This study published in the Canadian Medical Association Journal used mixed methods (analyzing provincial health care data and conducting sharing circles, a focus group & 1:1 interviews) to understand the experiences of Indigenous and non-indigenous peoples in emergency departments (11 686 287 ED visits, 9.4% of which were by Indigenous peoples). Quantitative analysis revealed that visits by First Nations patients were nearly twice as likely to end with them leaving without being seen or against medical advice (which could not be explained by other factors such as their diagnosis, acuity of their condition, geographical location, or patient demographics other than First Nations status). Qualitative analysis revealed that racism, stereotyping, communication issues, transportation barriers, long waits, and being made to wait longer than others as reasons for leaving. These findings highlight the systemic racism that Indigenous peoples face in accessing healthcare.

This recent systematic review and meta-analysis explored the evidence for a dose-response relationship in shockwave therapy for clinical outcomes of patients with knee OA.  A total of 7 RCTs (N= 450) found a negative linear relationship between the doses of ESWT and WOMAC scores at 1 wk. (p = 0.0398) and 4 wk. (p = 0.001) follow ups, but not at 12 wks. (p = 0.202) suggesting that using higher energy levels of ESWT to treat knee OA could lead to greater improvement in clinical outcomes compared to using lower energy levels.

PABC members Dr. JF Esculier and Dr. M Hunt, myself, and international colleagues, recently published a paper evaluating an online education resource about running and knee OA (KOA). The resource (free, in 7 languages) includes: a description & epidemiology of KOA,  association between imaging & symptoms, risk factors for KOA,  benefits of running on overall health, association between running & KOA prevalence, benefits of running on knee health in healthy individuals, running in people with KOA and suggested training modifications, & a summary infographic. An international survey (60 countries) of 2694 members of the public, including runners and non-runners with and without KOA, as well as healthcare professionals provided feedback rating it highly useful (9/10) with most people reporting more positive perceptions about recreational running and knee health (46.2% changed a little bit, 19.3% a moderate amount and 11.3% changed a lot). Check out this great new free resource. 😊

This systematic review (of 10 articles) and meta-analysis (of 8 articles) found that pelvic floor muscle training improved quality of life (QoL), mainly for patients with stress urinary incontinence, in women with urinary incontinence. The size of this effect was ‘moderate’ when studies using pre-post evaluation of single groups were analyzed but ‘small’ when analysis was undertaken across controlled studies (a more rigorous study design).

This study validated the use of the Cervical Torsion Test (CTT) and the Head Neck Differentiation Test (HNDT) in patients with peripheral vestibular hypofunction (VH). Comparison of 19 patients with VH (diagnosed with the video Head Impulse Test[HA1] ) to 19 matched healthy controls revealed that: 84.2% of people with VH experienced symptoms with these tests (vs 5.2% of controls). Overall, the HNDT had better discriminatory ability i.e. had better sensitivity (ability to detect true positives) and specificity (ability to detect true negatives) than the CTT and thus is likely more useful in both ruling VH in or out. This study also showed that positive CTT and HNDT tests provoking symptom reproduction with torsion may help identify if neck problems are possibly contributing to dizziness.

The intent of this scoping review was to provide guidance to clinicians and scientists re the current evidence for bicycling exercise (2 types – assisted, non-assisted; 3 modes- speed, aerobic or force) for persons with Parkinson’s Disease (PwPD). Thirty-four studies were identified from 3 databases: statistical significance for reducing motor symptoms was reported in 83%, improving body function structure impairments in 78%, reducing disease severity in 82%, improving gait in 72% and improving balance in 60%. Clinically meaningful improvements were found in 71% of the studies for reducing disease severity and in 50% for improving gait.

This interesting commentary provides a summary of recent advances in pain neuroscience (which has typically been used in chronic/persistent pain) and proposing a model for use with people experiencing acute pain.

This systemic and meta-analysis (Bayesian model network meta-analysis) analyzed data from 27 studies (N=2,242) to reveal a nonlinear relationship between exercise and cognitive improvement in AD patients. Cognition significantly improved at an exercise dose of up to 1000 METs-min/week. The optimal dose was found to be 650 METs-min/week with aerobic exercise being most effective. For aerobic exercise, the optimal cognitive enhancement dose was 660 METs-min/week. You can use this free online tool to understand METs-min/week

We are learning much more about ME/CFS as it has gained increasing attention as a result of the prevalence of long COVID. This article proposes a new model of understanding ME/CFS by synthesizing literature describing different origins (genetic vulnerabilities and environmental triggers).

This paper proposes a new evidence-guided framework to underpin the teaching and clinical application of manual therapy. It is the result of a blend of a literature review with the perspectives from an international group of academics, clinicians and researchers in addition to a consensus process. It proposes that (1) manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations and that (2) these interventions should be delivered in a contextualized healing environment with a well-developed person-practitioner therapeutic alliance.