JOSPT Insights

The RESTORE trial, published in 2023, put cognitive functional therapy (CFT) on the map as an effective approach for managing chronic, disabling low back pain. Since then, there has been more research supporting CFT, including a large network meta-analysis published in JOSPT in early 2026. In today's episode, we explore the results of the CONFeTTI trial, which tested the CFT+ intervention - combined care delivered by a physiotherapist and a psychologist in an interdisciplinary pain clinic.
Dr Henrik Bjarke Vægter led the CONFeTTI trial. He is an experienced physiotherapist and head of the interdisciplinary Pain Centre at Odense University Hospital in Denmark. Dr Bjarke Vægter is Professor of Physiotherapy and Pain Treatment at the University of Southern Denmark's Department of Clinical Research.
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RESOURCES
CONFeTTI trial
Tailored exercise therapy with or without psychological interventions: systematic review with network meta-analysis

How many patients describe receiving what sounds like inadequate care for osteoarthritis before they reached your clinic? Osteoarthritis is one of the most common chronic musculoskeletal conditions. When there are many trustworthy, international clinical guidelines that clearly outline what best-practice osteoarthritis care should entail, why are so many patients missing out on high-value care?
Today's guest, Dr Jodi Young, discusses her team's analysis of data from nearly 25,000 patients who received osteoarthritis care in the United States, and what these data say about osteoarthritis care. Dr Young is the Director of Research for the Doctor of Science in Physical Therapy program at Bellin College in Green Bay, Wisconsin. She is also a fellow of the American Academy of Orthopaedic Manual Physical Therapists.
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RESOURCES
Real-world use of exercise and manual therapy for managing knee osteoarthritis: https://www.jospt.org/doi/10.2519/josptopen.2026.0221
Opioid prescribing to active duty US military personnel: https://pubmed.ncbi.nlm.nih.gov/37507224/
Opioid vs. non-opioid medications for people with chronic back pain or hip or knee OA (SPACE Trial): https://pubmed.ncbi.nlm.nih.gov/29509867/
Opioid use patterns among active duty service members and civilians: https://pubmed.ncbi.nlm.nih.gov/29514335/
JOSPT Insights episode 257 - Reflecting on contemporary manual therapy: https://pod.link/1522929437/episode/NzM4ZjYwY2EtMzNhYi00OTI5LWE5OTAtZmUwY2ZkM2QxMDA0

There's plenty of debate in the musculoskeletal rehabilitation community about how to clearly communicate with patients about a diagnosis. Clinicians are trying to balance being clear about what the likely cause of the symptoms is without inducing unnecessary worry. How much should you—or even can you—accurately describe the pathology and anatomy of the problem? On the flip side, others have strongly argued that pathoanatomic labels do more harm than good.
Today, experienced musculoskeletal physiotherapist and researcher (Laval University, Canada), Marc Perron makes the case that clinicians should not hide the pathology and anatomy—it's how you talk with patients about their diagnosis that matters most.
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RESOURCES
Physical therapists diagnosing musculoskeletal conditions: don't hide what matters - just say it the right way: https://www.jospt.org/doi/10.2519/jospt.2026.14197

Psychological factors like a person's thoughts, beliefs and emotions can exert a strong influence on rehabilitation outcomes for people with chronic musculoskeletal conditions. When a person has pain, they might feel scared to move or convinced that moving in a certain way will damage their body. Today's discussion focuses on how a person's thoughts about shoulder pain can change over an 8-week exercise-based rehabilitation program, and the implications for how musculoskeletal rehabilitation clinicians approach discussions about fear and moving with the patients you work with. Dr Courtney Mears and Dr Matthew Heindel discuss their recent JOSPT publication (linked below).
Dr Mears is a physical therapist at the University of Southern California, and a researcher in the Clinical Biomechanics Orthopedic and Sports Outcomes Research Lab. Her research focuses on understanding the relationship between psychosocial factors, shoulder pain, and functional outcomes.
Dr Heindel is a physical therapist, and a postdoctoral associate at Duke University’s School of Medicine, where he studies the neuroimmune mechanisms of chronic musculoskeletal pain. Dr Heindel completed his PhD on the mechanics of pain and muscle dysfunction in rotator cuff tendinopathy in 2025 at the Clinical Biomechanics Orthopedic and Sports Outcomes Research Lab at the University of Southern California.
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RESOURCES
Changes in pain-related fear: https://www.jospt.org/doi/10.2519/jospt.2026.13563
OSPRO yellow flag assessment tool: https://www.jospt.org/doi/10.2519/jospt.2016.6487

Does hip crepitus make a difference to the health of the joint? Does crepitus indicate damage, harm or progression of osteoarthritis? How should clinicians explain hip crepitus and its implications to patients? Today's guest addresses those questions and more in a deep dive on hip crepitus. Dr Danilo De Oliveira Silva (La Trobe University) discusses his JOSPT article, Self-Reported Hip Crepitus Is Prevalent in Football Players With Hip/Groin Pain, but Is It Associated With Early Hip Osteoarthritis Structural Features? A Longitudinal Study, with Dan and Marquis.
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RESOURCES
Self-reported hip crepitus - longitudinal study: https://www.jospt.org/doi/10.2519/jospt.2025.13474
Beliefs and attitudes about hip crepitus: https://pubmed.ncbi.nlm.nih.gov/41056730/