Purpose: Hallux valgus is a common foot deformity affecting primarily adults and the elderly, especially females, resulting in significant changes in foot architecture and function. This study aimed to investigate the knowledge, attitudes, and practices (KAP) regarding hallux valgus among women. Patients and Methods: Between July and August 2023, a self-administered questionnaire was utilized to collect demographic data along with KAP scores from 526 women, 291 (55.32%) of whom were over 30 years of age. Results: The mean scores were 7.04 ± 2.25 for knowledge (range: 0– 10), 36.24 ± 2.98 for attitude (range: 11– 55), and 25.02 ± 4.90 for practice (range: 7– 35). Multivariate logistic regression identified knowledge (OR = 1.335, 95% CI: 1.213– 1.469, P < 0.001), age over 30 years (OR = 1.517, 95% CI: 1.026– 2.244, P = 0.037), monthly income above 10,000 Yuan (OR = 1.638, 95% CI: 1.111– 2.415, P = 0.013), and mild hallux valgus (OR = 1.974, 95% CI: 1.246– 3.127, P = 0.004) as independently linked to proactive practices. Additionally, the structural equation model indicated a direct effect of knowledge on practice (β = 0.765, P < 0.001). Conclusion: Women showed adequate knowledge but suboptimal attitudes and proactive practices concerning hallux valgus. Enhancing patient education is vital for improving understanding and addressing misconceptions regarding this condition.

National data on the characteristics of ambulatory visits with non-specific shoulder pain (NSSP) labels are lacking. The aim of this study was to identify the differences in the utilization of physical therapy (PT) for visits with NSSP labels and visits with specific shoulder pain (SSP) labels by using National Ambulatory Medical Care Survey (NAMCS) database. The NAMCS was queried from 2007 to 2016 to identify the ambulatory visits for shoulder pain. The study population was stratified according to the top 3 diagnoses, including NSSP group and SSP group. Data on patient, practice and visit characteristics were included, as variables in both descriptive and adjusted analyses. Differences in these characteristics and clinical management for the two groups were tested. Multivariable logistic regression analyses were employed to identify the association between the diagnosis type and utilization of PT. An estimated total of 86.49 million adult ambulatory visits for shoulder pain were identified in this study. Of these, 24.31 million visits (28.1%) were assigned to NSSP labels. Combining all years, PT was prescribed in approximately 10.8% of visits with NSSP labels, which was significantly lower than visits with SSP labels (22.2%). After adjustment for covariates including age, sex, race, expected source of payment, metropolitan statistical area (MSA), major reason for this visit, injury related, referred for this visit, continuity of care, number of medical comorbidities, and physician specialty, visits assigned to NSSP labels had significantly lower odds of prescribing PT compared to visits assigned to SSP labels (adjusted OR = 0.62, 95% CI: 0.41–0.94). The results of this retrospective cross-sectional study identified the significant differences in the utilization of PT for ambulatory visits with NSSP labels and SSP labels by using NAMCS database. These findings may help diminish management disparities and improve appropriate use of PT in the ambulatory management of shoulder pain.

Objectives: The aim of this study was to identify the differences in the clinical management of shoulder pain by primary care physicians (PCPs) and non-primary care physicians (non-PCPs) from the National Ambulatory Medical Care Survey (NAMCS) dataset. Methods: This cross-sectional study included ambulatory care visits for shoulder pain by using NAMCS data from 2007 to 2019. Descriptive statistics were presented to assess patient-level and visit-level characteristics of the sampled visits. By controlling for patient-level and visit-level covariates, we conducted a multivariable logistic regression to evaluate the influence of primary care physician status on the utilization of health services (pain medications, PT referral, health education/counseling, and diagnostic imaging) for shoulder pain. Results: There were 74.43 million ambulatory care visits by adults with shoulder pain during the study period, and nearly one-third of these shoulder visits were made to PCPs. As compared with non-PCPs, PCPs had higher adjusted odds of prescribing narcotic analgesics (adjusted odds ratio [OR] = 1.62, 95% confidence interval [CI]: 1.04–2.51), skeletal muscle relaxants (adjusted OR = 2.71, 95% CI: 1.65–4.45), other pain medications (adjusted OR = 1.87, 95% CI: 1.13–3.07), and lower odds of prescribing PT (adjusted OR = 0.34, 95% CI: 0.21–0.55) and MRI (adjusted OR = 0.46, 95% CI: 0.25–0.84). Conclusion: We observed significant differences in the services ordered or provided by PCPs versus non-PCPs for shoulder pain in ambulatory care settings. These results may reveal the higher reliance of pharmacological approaches, coupled with the potential under-utilization of PT during the ambulatory shoulder care provided by PCPs compared to non-PCPs in the United States.