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BackgroundPeople with low back pain (LBP) in the community often do not receive evidence-based advice and management. Community pharmacists can play an important role in supporting people with LBP as pharmacists are easily accessible to provide first-line care. However, previous research suggests that pharmacists may not consistently deliver advice that is concordant with guideline recommendations and may demonstrate difficulty determining which patients require prompt medical review. A clinical decision support system (CDSS) may enhance first-line care of LBP, but none exists to support the community pharmacist–client consultation. ObjectiveThis study aimed to develop a CDSS to guide first-line care of LBP in the community pharmacy setting and to evaluate the pharmacist-reported usability and acceptance of the prototype system. MethodsA cross-platform Web app for the Apple iPad was developed in conjunction with academic and clinical experts using an iterative user-centered design process during interface design, clinical reasoning, program development, and evaluation. The CDSS was evaluated via one-to-one user-testing with 5 community pharmacists (5 case vignettes each). Data were collected via video recording, screen capture, survey instrument (system usability scale), and direct observation. ResultsPharmacists’ agreement with CDSS-generated self-care recommendations was 90% (18/20), with medicines recommendations was 100% (25/25), and with referral advice was 88% (22/25; total 70 recommendations). Pharmacists expressed uncertainty when screening for serious pathology in 40% (10/25) of cases. Pharmacists requested more direction from the CDSS in relation to automated prompts for user input and page navigation. Overall system usability was rated as excellent (mean score 92/100, SD 6.5; 90th percentile compared with similar systems), with acceptance rated as good to excellent. ConclusionsA novel CDSS (high-fidelity prototype) to enhance pharmacist care of LBP was developed, underpinned by clinical practice guidelines and informed by a multidisciplinary team of experts. User-testing revealed a high level of usability and acceptance of the prototype system, with suggestions to improve interface prompts and information delivery. The small study sample limits the generalizability of the findings but offers important insights to inform the next stage of system development.

* OBJECTIVE: To investigate whether improvements in forward bending were related to improvements in pain and disability in people with chronic low back pain (CLBP) who were undergoing Cognitive Functional Therapy (CFT). * DESIGN: Longitudinal observational study. * METHODS: Two hundred and sixty-one participants with CLBP received CFT. Forward bending was assessed at each treatment session over 13 weeks (an average of 4.3 timepoints per participant [range, 1-8]). Spinal range of motion (ROM) and velocity were recorded using 2 inertial measurement units located at T12 and S2. Participants reported (1) average pain intensity (0-10 scale) (pain) and (2) pain-related activity limitation (Roland Morris Disability Questionnaire [disability]) via online questionnaires at 0, 3, 6, and 13 weeks. Multivariate multilevel models were used to evaluate associations between individual rates of change over time for 3 spinal movement measures (trunk velocity, trunk ROM, lumbar ROM) and pain/disability. tRESULTS: Strong correlations were observed for increased trunk velocity with reduced pain (r = -0.81; 95% CI: -0.98, -0.05) and with reduced disability (r = -0.77; 95% CI: -0.95, -0.22). Moderate correlations were observed between increased trunk ROM with reduced pain (r = -0.37; 95% CI: -0.67, 0.04) and with reduced disability (r = -0.32; 95% CI: -0.6, 0.03). There was no evidence of association between changes in lumbar ROM and pain (r = -0.46; 95% CI: -0.90, 0.44) or disability (r = -0.01; 95% CI: -0.56, 0.55). tCONCLUSION: Reductions in pain and disability were strongly correlated with increased trunk velocity in people with CLBP who were undergoing CFT. These findings are consistent with CFT that explicitly trains "nonprotective" spinal movement. [ABSTRACT FROM AUTHOR]

Background The availability of multidisciplinary care for the management of chronic pain is uncommon outside specialist clinics. The present study aims to determine the physical intervention use of patients participating in an online psychological pain management program and whether exposure to physical interventions in these patients alters treatment outcomes compared with patients who do not access physical interventions. Methods Data were obtained from 2 previously published randomized controlled trials of an online psychological pain management program. Physical intervention exposure (categories: none, 1–3 sessions, 4+ sessions) was assessed at baseline, after treatment, and at 3-month follow-up. Primary outcomes included depression, anxiety, pain intensity, and pain-related disability. Generalized estimating equation models were used to compare treatment outcomes among those with different physical intervention frequencies and periods of exposure. We assessed whether changes in primary outcomes differed (moderated) by the period and category of physical intervention exposure. Results Of the patients (n  = 1074) who completed the baseline questionnaire across both randomized controlled trials, 470 (44%) reported physical intervention use at baseline, 383 (38%) reported physical intervention use after treatment, and 363 (42%) reported physical intervention use at 3-month follow-up. On average, there were moderate–large reductions from baseline to after treatment with respect to all outcomes (Cohen's d  = 0.36–0.82). For all outcomes, the interaction of time by physical intervention exposure was statistically nonsignificant. Conclusion A substantial proportion of patients who participated in a psychologically informed pain management program were establishing, continuing, or stopping additional physical interventions. The frequency of and period of exposure to physical interventions did not appear to moderate treatment outcomes. Clinical trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12613000252718 and ACTRN12615001003561). The website for registration information is https://www.anzctr.org.au [ABSTRACT FROM AUTHOR]

Background: Systematic reviews are potentially less biased and provide more precise estimates than primary studies of diagnostic test accuracy. Their use to inform evidence-based diagnosis is rapidly expanding. However, the extent, scope and methodologies of systematic reviews of studies of the accuracy of diagnostic tests relevant to physical therapy have not yet been described. Information about methods used in these systematic reviews could inform future reviews and subsequently improve evidence-based diagnosis in physical therapy. Objectives: To describe the systematic review methodology of diagnostic test accuracy studies relevant to physical therapy. Methods: All systematic reviews indexed on DiTA (Diagnostic Test Accuracy database) were included. Data on methodology, reporting characteristics, and review topics were extracted. A random sample was assessed for risk of bias using the Risk Of Bias In Systematic Reviews (ROBIS) tool. Results: The review included 241 reviews published between 1995 and 2022, covering all 10 major physical therapy subdisciplines, although 90% related to musculoskeletal physical therapy. In 72% of reviews, QUADAS and QUADAS-2 were used to assess the risk of bias. In a random sample of included reviews, 47% of reviews displayed a 'high' risk of bias. Conclusions: Systematic reviews of diagnostic test accuracy studies relevant to physical therapists are becoming more prevalent. There is a relatively large number of these reviews however a large proportion use methods that expose them to bias. This makes the interpretation of their results more difficult. Future research could focus on publishing methodology guidelines for physical therapy-relevant diagnostic test accuracy reviews. [ABSTRACT FROM AUTHOR]

Capsule: The breeding productivity of the Common Scoter population in Scotland's Flow Country remained relatively stable during a 44% population decline in Britain and Ireland. Aim: To investigate breeding productivity changes in the eastern Flow Country's Common Scoter population over 22 years and identify possible threats and causes of change during a period of national population decline. Methods: Common Scoters from 32 breeding sites were surveyed annually between 2002 and 2023. Each site was visited two to three times in May (pre-nesting period) and two to three times in July and August (post-hatching period) to record the numbers of adult and juvenile Common Scoters. Results: Between 2002 and 2023, whilst the Common Scoter population declined (approximately 44% from 27 to 15 breeding pairs) across the study area, breeding productivity (defined as large ducklings per female) remained stable, averaging 0.44 (range of annual means 0.00–1.06) large ducklings per female. The number of small ducklings per female also remained relatively stable. A year of higher breeding productivity did not result in an increase in the number of breeding females in the following years, suggesting that the cause of the population decline lies away from the breeding region. Conclusion: Breeding productivity needs to increase, and poor breeding seasons need to be prevented to help maintain this population. The causes of the Common Scoter's decline away from the breeding area need to be resolved to prevent local extinction. This could be assisted with the removal of non-native forestry plantations in the area, which has been observed to benefit other ground-nesting species by alleviating predation pressure, and by maintaining lake habitat quality, as reflected in shallow water and abundant large invertebrates. [ABSTRACT FROM AUTHOR]