Prolonged gaze at a smartphone is characterized by pronounced flexion of the cervical spine and is associated with health risks. In addition, it is suspected that smartphone distraction could lead to gait changes. Therefore, the aim of this study was to detect smartphone-associated postural changes at thoracic and lumbar levels as well as gait changes. Spinal analysis was performed prospectively in 21 healthy men using the DIERS 4Dmotion^®Lab in a controlled crossover design to evaluate posture-associated parameters while standing and walking. The examination sequence provided three randomized gaze directions: GN = Gaze Neutral; S1H = Smartphone one-handed; S2H = Smartphone two-handed. Results reveal a higher vertebra prominens (VP)-flexion in S1H (23.8° ± 6.9°; p ≤ 0.001) and S2H (22.4° ± 4.7°; p ≤ 0.001) compared to GN (17.6° ± 3.8°). Kyphosis angles were also different with higher values observed in S1H (58.8° ± 5.8°; p ≤ 0.001) and S2H (61.6° ± 4.9°; p ≤ 0.001) compared to GN (49.1° ± 4.6°). During walking, similar results were observed in kyphosis angles. No differences were observed in gait during smartphone use (p = 0.180–0.883). The study revealed a significantly increased inclination of the lower cervical and thoracic spine during smartphone use. However, the inclination was larger during S2H. Standing or walking conditions did not affect the measurement outcomes. Long-term smartphone use associated with a larger inclination of the cervical and thoracic spine might result in increased pressure and shear forces acting on vertebral bodies, intervertebral discs, and muscles, which potentially increases the risk of spinal pain and disease.

Background: Pressure pain thresholds (PPT) are a component of Quantitative Sensory Testing and are used to assess mechanical pain sensitivity. Joint‐specific PPT measurements are relevant because many joint disorders involve altered pain processing at and around joints. This study aims to establish such reference values that might contribute to evaluate deviations in pain sensitivity in specific patient populations. Methods: This study retrospectively analysed PPT data from 407 healthy male individuals. Pressure was applied in a standardised manner using an algometer at eight anatomical landmarks: bilaterally at the elbow, knee and ankle joints, as well as the sternum and forehead. Percentile‐based, landmark‐discriminative normative data were calculated for PPT in general and segmented for age, BMI and mean subjective pain over 4 weeks. Results: Median (IQR) PPT values (N/cm ² ) for anatomical landmarks are as follows: ankle = 47.2 (35.9, 63.8), knee = 65.9 (48.6, 89.1), elbow = 58.0 (40.5, 81.1), sternum = 39.8 (30.2, 53.3) and forehead = 35.5 (26.8, 45.0). Between‐group analyses revealed no significant effect of BMI on PPT at any landmark assessed, no significant effect of age, except for the elbow joint ( p = 0.035) and no effect of the presence of pain, except for the ankle ( p = 0.020) and elbow joint ( p = 0.010). Conclusion: This study provides normative joint‐specific PPT values in healthy male individuals, offering reference values for both clinical and research applications. These values can assist in interpreting PPT measured in clinical settings and in identifying abnormal pain sensitivity. Significance Statement: Pressure pain thresholds are an important measure in Quantitative Sensory Testing, yet comprehensive normative data for joint‐specific PPT in healthy individuals have been lacking. This study establishes reference values across multiple anatomical landmarks, providing a critical benchmark for evaluating pain sensitivity deviations in musculoskeletal disorders. These findings enhance the interpretation of PPT measurements, supporting improved pain assessment and diagnostic accuracy.

Introduction: Patients with haemophilia (PwH) often suffer from psychological symptoms such as depression or anxiety. To date, uncertainty exists about the determinants predicting worse psychological outcomes. Therefore, this study aimed to investigate the extent of depressive, anxiety and stress‐related symptoms in PwH compared to the healthy population and determine the impact of disease‐specific and arthropathy‐related parameters. Methods: Levels of depression, anxiety, stress and overall emotional distress were queried in a total of 379 PwH and 271 healthy controls by handing out the Depression, Anxiety and Stress Scale 21. In addition, disease‐specific variables (e.g., type, severity, viral infections), pain intensity (NRS from 0 to 10), pain persistence (Likert‐scale from 1 to 6), pain sensitivity (pressure pain thresholds [PPT]) and the orthopaedic joint score (Haemophilia Joint Health Score v2.1; HJHS) were assessed to analyse associations with psychological symptoms. Results: PwH had higher scores for depression, anxiety, stress and overall emotional distress compared to the healthy cohort. Regarding disease‐specific outcomes, only PwH with hepatitis or HIV showed higher scores for depression (hepatitis, p = 0.020), stress (hepatitis, p = 0.005; HIV, p = 0.048) and overall emotional distress (hepatitis, p = 0.020). Spearman's rank correlation further revealed significant associations between NRS, pain persistence, PPT and HJHS with all psychological outcomes, though most effect sizes were weak. Conclusion: These results provide further evidence for a poorer psychological profile in PwH compared to the healthy population. Particularly, pain‐related outcomes, but also joint degeneration and the presence of viral infections, are related to enhanced psychological symptoms.

Introduction: Physical functioning is compromised in patients with haemophilia (PwH). However, factors negatively influencing subjective physical performance (SPP) remain underexplored. Hence, this study aimed to compare the SPP of PwH with healthy controls (CON), to differentiate them based on disease‐specific, person‐related, and arthropathy‐related parameters, and to identify overarching determinants influencing SPP. Methods: SPP was assessed in 301 PwH and 263 CON via the HEP‐Test‐Q, which divides SPP into a total score and four distinct dimensions (e.g., mobility). Additionally, disease‐specific (i.e., type, severity, treatment regime, HIV, hepatitis), person‐related (i.e., age, BMI), and arthropathy‐related parameters (i.e., current pain intensity (NRS‐now) and average pain intensity across 4 weeks (NRS‐4w) and the HJHS) were examined, and associations with SPP were calculated. Results: All PwH and PwH subgroups demonstrated significantly greater impairment across all SPP dimensions compared to CON. Apart from the type of haemophilia (A vs. B, p = 0.894), significant differences in total SPP were observed among PwH subgroups for severity (severe vs. non‐severe, p = 0.012), treatment (prophylaxis vs. on demand, p = 0.002), HIV (no vs. yes), and hepatitis (no vs. yes, both p < 0.001). A multiple linear regression model further revealed significant predictive effects for HJHS ( p < 0.001) and NRS‐4w ( p < 0.001) on the total SPP score. Conclusion: PwH perceived their physical performance as significantly worse across all dimensions compared to CON. The decreased SPP in PwH can be attributed primarily to arthropathy‐related factors, that is, an impaired joint status and persistent pain. To oppose the decline in SPP, tailored sports‐therapeutic programs should be integrated into the multimodal treatment concept.

Background: The successful conservative treatment of spinal osteoporotic fractures with orthoses has been extensively studied in the past, but data on the benefit of additional orthotic treatment after kyphoplasty are lacking. The aim of this study was to examine the influence of a thoracolumbar orthosis (TLO) on movement activity, pain perception, and functional parameters after kyphoplasty of osteoporotic spinal fractures. Methods: This randomized-controlled-trial included patients with osteoporotic spine fractures of the thoracal and lumbar spine with indication for primary kyphoplastic treatment. The intervention group postoperatively wore a TLO for eight weeks (controlled by a thermal sensor and diary) while the control group did not receive an orthosis. Both groups were equipped with an activity tracker to determine step activity during this time. An examination of activity, pain perception, and functional parameters was performed pre- and immediately postoperatively as well as 2/8/12/24 weeks after surgery. Results: Fifty five patients (mean age: 69 ± 7 years) were included in this study. Over the 8-week postoperative period, both groups showed significant changes in step activity (p = 0.003) but no group difference (p = 0.891). Furthermore, no group differences were seen in weekly activity, pain perception, and functional parameters (p = 0.580; 0.298; 0.529). According to the temperature measurement, participants in the intervention group wore the orthosis for an average of 2.8 h per day but stated to wear it 4-6 h per day in their diaries. Conclusions: The TLO showed no influence on postoperative physical conditions after kyphoplasty. However, tendencies of lower pain perception in the intervention group could be shown. The contrast between objective and subjective wearing time highlights the significance of sensitizing patients in wearing orthoses to achieve a clinically relevant outcome. The reduced wearing time could have influenced the results, which probably means that the effects cannot be fully utilized. For this reason, additional training in way of wearing and duration including control mechanisms as well as motivational systems are needed to improve the patient's compliance and the effect of the orthosis. Level of evidence: Therapeutic Level I.

Considering the fact that Toxoplasma is a common parasite of humans and Toxoplasma bradyzoites can reside in skeletal muscle, T. gondii-mediated immune responses may modulate the progression and pathophysiology of another musculoskeletal disorder, osteoporosis. In the current study, we investigated the association of bone health and Toxoplasma gondii infection status. A total of 138 patients living in Germany with either osteopenia or osteoporosis were included in the study, and they were categorized into two groups, T. gondii uninfected (n = 74) and infected (n = 64), based on the presence of T. gondii-specific IgG antibodies. The demographic and clinical details of the study subjects were collected from the medical records. Logistic regression analysis was performed to delineate the association of bone health parameters with the infection status. The prevalence of toxoplasmosis was 46.4% in the study participants. The infected individuals with osteopenia and osteoporosis showed higher levels of mean spine and femoral T score, Z score, and bone mineral density (BMD), indicating improved bone health compared to the uninfected group. Logistic regression analysis showed that subjects with T. gondii infection displayed increased odds of having a higher mean femur T score, femur BMD, and femur Z score even after adjusting for age, creatinine, and urea levels. However, when the duration of drug intake for osteoporosis was taken into account, the association lost statistical significance. In summary, in this study, an improvement in osteopenia and osteoporosis was observed in Toxoplasma-infected patients, which may be partly due to the longer duration of drug intake for osteoporosis in the infected patient group.