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Background: Total knee arthroplasty (TKA) is an effective procedure. However, for some patients, the outcomes are not satisfactory. Identification of TKA determinants could help manage these patients more efficiently. The purpose of this study was to identify pre- and perioperative determinants of pain, functional limitations and health-related quality of life (HRQoL) 6 months after TKA. Methods: 138 participants were recruited from 3 hospitals in Quebec City, Canada and followed up until 6 months after surgery. Data were collected through review of the subjects' medical files and structured telephone interviews before and 6 months after TKA. Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the SF-36 Health Survey. Independent variables included demographic, socioeconomic, psychosocial, clinical and surgical characteristics of participants as well as data on health services utilization. Stepwise multiple regression analysis was used to assess the strength of the associations between the independent variables and the WOMAC and SF-36 scores. Results: Higher preoperative pain, cruciate retaining implants and the number of complications were significantly associated with worse pain 6 months after TKA (p < 0.05) and explained 11% of the variance of the WOMAC pain score. Higher preoperative functional limitations, being single, separated, divorced or widowed, being unemployed or retired and the number of complications were significantly associated (p < 0.05) with worse functional limitations 6 months after TKA and explained 16% of the variance of the WOMAC function score. Lower preoperative HRQoL, contralateral knee pain, higher psychological distress and comorbidities were significantly associated (p < 0.05) with worse HRQoL 6 months after TKA and explained 23% of the variance of the SF-36 physical functioning score. Conclusions: Several variables were found to be significantly associated with worse outcomes 6 months after TKA and may help identify patients at risk of poorer outcome. The identification of these determinants could help manage patients more efficiently and may help target patients who may benefit from extensive rehabilitation. [ABSTRACT FROM AUTHOR]

Background. The ability to generate vivid images of movements is variable across individuals and likely influenced by sensorimotor inputs. Objectives. The authors examined (1) the vividness of motor imagery in dancers and in persons with late blindness, with amputation or an immobilization of one lower limb; (2) the effects of prosthesis use on motor imagery; and (3) the temporal characteristics of motor imagery. Methods. Eleven dancers, 10 persons with late blindness, 14 with amputation, 6 with immobilization, and 2 groups of age-matched healthy individuals (27 in control group A; 35 in control group B) participated. The Kinesthetic and Visual Imagery Questionnaire served to assess motor imagery vividness. Temporal characteristics were assessed with mental chronometry. Results. The late blindness group and dance group displayed higher imagery scores than respective control groups. In the amputation and immobilization groups, imagery scores were lower on the affected side than the intact side and specifically for imagined foot movements. Imagery scores of the affected limb positively correlated with the time since walking with prosthesis. Movement times during imagination and execution (amputation and immobilization) were longer on the affected side than the intact side, but the temporal congruence between real and imagined movement times was similar to that in the control group. Conclusions. The mental representation of actions is highly modulated by imagery practice and motor activities. The ability to generate vivid images of movements can be specifically weakened by limb loss or disuse, but lack of movement does not affect the temporal characteristics of motor imagery. [ABSTRACT FROM AUTHOR]

Background: Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 25% of adult with mTBI present persistent symptoms. Headache, dizziness, nausea and neck pain are the most commonly reported symptoms and are frequently associated with cervical spine and vestibular impairments. The most recent international consensus statement (2017 Berlin consensus) recommends the addition of an individualized rehabilitation approach for mTBI with persistent symptoms. The addition of an individualized rehabilitation approach including the evaluation and treatment of cervical and vestibular impairments leading to symptoms such as neck pain, headache and dizziness is, however, recommended based only on limited scientific evidence. The benefit of such intervention should therefore be further investigated. Objective: To compare the addition of a 6-week individualized cervicovestibular rehabilitation program to a conventional approach of gradual sub-threshold physical activation (SPA) alone in adults with persistent headache, neck pain and/or dizziness-related following a mTBI on the severity of symptoms and on other indicators of clinical recovery. We hypothesize that such a program will improve all outcomes faster than a conventional approach (between-group differences at 6-week and 12-week). Methods: In this single-blind, parallel-group randomized controlled trial, 46 adults with subacute (3 to12 weeks post-injury) persistent mTBI symptoms will be randomly assigned to: 1) a 6-week SPA program or 2) SPA combined with a cervicovestibular rehabilitation program. The cervicovestibular rehabilitation program will include education, cervical spine manual therapy and exercises, vestibular rehabilitation and home exercises. All participants will take part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome will be the Post-Concussion Symptoms Scale. The secondary outcomes will be time to clearance to return to function, number of recurrent episodes, Global Rating of Change, Numerical Pain Rating Scale, Neck Disability Index, Headache Disability Inventory and Dizziness Handicap Inventory. A 2-way ANOVA and an intention-to-treat analysis will be used. Discussion: Controlled trials are needed to determine the best rehabilitation approach for mTBI with persistent symptoms such as neck pain, headache and dizziness. This RCT will be crucial to guide future clinical management recommendations. Trial registration: ClinicalTrials.gov Identifier - NCT03677661, Registered on September, 15th 2018. [ABSTRACT FROM AUTHOR]

Highlights from the article: Keywords: catalysis; cluster compounds; gold; phosphane ligands; polyoxometalates Catalysis, cluster compounds, gold, phosphane ligands, polyoxometalates.

Contexte/problématique : Une évaluation des besoins réalisée en 2009 a révélé que les programmes de résidence de l'Université Laval souhaitaient documenter l'exposition clinique individuelle des résidents Objectifs/question : Un outil de documentation de l'expérience clinique (logbook) paramétrable selon les besoins de chaque discipline permettra-t-il un meilleur encadrement pédagogique des résidents ? Méthodes : En 2010-2011, CliniFolio-R, un logbook accessible via le Web, a été élaboré et fut implanté initialement par cinq programmes en juillet 2011. Après une année d'utilisation, une analyse des données produites par le logbook a été faite pour ces cinq premiers programmes. Cette analyse a été présentée aux responsables des cinq programmes initiaux pour fins de discussions quant à l'utilisation pédagogique du logbook avec les résidents ainsi que de l'utilisation des données au sein du programme Résultats : En date de janvier 2012, CliniFolio-R a été mis en œuvre par 12 programmes de résidence (107 utilisateurs), alors que deux autres programmes en sont à planifier son implantation Aucun problème technologique important n'a eu lieu Après une année de mise en œuvre, l'analyse des saisies effectuées par les résidents des cinq premiers programmes ayant utilisé cet outil a révélé une utilisation soutenue par les résidents (n = 10851 saisies par 46 résidents). Les entrevues avec les répondants de ces cinq programmes indiquent que quatre programmes ont surveillé l'activité du logbook, mais un seul a utilisé les données dans le cadre du mentorat Après avoir examiné les données et rapports avec chaque programme, tous ont exprimé leur intention d'utiliser à l'avenir les rapports de saisies en relation avec le mentorat Discussion/conclusion : Bien qu'il y ait eu un faible usage pédagogique des données saisies dans le logbook au cours de la première année d'implantation, force est de constater que les réunions de suivi avec les programmes ont eu un impact réel sur leur intention d'utiliser les rapports de saisies des résidents en relation avec le mentorat au cours de la prochaine année. En accord avec la littérature à ce sujet[1], cette étude illustre bien l'importance d'un soutien continu auprès des programmes à la suite de l'implantation d'outils de portfolio comme le logbook CliniFolio-R. [ABSTRACT FROM AUTHOR]

The first synthesis of a triazolium salt with ferrocene-based planar chirality is described. It was obtained from enantiopure Kagan's acetal, via the construction of a lactam intermediate. The corresponding 1,2,4-triazolylidene-Cu(I) complex was prepared. Its structure as well as the parent triazolium salt were characterized by X-ray diffraction analysis. [ABSTRACT FROM AUTHOR]

The reaction of [Ir(cod)( μ -Cl)] 2 (cod = 1,5-cyclooctadiene) with 2 equiv of the ketophosphine Ph 2 PCH 2 C(O)Ph in the presence of TlPF 6 afforded the hydrido, phosphino-enolate Ir(III) complex [IrH(cod){Ph 2 PCH ··· C( ··· O)Ph, κP , κO }{Ph 2 PCH 2 C(O)Ph, κP }]PF 6 ( 4 ), which results from the room temperature activation of a C–H bond from the PCH 2 moiety. The distorted octahedral coordination environment around the metal centre in 4 contains the cod ligand, the P atom of the monodentate ketophosphine and the P,O donor atoms of a chelating phosphino-enolate ligand acting as a 3-electron donor. The hydride ligand was located on the difference Fourier map obtained by single-crystal X-ray diffraction studies and is trans to the enolate oxygen and cis to the two, mutually cis P atoms. The reaction of this complex with NaH in THF led to the isolation of the Ir(I) complex [Ir(cod){Ph 2 PCH ··· C( ··· O)Ph, κP , κO }{Ph 2 PCH 2 C(O)Ph, κP }] ( 5 ). The penta-coordination environment around the metal centre in 5 includes the cod ligand, one 3-electron donor P,O chelating phosphino-enolate ligand and a P-bound Ph 2 PCH 2 C(O)Ph ligand containing an uncoordinated ketone function. The structures of 4 ·CH 2 Cl 2 and 5 ·C 7 H 8 have been determined by X-ray diffraction analysis. [ABSTRACT FROM AUTHOR]

Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of “return to work in good health” (RWGH—a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects ( n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of “success” in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of “failure” in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success. [ABSTRACT FROM AUTHOR]

We herein report on the synthesis, structure, and use in alkyne hydroboration catalysis of [(IPrCl)Zn−R]+ and [(ItBu)Zn−R]+ cations bearing IPrCl (IPrCl=1,3‐bis[2,6‐bis(1‐methylethyl)phenyl]‐4,5‐dichloro‐1,3‐dihydro‐imidazol‐2‐ylidene) and the sterically demanding ItBu carbene (ItBu=1,3‐bis(1,1‐dimethylethyl)−1,3‐dihydro‐imidazol‐2‐ylidene). Ionization of neutral precursors [(IPrCl)ZnR2] (1 a, R=Et; 1 b, R=Me) and [(ItBu)ZnEt2] (2) with one equivalent of [Ph3C][B(C6F5)4] led to with robust and stable two‐coordinate ZnII cations [(IPrCl)Zn−R]+ (3 a, R=Et; 3 b, R=Me) and [(ItBu)Zn−Et]+ (4), respectively, all isolated as [B(C6F5)4]− salts. Further derivatization of alkyl cations 3 b and 4 by reaction with one equivalent of [B(C6F5)3] afforded cations [(IPrCl)Zn−C6F5]+ (5) and [(ItBu)Zn−C6F5]+ (6) as [B(C6F5)4]− salts, with cation 6 displaying a limited stability in solution. The molecular structures of cations 3 b, 4 and 5 were confirmed through X‐ray diffraction studies. Among stable cations, Fluoride ion affinity (FIA) estimations agree with cation 5 being the most Lewis acidic in thus far reported [(IPrCl)Zn−R]+ cations. In the presence of pinacol borane and 1‐octyne, cations 3 a–b, 5 and [(IPrCl)Zn−C6F5]+ (5 mol%) slowly catalyze the selective cis‐hydroboration of 1‐octyne to the vinylborane product A. Cation 5 also mediates 2‐hexyne hydroboration to afford a mixture of hydroboration products B and C. In the case of hydroboration catalysis mediated by cations 5 and [(IPrCl)Zn−C6F5]+, experimental data and preliminary DFT calculations are consistent a Lewis‐acid‐type catalysis. [ABSTRACT FROM AUTHOR]

Since the beginning of the 2000's, homogeneous gold catalysis has emerged as a powerful tool to promote the cyclization of unsaturated substrates with excellent regioselectivity allowing the synthesis of elaborated organic scaffolds. An important goal to achieve in gold catalysis is the possibility to induce enantioselective transformations by the assistance of chiral complexes. Unfortunately, the linear geometry of coordination for gold usually encountered in complexes at the +1 oxidation states renders this goal very challenging. In consequence, the interest toward the synthesis of chiral gold(III) complexes is steadily growing. Indeed, the square planar geometry of the gold(III) cation appears more suitable to promote chiral induction. Beside catalysis, gold(III) complexes have also shown promising potential in the field of pharmacology. Herein, syntheses and applications of well‐defined gold(III) complexes reported over the last fifteen years are summarized. [ABSTRACT FROM AUTHOR]

A letter to the editor about Web sites that offer evidence-based medicine content is presented.

The coordination chemistry of chiral NHC-oxazoline bidentate ligands was investigated with silver(I) and gold(I), yielding stable dinuclear cationic complexes in good yields via N -coordination of the oxazoline heterocycle. After full characterization of these complexes, the reactivity in homogeneous catalysis and under oxidative conditions was studied. [Display omitted] [ABSTRACT FROM AUTHOR]

The objective of this study is to review randomized controlled trials evaluating the efficacy of surgery for the treatment of rotator cuff (RC) tendinopathy. Studies up to August 2013 were located in the PubMed, Embase, CINAHL, and PEDro databases using relevant keywords. Studies were included if: (1) participants had rotator cuff tendinopathy, (2) the trials were conducted on an adult population (≥18 years old), (3) at least one of the interventions studied was a surgical procedure, (4) study design was a randomized controlled trial (RCT), and (5) the article was written in English or French. Characteristics of the included studies were extracted using a standardized form. Two independent raters reviewed the methodological quality of the studies using the Risk of Bias Assessment tool developed by the Cochrane Collaboration Group. Differences were resolved by consensus. Fifteen trials met our inclusion criteria. After consensus, the mean methodological quality for all studies was 58.9 ± 10.8 %. In three out of four RCTs of moderate or low methodological quality, no significant difference in treatment effectiveness was observed between open or arthroscopic acromioplasty compared to exercises in the treatment of RC tendinopathy. Based on two studies of low or moderate methodological quality, no difference in treatment effectiveness was observed between arthroscopic and open acromioplasty. Two other RCTs of low to moderate quality, however, found that arthroscopic acromioplasty yielded better results in the short-term for shoulder range of motion in flexion but that both procedures were comparable in the long-term. One additional study favored open acromioplasty over arthroscopic acromioplasty for the treatment of RC tendinopathy. Based on low- to moderate-quality evidence, acromioplasty, be it open or arthroscopic, is no more effective than exercises for the treatment of RC tendinopathy. Low-grade evidence also suggests that arthroscopic acromioplasty may yield better results in the short-term for shoulder range of motion in flexion compared to open acromioplasty, but long-term results are comparable between the two types of surgery. More high-quality RCTs are required in order to provide comprehensive treatment guidelines to healthcare providers. [ABSTRACT FROM AUTHOR]

Objective The purpose of the current study was to assess, in patients scheduled for primary total knee replacement (TKR), the effects of pre-surgery waiting time on pain and functional limitations related to the knee joint undergoing surgery, on health-related quality of life (HRQoL) and on contralateral knee pain 6 months after surgery. Method A total of 141 patients scheduled for TKR were recruited from three hospitals in Quebec City, Canada, and followed up until 6 months after surgery. Pre-surgery wait, defined as the time between enrolment on the pre-surgery waiting list and surgery, was considered in four categories (≤3, >3-6, >6-9, >9 months). Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC). HRQoL was measured with the SF-36. Results Mean pre-surgery waiting time was 184 (SD: 120.8) days. Six months after TKR, a significant difference was seen between the four groups of pre-surgery wait in terms of HRQoL SF-36 role physical [ F(3, 136) = 2.74, P = 0.046] and contralateral knee WOMAC pain [ F(3, 136) = 5.78, P = 0.0009] scores. Participants with the longest pre-surgery wait (>9 months) showed the worst scores 6 months after TKR. Conclusions Longer pre-surgery waiting time had a negative clinically important impact on HRQoL and contralateral knee pain 6 months after surgery. [ABSTRACT FROM AUTHOR]

The article presents a study on factors that influence information and communication technologies (ICTs) adoption by healthcare professionals. It reviews 101 studies which suggest that system usefulness and ease of use are facilitating factors. Meanwhile design, time and technical concerns are limiting factors.

Objective. To examine the change in pain and function related to the knee scheduled for surgery, change in health-related quality of life (HRQoL) and change in contralateral knee pain during pre-surgery wait up until time of surgery. [ABSTRACT FROM PUBLISHER]

Purpose The Continuing Professional Development Center of the Faculty of Medicine at Laval University offers an internet-based program on evidence-based medicine (EBM). After one year, only three physicians out of the 40 who willingly paid to register had completed the entire program. This descriptive study aimed to identify physicians' beliefs regarding their completion of this online program. Methods Using theoretical concepts from the Theory of Planned Behaviour, a semi-structured telephone interview guide was developed to assess respondents' attitudes, perceived subjective norms, perceived obstacles and facilitating conditions with respect to completing this internet-based program. Three independent reviewers performed content analysis of the interview transcripts to obtain an appropriate level of reliability. Findings were shared and organised according to theoretical categories of beliefs. Results A total of 35 physicians (88% response rate) were interviewed. Despite perceived advantages to completing the internet-based program, barriers remained, especially those related to physicians' perceptions of time constraints. Lack of personal discipline and unfamiliarity with computers were also perceived as important barriers. Conclusions This study offers a theoretical basis to understand physicians' beliefs towards completing an internet-based continuing medical education (CME) program on EBM. Based upon respondents' insights, several modifications were carried out to enhance the uptake of the program by physicians and, therefore, its implementation. [ABSTRACT FROM AUTHOR]

Keywords: catalysis; chiral ligands; enantioselectivity; gold EN catalysis chiral ligands enantioselectivity gold 1 1 1 06/30/21 20210625 NES 210625 B Since two decades b , tremendous progresses were made in gold chemistry. This is particularly true in the field of enantioselective catalysis, where the gold(III) complexes are expected to provide better asymmetric inductions. Despite a more challenging chemistry, gold(III) complexes have recently attracted more and more attention as potential surrogates of gold(I) complexes. [Extracted from the article]

Purpose: The objective of this study was to compare the effects of an in-clinic cervicovestibular rehabilitation program (education, home exercises, manual techniques, sub-symptom threshold aerobic exercise [STAE] program) to a similar program (education, home-exercises, STAE program), but without manual techniques, provided in a telerehabilitation format in adults with persisting post-concussion symptoms (PCS)., Materials and Methods Design: In this parallel-group non-randomized clinical trial, 41 adults with persisting PCS were allocated to the in-clinic ( n  = 30) or telerehabilitation ( n  = 11) program. The outcome measures, which included the Post-Concussion Symptom Scale (PCSS; primary outcome), Numerical Pain Rating Scale (NPRS) for neck pain and headache and three disability questionnaires, were collected at baseline, weeks 6, 12, and 26. Non-parametric analysis for longitudinal data (NparLD) was used., Results: For the PCSS, there was a group-by-time interaction ( p  = 0.05) with significant between-group differences at week 6, 12, and 26 ( p  < 0.05) for the in-clinic group. There were also group-by-time interactions for NPRS neck pain and headache ( p  < 0.05) for the in-clinic group., Conclusion: The study suggests that a telehealth format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement. These results must be interpreted with caution given the limited number of participants. ClinicalTrials.gov Identifier: NCT03677661.IMPLICATION FOR REHABILITATIONThe telerehabilitation format for adults with persisting post-concussion symptoms was widely implemented in the COVID-19 pandemic without any evidence of efficacy over the more traditional in-clinic rehabilitation format.The study suggests that a telerehabilitation format failed to reach the efficiency of an in-clinic rehabilitation program in terms of symptoms reduction and functional improvement.Clinicians should try to incorporate some in-clinic appointments when a telerehabilitation format is required such as for patients in underserved area.

Objective: To determine what tests and measures accurately diagnose persisting post-concussive symptoms (PPCS) in children, adolescents and adults following sport-related concussion (SRC)., Design: A systematic literature review., Data Sources: MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL and SPORTDiscus through March 2022., Eligibility Criteria: Original, empirical, peer-reviewed findings (cohort studies, case-control studies, cross-sectional studies and case series) published in English and focused on SRC. Studies needed to compare individuals with PPCS to a comparison group or their own baseline prior to concussion, on tests or measures potentially affected by concussion or associated with PPCS., Results: Of 3298 records screened, 26 articles were included in the qualitative synthesis, including 1016 participants with concussion and 531 in comparison groups; 7 studies involved adults, 8 involved children and adolescents and 11 spanned both age groups. No studies focused on diagnostic accuracy. Studies were heterogeneous in participant characteristics, definitions of concussion and PPCS, timing of assessment and the tests and measures examined. Some studies found differences between individuals with PPCS and comparison groups or their own pre-injury assessments, but definitive conclusions were not possible because most studies had small convenience samples, cross-sectional designs and were rated high risk of bias., Conclusion: The diagnosis of PPCS continues to rely on symptom report, preferably using standardised symptom rating scales. The existing research does not indicate that any other specific tool or measure has satisfactory accuracy for clinical diagnosis. Future research drawing on prospective, longitudinal cohort studies could help inform clinical practice., Competing Interests: Competing interests: KOY is editor-in-chief of the journal Neuropsychology for which he receives an editorial stipend from the American Psychological Association. He is an unpaid consulting editor for Archives of Clinical Neuropsychology and Journal of Head Trauma Rehabilitation. He is an unpaid member of the Scientific Advisory Committee for Brain Injury Canada. He is the chair of the Canadian Concussion Network, which is funded by a grant from Canadian Institutes of Health Research (CIHR) to the University of Calgary; he is principal applicant on the grant but receives no income from it. He is a principal investigator (PI) on another grant from CIHR from which he derives no income. He is a co-investigator on research grants from CIHR, the US National Institutes of Health (NIH), Brain Canada Foundation and National Football League Scientific Advisory Board; he derives income only from the grant from NIH. He serves as a member of a CIHR grant review panel for which he receives an honorarium. He receives book royalties from Guilford Press and Cambridge University Press. He has received travel support and honorarium for presentations to multiple organisations. He has served or serves on the following committees/boards for which he receives honorarium: Independent Data Monitoring Committee (IDMC), Care for Post-Concussive Symptoms Effectiveness (CARE4PCS-2) Trial, National Institute for Child Health and Human Development; Observational Study Monitoring Board (OSMB), Approaches and Decisions in Acute Pediatric TBI (ADAPT) Trial, National Institute of Neurological Disorders and Stroke; National Research Advisory Council, National Pediatric Rehabilitation Resource Center, Center for Pediatric Rehabilitation: Growing Research, Education, and Sharing Science (C-PROGRESS), Virginia Tech University. AMR received a stipend for the clerical and administrative aspects of the systematic review. She has received research grants from the Tonal Strength Institute and Alberta Bone and Joint Strategic Clinical Network. ZP has no disclosures. CD was a pharmaceutical funded invited expert panelist (Teva) for CGRP monoclonal antibody treatment in chronic migraine and received a pharmaceutical funded grant for growth hormone deficiency following concussion. She has grants as PI or co-investigator from the Canadian Department of National Defense, CIHR, Tri-council funding New Frontiers, Alberta Provincial government and Foundations for Physical Medicine and Rehabilitation. She holds a patent for urine metabolites in the diagnosis of concussion. PF is a co-investigator on a research grant from the NFL’s 'Play Smart. Play Safe' Initiative and an Executive committee member of the Canadian Concussion Network (financed by CIHR). He received honorarium for an expert group discussion on blood biomarkers for concussion in December 2020. SH provides client consultation services for military/veteran health, neuroscience, health, sports medicine, neurodegenerative disease, neurotrauma, nuclear medicine, molecular imaging, nuclear and radiation accidents and incidents, and health equity. Consult services includes support to Prevent Biometrics; advisor to Synaptek; advisor/consultant for the Collaborative Neuropathology Network Characterizing Outcomes of TBI (CONNECT-TBI); advisor to NanoDX; and reviewer for Peer Reviewed Alzheimer’s Disease Research Program. SH is chief of Health Equity and Deputy Medical Director for the NFL Players Association, Medical Director for the MLS Players Association. He receives grant support (no income) from the following: Co-PI, Long-term Impact of Military-relevant Brain Injury Consortium – Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC); Advisory Board member to Concussion Legacy Foundation Project Enlist; Advisory Board member to the University of Michigan Concussion Center; advisor to Gryphon Bio; ad hoc reviewer for VA Brain Health Research; invited reviewer to Congressionally Directed Medical Research Programs; National Academy of Science, Engineering, and Medicine 'Accelerating Progress in TBI Research and Care'; NASEM TBI Forum committee member (currently inactive); contributor to Post-traumatic Epilepsy Former Department of Defense work: NFL Scientific Advisory Board member; NCAA-DoD CARE Medical Advisory Board Member; DoD Brain Health Research Coordinating Officer and Medical Advisor to the Principal Assistant for Research and Technology (PAR&T), United States Army Medical Research and Development Command (USAMRDC); Ex Officio National Advisory Neurological Disorders and Stroke (NANDSC) Council Member. KJS has no disclosures. KB receives funding from the Motor Accident Insurance Commission, Queensland Australia. She is a committee member on the Medical Advisory Board, Concussion Australia. She is Chief Investigator, for the first Australia and New Zealand Guidelines for the assessment and management of mild traumatic brain injury and persisting post-concussion symptoms, supported by the Medical Research Future Fund Australia. She has received travel support and honorarium for presentations to organisations. GAD is a member of the Scientific Committee of the 6th International Conference on Concussion in Sport; an honorary member of the AFL Concussion Scientific Committee; Section Editor, Sport and Rehabilitation, NEUROSURGERY; and has attended meetings organised by sporting organisations including the NFL, NRL, IIHF, IOC and FIFA; however, he has not received any payment, research funding, or other monies from these groups other than for travel costs. RJE is a paid consultant for the NHL and co-chair of the NHL/NHLPA Concussion Subcommittee. He is also a paid consultant and chair of the Major League Soccer concussion committee, and a consultant to the US Soccer Federation. He previously served as a neuropsychology consultant to Princeton University Athletic Medicine and EyeGuide. He is currently a co-PI for a grant funded by the NFL (NFL-Long) through Boston Children’s Hospital. He occasionally provides expert testimony in matters related to MTBI and sports concussion, and occasionally receives honoraria and travel support/reimbursement for professional meetings. NF-D is a member of the International independent FIFA Concussion Advisory Group; GOTS Concussion Committee Innovation and Technology Panel, UK Department for Digital, Culture, Media and Sport; Concussion in Sport Group (CISG); NINDS CDE Sports Concussion CDE Subacute Subgroup (National Institutes of Health); IFAB Concussion Expert Group; Swiss Neurology Society; Swiss Society for Clinical Neurophysiology; European NeuroOphthalmology Society; and Concussion in Sport Group (CISG). She is an Editorial Board Member for the Journal of Concussion, Journal of Science and Medicine in Football. CF is a PhD candidate at the School of Medicine & Health at University College Cork, Ireland. He is currently head of physiotherapy at the sports medicine department of the Sports Surgery Clinic (SSC), Dublin Ireland. SSC have paid the fees of his PhD and contributed towards the cost of him attending the 6th International Conference on Concussion in Sport in Amsterdam, 2022. From October 2017 to July 2020, he worked as national team lead physiotherapist for the IRFU Senior Men’s rugby team. He is a member of the Irish Society of Chartered Physiotherapists. Since 2022, he is a founder and shareholder (10%) of Fizfit Ltd., a start-up which focused on recovery and activation products for musculoskeletal health. IG has paid employment relationships with McGill University and the McGill University Health Center. She has received grants in the last 3 years from: Canadian Institutes of Health Research; Fonds de recherche du Québec – Santé; Research Institute of the McGill University Health Center; McGill University; and Institut National du Sport du Québec. CCG discloses the following grants and research support: Hit-IQ (2022-2023); NIH NINDS (R01 NS110757 2019-2024); NINDS (U54 NS121688 2021-2026); UCLA Brain Injury Research Center, UCLA Steve Tisch BrainSPORT program, Easton Clinic for Brain Health/Je os a clinical consultant (provide clinical care to athletes) for the NBA, NFL-Neurological Care Program, NHL/NHLPA, and Los Angeles Lakers. He is a member of the Advisory Board (non-compensated) for Major League Soccer, National Basketball Association, and US Soccer Federation. He is a member of the Advisory Board (Compensated) for Highmark Interactive; he occasionally serves as an expert witness in medicolegal cases. He is a shareholder in Highmark Interactive stock options. He receives book royalties from Blackwell/Wiley Publishing. GLI serves as a scientific advisor for NanoDX®, Sway Operations, LLC, and Highmark, Inc. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs (including former athletes), and on the topic of suicide. He has received past research support or funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He receives royalties from the sales of one neuropsychological test (WCST-64). He has received travel support and honorariums for presentations at conferences and meetings. He has received research funding as a principal investigator from the National Football League, and subcontract grant funding as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He has received research funding from the Wounded Warrior Project™. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, the National Rugby League, Boston Bolts, and the Schoen Adams Research Institute at Spaulding Rehabilitation. MM is a sport and exercise medicine physician working in private consulting practice and is the Chief Medical Officer for the Australian Football League. He is a shareholder of Olympic Park Sports Medicine Centre in Melbourne, Australia. He is ex-senior physician at the Hawthorn Football Club (AFL) and ex-Chief Executive Officer of the AFL Doctors Association. He has received research grants from the Australian Football League. He has received travel support from the Australian Football League, FIFA and the International Olympic Committee to attend and present at international conferences. He is a member of the Scientific Committee for the 6th International Conference on Concussion in Sport. He is an honorary member of the International Concussion in Sport Group,and the Australian Rugby Union Concussion Advisory Group. He is an independent concussion consultant for World Rugby. KS has received grant funding from CIHR, National Football League Scientific Advisory Board, International Olympic Committee Medical and Scientific Research Fund, World Rugby, Mitacs Accelerate, University of Calgary) with funds paid to her institution and not to her personally. She is an Associate Editor of BJSM (unpaid) and has received travel and accommodation support for meetings where she has presented. She coordinated the writing of the systematic reviews that informed the 6th International Conference on Concussion in Sport, for which she has received an educational grant to assist with the administrative costs associated with the writing of the reviews. She is a member of the AFL Concussion Scientific Committee (unpaid position) and Brain Canada advisory committee (unpaid positions). She works as a physiotherapy consultant and treats athletes of all levels of sport from grass roots to professional., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI)., Design: Systematic review and meta-analysis., Data Sources: Four bibliographic databases (from inception until November 2021): Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL., Eligibility Criteria: Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises., Results: Eleven studies were included in this systematic review. When wearing foot orthoses, the risk ratio of developing a BSI on any lower extremity bone is 0.47 (95% CI 0.26 to 0.87; p = 0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p = 0.79). No meta-analyses could be performed for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study., Conclusion: This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence.

BACKGROUND: Decision rules (eg, Canadian computed tomography head rule [CCHR] for adults and Pediatric Emergency Care Applied Research Network [PECARN] rule for children/adolescents) are used in emergency settings (emergency room [ER] rules) to assess traumatic brain injuries (TBIs). The rules have a high-sensitivity and near-perfect negative predictive value that help to rule out more severe TBI. CLINICAL QUESTION: Which criteria should be added to the Sport Concussion Assessment Tool 5 (SCAT5) to reach the sensitivity of the ER rules and improve the utility of the SCAT5 for screening for higher-severity head and brain injuries? KEY RESULTS: We performed a comparative analysis of the SCAT5 with the CCHR and PECARN rules. We compared the presence (yes or no) and comparative "face value" sensitivity (lower, identical, or higher) of the SCAT5 criteria to the ER rules criteria. Loss of consciousness, vomiting, severe/increasing headache, and seizure are SCAT "red flags" with similar or higher sensitivity compared to ER rules criteria. Five criteria had lower sensitivity or were absent from the SCAT. Emergency room rules include any abnormality on the Glasgow Coma Scale (GCS<15), but only a "deterioration of the state of consciousness" is considered a "red flag" in the SCAT5. Persistent retrograde amnesia for more than 30 minutes, age>65, severity of the mechanism of injury, and signs of skull fractures are not mentioned in the SCAT5. CLINICAL APPLICATION: We identified 5 criteria that could inform the evolution the SCAT5 to improve its ability to rule out more severe TBI in a sideline assessment context. J Orthop Sports Phys Ther 2023;53(3):113-119. Epub: 9 December 2022. doi:10.2519/jospt.2022.11301 .

Background: In the context of concerns regarding the cardiorespiratory fitness (CRF) of youth populations, the aims of this study were: (1) to update reference values for the VO 2 max for school-aged Canadians and (2) to document secular trends in CRF after a 35-year interval., Methods: Between September 2014 and April 2017, the CRF of 3725 students (53.2% boys; 6.0 to 17.9 yrs) was determined using the 20-m shuttle run test. The sample was collected in 36 different schools from six cities of Québec (Canada)., Results: Median values of VO 2 max decreased with age in both sexes ( p ≤ 0.05). By the age of 10, more than 20% of boys showed VO 2 max values below the recommended value (42 ml·kg -1 ·min -1 ). At the age of 17, that proportion reached 56.8%. A similar proportion of 12 yrs girls (20%) were under the recommended minimal value (37 ml·kg -1 ·min -1 ) and that value reached 69.9% at the age of 17. Compared to 1982, the VO 2 max at age 17 has declined by 18% for boys and 12% for girls. The situation is worse in terms of functional capacity (number of stages completed) with an overall decrease of more than 30%., Conclusion: This study demonstrates that, compared to data obtained using the same methodology 35 years ago, the CRF and functional capacity of children and adolescents has declined to levels that should raise concerns from a public health perspective. Thus, the development of strategies to promote a physically active lifestyle in youth is more relevant than ever., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Leone, Levesque, Bourget-Gaudreault, Lemoyne, Kalinova, Comtois, Bui, Léger, Frémont and Allisse.)

Background: The Post-Concussion Symptom Scale (PCSS) is used to assess the number and intensity of symptoms after a concussion/mild traumatic brain injury. However, its responsiveness to monitor clinical recovery has yet to be determined., Purpose: To evaluate the responsiveness of the PCSS to change and longitudinal validity in patients with persistent postconcussive symptoms as well as to explore the responsiveness of other clinical outcome measures to monitor recovery of physical symptoms in patients with persistent postconcussive symptoms., Study Design: Cohort study (diagnosis); Level of evidence, 2., Methods: Patients with persistent symptoms after a concussion (N = 109) were evaluated using self-reported questionnaires at baseline and after a 6-week rehabilitation program. The program consisted of an individualized symptom-limited aerobic exercise program combined with education. Questionnaires included the PCSS, Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), and Numeric Pain Rating Scale (NPRS) related to 1) neck pain and 2) headache. Internal responsiveness was evaluated using the effect size (ES) and standardized response mean (SRM), and external responsiveness was determined with the minimal clinically important difference (MCID) calculated using a receiver operating characteristic curve. The global rating of change was used as the external criterion. Pearson correlations were used to determine the longitudinal validity., Results: The PCSS was highly responsive (ES and SRM, >1.3) and had an MCID of 26.5 points (of 132) for the total score and 5.5 (of 22) for the number of symptoms. For longitudinal validity, low to moderate correlations were found between changes in PCSS and changes in NDI, HDI, and DHI. The NDI, HDI, DHI, and NPRS were also highly responsive (ES and SRM, >0.8)., Conclusion: All questionnaires including the PCSS were highly responsive and can be used with confidence by clinicians and researchers to evaluate change over time in a concussion population with persistent symptoms., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Funding was provided by the REPAR and by the OPPQ. The funding agency/sponsor had no role in the study design, manuscript preparation, or decision to submit for publication. P.L. received a doctoral training scholarship from the FRQ-S. J.S.R. was supported by a salary award from the FRQ-S. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

OBJECTIVES: To present the methods used to develop a clinical practice guideline (CPG) with recommendations endorsed by key stakeholders for assessing, managing, and supporting return to work for adults with rotator cuff disorders. DESIGN: Clinical practice guideline development. METHODS: A steering committee composed of the research team of this project led the development of this CPG in 5 phases, which followed the standards of the NICE and AGREE II collaborations. During the preparation phase (I), a multidisciplinary working committee of experts in managing rotator cuff disorders (n = 20) determined the scope and objectives of the CPG. The recommendations development phase (II) included initial knowledge synthesis, development of preliminary recommendations, systematic consultations with a multidisciplinary panel of key stakeholders (n = 51) using a modified three-round Delphi approach and drafting of the original CPG. In the external evaluation phase (III), an external committee of experts evaluated the original CPG using the AGREE II tool. In the dissemination phase (IV), the strategy for disseminating the CPG was developed and implemented. During the update phase (V), the CPG was revised based on an update of the initial knowledge synthesis. RESULTS: Seventy-three preliminary recommendations were developed from the initial knowledge synthesis. During the Delphi consultation, all of these recommendations were endorsed, and one new recommendation was proposed by panelists. The original CPG received an overall AGREE II score of 83% from the external evaluators. In 2021, an update of the initial 2017 knowledge synthesis was conducted and 13 recommendations were revised. CONCLUSION: The 5-phase consensus methods approach guided the development of a high-quality CPG on assessing, managing, and supporting return to work for adults with rotator cuff disorders. J Orthop Sports Phys Ther 2022;52(10):665-674. Epub: 27 July 2022. doi:10.2519/jospt.2022.11307 .

OBJECTIVE: To develop a clinical practice guideline covering the assessment, management, and return to work of adults with rotator cuff disorders. DESIGN: Clinical practice guideline. METHODS: Using systematic reviews, appraisal of the literature, and an iterative approach to obtain consensus from key stakeholders, clinical recommendations and algorithms were developed in the context of the health care system and work environment of the province of Quebec (Canada). RESULTS: Recommendations (n = 73) and clinical decision algorithms (n = 3) were developed to match the objectives. The initial assessment should include the patient's history, a subjective assessment, and a physical examination. Diagnostic imaging is only necessary in select circumstances. Acetaminophen, nonsteroidal anti-inflammatory drugs, and injection therapies may be useful to reduce pain in the short term. Clinicians should prescribe an active and task-oriented rehabilitation program (exercises and education) to reduce pain and disability in adults with rotator cuff disorders. Subacromial decompression is not recommended to treat rotator cuff tendinopathy. Surgery is appropriate for selected patients with a full-thickness rotator cuff tear. A return-to-work plan should be developed early, in collaboration with the worker and other stakeholders, and must combine multiple strategies to promote return to work. CONCLUSION: This clinical practice guideline was developed to assist the multidisciplinary team of clinicians who provide health care for adults with a rotator cuff disorder. The CPG guides clinical decisionmaking for diagnosis and treatment, and planning for successful return to work. J Orthop Sports Phys Ther 2022;52(10):647-664. Epub: 27 July 2022. doi:10.2519/jospt.2022.11306 .

The objective of this study was to compare the effects of a cervicovestibular rehabilitation program combined with symptom-limited aerobic exercise (SLAE) program to a SLAE program alone in adults with persistent symptoms after mild traumatic brain injury (mTBI) on severity of symptoms and other indicators of clinical recovery. In this single-blind, parallel-group randomized controlled trial, 60 adults with persistent symptoms after mTBI were randomly assigned to: (1) a 6-week SLAE program or (2) a 6-week cervicovestibular rehabilitation program combined with a SLAE program. All participants took part in four evaluation sessions (baseline, week 6, 12, and 26) performed by a blinded evaluator. The primary outcome was the Post-Concussion Symptoms Scale (PCSS). The secondary outcomes were Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), time to return to function, and physical cervical and vestibular measures. Non-parametric analysis for longitudinal data was used to evaluate the effect of interventions on outcomes. For PCSS, NPRS, NDI, HDI, DHI, and return to function, there were no group-by-time interactions at any time points follow-up ( p  > 0.05); clinically significant time effects were, however, observed ( p  < 0.05). There were group-by-time interactions at weeks 6 and 12 for vestibulo-ocular reflex ( p  < 0.003) and the craniovertebral mobility ( p  < 0.001) measures in favor of the cervicovestibular rehabilitation group. The study indicates that a cervicovestibular rehabilitation program combined with SLAE was not superior to a SLAE program alone in term of symptoms and functional level improvement but resulted in improved physical cervical and vestibular function.

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.)