Integrating a Longitudinal Course on the Principles of Research in an Outcomes-Based Undergraduate Medical Education Curriculum.

Background and Need for Innovation: Teaching and learning approaches can support medical students in developing the research skills necessary to be adept consumers of scientific research. Despite various influencing factors, existing literature on effective strategies in undergraduate medical education remains limited. Goal of Innovation: Using a spiraled curriculum, we created and evaluated a longitudinal course to enhance medical students' research abilities. Steps Taken for Development and Implementation of Innovation: During a recent curriculum renewal at one medical school, a three-year longitudinal course on the principles of research was developed and implemented. The innovation of this course includes the sequential nature and deliberate redundancy of curriculum content, how new knowledge is linked to prior learning, and the progressive level of difficulty in knowledge application and skill development. Evaluation of Innovation: The authors analysed faculty members' and students' satisfaction and their perceptions of each session of the course using program evaluation data collected between 2019 and 2021. Both faculty members and students recognized the benefits of revisiting concepts and highlighted learning outcomes like improved synthesis of information, explaining findings to patients, and enhanced critical thinking. Critical Reflection: The adoption of a spiraled curriculum in undergraduate medical education offers a systematic approach for developing students' research skills. The positive reception of this innovation underscores its potential to help future health professionals form a professional identity as adept researchers. However, its implications demand careful consideration and ongoing evaluation to ensure that the desired outcomes are sustained.

Understanding musculoskeletal disorders in dancers: The role of lumbopelvic muscles and movement competency.

OBJECTIVE: To investigate whether transversus abdominis activation (TrA), hip strength, and movement competency are associated with the incidence of musculoskeletal disorder episodes (MDEs) in dancers when controlling for confounding variables. The secondary objectives were to determine if there were differences between professional and preprofessional dancers for the aforementioned factors, as well as to determine if there were differences in TrA activation and hip strength between the dominant and non-dominant sides. DESIGN: Prospective cohort study. METHODS: 118 dancers were recruited. The independent variables were collected at the beginning of the dance season: 1) TrA activation, 2) hip strength, and 3) movement competency. To assess the development of MDEs, a weekly electronic diary was used over a 38-week period. MDEs were compiled for each dancer's whole body and subdivided into total musculoskeletal disorder episodes (all body parts) and lower quadrant musculoskeletal disorder episodes (lower limb and lower back). RESULTS: Lower TrA, as well as higher hip abductor and external rotator strength, were associated with a lower incidence of MDEs. TrA activation (ß = 0.260, p = 0.023) and hip external rotator strength (ß = -0.537, p = 0.002) could significantly explain 25.4% of the variance of total MDEs, as well as 20.9% of the variance of lower quadrant musculoskeletal disorder episodes (ß = 0.272, p = 0.016; ß = -0.459, p = 0.011). No significant associations were found between movement competency and MDEs. CONCLUSIONS: Higher hip strength could be a protective factor for MDEs among dancers. Further studies are needed to better understand the involvement of the transversus abdominis in MDEs.

Passion and performance anxiety: How it affects the incidence of musculoskeletal disorders in dancers.

OBJECTIVES: This study aimed to examine the association between the incidence of musculoskeletal disorder episodes (MDEs) and obsessive and harmonious passion as well as performance anxiety throughout a dance season, which lasted 38 weeks. DESIGN: Prospective cohort study. METHODS: A total of 118 professional and preprofessional dancers were recruited and assessed at baseline, while 88 completed the follow-up. Their levels of passion and performance anxiety were assessed at the beginning of a dance season using the Passion Scale and the Kenny Music Performance Anxiety Inventory, respectively. To monitor the incidence of MDEs throughout a dance season, dancers were asked to complete a weekly electronic diary. RESULTS: A higher level of obsessive passion was associated with a higher incidence of MDEs causing an interruption of dance activities (ß = 0.264, p = 0.022). Harmonious passion and performance anxiety were not associated with MDEs throughout the season. CONCLUSIONS: Findings of this study support the role of obsessive passion in the development of MDEs in dancers.

Long-Term Consequences of COVID-19 in Predominantly Immunonaive Patients: A Canadian Prospective Population-Based Study.

Background: Lingering symptoms are frequently reported after acute SARS-CoV-2 infection, a condition known as post-COVID-19 condition (PCC). The duration and severity of PCC in immunologically naïve persons remain unclear. Furthermore, the long-term consequences of these chronic symptoms on work and mental health are poorly documented. Objective: To determine the outcome, the risk factors, and the impact on work and mental health associated with post-COVID-19 symptoms. Methods: This prospective population-based study assessed acute COVID-19 symptoms and their evolution for up to nine months following infection. Individuals aged 18 years and older with COVID-19 in three Canadian regions between 1 November 2020 and 31 May 2021 were recruited. Participants completed a questionnaire that was either administered by trained student investigators over the phone or self-administered online. Results: A total of 1349 participants with a mean age of 46.6 ± 16.0 years completed the questionnaire. Participants were mostly unvaccinated at the time of their COVID-19 episode (86.9%). Six hundred and twenty-two participants (48.0%) exhibited one symptom or more, at least three months post-COVID-19. Among participants with PCC, 23.0% to 37.8% experienced fatigue at the time of survey. Moreover, 6.1% expressed psychological distress. Risk factors for PCC and fatigue included female sex (OR = 1.996), higher number of symptoms (OR = 1.292), higher severity of episode (OR = 3.831), and having a mental health condition prior to the COVID-19 episode (OR = 5.155). Conclusions: In this multicenter cohort study, almost half (47%) of the participants reported persistent symptoms >3 months after acute infection. Baseline risk factors for PCC include female sex, number and severity of symptoms during acute infection, and a previous diagnosis of mental health disorder. Having PCC negatively impacted health-related quality of life and these patients were more likely to exhibit psychological distress, as well as fatigue.

Effect of Conservative Interventions for Musculoskeletal Disorders in Preprofessional and Professional Dancers: A Systematic Review.

Background: Preprofessional and professional dancers are among the athletes who sustain the most musculoskeletal disorders. In recent years, conservative treatment and preventive measures have been investigated in this population. However, no systematic review regarding their effectiveness has been conducted. Hypothesis/Purpose: The aim of this systematic review was to locate, appraise and synthesize the available information on conservative interventions currently used for treating and preventing MSK disorders and their effect on pain and function in preprofessional and professional dancers. Study design: Systematic review. Methods: A systematic literature search was conducted using PubMed, CINHAL, ERIC, SportDiscus and Psychology and behavioral science collection. Prospective and retrospective cohort studies, as well as randomized and non-randomized controlled trials investigating conservative interventions for musculoskeletal disorders in preprofessional and professional dancers were included in this study. The main outcome measures included pain intensity, function, and performance. All included studies were evaluated for risk of bias using the Downs and Black checklist. Results: Eight studies were included in the review. These studies included ballet and contemporary dancers, as well as professional and preprofessional dancers. In total, the studies included 312 dancers, 108 male and 204 female. Studies had a risk of bias that ranged from poor (8/28) to good (21/28) on the Downs and Black checklist. The conservative interventions used included customized toe caps, dry-needling, motor imagery, and strength and conditioning programs. The use of customized toe caps, motor imagery and strength and conditioning programs had promising results regarding pain and function in dancers. Conclusion: In order to reach a solid conclusion, more quality studies are needed. The addition of control groups to studies, as well as multimodal interventions should be considered. Level of Evidence: I.

Movement Competency Screen: Rethinking the Rating.

Background: Dancers are at high risk of musculoskeletal disorders. There has been a growing interest in the last few years in pre-season screening using tools to evaluate movement competency, among which is the Movement Competency Screen (MCS). It is currently scored using a categorical 3-level rating system, but this method does not seem to take into account the load level of movements. A 5-level scoring system could potentially alleviate this problem. Hypothesis/Purpose: For each scoring system, to investigate (1) the internal consistency, and (2) the association with transversus abdominis activation (TrA), hip muscle strength and with Functional Movement screen (FMSTM) total score. Study design: Secondary analyses of a prospective cohort study. Methods: One hundred and eighteen professional and preprofessional dancers evolving in ballet or contemporary dance were recruited. The MCS was performed and was scored according to the 3- and 5-level scoring systems. The key variables for movement competency that were considered for convergent validity were the activation ratio of the TrA evaluated with ultrasound imaging and hip strength assessed with a handheld dynamometer. Movement competency was also measured with the FMSTM. Results: Internal consistency was higher for the 5-level scoring of the MCS items ($*$\alpha$*$=0.548) compared to the 3-level scoring system ($*$\alpha$*$=0.494). Multiple linear regressions showed that TrA activation, hip adductor strength, and FMSTM could significantly explain 24.0% of the variance for the 5-level scoring system of the MCS whereas hip internal rotator strength and FMSTM could explain only 16.4% of the variance for the 3-level scoring system. Conclusion: The 5-level scoring system showed better metrologic properties in terms of internal consistency and concurrent validity and therefore, should be preferred over the 3-level scoring system in future research. Level of Evidence: Level III.

Comparison of the Pressure Biofeedback Unit and Real-Time Ultrasound Imaging as Feedback Tools to Contract the Transversus Abdominis Muscle: A Randomized Controlled Trial in Healthy Older Adults.

BACKGROUND AND PURPOSE: The transversus abdominis (TrA) is a key muscle for lumbar stabilization and is often retrained in physical therapy. Feedback tools, such as the pressure biofeedback unit (PBU) and rehabilitative ultrasound imaging (RUSI), are frequently used by physical therapists to train their patients and improve their patients' ability to contract this muscle. However, the effect of these tools in rehabilitating the TrA in older adults remains to be demonstrated, as is their efficiency in transferring the skill of recruiting the TrA from a supine position to a standing position.The objective of the study was to compare the immediate effectiveness of the PBU and RUSI to reeducate the TrA muscle in a population of asymptomatic older adults (without pain). METHODS: Forty participants were randomized into 2 groups (RUSI or PBU). The intervention included a training session involving 15 TrA contractions held for 10 seconds with the corresponding feedback device. The dependent variable, TrA thickness (a muscle activation indicator), was measured using ultrasound images before and after the intervention in a supine and standing position. Nonparametric analyses were used for inter- and intragroup comparisons. RESULTS AND DISCUSSION: The results showed no between-group differences in TrA activation ratio (AR) in the supine or standing position (supine AR: TrA RUSI thickness change P = .53 vs PBU thickness change P = .73, comparison between groups P = .51; standing AR: TrA RUSI thickness change P = .003 vs PBU thickness change P = .10; comparison between groups P = .61). However, the change in TrA thickness compared to the other abdominal wall muscles in a standing position was significantly less post-intervention for the RUSI group only (RUSI P = .006 vs PBU P = .72). Both groups remained similar post-intervention for this outcome (P = .20). CONCLUSIONS: Neither the RUSI nor the PBU seems to have the desired effect on the activation of TrA in asymptomatic older adults.

Transcranial direct current stimulation for provoked vestibulodynia: What roles do psychosexual factors play in treatment response?

There is growing evidence that provoked vestibulodynia (PVD), a frequent and debilitating condition, is characterized by central sensitization. This study aimed to examine predictive factors of transcranial direct current stimulation (tDCS) efficacy in this chronic pain population. Exploratory analysis derived from a randomized controlled trial was performed to assess predictors of pain reduction among 39 women with PVD who received 10 daily sessions of either active or sham tDCS. Clinical characteristics (e.g. pain intensity, duration and pain sensitivity) and psychosexual factors (e.g. pain catastrophizing, pain-related fear, anxiety, depressive symptoms and vaginal penetration cognitions) were assessed at baseline and used to predict tDCS response at 3-month follow-up. Analysis revealed that higher depressive symptoms and lower negative self-image cognitions were significant predictors of pain reduction at follow-up and accounted for 62.3% of the variance in the active tDCS group. Higher genital incompatibility cognitions were related to poorer response, regardless of treatment group. These findings suggest that women with PVD presenting higher depressive symptoms and lower levels of negative self-image cognitions could derive greater benefits from tDCS. These results suggest that tDCS could be effective in a subgroup of women with PVD - a possibility worth exploring with future prospective larger studies.

An Investigation of the Association between Transversus Abdominis Myofascial Structure and Activation with Age in Healthy Adults using Ultrasound Imaging.

BACKGROUND: Because of their importance in core stability, training the deep abdominal muscles, fascial structures and particularly the transversus abdominis, is a key component of many sport and physical therapy programs. However, there are gaps in knowledge about age-related changes in the structure and activation capacity of these muscles. HYPOTHESIS/PURPOSE: This study investigated the association between deep abdominal muscles and fascial structures and transversus abdominis activation with age in healthy adults. STUDY DESIGN: A cross-sectional study. METHODS: Eighty-six adults aged 18 to 77 participated in this study. An ultrasound image of their transversus abdominis, internal oblique, external oblique and associated fasciae was first captured at rest, then during a contraction of the transversus abdominis. Bivariate correlation analyses and hierarchical analyses were performed (significance level: p < 0.05). RESULTS: The thickness of these three muscles decreases with age ( ρ = -0.66 for external oblique, -0.51 for internal oblique and -0.58 for transversus abdominis), whereas the thickness of their fasciae increases ( ρ = 0.39 for the fascia of external oblique, 0.54 for the fascia between internal oblique and external oblique, and 0.74 for the fascia between internal oblique and transversus abdominis). Transversus abdominis activation decreases with age (r =-0.44). Age accounts for 19.5% of the variance in transversus abdominis activation. CONCLUSION: These results demonstrate that normal aging is associated with changes in deep abdominal myofascial structures and transversus abdominis activation. Assessment of these metrics can provide valuable baseline information for physical therapists involved in rehabilitation and strengthening programs targeting older individuals. LEVEL OF EVIDENCE: Level 2.

Does the Movement Competency Screen Correlate with Deep Abdominals Activation and Hip Strength for Professional and Pre-professional Dancers?

BACKGROUND: Dancers are a unique category of athletes who are frequently injured and experience pain. The primary cause of dance injuries is overuse, which could potentially be prevented. However, literature is scarce regarding validated methods of evaluating the risk of injury in dancers. The Movement Competency Screen (MCS) could potentially fill this gap. HYPOTHESIS/PURPOSE: To investigate the validity of the Movement Competency Screen (MCS) for dancers by 1) examining the correlation between scores on this functional test and the activation of deep abdominals and hip strength; 2) investigating the correlation between MCS scores and those of the Functional Movement Screen (FMS™). STUDY DESIGN: Cross-sectional study. METHODS: A total of 77 pre-professional and professional dancers from ballet and contemporary backgrounds were evaluated. The activation of deep abdominals was evaluated using ultrasound imaging and the hip strength was evaluated using a handheld dynamometer. The FMS™, another tool evaluating fundamental movement competency, was also administered. RESULTS: The dancers' MCS score was correlated with the activation of the transversus abdominis (r=0.239, p=0.036) and the strength of hip abductors (r=0.293, p=0.010), adductors (r=0.267, p=0.019) and external rotators (r=0.249, p=0.029). The MCS score was also correlated with the FMS™ score (r=0.489, p<0.001). CONCLUSION: This study shows that the MCS score is correlated with deep abdominal activation and hip strength in dancers, as well as with the FMS™ score. These findings provide evidence toward the validation of the MCS in dancers. LEVELS OF EVIDENCE: Level 2B.

Efficiency and Cost: E-Recruitment Is a Promising Method in Gynecological Trials.

BACKGROUND: Recruitment of participants is crucial to the success of any trial as it can have a major impact on study costs, the duration of the study itself, and, more critically, trial failure. Given that vulvodynia particularly affects young women, the use of social media and e-recruitment could prove efficient for enrollment. AIM: To compare the efficiency, effectiveness, and cost-effectiveness of three different recruitment methods. METHODS: The comparison data were collected as part of a bicentric randomized controlled trial evaluating the efficacy of physiotherapy in comparison with topical lidocaine in 212 women suffering from provoked vestibulodynia. The recruitment methods included: (i) conventional methods (eg, posters, leaflets, business cards, newspaper ads); (ii) health professional referrals, and (iii) e-recruitment (eg, Facebook ads and web initiatives). Women interested in participating were screened by telephone for eligibility criteria and were assessed by a gynecologist to confirm their diagnosis. Once included, structured interviews were undertaken to describe their baseline characteristics. MAIN OUTCOME MEASURES: The outcomes of this study were the recruitment efficiency (the number of patients screened/enrolled), recruitment effectiveness (the number of participants enrolled), cost-effectiveness (cost per enrolled participant), and retention rate, and baseline characteristics of participants were monitored for each method. RESULTS: The conventional methods (n = 101, 48%) were more effective as they allowed for greater enrollment of participants, followed by e-recruitment (n = 60, 28%) and health professional referrals (n = 33, 16%) (P < 0.007). Recruitment efficiency was found to be similar for e-recruitment and referrals (60/122 and 33/67, 49%, P = 0.055) but lower for conventional methods (101/314, 32%, P < 0.011). Nonsignificant differences were found between the three groups for baseline characteristics (P ≥ 0.189) and retention rate (91%, P ≥ 0.588). The average cost per enrolled participant was fairly similar for e-recruitment ($117) and conventional methods ($110) and lower for referrals ($60). CLINICAL IMPLICATIONS: Our results suggest that having a variety of recruitment methods is beneficial in promoting clinical trial recruitment without affecting participant characteristics and retention rates. STRENGTH & LIMITATIONS: Although recruitment methods were used concomitantly, this study gives an excellent insight into the advantages and limitations of recruitment methods owing to a large sample size. CONCLUSION: The study findings revealed that e-recruitment is a valuable recruitment method because of its comparable efficiency and cost-effectiveness to health professional referrals and conventional methods, respectively. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, number NCT01455350. Benoit-Piau J, Dumoulin C, Carroll MS, et al. Efficiency and Cost: E-Recruitment Is a Promising Method in Gynecological Trials. J Sex Med 2020;17:1304-1311.

Fear-avoidance and Pelvic Floor Muscle Function are Associated With Pain Intensity in Women With Vulvodynia.

OBJECTIVE: To investigate the association between fear-avoidance variables, pelvic floor muscle (PFM) function, pain intensity in women with provoked vestibulodynia (PVD), as well as the moderator effect of partner support. MATERIALS AND METHODS: A sample of 173 women diagnosed with PVD participated in the study. Fear-avoidance variables were assessed with validated self-administered questionnaires: pain catastrophizing (Pain Catastrophizing Scale), pain-related fear (Pain Anxiety Symptoms Scale), and partner support (Partner Support Questionnaire). Pain intensity was evaluated using a numerical rating scale. PFM function, including maximal strength, speed of contraction, flexibility, and muscle tone, was evaluated with a dynamometric speculum. RESULTS: Pain catastrophizing was significantly associated with pain intensity (ß=0.310, P<0.001), partner support (ß=0.194, P=0.004), and PFM flexibility (ß=-0.255, P<0.001). Fear-avoidance, PFM variables, and partner support explained 28.3% of the variance in pain during intercourse (P<0.001). The addition of PFM was of particular interest as it explained a significant addition of 9% of the variance in pain intensity. Partner support was found to moderate the association between pain intensity and catastrophizing. Among women with high partner support, catastrophizing was not significantly related to pain (b=0.150, P=0.142). When partner support was low, catastrophizing was significantly related to pain (b=0.068, P<0.001). DISCUSSION: Findings of this study support that the symptomatology of PVD can be explained partly by fear-avoidance variables and PFM function. This study supports the significant role of PFM function and its importance in the pathophysiology of PVD. It also sheds light on the role of partner support and its moderating effect on pain catastrophizing.