessandro Geronimo, Giuseppe Solarino and Biagio Moretti
Rheumato 2023, 3(3), 196-200; https://doi.org/10.3390/rheumato3030014 - 14 Aug 2023
Viewed by 2488
Abstract
Lipoma arborescens (LA) is a rare benign soft tissue tumor characterised by a hyperproliferation of villi and fat cells in the joint synovium. It is most frequently localized in the knee as reported here. This is a case report of a 16-year-old adolescent, [...] Read more.
Lipoma arborescens (LA) is a rare benign soft tissue tumor characterised by a hyperproliferation of villi and fat cells in the joint synovium. It is most frequently localized in the knee as reported here. This is a case report of a 16-year-old adolescent, affected by type I diabetes mellitus, who reported left knee pain and functional limitation to medical attention. She performed a physical examination, MRI and biopsy using an arthroscopic approach, leading to the LA diagnosis and classification. The LA has been thus treated with an arthroscopic synovectomy, which is the treatment of choice for LA, characterized by a low recurrence rate. Full article
(This article belongs to the Special Issue Primary Care Education in Musculoskeletal Disease)
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12 pages, 2792 KiB  
Protocol
A Study Protocol on the Effectiveness of Radial Shockwave Therapy on Myofascial Pain Syndrome: A Mixed Methods Study That Combines a Randomised Control Trial and Semi-Structured Interviews
by Collins Ogbeivor, Huda AlMubarak, Tola Akomolafe, Hamad Alkahtani, Hussain AlMugizel, Hala Aldosari and Nouf Aldhwayan
Rheumato 2023, 3(1), 106-117; https://doi.org/10.3390/rheumato3010009 - 16 Mar 2023
Viewed by 2938
Abstract
Background: Myofascial pain syndrome (MPS) is a common, costly and often persistent musculoskeletal problem. Radial shockwave (RSW) is one of the most common treatments for MFS. However, there is very low-level evidence to support its short-term benefit, due to poor methodological qualities. Furthermore, [...] Read more.
Background: Myofascial pain syndrome (MPS) is a common, costly and often persistent musculoskeletal problem. Radial shockwave (RSW) is one of the most common treatments for MFS. However, there is very low-level evidence to support its short-term benefit, due to poor methodological qualities. Furthermore, previous studies have not considered the experiences of patients regarding this intervention. This study will investigate the effectiveness of RSW compared to a sham (placebo) for patients with MPS and establish the experiences of patients receiving the treatment. Methods: A mixed methods study of a pragmatic randomised controlled trial and semi-structured-interviews that will involve 120 potential participants with MPS is used. The intervention group will receive six sessions of RSW: 1.5 bars, 2000 pulses, frequency 15 Hz. The control group will receive an identical treatment except that they will receive a no-energy shock of 0.3 bar. Results: The outcome measures are a numeric pain scale, neck disability index (NDI), pressure pain threshold (PPT) and SF-12 questionnaires at 4 and 8 weeks’ follow-up between the two groups. Conclusion: The expectation is that this study will add to the body of knowledge required to make effective treatment choices on RSW in the management MFS. Full article
(This article belongs to the Special Issue Primary Care Education in Musculoskeletal Disease)
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