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What are the consequences of musculoskeletal pain in adolescents? A critical qualitative systematic review and meta-synthesis
No full textThere is a paucity of research into the lived experiences of adolescents with musculoskeletal pain. This study synthesised the available qualitative research on musculoskeletal pain consequences in adolescents. CINAHL, EMBASE, MEDLINE, PsycINFO and Research Rabbit were searched, and a critical qualitative systematic review and meta-synthesis was performed (Prospero ID=476626). Screening and data extraction were completed in duplicate. Critical appraisal of included studies and level of confidence in the findings were assessed. A thematic synthesis approach was used to derive analytical themes. Twelve studies were included (n=213). Adolescents (age range 8–22 years) reported functional impediments that impacted daily living, mobility, school, socializing, and sleep. Distress and concern regarding movement, health, isolation, autonomy, support, healthcare experiences, and their future were also reported. Adolescents report complex and burdensome consequences of musculoskeletal pain. The functional impediments and the psychosocial impacts lead adolescents to feel distressed, isolated, and unsupported. Confidence in the findings according to the GRADE-CERQual assessment showed high, moderate and low confidence across the results. This knowledge can be used to develop meaningful communication and understanding in clinical encounters with adolescents, and provide focus for more impactful research, addressing the consequences reported by adolescents
A call for improving the internal validity and the reporting of manual therapy trials self-labelled as pragmatic: A methodological review
No full textObjectives
This study provides further data from a review assessing methodological characteristics of pragmatic randomised controlled trials (pRCTs) published in manual therapy (MT). In this second part, we aim to assess the report, the risk of bias (RoB), and the relationship between these items and the pragmatism scores of the self-labelled pRCTs in the MT field.
Study design and setting
We searched MEDLINE and the Cochrane Central Register of Controlled Trials for pRCTs in the MT field from inception to January 2024. Two independent reviewers screened the trials using several CONSORT extensions and assessed them using the Cochrane Risk of Bias tool. We performed a descriptive analysis using frequencies and percentages and a relation analysis between the trials' pragmatism, their reporting, and their RoB.
Results
We included 39 self-labelled MT pRCTs. Compliance with CONSORT items was higher than 70 % in one-third of the included trials (13/39) but varied across items. Performance and detection bias were the main threats to internal validity (we rated 90 %, 35/39, and 77 %; 30/39 of trials at high risk of bias, respectively). Selective reporting bias was unclear in almost half of the sample (46 %; 18/39). No relation was found between the highly pragmatic attitude and good reporting except for CONSORT item 25 (Sources of funding and other support) (p = 0.006). No relation was found between the RoB and the pragmatic attitude of the studies. The percentage of compliance with CONSORT items was higher in the trials with low RoB.
Conclusion
Pragmatic trials in MT have significant methodological limitations, and their reporting is suboptimal. Nonetheless, trials with less risk of bias had higher compliance with CONSORT items
Occupational stress and wellbeing: A qualitative exploration of the perspectives and experiences of migrant sonographers practising in the United Kingdom
No full textObjective: The objective of this study was to perform a narrative review of digital Positron emission
tomography-computed tomography (PET-CT) scanners, focussing on the current development in the
technology of optimized crystal size and design, the time of flight (ToF) resolution, sensitivity, and axial
field of view (AFOV).
Key findings: It was observed that significant developments were carried out on the optimization of
scintillation crystal size which results in the improvement of spatial resolution. such developments
include the upgrade in the AFOV after the integration of SiPM technology, which results in dynamic
parametric imaging acquisition in PET and sensitivity boost. The improvement in ToF resolution and the
better ToF resolution values, which result in a boost in adequate sensitivity and signal-to-noise ratio
(SNR). Other upgrades include the use of the smallest crystal size of 2.76 � 2.76 mm, and the use of the
lowest ToF resolution of 214 ps. The use of the largest AFOV of 194 cm with the highest observed NEMA
sensitivity of 225 cps/kBq for the total body PET-CT system.
Conclusion: Digital PET-CT systems offer various advantages such as a reduction in radiation dose from
injected radiopharmaceuticals doses and the overall PET acquisition time with an improved diagnostic
certainty. This is because of the better performance of the SiPM detector. Digital PET-CT also has added
benefits of the dynamic acquisition and Patlak modeling capabilities into routine clinical practice with
the advancement in higher AFOV PET systems.
Implication: This will help the users choose the best system during the evaluation of the PET-CT for
purchase in clinical and research applications. This review will further help in teaching the latest
technology and developments in PET-CT systems
Clinical Trial: Rifaximin Therapy Versus a Low Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAP) Diet In Irritable Bowel Syndrome: A Randomised Controlled Trial
No full textBackground
Rifaximin and the low FODMAP diet (LFD) are suggested as second-line therapies for irritable bowel syndrome (IBS). Direct comparative data are limited.
Aims
To compare the efficacy of rifaximin and LFD in IBS.
Methods
In this single-blind, randomised controlled trial, we allocated adults with IBS to rifaximin or LFD. The primary outcome was composite symptom improvement (abdominal pain/discomfort and stool consistency/frequency) at Week 4. Secondary outcomes included individual symptom improvement, ≥ 50 point reduction in IBS Symptom Severity Scale (IBS-SSS), health-related quality of life (HRQOL), Hospital Anxiety and Depression Scale (HADS), small intestinal bacterial overgrowth (SIBO) eradication, adherence and adverse events.
Results
We randomised 100 patients equally (median age 50 years; 52% female; 68% IBS-D; 17% SIBO). Based on the composite symptom assessment, response rates were similar between groups (rifaximin 56.0% vs. LFD 48.0%, p = 0.423) at Week 4. However, rifaximin led to significantly earlier individual symptom improvement at Week 2, including global symptoms (90.0% vs. 72.0%, p = 0.022), bloating (84.0% vs. 58.0%, p = 0.004) and abdominal pain (80.0% vs. 58.0%, p = 0.017). HRQOL and anxiety scores improved in both groups. SIBO eradication was observed in 63.6% (rifaximin) and 50.0% (LFD). Adherence was significantly better with rifaximin (95.9% vs. 77.8%, p = 0.008). No serious adverse events occurred.
Conclusion
Rifaximin is as effective as LFD in treating IBS over 4 weeks. However, it provides faster symptom relief and higher treatment adherence, making it a practical alternative for symptom management
Remote multicomponent rehabilitation compared to standard care for survivors of critical illness after hospital discharge (iRehab): a protocol for a randomised controlled assessor-blind clinical and cost-effectiveness trial
No full textBackground
The consequences of critical illness can be substantial and multifactorial, encompassing physical deconditioning, mental health impairments, fatigue, and declines in health-related quality of life. We hypothesise that for people discharged after intensive care unit (ICU) for a critical illness, a six-week remote multicomponent rehabilitation intervention improves health-related quality of life, physical function, fatigue, mood, and other health-related outcomes after eight weeks, compared to standard care.
Methods
This is a pragmatic, randomised controlled, open-label, assessor blind, multicentre, clinical and cost effectiveness trial with internal pilot and embedded process evaluation. Recruitment will take place in NHS hospitals across the UK. Adults (n=428: control n= 197; intervention: n=231) within 12 weeks of discharge from hospital following an ICU admission for critical illness, requiring mechanical ventilation ≥48hours will be recruited.
The intervention is a six week multicomponent, structured, rehabilitation programme, delivered remotely by a trained intervention team. The intervention includes four components: weekly symptom management; targeted exercise; psychological support, and peer support and information. The control group will receive standard NHS care.
The primary outcome is Health-related quality of life (HRQoL) at eight weeks post-randomisation measured using the EQ-5D-5L. Secondary outcomes are: HRQoL (six months), physical function, fatigue, anxiety and depression, healthcare resource use at eight weeks and six months and intervention acceptability.
Conclusions
This trial will test a centrally delivered mulitcomponent rehabilitation intervention for survivors of critical illness, irrespective of geographic location or critical illness diagnosis
Guidance strategies for infantile asymmetry prevention: a systematic review
No full textBackground Infantile asymmetries of posture, movement and/or shape are common. Coincidence in the presentation of asymmetrical features can lead to a broad spectrum of descriptors. Published guidelines on prevention strategies are not currently available. The objective of this systematic review was to find, evaluate, and synthesise the available evidence regarding the effectiveness of prevention strategies for infantile asymmetries, specifically strategies
involving paediatric screening and/or guidance to parents.
Methods This review has been reported based on Preferred Reporting Items for Systematic Reviews and MetaAnalysis (PRISMA) and the review protocol was prospectively registered on the Open Science Framework, (https://
osf.io/rgzev/). Searches were conducted on Ovid Medline, Ovid AMED, and PEDro. Inclusion criteria of articles were
infants<28 weeks old who had received either an early musculoskeletal screen and/or education to parents on home
care guidance/exercises to prevent asymmetry development. Any primary research was included. There was no limit
placed upon date of publication. Data were screened, extracted and appraised in duplicate by at least two blinded
reviewers. The Cochrane Collaboration’s tool for assessing risk of bias available as part of Covidence was used by two
reviewers independently.
Results Of the 878 papers retrieved, 19 studies were included: 9 randomised controlled trials, 6 cohort studies and 4
non-randomised experimental studies. The presenting conditions included head shape asymmetry in 16/19 studies, cervical range of motion in 10 studies and positional preference in 3. Due to a lack of homogeneity between all
the studies, it was not possible to pool the data and conduct meta-analysis. Guidance strategies show better outcomes in asymmetry prevention when provided early (<3 months) and under supervision of a healthcare professional. The overall risk of bias for cohort and non-randomised experimental studies was considered to be ‘low’,
and‘adequate’ or‘low’ for randomised controlled trials. The GRADE level of evidence was found to be ‘very low’.
Conclusion Early parental guidance may prevent infantile asymmetry when supervised by a trained healthcare
professional and with good adherence from parents. Further studies with a higher methodological rigour are needed
to identify and perform comparative interventions
Ununited mobile odontoid fracture: Clinical and imaging findings with subsequent management: A case report
No full textObjective: The purpose of this case study is to describe the clinical presentation and imaging evaluation of an acute
type II dens fracture that failed to unite with immobilization. Subsequent management aimed at optimizing the
patient’s quality of life is discussed.
Clinical Presentation: An 84-year-old male presented to a chiropractic clinic 4 days after a ground-level fall onto
his face. He demonstrated facial bruising, severe pain of the neck and severely limited cervical rotation. Based on the
clinical findings and history, the attending chiropractor suspected a cervical spine fracture.
Intervention and outcome: The chiropractor proceeded to take cervical spine radiographs which showed a
type II dens fracture and anterior translation of C1. The patient was then transported to the hospital by
ambulance, where computed tomography (CT) confirmed the presence of a type II odontoid fracture. Following
immobilization, initially with a hard collar and later a soft collar, the dens fracture healed but with non-union.
A magnetic resonance imaging scan with flexion and extension showed translation of the dens, however no
spinal cord compromise was demonstrated. Surgery was not advised due to the patient’s age and lack of cord
compromise. The chiropractor resumed management after medical clearance, focusing on fall prevention
strategies, neck strengthening exercises and gentle soft tissue work.
Conclusion: Upright magnetic resonance imaging with flexion and extension was helpful for evaluation and further
management of a non-united mobile type II dens fracture. Patients who experience non-union of type II odontoid
fracture may benefit from conservative measures aimed at falls prevention, such as balance exercises, bone and heart
health evaluation, muscle strengthening, cataract evaluation and scrutiny for hazards in the home. (J Chiropr Med
2025;00;1-7
European research Priorities for Osteopathic Care (PROCare): a sequential exploratory investigation and survey
No full textObjectives The aim of this study is to identify and analyse research priorities across the osteopathic profession internationally, to determine how different interested parties conceptualise research importance and to examine how contextual factors influence research prioritisation.
Design A mixed methods sequential exploratory design combining an umbrella review, a thematic analysis, an expert consensus agreement and an international cross-sectional survey was used to define, validate and evaluate research priorities.
Setting An international online survey, available in nine languages, was distributed through professional osteopathic organisations and network worldwide, a patient representative organisation and social media.
Participants 2229 respondents including patients (7.4%), practitioners (42.1%), students (17.4%), educators (13.5%), researchers (5.0%) and policy makers (4.3%) from across 42 countries.
Primary and secondary outcome measures Primary outcomes were interested party’s conceptualisation of research importance and validation of the priorities in Research for Osteopathic Care (PROCare) framework. Secondary outcomes included current research priorities across interested parties groups and influence of contextual factors on prioritisation.
Results Three distinct approaches to priority-setting emerged: conservative (42.9%), sceptic (20.2%) and enthusiast (36.9%). Organising research priorities as a construct built from domains and subdomains was shown to be internally valid (Cronbach’s α=0.911). ‘Patient safety’ (nominated by 82% of relevant countries) and ‘physical activities and mobility’ (51.0%) were the most prioritised subdomains. ‘Digital health’ ranked lowest (28th of 28 subdomains). Significant geographic variations were observed mainly for the overall importance to most research domains. Strong consensus emerged around core priorities including patient safety, physical activity promotion and understanding treatment mechanisms.
Conclusions The PROCare framework provides a validated structure for evaluating osteopathic research priorities across diverse interested parties. While geographic variations exist in priority emphasis, fundamental agreement on key research domains suggests potential for internationally coordinated research strategies. Future work should focus on developing mechanisms to ensure balanced representation of conservative, sceptic and enthusiast perspectives in research planning
Profile of patients presenting to Australian osteopaths: Results from a national health service use survey
No full textBackground and purpose
Musculoskeletal conditions are one of the most common complaints affecting the Australian population. Affected individuals often seek care from a range of health professionals including osteopaths. Osteopaths provide care for musculoskeletal conditions using manual therapy, exercise, and patient education. The current study is a secondary analysis of data from an Australian health service use survey.
Materials & methods
Respondents were asked to indicate the range of health professionals they consulted during the period February 2021 and February 2022. Additional data collected from respondents related to demographic variables, presence of chronic conditions in addition to the Personal Wellbeing Index (PWI) and Short Form 20 (SF-20). Data were descriptively analysed based on whether the respondent reported consulting with an osteopath or not.
Results
In the period February 2021-February 2022, of the 2354 respondents, 143 (6.1 %) indicated they had consulted with an osteopath. Over half of those who consulted with an osteopath identified as female (51.7 %), had private health insurance (59.4 %) and/or a healthcare card (69.9 %). No significant difference was observed between respondents who consulted with an osteopath and those who did not for PWI scores (p > 0.05). SF-20 scores were significantly lower for those who consulted with an osteopath compared with those who did not (p < 0.01).
Conclusion
This secondary analysis contributes to our understanding of the profile of patients presenting to Australian osteopaths, particularly health related quality of life and subjective wellbeing of this patient cohort
Linking 24-hour movement behaviour guidelines to core symptoms and school engagement of youth with moderate/severe ADHD
No full textBackground: The independent associations of physical activity (PA), sleep duration (SL), and screen time (ST) with health outcome measures have been well-documented among children and adolescents, but not in youth with moderate/severe ADHD. To this end, the present study aimed to investigate the associations between three components within 24-hour movement behaviour (24-HMB) framework and core symptoms and school engagement in youth with moderate/severe ADHD.
Methods: This study used pooled data from the 2021-2022 U.S. National Survey of Children's Health, which included a nationally representative sample of 4797 youth aged 6-17 years. Logistic/Ordinal regressions examined associations between meeting 24-HMB guideline combinations and core symptoms and school engagement among youth with moderate/severe ADHD, adjusting for age, sex, family income, body mass index, and ethnicity.
Results: Only 6.9% of youth with moderate/severe ADHD met all three 24-HMB guidelines. Compared to those meeting no guidelines, youth meeting all guidelines was beneficially associated with inattention symptoms (self-regulation: OR=0.44, 95%CI: 0.35-0.57; concentration: OR= 1.26, 95%CI: 1.01-1.55) and better performance of school engagement (caring about doing well: OR = 0.52, 95%CI: 0.41-0.65; completing homework: OR = 0.49, 95%CI: 0.39-0.62). Meeting the ST + SL guidelines was associated with significantly lower odds of hyperactivity/impulsivity symptoms (argument, OR = 1.33, 95% CI: 1.12-1.58; staying calm, OR = 0.59, 95% CI: 0.46-0.75) compared to those who met none of guidelines.
Conclusions: Meeting 24-HMB guidelines was associated with lower likelihood of ADHD core symptoms and greater likelihood of school engagement. Integrative "whole day" behavioural interventions warrant consideration for improving school engagement-related outcomes and reducing ADHD core symptoms in this vulnerable population