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The purpose of this meta-ethnography was to synthesize the research exploring patient/provider perceptions of clinical conversations (CC) centered on chronic musculoskeletal pain (CMP) in vulnerable adult populations. A systematic search for qualitative/mixed method studies in CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used PRIMSA-P guidelines. Data synthesis used eMERGe guidelines; findings were presented in nested hierarchal theoretical frameworks. The included studies explored patients' (n = 18), providers' (n = 2), or patients' and providers' perspectives (n = 5) with diversity in patient participants represented (n = 415): immigrants, indigenous people, women, and veterans. Themes for each level of the nested hierarchal models revealed greater complexity in patients' perceptions about the CC in CMP relative to clinicians' perceptions. A unique finding was sociopolitical/historical factors can influence CC for vulnerable populations. The combined nested hierarchical models provided insight into the need for clinicians to be aware of the broader array of influences on the CC. Key themes indicated that improving continuity of care and cultural training are needed to improve the CC. Additionally, due to patients' perception of how healthcare systems' policies influence the CC, patients should be consulted to guide the change needed to improve inequitable outcomes. Healthcare providers wishing to improve the clinical conversation in chronic musculoskeletal pain can more broadly explore potential factors influencing patients' experiences and perceptions. Screening during the clinical conversation can include assessing for sociopolitical and historical influences on patients' experiences with chronic musculoskeletal pain. Healthcare providers can explore how to minimize disjointed care in an effort to improve the clinical conversation and outcomes in chronic musculoskeletal pain. Healthcare providers and patients can work together to improve inequitable outcomes for vulnerable adults with chronic musculoskeletal pain. This may include cultural training for healthcare providers that is informed by patients. [ABSTRACT FROM AUTHOR]

Healthcare clinical decision makers' (CDMs) attitudes, beliefs, and biases can negatively contribute to both clinical conversations and subsequent inequitable management decisions in persistent musculoskeletal pain (PMP). Understanding the factors that may contribute to CDMs' decisions is particularly important for vulnerable patient populations. The aim of this systematic review was to synthesize the current research investigating the impact of CDM's attitudes, beliefs, and biases on the process of care in PMP management in adults. A systematic search following PRISMA guidelines was run in five databases: CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science. Included studies: vulnerable adult populations with chronic pain. Methodological quality was assessed with the Downs and Black tool. Nine studies were included. Studies examined CDMs' perceptions of case vignettes used in medical schools, allied health professional programs, and in healthcare settings. Implicit biases related to pain severity and favoring medical evidence influenced CDMs' perceptions of case legitimacy. Pharmaceutical management decisions were influenced by race/ethnicity, gender, pain severity, medical evidence, and non-verbal patient behavior. Pain severity influenced non-pharmaceutical management decisions. Implicit biases related to race/ethnicity, gender, supporting medical evidence, and pain severity were demonstrated in educational settings and persisted in clinical settings. Health professional curricula should include training with a focus on outcomes that demonstrate increased awareness of the factors that could lead to inequitable management decisions. Addressing biases during the training of CDMs will be necessary to improve congruency of clinical conversations and minimize marginalization of patient care in PMP. [ABSTRACT FROM AUTHOR]

Objective Chronic musculoskeletal pain (CMP) outcomes are affected by numerous variables, including the clinical conversation. When good therapeutic/working alliances are formed, congruent clinical conversations can lead to improved CMP outcomes. Identifying patient/provider attitudes, beliefs, and biases in CMP that can influence the clinical conversation, and thus clinical management decisions, is foundationally important. Design The aims of this systematic review were to 1) summarize the evidence of the attitudes and beliefs of patients and health care providers (HCPs) involved in the clinical conversation about CMP, and 2) examine whether and how these perceptions impacted the process of care. Methods A systematic search of CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Included studies were those investigating vulnerable adult populations with chronic pain. Study bias was examined with the Downs and Black tool. Results Seven retrospective studies were included. When making pharmaceutical management decisions, HCPs demonstrated negative implicit biases toward minorities and women. When making referrals to multidisciplinary care, HCPs demonstrated negative implicit biases toward women with lower educational attainment. Unmet patient expectations resulted in higher dropout rates at multidisciplinary pain management programs. Patients' trust was influenced by the health care setting, and patients often had limited options secondary to health insurance type/status. Conclusion These findings suggest that patients with CMP may experience a marginalized process of care due to HCPs' negative implicit biases, unmet patient expectations, and the health care setting. Results suggest several factors may contribute to inequitable care and the recalcitrant nature of CMP, particularly in vulnerable populations with limited health care choices. [ABSTRACT FROM AUTHOR]

E-sports is becoming increasingly popular; however, participation is not without risks. Certain lifestyle factors associated with gaming may have negative effects on the wellbeing of the players. This systematic review of current studies of e-athletes' health and wellbeing, primarily focused on athletes level of physical activity. This review also aimed to gain insight on potential health promotion and management strategies for e-gamers and e-athletes. Four online databases (Medline, SCOPUS, Web of Science, and EBSCO) were searched for full-text English articles published between 2010 and April 2020. A total of six articles met the inclusion criteria and were included for review. From the six studies, five themes were identified: (1) demographics of e-sports; (2) e-athletes' level of physical activity, compared to World Health Organization (WHO) guidelines; (3) reasons to engage in physical activity; (4) physical training as a part of e-sport training; and (5) degree of sedentary time. Other findings included e-sports injuries reported by participants, broader aspects of health behaviors, along with proposals for multiple disciplinary team approaches to e-athlete management. Despite the level of sedentary behavior and e-sports related injuries from the reviewed studies, the majority of e-athletes in the studies included met WHO physical activity guidelines with health promotion as primary motivation. Other health behaviors (sleep and diet) are particularly relevant to e-athletes. More research is needed to better understand this population's health-related behavior and habits to better establish their wellbeing and health risks. [ABSTRACT FROM AUTHOR]

Physical activity (PA) is a primary and secondary strategy used to reduce the risk of non-communicable diseases, whilst reducing the risk of morbidities. Approximately 71% of deaths that occurred in 2016 worldwide were due to non-communicable diseases. For men, many of these deaths could be prevented through lifestyle changes such as increasing physical activity; however, most older men struggle to complete the recommended 150 min/week of physical activity. This review aimed to investigate the barriers that prevent older men from engaging in physical activity, and what factors (or facilitators) encourage them to participate. A systematic search was conducted across nine databases for papers published between 2010 and 2020. Studies were screened for eligibility and quality-assessed, data were extracted, and themes identified. A total of 7 qualitative studies, one cross-sectional study and one randomized controlled trial, were included in the review; this included a total of 921 male participants aged above 60 years old. Barriers and motivating factors were categorized as follows: personal, environmental, and exercise tasks. Older men were commonly motivated to exercise to preserve meaningfulness in their lives, for accomplishment, and to maintain physical and mental health. The common barriers identified by older men included: unmotivating attitudes from their social environment, fear of injury, and lack of appropriate opportunities. Men are more likely to engage in PA if it is meaningful, preserves or improves physical function, and strengthens their social relationships. These findings provide insights about strategies to engage older men in physical activity, and thus improve their quality of life. [ABSTRACT FROM AUTHOR]

People with disability are insufficiently physically active for health. This study identified the volume, quality, and findings of research that exposes environmental and personal barriers of physical activity participation for people with neurological conditions. CINAHL, Sport Discus, EMBASE, Medline, and AMED were systematically searched between 1999 and week one 2010 for peer reviewed studies that fit the aim of the review. Identified barriers to physical activity participation were categorized into the World Health Organization's ICF framework of domains. Of the 2,061 studies uncovered in the search, 29 met inclusion criteria and 28 met quality appraisal. Findings showed that barriers to physical activity participation arise from personal factors that, coupled with lack of motivational support from the environment, challenge perceptions of safety and confidence to exercise. [ABSTRACT FROM AUTHOR]

As part of traditional Chinese medicine, acupoints are considered a dynamic functional area, which can reflect the internal condition of the body. When the body is suffering from disease or injury, corresponding acupoints are believed to be activated and manifest in several sensitized forms, including expansion of the receptive field, pain sensitization, and heat sensitization. Such phenomena are believed to gradually disappear concomitantly with recovery from the disease. Acupoint states are therefore changeable according to health status, a phenomenon known as acupoint sensitization. This review aims to provide an overview of acupoint sensitization based on existing research results and determine priorities for future research. Systematic literature retrieval was conducted in Medline, Embase, Cochrane Library, CINAHL, and AMED from inception to 18 July 2018. Current evidence from research findings to date indicate that acupoint sensitization is based on neurogenic inflammation and that stimulation of sensitized acupoints presents a potential trend of generating a better clinical effect when compared with stimulation of unsensitized points. [ABSTRACT FROM AUTHOR]

Background: Chronic musculoskeletal pain in the elderly is highly prevalent, with osteoarthritis, low back pain, neck pain and other musculoskeletal disorders as the leading contributors to pain chronicity and disability. Previous reviews identifying effective components of non-pharmacological interventions for treating chronic pain have either few studies or the included studies examine outcome over a limited time span. This systematic review will investigate the effectiveness and components of interventions associated with management of chronic musculoskeletal pain in older adults (≥65 years). Methods/Design: This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Randomised controlled trials of non-pharmacological interventions aimed at reducing pain in older adults with chronic musculoskeletal pain will be included. Articles will be identified through a comprehensive search of the following databases: Ovid MEDLINE, Embase, CINAHL, AMED, Scopus, Web of Science and PEDro. Two review authors will independently screen articles retrieved from the search for eligibility, and extract relevant data on methodological issues. A narrative synthesis will be completed if there are insufficient data for a meta-analysis. The narrative synthesis will summarise the current state of knowledge, interventions, study designs and robustness of evidence. Discussion: Findings of the study will inform support programs and interventions to assist people aging with pain, carers and other supporters and practitioners. Systematic review registration: PROSPERO 2017:CRD42017074173. [ABSTRACT FROM AUTHOR]

Objectives Musculoskeletal conditions (MSCs) are the leading cause of disability and chronic pain in the developed world, impacting both functional ability and psychosocial health. The current review investigates the effectiveness of yoga on primary outcomes of functional ability, pain and psychosocial outcomes across a range of MSCs. Methods A comprehensive search of 20 databases was conducted for full-text, randomized controlled trials of yoga in clinically diagnosed MSCs. Result Seventeen studies met the inclusion criteria, involving 1,626 participants with low back pain (LBP), osteoarthritis (OA), rheumatoid arthritis (RA), kyphosis or fibromyalgia. Studies were quality rated, and analysed for the effect of yoga on primary outcomes, immediately post-intervention. Twelve studies were rated as good quality. Yoga interventions resulted in a clinically significant improvement in functional outcomes in mild-to-moderate LBP and fibromyalgia, and showed a trend to improvement in kyphosis. Yoga significantly improved pain in OA, RA and mild-to-severe LBP. Psychosocial outcomes were significantly improved in mild-to-moderate LBP and OA. Meta-analysis of good-quality studies showed a moderate treatment effect for yoga of −0.64 (95%CI −0.89 to −0.39) for functional outcomes and −0.61 (95%CI −0.97 to −0.26) for pain outcomes. Conclusions Evidence suggests that yoga is an acceptable and safe intervention, which may result in clinically relevant improvements in pain and functional outcomes associated with a range of MSCs. Future analysis of outcomes which take into account the amount of yoga received by participants may provide insight into any putative duration or dosage effects of yoga interventions for MSCs. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Electrical stimulation at acupuncture points (acupoints) has been investigated for its utility in lowering blood glucose in hyperglycemic humans and animal models. Only two studies were found using electroacupuncture in human subjects, and in both of these, the participants were normal (nondiabetic) and electrical stimulation was carried out at several acupoints. It had a hypoglycemic effect in obese women with calorific restriction diet using electrical stimulation of 2Hz for 30 minutes/day for 20 days, but no change occurred in blood glucose of fasted patients in the other study using 1Hz for 15 minutes. Fourteen animal studies were found, of which, 11 were performed in diabetic and normal rats. A hypoglycemic effect was observed in fasted type 1 diabetic rats using the Zusanli (ST36) leg acupoint with electrical stimulation of 15Hz for 30 minutes and 60 minutes. In fasted type 2 diabetic rats, blood glucose was lowered using the Zusanli acupoint with electrical stimulation parameters of 15Hz and 10mA for 30 minutes. Also, using the Zhongwan (CV12) abdomen acupoint with electrical stimulation parameters of 15Hz and 10mA for 90 minutes had a hypoglycemic effect in fasted type 2 diabetic rats. In fasted normal rats, electrical stimulation of 2Hz or 15Hz for 30 minutes at the Zusanli or Zhongwan acupoint caused a decrease in blood glucose. Future studies are required in fasted diabetic rats to determine the effect of electroacupuncture on blood levels of insulin, lipids, fatty acids and β-endorphin, and blood flow and nerve conduction velocity. Studies with fasted normal and diabetic human subjects treated by electroacupuncture are warranted using data from animal experiments to inform such studies. [Copyright &y& Elsevier]