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Background: Depression and anxiety disorders are considered to be among the greatest burdens of disease in children and adolescents. Recent literature has reported music therapy to be a safe and potentially effective intervention for the treatment of depression and anxiety. This systematic review examined the effectiveness of music therapy in reducing the symptom severity of depression and/or anxiety among children and adolescents. Methods: Randomized controlled trials (RCTs) were obtained from a systematic search of nine major English databases from inception to January 2021. Studies were categorized by outcome, music therapy technique and follow‐up period. Results: Seven RCTs (n = 589) were included. Four RCTs had some concern of bias, while three had high risk of bias. Statistical pooling was not appropriate due to clinical heterogeneity. Four studies (n = 428) favoured music therapy for improvement of depressive symptoms at short‐ and intermediate‐term follow‐ups compared to control. One study (n = 106) favoured music therapy for improvement of anxiety symptoms at short‐term follow‐up compared to control. No studies favoured any control over music therapy for symptom improvement of depression and/or anxiety. Conclusion: Limited evidence suggests music therapy is an effective treatment for improving depression and/or anxiety symptom severity in children and adolescents. More high‐quality RCTs are needed to address methodological flaws of current studies. [ABSTRACT FROM AUTHOR]

Myofascial pain syndrome (MPS) is characterized by the presence of clinically detected myofascial trigger points (MTrPs). Diagnostic ultrasound (US) has been proposed as a method to strengthen the reliability of MTrP localization, thus potentially improving the efficacy and safety profile of interventional procedures. The objective is to evaluate the benefit and safety profile of any US-guided interventional procedure for MPS. Medline, Embase, PubMed, the Allied and Complementary Medicine Database (AMED), and Web of Science were systematically searched from their inception to May 2020 for any randomized controlled trial that evaluated treatment benefit and safety of any US-guided interventional procedure for MPS. The primary outcome of interest was pain severity. Additional outcomes of interest were function and adverse effects. The risk of bias was assessed using the Risk of Bias V.2.0 tool. eleven studies met all inclusion and exclusion criteria. Two studies (n=174) with a high risk of bias revealed some evidence supporting US guidance over blinded interventions for improvement in pain and function. Eight studies (n=483) with varying risks of bias were of head-to-head comparisons of different US modalities. These studies revealed that US-guided local anesthetic injections were inferior to US-guided pulse radiofrequency and US-guided dry needling (DN). US-guided DN was also found to be superior to US-guided platelet-rich-plasma injections but inferior to US-guided miniscalpel. Meanwhile, one study (n=21) with some concerns of bias found that US-guided local anesthetic injections were superior to non-steroidal anti-inflammatory drugs for pain outcomes and fewer adverse events. All US-guided procedures resulted in zero or minimal self-limited adverse events. Issues with clinical relevance, limited sample sizes, and small point estimates warrant more high-quality research to better characterize the possible value of US-guided injections. [ABSTRACT FROM AUTHOR]

Objective To assess if different forms of regulation lead to differences in the quality of journal advertisements. Design Cross-sectional study. Participants Thirty advertisements from family practice journals published from 2013 to 2015 were extracted for three countries with distinct regulatory pharmaceutical promotion systems: Australia, Canada and the USA. Primary and secondary outcome measures Advertisements under each regulatory system were compared concerning three domains: information included in the advertisement, references to scientific evidence and pictorial appeals and portrayals. An overall ranking for advertisement quality among countries was determined using the first two domains as the information assessed has been associated with more appropriate prescribing. Results Advertisements varied significantly for number of claims with quantitative benefit (Australia: 0.0 (0.0–3.0); Canada: 0.0 (0.0–5.0); USA: 1.0 (0.0–6.0); p=0.01); statistical method used in reporting benefit (relative risk reduction, absolute risk reduction and number needed to treat; Australia: 6.7%, n=2; Canada: 10.0%, n=3; USA: 36.6%, n=11; p=0.02); mention of adverse effects, warnings or contraindications (Australia: 13.3%, n=4; Canada: 23.3%, n=7; USA: 53.3%, n=16; p=0.002); equal prominence between safety and benefit information (Australia: 25.0%, n=1; Canada: 28.6%, n=2; USA: 75.0%, n=12; p=0.04); and methodological quality of references score (Australia: 0.4150 (0.25–0.70); Canada: 0.25 (0.00–0.63); USA: 0.25 (0.00–0.75); p<0.001). The USA ranked first, Canada second and Australia third for overall quality of journal advertisements. Significant differences for humour appeals (Australia: 3.3%, n=1; Canada: 13.3%, n=4; USA: 26.7%, n=8; p=0.04), positive emotional appeals (Australia: 26.7%, n=8; Canada: 60.0%, n=18; USA: 50.0%, n=15; p=0.03), social approval portrayals (Australia: 0.0%, n=0; Canada: 0.0%, n=0; USA: 10.0%, n=3; p=0.04) and lifestyle or work portrayals (Australia: 43.3%, n=13; Canada: 50.0%, n=15; USA: 76.7%, n=23; p=0.02) were found among countries. Conclusions Different regulatory systems influence journal advertisement quality concerning all measured domains. However, differences may also be attributed to other regulatory, legal, cultural or health system factors unique to each country. [ABSTRACT FROM AUTHOR]

Introduction: There is a paucity of long-term treatment benefit and safety data of botulinum toxin A (BTX-A) for cervical dystonia (CD) and myofascial neck pain syndrome (MPS). Additionally, the prevalence of adjunct modality uses during this period is unknown despite evolving practices. Objective: To assess and compare treatment benefit, safety, and adjunct modality prevalences of long-term BTX-A injections between CD and MPS patients. Design: Retrospective cohort study. Setting: Private practice tertiary care clinics in Toronto. Patients: Convenience sample of 37 (52.9%) CD and 33 (47.1%) MPS patients treated for a mean±SD duration of 7.2± 4.3 and 8.3± 4.7 years, respectively. Interventions: BTX-A injections administered at least once yearly, for a duration longer than 1 year. Main Outcome Measures: Toronto Western Spasmodic Torticollis Rating Scales (TWSTRS) for disability and pain, Patient Global Impression of Change (PGIC) score, time to peak effect, duration of total response, adverse effects, and prevalence of adjunct modalities. Results: CD patients experienced improvements in TWSTRS disability (17.57± 6.79 to 9.81± 4.35, p< 0.001) and pain (14.61± 3.08 to 9.05± 3.49, p< 0.001) scores as well as PGIC score (52.00%± 23.60% to 64.80%± 23.60%, p=0.007). MPS patients experienced improvements in TWSTRS disability (15.86± 7.70 to 10.07± 7.01, p=0.01) and pain (15.25± 4.09 to 10.85± 4.49, p=0.01) scores. In both cohorts, there were no changes in time to peak effect and duration of total response. Adverse effects were minimal and self-limiting. Prevalences of adjunct modalities used by CD versus MPS patients were 28.13% versus 50.00% for anesthetic procedures, 23.08% versus 15.38% for image-guidance, 65.71% versus 56.25% for pectoralis minor injections, and 47.06% versus 53.13% for cannabis-use. Conclusion: There were demonstrated and comparable treatment benefit, safety, and adjunct modality prevalences. Our study is the first to demonstrate that long-term BTX-A injections for MPS, although commonly used off-label, can be effective and safe. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the proportion of sport-related concussion (SRC) cases among student athletes that resulted in a relapse of their symptoms due to premature return to play (RTP) or premature return to learn (RTL) has changed compared with a prior (2006 to 2011) study., Design: Retrospective cohort study of electronic medical record charts from a 5-year period (2011 to 2016) compared with previous data., Setting: A sport and exercise medicine physician's office-based practice in Ontario., Participants: Two-hundred forty-one students who had 258 distinct cases of SRC diagnosed., Main Outcome Measures: Premature RTP and RTL were defined as chart records documenting the relapse, recurrence, or worsening of concussion symptoms that accompanied the patient's RTP or RTL., Results: Between 2011 and 2016, premature RTP and RTL resulted in a relapse of symptoms in 26.7% and 42.6% of cases, respectively. When compared with data from the 2006 to 2011 chart review, the incidence of premature RTP decreased by 38.6%. However, the rate of the relapse of symptoms associated with premature RTL decreased by only 4.7%. There was a relapse of symptoms in 43.4% of the cases involving female students and 29.7% of the cases involving male students, indicating that female patients are more likely to experience a relapse of symptoms. Cases involving female athletes also resulted in much later RTP clearance compared with those involving male athletes, with a median duration that was almost double that of male athletes' cases (49 days vs 25 days)., Conclusion: An important decrease in the relapse of symptoms in the context of premature RTP occurred over the 2006 to 2016 period. However, this decrease was minimal for RTL. This may reflect the fact that efforts to implement structured RTP strategies arose earlier than those to implement RTL strategies. Efforts are needed to find the best method of implementing a coordinated plan for the postconcussion athlete who is returning to school., (Copyright© 2022 the College of Family Physicians of Canada.)

Objective: To identify barriers to and facilitators of return to learning (RTL) for female secondary school students following a sport-related concussion (SRC), and to identify critical junctures on the injury-to-recovery continuum that can be targeted to enhance the RTL process., Design: A grounded theory approach using in-depth qualitative interviews., Setting: Secondary schools within the York Region District School Board in Ontario., Participants: Ten female secondary school students who presented to a sports medicine physician with an SRC in 2015 or 2016. Five of the students received a Green Folder intervention containing an RTL strategy, while 5 students received no RTL intervention following their SRC., Methods: In-depth interviews were conducted in person or by telephone. All interviews were audiorecorded and transcribed. The transcriptions were analyzed, coded, and examined for common themes by 2 independent reviewers., Main Findings: Barriers to RTL included a lack of a graduated RTL process, students' own internal stress, poor communication of expectations, lack of concussion education, and inadequate support from teachers. Facilitators of RTL included academic accommodations and having a primary contact person within the school system. Owing to inconsistent implementation, the impact of the Green Folder intervention as a facilitator of RTL remains unknown., Conclusion: Results of this study support existing findings in the realm of concussion research. A novel finding includes the importance of a primary contact person as a facilitator of RTL. This person could help to overcome some of the identified barriers to RTL and improve outcomes by assisting with academic accommodations, providing reassurance regarding these accommodations, improving education among teachers and students, and enhancing communication between stakeholders., (Copyright© 2022 the College of Family Physicians of Canada.)