A Win-Win for Sport and Exercise Medicine and Primary Care: A Qualitative Case Study of the Added Competence Model in Canada.

OBJECTIVE: To understand the unique impacts of the College of Family Physicians of Canada's (CFPC) Certificate of Added Competence (CAC) in Sport and Exercise Medicine (SEM) on the delivery of comprehensive care in Canada. DESIGN: Secondary analysis of qualitative interview data collected during a multiple case study of the impacts of the CAC program in Canada. SETTING: Six cases purposively sampled from across Canada. Each case was bound by a collective of healthcare providers who work with a defined group of patients. PARTICIPANTS: Across the cases, 48 individuals participated, including SEM and other enhanced skill family physicians, generalist family physicians, residents, specialists, and administrative staff. MAIN OUTCOME MEASURES: Qualitative descriptions of the impacts of the SEM certificate on comprehensive care provision in Canada. RESULTS: SEM certificate holders experience enhanced well-being and professional satisfaction while also benefitting comprehensive care in communities in numerous ways. That SEM certificate holders may prioritize professional interests over community healthcare needs was identified as a potential drawback. Athletes and physically active individuals have specific healthcare needs, and may constitute a significant critical mass to be considered a community unto themselves. CONCLUSIONS: The SEM certificates impact healthcare positively when holders work in collaborative models that are well aligned with local community needs. Expanding the awareness of the scope of SEM and advocacy for adequate remuneration for these services have the potential to enhance SEM contributions to comprehensive family medicine in Canada.

Treating low back pain in athletes: a systematic review with meta-analysis.

OBJECTIVE: To summarise the evidence for non-pharmacological management of low back pain (LBP) in athletes, a common problem in sport that can negatively impact performance and contribute to early retirement. DATA SOURCES: Five databases (EMBASE, Medline, CINAHL, Web of Science, Scopus) were searched from inception to September 2020. The main outcomes of interest were pain, disability and return to sport (RTS). RESULTS: Among 1629 references, 14 randomised controlled trials (RCTs) involving 541 athletes were included. The trials had biases across multiple domains including performance, attrition and reporting. Treatments included exercise, biomechanical modifications and manual therapy. There were no trials evaluating the efficacy of surgery or injections. Exercise was the most frequently investigated treatment; no RTS data were reported for any exercise intervention. There was a reduction in pain and disability reported after all treatments. CONCLUSIONS: While several treatments for LBP in athletes improved pain and function, it was unclear what the most effective treatments were, and for whom. Exercise approaches generally reduced pain and improved function in athletes with LBP, but the effect on RTS is unknown. No conclusions regarding the value of manual therapy (massage, spinal manipulation) or biomechanical modifications alone could be drawn because of insufficient evidence. High-quality RCTs are urgently needed to determine the effect of commonly used interventions in treating LBP in athletes.