Cristiane R. Carlesso

OBJECTIVE: To examine associations between lumbar paraspinal muscle morphology and physical function, disability, and pain in chronic low back pain (LBP). DESIGN: Cross-sectional study. METHODS: Cross-sectional area (CSA) and attenuation of the erector spinae and multifidi (upper: L1-L3; lower: L4-S1), psoas, and quadratus lumborum (L3) were measured from computed tomography images. Performance-based physical function was assessed using the five times sit-to-stand, 2-minute walk, 4-meter walk, active sit-up, and single-leg stance tests. Disability and symptoms were evaluated using the Oswestry Disability Index, the numeric pain rating scale, and painDETECT. Linear and logistic regression analyses were conducted, adjusting for age, sex, and body mass index (BMI). RESULTS: We analyzed data from 193 adults (age: 55.0 ± 16.0 years; BMI: 27.2 ± 4.0; 55% female). Lower erector spinae CSA was associated with walking speed ( β = .00006, P = .021); upper erector spinae CSA, with balance ( β = .002, P = .039); lower multifidi CSA, with neuropathic symptoms ( β = −.010, P = .017); and quadratus lumborum CSA, with abdominal endurance ( β = −.006, P = .012). Upper erector spinae attenuation was associated with abdominal endurance ( β = .046, P = .047), whereas quadratus lumborum attenuation was associated with balance ( β = .046, P = .018). CONCLUSION: Lumbar paraspinal muscle morphology was associated with physical function and neuropathic symptoms in people with chronic LBP. JOSPT Open 2026;4(2):181-195. Epub 16 February 2026. doi:10.2519/josptopen.2026.0202

Importance: Total knee replacement (TKR) is common for advanced cartilage degeneration. Often, functional limitations persist, and late-stage exercise (2–4 months after TKR) may improve recovery. Objective: The objective of this study was to identify predictors of late-stage functional recovery after TKR and their variations by exercise program. Design: This study was a secondary analysis of a randomized controlled trial. Setting: The settings were 1 physical therapy clinic and 4 community centers in Allegheny County, Pennsylvania. Participants: The study included 199 individuals (mean age = 70 years; body mass index = 31 kg/m2; 60% women). Interventions: Interventions were physical therapy exercises, community-based exercises, and usual care. Main Outcome and Measures: The main outcome was functional recovery at 6 months after intervention. Functional recovery was defined as ≥50% improvement on the Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale, at least somewhat better on the Global Rating of Change, and ≥ 20% improvement on ≥2 performance-based tests. Predictors were identified using logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results: In the entire cohort, 33% of participants achieved functional recovery, including 42% in the physical therapy group and 38% in the community group. Overall, better baseline health (odds ratio [OR] = 2.70 [95% CI = 1.34–5.47]), discharge to home (OR = 6.24 [95% CI = 1.94–20.09]), and higher Western Ontario and McMaster Universities Osteoarthritis Index pain subscale scores (OR = 1.22 [95% CI = 1.07–1.40]) predicted functional recovery. In the physical therapy group (n = 83), positive predictors were better health (OR = 4.40 [95% CI = 1.20–16.06]), discharge to home (OR = 11.67 [95% CI = 2.01–67.76]), regular use of nonsteroidal anti-inflammatory drugs (OR = 3.76 [95% CI = 1.11–12.78]), and as-needed use of analgesics (OR = 10.53 [95% CI = 1.75–63.48]). Negative predictors, associated with a lower likelihood of recovery, were regular use of salicylates (OR = 0.22 [95% CI = 0.07–0.74]) and greater use of pain-coping strategies (OR = 0.51 [95% CI = 0.29–0.89]). No predictors were identified in the community group (n = 76). Conclusions: Better baseline health, discharge to home after TKR, and higher pain levels predicted functional recovery. Physical therapy provided additional benefits for a subset of participants. Relevance: This evidence helps clinicians set realistic functional recovery expectations and strategies to facilitate function late after TKR.