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OBJECTIVE: Advances in amyotrophic lateral sclerosis (ALS) gene discovery, ongoing gene therapy trials, and patient demand have driven increased use of ALS genetic testing. Despite this progress, the offer of genetic testing to persons with ALS is not yet standard of care. Our primary goal is to develop clinical ALS genetic counseling and testing guidelines to improve and standardize genetic counseling and testing practice among neurologists, genetic counselors or any provider caring for persons with ALS. METHODS: Core clinical questions were identified and a rapid review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) 2015 method. Guideline recommendations were drafted and the strength of evidence for each recommendation was assessed by combining two systems: the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) System and the Evaluation of Genomic Applications in Practice and Prevention (EGAPP). A modified Delphi approach was used to reach consensus among a group of content experts for each guideline statement. RESULTS: A total of 35 guideline statements were developed. In summary, all persons with ALS should be offered single-step genetic testing, consisting of a C9orf72 assay, along with sequencing of SOD1, FUS, and TARDBP, at a minimum. The key education and genetic risk assessments that should be provided before and after testing are delineated. Specific guidance regarding testing methods and reporting for C9orf72 and other genes is provided for commercial laboratories. INTERPRETATION: These evidence-based, consensus guidelines will support all stakeholders in the ALS community in navigating benefits and challenges of genetic testing.

Context: Competency-based education (CBE) is entrenched in educating health professionals in Canada. CBE is a framework that identifies desired performance characteristics in training competent, entry-level health professionals. Objective: To update, develop, and validate a new Canadian Athletic Therapists Association (CATA) framework for athletic therapy education. Design: Framework development occurred in 4 phases and was developed through a multistage process that involved a scoping review (phase 1) and consensus methodology (ie, a blending of modified Ebel and modified Delphi consensus methods; phases 2-4). Patients or Other Participants: Phase 2: a total of 7 experts (program directors) from each Canadian accredited institution. Phase 3: a total of 14 experts (1 program director and educational expert from each accredited institution). Phase 4: a total of 7 experts (program directors) and 246 certified members of the CATA. Main Outcome Measure(s): Each phase consisted of a systematic process with 80% consensus agreement set a priori. In phase 1, a scoping review was conducted to identify common terminology that could be used to guide the framework development process and to identify competency frameworks used by other health professional organizations. Phase 2 consisted of adopting a common language that would serve to keep the expert group on the task at hand and avoid confusion. In phase 3, frameworks used by other health professional organizations were evaluated and used to determine the validity of the old CATA framework. In phase 4, the old CATA framework was updated and a new framework was developed and validated. Results: In phase 1, the result of the scoping review yielded 368 papers, of which 5 were used to propose a common language for phase 2 and 9 highlighted competency frameworks used by other health professions for comparison in phase 3. In phase 3, the expert group voted unanimously to adopt and adapt the CanMEDS framework (ie, roles). In phase 4, the new CATA competency framework was validated, and most competencies achieved consensus. Competencies that did not achieve consensus in the first round of voting underwent face-to-face discussions via videoconferencing. After discussions, the remaining competencies were revised, and all newly worded competencies achieved consensus. Conclusions: The resultant framework was validated, and most competencies achieved consensus. The new athletic therapy competency framework outlines the 165 competencies resulting from this methodical process and will hopefully facilitate interdisciplinary communication and practice.

Musculoskeletal (MSK) conditions, particularly shoulders, knees, and the low back issues, place a significant burden on individuals, society, and healthcare systems. There is a lack of attention to negative health effects impacting patients because of their interactions to access appropriate diagnostics, assessments, and treatments. This scoping review intends to search and synthesize peer-reviewed evidence on the negative health impacts associated with navigating the healthcare system for MSK care. A scoping review will be conducted following the PRISMA guidelines for Scoping Reviews and Arksey and O'Malley's 5-step process. Six databases will be searched with no time or geographic limits. Included articles must meet all the following criteria: 1) the patients must be adults, 2) patients must be seeking care for their knee, low-back, or shoulder condition, 3) interacted with the healthcare system, and 4) experienced health impacts due to navigating the healthcare system. Information from each article will be charted in a pre-determined extraction. This protocol aims to share our methods ahead of analysis to increase rigour and transparency. The scoping review results will better elucidate the health impacts of the inaccessibility of high-quality care for MSK conditions. The findings also aim to inform the development of patient-centered outcomes to evaluate alterations to the current MSK pathways. [ABSTRACT FROM AUTHOR]

Several barriers exist in Alberta, Canada to providing accurate and accessible diagnoses for patients presenting with acute knee injuries and chronic knee problems. In efforts to improve quality of care for these patients, an evidence-informed clinical decision-making tool was developed. Forty-five expert panelists were purposively chosen to represent stakeholder groups, various expertise, and each of Alberta Health Services' 5 geographical health regions. A systematic rapid review and modified Delphi approach were executed with the intention of developing standardized clinical decision-making processes for acute knee injuries, atraumatic/overuse conditions, knee arthritis, and degenerative meniscus. Standardized criteria for screening, history-taking, physical examination, diagnostic imaging, timelines, and treatment were developed. This tool standardizes and optimizes assessment and diagnosis of acute knee injuries and chronic knee problems in Alberta. This project was a highly collaborative, province-wide effort led by Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI). [ABSTRACT FROM AUTHOR]

This chapter demonstrates how Decoding work can be used productively within a curriculum change process to help make design decisions based on a more nuanced understanding of student learning and the relationship of a professional program to the field.

Background: Low back pain (LBP) is a common condition causing disability and high healthcare costs. Alberta faces challenges with unnecessary referrals to specialists and long wait times. A province‐wide standardized clinical care pathway based on evidence‐based best practices can improve efficiency, reduce wait times, and enhance patient outcomes. Implementing such pathways has shown success in other areas of healthcare in Alberta. This study developed a clinical decision‐making pathway to standardize care and minimize uncertainty in assessment, diagnosis, and management. Methods: A systematic rapid review identified existing tools and evidence that could support a comprehensive LBP clinical decision‐making tool. Forty‐seven healthcare professionals participated in four rounds of a modified Delphi approach to reach consensus on the assessment, diagnosis, and management of patients presenting to primary care with LBP in Alberta, Canada. This project was a collaborative effort between Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJHSCN) and the Alberta Bone and Joint Health Institute (ABJHI). Results: A province‐wide expert panel consisting of professionals from different health disciplines and regions collaborated to develop an LBP clinical decision‐making tool. This tool presents clinical care pathways for acute, subacute, and chronic LBP. It also provides guidance for history‐taking, physical examination, patient education, and management. Conclusions: This clinical decision‐making tool will help to standardize care, provide guidance on the diagnosis and management of LBP, and assist in clinical decision‐making for primary care providers in both public and private sectors. [ABSTRACT FROM AUTHOR]

Context: Competency-based education requires strong planning and a vehicle to deliver and track students' progress across their undergraduate programs. Clinical presentations (CPs) are proposed as 1 method to deliver a competency-based curriculum in a Canadian undergraduate athletic therapy program. Objective: Validation of 253 CPs. Setting: Canadian universities/colleges and clinical practices. Patients or Other Participants: Six Canadian Athletic Therapists Association-accredited program directors and 6 athletic therapists with at least 10 years of experience working in both field and clinical athletic therapy settings. Intervention(s): We surveyed 12 experts who rated the importance and difficulty of 253 CPs using a 100-mm and electronic visual analog scale with "extremely important" at 1 anchor and "irrelevant" at the other end. Difficulty was measured in a similar manner anchored by "extremely difficulty" and "extremely easy." Main Outcome Measure(s): Descriptive statistics for importance and difficulty were tabulated on all CPs. An importance-difficulty index was calculated as a mean score of both importance and difficulty scores. Results: Data were converted into quartiles to represent a 4-point categorical importance scale to mimic the original categories from the Ebel procedure (ie, essential, important, acceptable, and questionable). Difficulty was likewise converted into quartiles representing a 4-point categorical difficulty scale. Mean importance scores ranged from 99.3 for airway management (ie, most important) to 54 for high altitude cerebral edema (ie, less important). Clinical presentation difficulty scales ranged from 89.8 for biceps contusion (ie, easier) to 21.2 for decompression illness (ie, harder). Conclusions: These 253 CPs are thought to be representative (ie, valid) of the athletic therapy scope of practice in Canada. To our knowledge, CPs have not been developed in the athletic therapy context prior to this research. We anticipate more will be identified as these CPs are used to align teaching, learning, and assessment within competency-based athletic therapy programs in Canada.

To 1) estimate the utilization and costs of physician and diagnostic imaging (DI) services for shoulder, knee, and low-back pain (LBP) conditions; and 2) examine determinants of the utilization and costs of these services.All patients visiting a physician for shoulder, knee, or LBP conditions (identified by the ICD-9 codes) in Alberta, Canada, in fiscal year (FY) 2022/2023 were included. Interested outcomes included numbers and costs of physician visits and DI exams stratified by condition, physician specialty, DI modality, and patients’ sex and age. Multivariate regressions were used to examine determinants of the outcomes.In FY 2022/2023, 10.4%, 7.0%, and 6.7% of the population saw physicians for shoulder, knee, and LBP conditions, respectively. This costs Alberta $307.04 million ($67.93 per capita), of which shoulder accounted for 41%, knee 28%, and LBP 31%. In the same FY, 17,734 computed tomography (CT), 43,939 magnetic resonance imaging (MRI), 686 ultrasound (US), and 170,936 X-ray exams related to shoulder/knee/LBP conditions were ordered for these patients, costing another $29.07 million, of which CT accounted for 14%, MRI 48%, US 0%, and X-ray 37%. Female, older age, comorbidity scores, and capital zone used physician services more frequently. Patients with a higher comorbidity index scores or more physician visits were more likely being referred for CT or MRI.Musculoskeletal conditions are common and result in patients seeking healthcare services. Visits to family physicians, specialists, and the ordering of DI contribute to extensive utilization of health services, contributing to considerable health system costs. [ABSTRACT FROM AUTHOR]

Five faculty members and one educational developer met regularly in support of a major curriculum change process to a clinical presentation model in an Athletic Therapy Program. What developed was a community of practice around professional practice in athletic therapy, which then in turn supported the implementation of the curriculum change. This qualitative self-study explores the aspects which emerged throughout this discussion process: curriculum and pedagogy, theory-to-practice, and building a professional community. We argue that a developing a community of practice amongst colleagues, enhancing their appreciation of one another as professional practitioners, is essential to supporting the process of curricular change, since such a change requires complex new learning for faculty members.. [ABSTRACT FROM AUTHOR]

While a variety of definitions persist, a common definition of physical literacy is that it encompasses the motivation, confidence, physical competence, knowledge and understanding to value and take responsibility for engagement in physical activities over the lifespan. While this perspective to physical literacy is broad, a great deal of curricular outcomes still focus on the physical competence, knowledge and understanding aspects of the framework leaving a gap in the holistic nature of the construct. This scoping review explores the construct of physical literacy within post‐secondary education, focusing on how social and emotional dimensions are integrated in teaching, delivery and assessment. This scoping review followed PRISMA‐ScR guidelines. Five online databases were used to identify papers published that used physical literacy in combination with post‐secondary as the educational setting with a focus on curriculum. The findings underscore a substantial gap in the literature. It was identified that the physical aspects of physical literacy were predominant with limited attention to the social and emotional domains. The gap implies that the comprehensive construct of physical literacy, which encompasses non‐physical facets, is often omitted in post‐secondary curricula. The review highlights an unexplored opportunity for post‐secondary institutions to intentionally construct more comprehensive physical literacy programmes. By incorporating social and emotional dimensions into these programmes, students gain a more holistic understanding of physical literacy. Subsequent research can delve into effective integration strategies and the potential benefits of such an approach. [ABSTRACT FROM AUTHOR]