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Background: Digital health technology is progressively transforming physiotherapy practice. Despite a maturing body of literature relating to physiotherapy digital health capability, research examining digital health physiotherapy competency standards is both lacking and lagging. Objective: Examine international professional practice competency standards for physiotherapists to identify themes common to digital health practice competency, published by international peak organizations governing physiotherapy practice. Methods: Systematic meta-synthesis of international peak organization physiotherapy practice competency standards. The study was undertaken over nine stages. Competency statements related to digital health were extracted, and further coded into resultant themes. Results: Eleven documents were analyzed. Fifty-two statements explicitly referenced digital health competency. Identified themes were as follows: 1) digital health data governance; 2) digital health data translation; and 3) digital health technologies. Where digital health-related competency statements do exist, they are skewed toward health information management activities. Conclusions: Digital health practice is currently under-represented in competency standards for physiotherapists. Workforce advancement in light of the burgeoning impact of digital health will prompt further updates to professional competency standards set by our peak organizations. This will have a flow on effect, whereby education providers (e.g. universities and other professional development providers) should consider curriculum and training that prepares individuals for digitally enabled practice. [ABSTRACT FROM AUTHOR]

Training load monitoring is employed to quantify training demands, to determine individual physiological adaptions and to examine the dose–response relationship, ultimately reducing the likelihood of injury and making a meaningful impact on performance. The purpose of this study is to explore the relationship between training load and injury in competitive swimmers, using the session rate of perceived exertion (sRPE) method. Data were collected using a prospective, longitudinal study design across 104 weeks. Data were collected from 34 athletes centralised in two of Swim Ireland's National Centres. Bayesian mixed effects logistic regression models were used to analyse the relationship between sRPE-TL and medical attention injuries. The average weekly swim volume was 33.5 ± 12.9 km. The weekly total training load (AU) averaged 3838 ± 1616.1. A total of 58 medical attention injury events were recorded. The probability of an association between training load and injury ranged from 70% to 98%; however, evidence for these relationships was deemed weak or highly uncertain. The findings suggest that using a single training load metric in isolation cannot decisively inform when an injury will occur. Instead, coaches should utilise monitoring tools to ensure that the athletes are exposed to an appropriate training load to optimise physiological adaptation. Future research should strive to investigate the relationship between additional risk factors (e.g., wellbeing, lifestyle factors or previous injury history), in combination with training load and injury, in competitive swimmers. [ABSTRACT FROM AUTHOR]

This Viewpoint provides practical guidance for early-career musculoskeletal clinicians who are navigating the complexities of clinical practice. Key themes are embracing uncertainty, seeing and treating the whole person, avoiding judgemental mindsets, embracing shared decision-making, focusing on building strong therapeutic relationships and finding a work-related niche that resonates with one's own passions and strengths. We encourage clinicians to consume information carefully in an era of social media health influencers, and suggest ways of accurately identifying reliable sources of information. We do not presume to inoculate against all challenges that clinicians will encounter. Instead, we strive to help early-career clinicians navigate potential friction points in clinic and research based on our collective experience. [ABSTRACT FROM AUTHOR]

Background: Exercise is the recommended first-line therapy for a degenerative meniscal tear (DMT). Despite this, knee pain attributed to DMTs are a common presentation to specialist orthopaedic clinics. In the primary care setting, the general practitioner (GP) plays a central role in managing patients with knee pain, but to date their perspective has not been explored in relation to DMTs. This study explored GPs' experiences of managing people with knee pain attributed to a DMT. Methods: A qualitative research design was adopted and practices in the South and Mid-West of Ireland were contacted via recruitment emails circulated through professional and research networks. Interested GPs contacted the researchers via email, and purposive and snowball sampling was used for recruitment. Semi-structured interviews were conducted online or over the telephone. Interviews were digitally recorded and transcribed. Data was analysed using an inductive approach to thematic analysis. Ethical approval was granted by the Irish College of General Practitioners (ICGP_REC_21_0031). Results: Seventeen semi-structured one-on-one interviews were conducted. Three main themes were identified with related subthemes: (1) GPs' experiences of relational aspects of care, (2) GP beliefs about what constitutes best care for patients with a DMT, and (3) how GP practice is enacted within the current healthcare setting. GPs described the challenge of maintaining a strong clinical alliance, while managing perceived patient expectations of a 'quick fix' and advanced imaging. They reported slowing down clinical decisions and feeling 'stuck' with limited options when conservative treatment had failed. GPs believed that exercise should be the core treatment for DMTs and emphasised engaging patients in an active approach to recovery. Some GPs believed arthroscopy had a role in circumstances where patients didn't improve with physiotherapy. Limited access to public physiotherapy and orthopaedic services hampered GPs' management plans and negatively impacted patient outcomes. Conclusions: GP beliefs around what constitutes best care for a DMT generally aligned with the evidence base. Nonetheless, there was sometimes tension between these beliefs and the patient's own treatment expectations. The ability to enact their beliefs was hampered by limited access to conservative management options, sometimes leading to early escalation of care. [ABSTRACT FROM AUTHOR]

To review and synthesize qualitative research studies exploring the experiences of Healthcare Providers (HCPs) of managing shoulder pain. A meta-ethnographic approach was adopted to review and synthesize eligible studies. The findings from each included study were translated into one another using Noblit and Hares' seven-stage process. A systematic search of eleven electronic databases was conducted in February 2021. Methodological quality was assessed using the CASP Appraisal Tool. Ten studies were included in the meta-synthesis, all deemed of high methodological quality. Three themes were identified; (1) Lack of consensus: "we all have different approaches." (2) Challenges to Changing Practice: It's "really hard to change and switch to a different approach," (3) Getting "Buy in" to Treatment: "...so you have to really sell it early". Healthcare providers working with people with shoulder pain struggle to reconcile, often conflicting, research recommendations with their own clinical experience, beliefs and patient expectations. These findings help explain the continued lack of consensus on how best to manage shoulder pain in clinical practice. Healthcare providers (HCPs) working with people with shoulder pain struggle to resolve conflicts between evidence-based recommendations, clinical experience, their own shoulder pain beliefs and patient expectations and preferences. Stronger collaboration across professional disciplines is needed to address the current lack of consensus on the management of shoulder pain. Many HCP's find it difficult to engage patients with shoulder pain in exercise and they work hard to "sell" this approach to patients using strategies such as education, shared decision making and therapeutic alliance. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify and describe the psychological and psychosocial constructs and outcome measures used in tendinopathy research. tDESIGN: Scoping review. tLITERATURE SEARCH: We searched the PubMed, EMBASE, Scopus, Web of Science, PEDro, CINAHL, and APA PsychNet databases on July 10, 2021, for all published studies of tendinopathy populations measuring psychological and psychosocial factors. tSTUDY SELECTION: Studies using a clinical diagnosis of tendinopathy or synonyms (eg, jumper's knee or subacromial impingement) with or without imaging confirmation. tDATA SYNTHESIS: We described the volume, nature, distribution, and characteristics of psychological and psychosocial outcomes reported in the tendinopathy field. tRESULTS: Twenty-nine constructs were identified, including 16 psychological and 13 psychosocial constructs. The most frequently-reported constructs were workrelated outcomes (32%), quality of life (31%), depression (30%), anxiety (18%), and fear (14%). Outcome measures consisted of validated and nonvalidated questionnaires and 1-item custom questions (including demographics). The number of different outcome measures used to assess an individual construct ranged between 1 (emotional distress) and 11 (quality of life) per construct. tCONCLUSION: There was a large variability in constructs and outcome measures reported in tendinopathy research, which limits conclusions about the relationship between psychological and psychosocial constructs, outcome measures, and tendinopathies. Given the wide range of psychological and psychosocial constructs reported, there is an urgent need to develop a core outcome set in tendinopathy. [ABSTRACT FROM AUTHOR]