Latent Profile Analysis of Canadian Military Veterans with Chronic Pain Identifies 5 Meaningful Classes through Self-Report Measures.

The purpose of this study was to identify meaningful response patterns in self-report survey data collected from Canadian military veterans with chronic pain and to create an algorithm intended to facilitate triage and prioritization of veterans to the most appropriate interventions. An online survey was presented to former members of the Canadian military who self-identified as having chronic pain. Variables collected were related to pain, physical and mental interference, prior traumatic experiences, and indicators from each of seven potential drivers of the pain experience. Maximum Likelihood-based Latent Profile Analysis (MLE-LPA) was used to identify clinically and statistically meaningful profiles using the seven-axis variables, and Classification and Regression Tree (CART) analysis was then conducted to identify the most parsimonious set of indicators that could be used to accurately classify respondents into the most relevant profile group. Data from N=322 veterans were available for analysis. The results of MLE-LPA indicated a 5-profile structure was optimal for explaining the patterns of responses within the data. These were: Mood-Dominant (13%), Localized Physical (24%), Neurosensory-Dominant (33%), Central-Dominant with complex mood and neurosensory symptoms (16%), and Trauma- and mood-dominant (14%). From CRT analysis an algorithm requiring only 3 self-report tools (central symptoms, mood screening, bodily coherence) achieved 83% classification accuracy across the 5 profiles. The new classification algorithm requiring 16 total items may be helpful for clinicians and veterans in pain to identify the most dominant drivers of their pain experience that may be useful for prioritizing intervention strategies, targets, and relevant healthcare disciplines. PERSPECTIVE: This article presents the results of latent profile (cluster) analysis of responses to standardized self-report questionnaires by Canadian military veterans with chronic pain. It identified 5 clusters that appear to represent different drivers of the pain experience. The results could be useful for triaging veterans to the most appropriate pain care providers.

Exploring differences between gender expressions in exercise self-efficacy and outcome expectations for exercise in individuals with stroke.

Gender expression may be associated with exercise self-efficacy and outcome expectations for exercise in the general population. Exercising for challenge and enjoyment are associated with the instrumental traits typically held by individuals with masculine gender expressions. Conversely, exercising for weight loss to receive validation from others are in line with the expressive traits most commonly held by individuals with feminine gender expressions. Moreover, possessing neither dominant nor expressive traits (undifferentiated gender expressions) have been linked to poorer psychological outcomes. Exercise is important after stroke, but gender differences in psychosocial factors for exercise in this population were unknown. The purpose of this study was to explore whether gender expression differences exist in exercise self-efficacy and outcome expectations for exercise post-stroke. Gender expression (masculine, feminine, androgynous, undifferentiated) was assessed using the Bem Sex-Role Inventory-12 (BSRI-12) in 67 individuals with stroke. Self-efficacy and outcomes expectations for exercise were assessed using the Self-Efficacy for Physical Activity Scale and Short Outcome Expectations for Exercise Scale, respectively. One-way analysis of covariance models were conducted, adjusting for biological sex, age, and time post-stroke. There were differences in exercise self-efficacy across the four gender expression groups (F(3,60) = 4.28, p<0.01), where individuals with masculine gender expressions had higher self-efficacy than those with undifferentiated gender expressions (adjusted mean: 3.56 [SE: 0.17] vs. 2.72 [SE:0.18], p<0.01). There were no differences in outcome expectations for exercise (F(3,57) = 1.08, p = 0.36) between gender expressions. In our pairwise comparisons, we found that individuals with masculine gender expressions had higher exercise self-efficacy than individuals possessing undifferentiated gender expressions. Strategies to enhance exercise self-efficacy after stroke are needed, particularly for individuals with undifferentiated gender expression. There were no associations between gender expression and outcome expectations for exercise after stroke. Clinicians may continue reinforcing the positive expectations towards exercise across all gender expressions.

Framing Physical Literacy for Adults Through a Rehabilitation Lens: An Expert Consensus Study.

Research indicates a positive relationship between physical literacy and healthy aging; however, there is no consensus on the components required to become a physically literate adult. The objective of this study was to understand how physical literacy for adults with chronic conditions is characterized from the perspective of healthcare professionals. Physiotherapy leaders and physical literacy researchers within North America were invited to an online consensus panel and presented with questions related to physical literacy and rehabilitation. A nominal group technique was used for idea generation, clarification, and ranking. Confidence and safety with movements, motivation and commitment to physical activity, the ability to self-monitor changes in function, and understanding the benefits of physical activity were key components when defining physical literacy. There is a need to reconceptualize physical literacy to include the rehabilitation needs of adults living with chronic conditions, and to design programs that promote physical literacy to enhance function and mobility.

Which Remote Rehabilitation Interventions Work Best for Chronic Musculoskeletal Pain and Depression? A Bayesian Network Meta-Analysis.

OBJECTIVE: To evaluate the effectiveness of remote rehabilitation interventions for people living with chronic musculoskeletal pain and depression. DESIGN: A systematic review with network meta-analysis (NMA) of randomized control trials. LITERATURE SEARCH: Cochrane Central Register of Controlled Trials, CINAHL, EMBASE, LILACS, MEDLINE, PSYNDEX and PsycINFO until May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials that evaluated the effectiveness of remote rehabilitation interventions in people with chronic musculoskeletal pain and depression. DATA SYNTHESIS: We used Bayesian random-effects models for the NMA. Effect estimates were comparisons between rehabilitation interventions and waitlist. We performed a sensitivity analysis based on bias in the randomisation process, large trials (>100 patient per arm) and musculoskeletal condition. RESULTS: Fifty-eight randomized controlled trials involving 10,278 participants (median sample size: 137 (IQR: 77 to 236) were included. Interactive-voice-response cognitive behavioural therapy (CBT) (SMD -0.66, 95%CrI -1.17 to -0.16), CBT in person (SMD -0.50, 95%CrI -0.97 to -0.04) and mobile-app CBT plus exercise (SMD -0.37, 95% CrI -0.69 to -0.02) were superior to waitlist at 12-weeks follow-up for reducing pain (> 98% probability of superiority). For depression outcomes, Internet-delivered CBT & tele-care was superior to waitlist at 12-weeks follow-up (SMD -0.51, 95% CrI -0.87 to -0.13) (> 99% probability of superiority). For pain outcomes, the certainty of evidence ranged from low to moderate. For depression outcomes, the certainty of evidence ranged from very low to moderate. The proportion of dropouts attributed to adverse events was unclear. No intervention was associated with higher odds of dropout. CONCLUSION: Interactive-voice-response CBT, and mobile-app CBT plus exercise showed similar treatment effects with in-person CBT on pain reduction among people living with chronic musculoskeletal pain and had over 98% probability of superiority than waitlist control at 12-weeks follow-up. Internet-delivered CBT & tele-care had over 99% probability of superiority than waitlist control for improving depression outcomes at 12-weeks follow-up.

Patient-Reported Outcome Measures for Patients with Upper Extremity Arthritis: Overview of Systematic Reviews.

Background: Arthritis leads to disabilities impacting patients' physical and mental health. Objective: To synthesize the evidence on measurement properties of the patient-reported outcome measures (PROMs) for people with upper extremity arthritis. Design: Overview of systematic reviews (SRs). Methods: We performed an electronic search of 6 databases to retrieve SRs looking at any measurement property related to PROMs for people with upper extremity arthritis. Two authors rated the risk of bias (ROB) of the included SRs using AMSTAR. We extracted data on measurement properties from each SR. Results: From 6 included SRs, 6 PROMs (Arthritis Impact Measurement Scale [AIMS], AIMS-2, AIMS-Short Form, Cedars-Sinai Health-Related Quality of Life for Rheumatoid Arthritis (CSHQ-RA), Revised CSHQ-RA, and Influence of Rheumatic Disease on General Health and Lifestyle) were evaluated in 2 or more SRs. The ROB of the included SRs ranged from moderate to high. Low- to moderate-quality evidence was found of good construct and criterion validity, acceptable content validity, and good responsiveness of the AIMS. We found low- to moderate-quality evidence of good internal consistency, test-retest reliability, and construct validity of the CSHQ-RA. Conclusion: We found a moderate to high ROB in the included SRs on the upper extremity PROMs for patients with arthritis. More evidence was specific to upper extremity arthritis in measures not in common use versus well-validated measures used in upper extremity conditions and recommended in current core sets. These factors suggest an urgent need for additional research to improve the scope and quality of evidence before recommendations can be made specific to patients with arthritis. Registration Number: on PROSPERO CRD 42019137491.

Tailoring and evaluating treatment with the Patient-Specific Needs Evaluation: A Patient-Centered Approach.

BACKGROUND: No patient-reported instrument assesses patient-specific information needs, treatment goals, and Personal Meaningful Gain (PMG, a novel construct evaluating individualized, clinically relevant improvement). This study reports the development of the Patient-Specific Needs Evaluation (PSN) and examines its discriminative validity (i.e., its ability to distinguish satisfied from dissatisfied patients) and test-retest reliability in patients with hand or wrist conditions. METHODS: A mixed-methods approach was used to develop and validate the PSN, following COSMIN guidelines, including pilot testing, a survey (pilot: n=223, final PSN: n=275), cognitive debriefing (n=16), expert input, and validation. Discriminative validity was assessed by comparing the satisfaction level of patients who did or did not achieve their PMG (n=1,985) and test-retest reliability using absolute agreement, Cohen's kappa, and ICCs (n=102). We used a sample of 2,860 patients to describe responses to the final PSN. RESULTS: The PSN has only five questions (completion time ±3 minutes) and is freely accessible online. The items and response options were considered understandable by 90-92% and complete by 84-89% of the end-users. The PSN had excellent discriminative validity (Cramer's V: 0.48, p<0.001) and moderate to high test-retest reliability (Kappa: 0.46-0.68, ICCs: 0.53-0.73). CONCLUSIONS: The PSN is a freely available patient-centered decision-support tool that helps clinicians tailor their consultations to the patient's individual needs and goals. It contains the PMG, a novel construct evaluating individualized, clinically relevant treatment outcomes. The PSN may function as a conversation starter, facilitate expectation management, and aid shared decision-making. The PSN is implementation-ready and can be readily adapted to other patient populations. LEVEL OF EVIDENCE: I.

Posture Evaluation of Firefighters During Simulated Fire Suppression Tasks.

BACKGROUND: Posture mechanics during fire suppression tasks are associated with musculoskeletal injuries in firefighters. METHODS: This study uses the Ovako Working Posture Analyzing System (OWAS) ergonomics tool to describe and evaluate the postures of 48 firefighters during 3 simulated tasks: (a) hose drag, (b) hose pull, and (c) high-rise pack lift. Ergonomics intervention prioritizations based on the OWAS action classification (AC) scores were identified using Wilcoxon signed-rank tests. Chi-square analyses identified associations between firefighter characteristics and OWAS AC scores. FINDINGS: The initial hose pick-up phase of each task was identified as a high priority for ergonomics intervention (OWAS AC = 4) in 45.8%, 54.2%, and 45.8% of cases for Tasks 1, 2, and 3, respectively. Lower BMI was associated with higher AC scores for the initial hose pick-up during Task 3 (likelihood ratio = 9.20, p value = .01). CONCLUSION: The results inform ergonomics priorities for firefighter training based on the tasks analyzed. Application to Practice: This study evaluates the posture mechanics of three commonly performed firefighting tasks. The results help inform an ergonomics training intervention focused on posture mechanics during occupational activities for firefighters.

Cluster analysis to identify the profiles of individuals with compromised bone health versus unfortunate wrist fractures within the Canadian Longitudinal Study of Aging (CLSA) database.

We used cluster analysis to determine the profiles of individuals who sustained wrist fractures. We found two groups: (1) young and active and (2) older and less active. This information may be used to identify individuals who require further bone health interventions to optimize healthy aging. INTRODUCTION: Distal radial fractures (DRF) are the most common of all fractures, with 6% of males and 33% of females having one at some point in their lifetime. We hypothesize that DRF consists of two subpopulations: one with compromised bone health that is early in the osteoporosis (OP) trajectory and another which are active and healthy and suffer a misfortune fracture due to their high activity levels or risk-taking behaviors. The latter is likely to recover with a minimal disability, while the former may signal a negative health trajectory of disability and early mortality. OBJECTIVE: To determine the profiles of individuals who sustained wrist fractures using cluster analysis within the Comprehensive Cohort of the Canadian Longitudinal Study on Aging (CLSA) database considering factors that reflect bone health and activity levels. METHODS: We included all the individuals who had a wrist fracture within the CLSA comprehensive cohort of the database (n = 968). The baseline data was used for this analysis. A 2-step cluster analysis was used to identify profiles that were both statistically and clinically meaningful. Variables that were used in the cluster analysis include demographic variables, physical activity status indicators, general health indicators, mobility indicators, bone health indicators, comorbid conditions, and lifestyle factors. RESULTS: We were able to identify two distinct profiles that were statistically and clinically meaningful confirming our hypothesis. One cluster included a predominantly younger cohort, who are physically active, with less comorbid conditions, better bone health, and better general health, while the opposite was true of the first cohort. CONCLUSION: We were able to identify two clusters-a healthy profile and a bone health compromised profile. This information may be used to identify the subgroup of people who should be targeted in the future for more intensive preventive health services to optimize healthy aging.

A qualitative study of healthy eating, physical activity, and mental health among single mothers in Canada.

Single motherhood is associated with higher demands in home and family responsibilities that may exist in similar sized households with grandparents. These demands can compete with opportunities and resources for maintenance of healthy behaviours. This may have been exacerbated during the COVID-19 pandemic since supports outside the home may have been restricted by public health measures. A qualitative narrative study was conducted to explore these issues with 12 single mothers in Canada. Semi-structured interviews provided an in-depth understanding of the challenges and facilitators to maintaining healthy eating habits, physical activity levels, and mental health. Theory-driven content and structural analysis were applied through a descriptive thematic approach. Challenges to maintaining healthy eating behaviours included stay-at-home orders, limited budget, unhealthy food/cravings, and lack of motivation. In contrast, living with grandparents who provide help or having an understanding of healthy food were factors that facilitated engagement in healthy eating. Challenges to maintaining physical activity levels included lack of willpower, lack of time, and low energy. Whereas time on one's own, weighing scales or outdoor gear, and weather conditions promoted physical activity. Spirituality and gratitude were the main coping mechanisms used to deal with loneliness, unemployment, and depressive symptoms. Further research into the utility of gratitude as a coping mechanism could inform public health interventions that aim to increase levels of well-being among single mothers.

Exploring Canadian Career Firefighters' Understanding of the Return-to-Work Process After Musculoskeletal Injuries.

PURPOSE: Firefighters perform dangerous and physically demanding work, increasing their risk of musculoskeletal injuries that can lead to work absences. Return-to-work procedures can help firefighters return-to-work sooner and safely. The purpose of this study was to explore what firefighters understand about return-to-work procedures in their workplaces, and what firefighters believe the facilitators and barriers to return-to-work are. METHODS: Thirty-eight Canadian career firefighters were recruited for semi-structured interviews. Qualitative descriptive methods were used to analyze the transcripts. Two researchers performed the inductive coding and thematic analysis. RESULTS: Five themes were identified: 1. Variation in the return-to-work process knowledge among firefighters based on their experiences; 2. Accessible medical resources and treatments to support injury recovery; 3. Light duties must be meaningful and suitable; 4. Pressures to return-to-work too soon may lead to negative consequences; and 5. Heavy physical demands of firefighting may become a barrier for return-to-work. 'Factors affecting RTW depended on personal experiences and context' was the overarching theme identified, as many reported facilitators for return-to-work were also reported as barriers in different contexts. There was a variation in the experiences and understanding of return-to-work. CONCLUSION: There is a lack of knowledge of the return-to-work processes. Firefighters require access to clear return-to-work policies and procedures and treatments that are targeted to firefighting duties to support recovery from injuries and regain physical abilities after an injury. Firefighters must be able to perform all essential duties before returning to firefighting work, as returning to work too soon can lead to further injury.

Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post-COVID-19 Condition: A Systematic Review and Meta-Analysis.

Importance: Current rehabilitation guidelines for patients with post-COVID-19 condition (PCC) are primarily based on expert opinions and observational data, and there is an urgent need for evidence-based rehabilitation interventions to support patients with PCC. Objective: To synthesize the findings of existing studies that report on physical capacity (including functional exercise capacity, muscle function, dyspnea, and respiratory function) and quality of life outcomes following rehabilitation interventions in patients with PCC. Data Sources: A systematic electronic search was performed from January 2020 until February 2023, in MEDLINE, Scopus, CINAHL, and the Clinical Trials Registry. Key terms that were used to identify potentially relevant studies included long-covid, post-covid, sequelae, exercise therapy, rehabilitation, physical activity, physical therapy, and randomized controlled trial. Study Selection: This study included randomized clinical trials that compared respiratory training and exercise-based rehabilitation interventions with either placebo, usual care, waiting list, or control in patients with PCC. Data Extraction and Synthesis: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pairwise bayesian random-effects meta-analysis was performed using vague prior distributions. Risk of bias was assessed using the Cochrane risk of bias tool version 2, and the certainty of evidence was evaluated using the GRADE system by 2 independent researchers. Main Outcomes and Measures: The primary outcome was functional exercise capacity, measured at the closest postintervention time point by the 6-minute walking test. Secondary outcomes were fatigue, lower limb muscle function, dyspnea, respiratory function, and quality of life. All outcomes were defined a priori. Continuous outcomes were reported as standardized mean differences (SMDs) with 95% credible intervals (CrIs) and binary outcomes were summarized as odds ratios with 95% CrIs. The between-trial heterogeneity was quantified using the between-study variance, τ2, and 95% CrIs. Results: Of 1834 identified records, 1193 were screened, and 14 trials (1244 patients; 45% female participants; median [IQR] age, 50 [47 to 56] years) were included in the analyses. Rehabilitation interventions were associated with improvements in functional exercise capacity (SMD, -0.56; 95% CrI, -0.87 to -0.22) with moderate certainty in 7 trials (389 participants). These improvements had a 99% posterior probability of superiority when compared with current standard care. The value of τ2 (0.04; 95% CrI, 0.00 to 0.60) indicated low statistical heterogeneity. However, there was significant uncertainty and imprecision regarding the probability of experiencing exercise-induced adverse events (odds ratio, 1.68; 95% CrI, 0.32 to 9.94). Conclusions and Relevance: The findings of this systematic review and meta-analysis suggest that rehabilitation interventions are associated with improvements in functional exercise capacity, dyspnea, and quality of life, with a high probability of improvement compared with the current standard care; the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes. Given the uncertainty surrounding the safety outcomes, additional trials with enhanced monitoring of adverse events are necessary.

Students' attitudes, beliefs and perceptions surrounding 2SLGBTQIA + health education and inclusiveness in Canadian physiotherapy programs.

BACKGROUND: Patients who identify as 2SLGBTQIA + report negative experiences with physiotherapy. The objectives were to evaluate student attitudes, beliefs and perceptions related to 2SLGBTQIA + health education and working with individuals who identify as 2SLGBTQIA + in entry-level physiotherapy programs in Canada and to evaluate physiotherapy program inclusiveness towards 2SLGBTQIA + persons. METHODS: We completed a nationwide, cross-sectional survey of physiotherapy students from Canadian institutions. We recruited students via email and social media from August-December 2021. Frequency results are presented with percentages. Logistic regression models (odds ratios [OR], 95%CI) were used to evaluate associations between demographics and training hours with feelings of preparedness and perceived program 2SLGBTQIA + inclusiveness. RESULTS: We obtained 150 survey responses (mean age = 25 years [range = 20 to 37]) from students where 35 (23%) self-identified as 2SLGBTQIA + . While most students (≥ 95%) showed positive attitudes towards working with 2SLGBTQIA + patients, only 20 students (13%) believed their physiotherapy program provided sufficient knowledge about 2SLGBTQIA + health and inclusiveness. Students believed more 2SLGBTQIA + training is needed (n = 137; 92%), believed training should be mandatory (n = 141; 94%) and were willing to engage in more training (n = 138; 92%). Around half believed their physiotherapy program (n = 80, 54%) and clinical placements (n = 75, 50%) were 2SLGBTQIA + -inclusive and their program instructors (n = 69, 46%) and clinical instructors (n = 47, 31%) used sex/gender-inclusive language. Discrimination towards 2SLGBTQIA + persons was witnessed 56 times by students and most (n = 136; 91%) reported at least one barrier to confronting these behaviours. Older students (OR = 0.89 [0.79 to 0.99]), individuals assigned female at birth (OR = 0.34 [0.15 to 0.77]), and students self-identifying as 2SLGBTQIA + (OR = 0.38 [0.15 to 0.94]) were less likely to believe their program was 2SLGBTQIA + inclusive. Older students (OR = 0.85 [0.76 to 0.94]) and 2SLGBTQIA + students (OR = 0.42 [0.23 to 0.76]) felt the same about their placements. Students who reported > 10 h of 2SLGBTQIA + training were more likely to believe their program was inclusive (OR = 3.18 [1.66 to 6.09]). CONCLUSIONS: Entry-level physiotherapy students in Canada show positive attitudes towards working with 2SLGBTQIA + persons but believe exposure to 2SLGBTQIA + health and inclusiveness is insufficient in their physiotherapy programs. This suggests greater attention dedicated to 2SLGBTQIA + health would be valued.

The effectiveness of biophysical agents in the treatment of carpal tunnel syndrome- an umbrella review.

BACKGROUND: Our objective was to summarize, synthesize, and integrate the evidence evaluating the effectiveness of biophysical agents compared to other conservative treatments, for the management of carpal tunnel syndrome (CTS). METHODS: This was an overview of systematic reviews (SRs). We searched several online databases and obtained SRs relating to managing CTS using biophysical agents. Two independent researchers screened and appraised the quality of the SRs using the A MeaSurement Tool to Assess systematic Reviews-2 appraisal tool. We extracted information related to study characteristics as well as the effectiveness of biophysical agents for CTS, the effect sizes, and between-group significances. We categorized the information based on the type of biophysical agent. We also performed a citation mapping and calculated the corrected covered area index. RESULTS: We found 17 SRs addressing 12 different biophysical agents. The quality of the SRs was mainly critically low (n = 16) or low (n = 1). The evidence was inconclusive for the effectiveness of Low-level Laser therapy and favorable for the short-term efficacy of non-thermal ultrasound in improving symptom severity, function, pain, global rating of improvement, satisfaction with treatment, and other electrophysiological measures compared to manual therapy or placebo. Evidence was inconclusive for Extracorporeal Shockwave therapy, and favorable for the short-term effectiveness of Shortwave and Microwave Diathermy on pain and hand function. The corrected covered area index was lower than 35% indicating a low overlap of the SRs. CONCLUSIONS: The findings were based on low-quality primary studies, with an unclear or high risk of bias, small sample sizes, and short follow-ups. Therefore, no recommendations can be made for the long-term effectiveness of any biophysical agents. High-quality evidence is needed to support evidence-based recommendations on the use of biophysical agents in the management of CTS. PROSPERO REGISTRATION NUMBER: CRD42022319002, registered on 17/04/2022.

Knowledge, behaviours, and training related to 2SLGBTQIA+ health education amongst entry-level physiotherapy students in Canada: results of a nationwide, cross-sectional survey.

BACKGROUND: Individuals who identify as 2SLGBTQIA+ report worse health outcomes than heterosexual/cisgender counterparts, in part due to poor experiences with healthcare professionals. This may stem from inadequate 2SLGBTQIA+ health and inclusiveness training in health professional student education. The purpose of the study was to evaluate knowledge, behaviours, and training related to 2SLGBTQIA+ health education and inclusiveness for entry-level physiotherapy students in Canada. METHODS: We conducted a nationwide, cross-sectional survey with physiotherapy students from accredited Canadian physiotherapy programs. We administered the survey through Qualtrics and recruited students through targeted recruitment emails and social media posts on Twitter and Instagram between August and December 2021. Survey responses are reported as frequencies (percentage). We also completed multivariable logistic regressions to evaluate associations among question responses related to working with 2SLGBTQIA+ individuals (i.e., communication, feeling prepared and assessment competency). Covariates included training hours (< 10/10 + hours) and 2SLGBTQIA+ identity (yes/no). RESULTS: A total of 150 students responded to the survey, with 35 (23%) identifying as 2SLGBTQIA+ . Many students felt confident in communicating effectively with clients who identify as 2SLGBTQIA+ (69%). However, only half (47%) felt comfortable assessing clients who identify as 2SLGBTQIA+ . Routine practice of inclusive behaviours such as using pronouns, considering identities are fluid and a patient's gender identity and/or sexual orientation may shift from one visit to the next, and considering trauma-informed care practices were reported from less than half of the students (< 45%). Around 29% of students reported no 2SLGBTQIA+ training in their physiotherapy program, while 47% reported 0-10 hours, and 24% reported 10 + hours of training. Students with 10 + hours of training had 92% higher odds of feeling competent in assessing 2SLGBTQIA+ clients, compared to those with < 10 hours of training. CONCLUSIONS: Entry-level physiotherapy students in Canada show a lack of understanding and awareness for 2SLGBTQIA+ health and inclusive behaviours which can meaningfully impact patient experience. Students report feeling incompetent when working with 2SLGBTQIA+ patients, which may be associated with lack of 2SLGBTQIA+ training in their programs. Greater efforts and attention towards increasing 2SLGBTQIA+ health education and inclusivity in Canadian entry-level physiotherapy programs is critically needed.

A systematic review of biopsychosocial prognostic factors of recovery after a proximal humerus fracture.

BACKGROUND: Proximal humerus fracture (PHF) is a common upper extremity injury. PHF often causes prolonged disability and interferes with independent function. PURPOSE: This study reviewed and summarized prognostic factors of recovery following PHF and classified them within the International Classification of Functioning, Disability and Health (ICF) with each domain sub-categorized by modifiability. STUDY DESIGN: Systematic review. METHODS: We searched MEDLINE, CINAHL, EMBASE, and PsychINFO from the date of database inception to March 2019 and updated searches in December 2021. Studies included examining an association between prognostic factors and recovery with at least a 6-month follow-up. Two independent reviewers used the Quality in Prognosis Studies tool for methodological bias and levels of evidence. Designs showed wide variability in terms of characteristics of the included population, definition of recovery, assessment of prognostic factors, and outcome measures used. This prevented pooled estimates from being produced. Prognostic factors linked to ICF domains were possible. RESULTS: Twenty-three studies including 4323 participants aged ≥18 met inclusion criteria. The risk of bias was low (35%), moderate (30%), and high (35%) across the included studies. Moderate evidence showed a significant association between pre-fracture functional independence and post-fracture complications with recovery. Fracture type, structural deformity, medication use, age, and gender were prognostic factors with inconclusive evidence. We assigned a weak level of evidence to the remaining 20 factors due to limited data. Immediate rehabilitation, compliance to post-fracture rehabilitation exercise, task-oriented exercise, and pain self-efficacy (i.e., coping behavior) are modifiable and are tapped into the ICF contextual factors. CONCLUSIONS: An array of factors that fit within an ICF biopsychosocial framework have been investigated as potential mediators of outcomes after PHF. The evidence is incomplete conceptually and in terms of research design quality. Preoperative functional status is predictive of functional recovery emphasizing the importance of healthy aging.

Diagnostic Test Accuracy of Provocative Maneuvers for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to summarize and evaluate the research on the accuracy of provocative maneuvers to diagnose carpal tunnel syndrome (CTS). METHODS: The MEDLINE, CINAHL, Cochrane, and Embase databases were searched, and studies that assessed the diagnostic accuracy of at least 1 provocative test for CTS were selected. Study characteristics and data about the diagnostic accuracy of the provocative tests for CTS were extracted. A random-effects meta-analysis of the sensitivity (Sn) and specificity (Sp) of the Phalen test and Tinel sign was conducted. The risk of bias (ROB) was rated using the QUADAS-2 tool. RESULTS: Thirty-one studies that assessed 12 provocative maneuvers were included. The Phalen test and the Tinel sign were the 2 most assessed tests (in 22 and 20 studies, respectively). The ROB was unclear or low in 20 studies, and at least 1 item was rated as having high ROB in 11 studies. Based on a meta-analysis of 7 studies (604 patients), the Phalen test had a pooled Sn of 0.57 (95% CI = 0.44-0.68; range = 0.12-0.92) and a pooled Sp of 0.67 (95% CI = 0.52-0.79; range = 0.30-0.95). For the Tinel sign (7 studies, 748 patients), the pooled Sn was 0.45 (95% CI = 0.34-0.57; range = 0.17-0.97) and the pooled Sp was 0.78 (95% CI = 0.60-0.89; range = 0.40-0.92). Other provocative maneuvers were less frequently studied and had conflicting diagnostic accuracies. CONCLUSION: Meta-analyses are imprecise but suggest that the Phalen test has moderate Sn and Sp, whereas the Tinel test has low Sn and high Sp. Clinicians should combine provocative maneuvers with sensorimotor tests, hand diagrams, and diagnostic questionnaires to achieve better overall diagnostic accuracy rather than relying on individual clinical tests. IMPACT: Evidence of unclear and high ROB do not support the use of any single provocative maneuver for the diagnosis of CTS. Clinicians should consider a combination of noninvasive clinical diagnostic tests as the first choice for the diagnosis of CTS.