Low back pain has an enormous impact on individuals and health systems. The large majority of individuals with low back pain have non-specific low back pain (also recently called primary low back pain by WHO), where the cause cannot be attributed to a specific pathology. Developing and implementing evidence-based guidelines to manage non-specific low back pain in primary care is essential to reducing the burden on individuals and health systems. Since 2001, periodic overviews of clinical practice guidelines for the management of patients with non-specific low back pain in primary care have been conducted. Since the last overview in 2018, new clinical practice guidelines for the management of low back pain have been published. This Review summarises management recommendations across international low back pain clinical practice guidelines for primary care and explores the changes in recommendations over time in guidelines published between 1994 and 2026.
Abstract Background Carers, including family members and companions, play a crucial role in supporting patients and sharing insights about their care experiences. Their influence is especially important in virtual hospital models, where patients receive remote hospital-level care using digital technologies. However, there is limited evidence examining what carers think about virtual hospitals or how their experiences could be improved. Methodology We explored Patient-Reported Experience Measure (PREM) surveys completed by 3047 patients and 235 carers to better understand their experiences with virtual hospitals and suggest insights into how to enhance carer and patient experience from the carer’s perspective. Participants were patients and carers discharged from an acute respiratory model of care within a virtual hospital (from 1st March 2020 to 26th August 2024). We conducted both statistical and qualitative (content) analysis. Mann-Whitney U test was used to compare differences between carer and patient responses to 12 Likert scale questions on their reported experience. Content analysis was applied to two free-text comments (What was the best part of the care you received from the virtual hospital? What part of your care provided by virtual hospital most needs improving?). Keywords from the content analysis of free-text responses were integrated with statistical findings from Likert-scale questions to develop insights. Results 3047 patients and 235 carers of PREM surveys were analysed. The overall rating of the virtual hospital service was the same between carer and patients, with the mean response of ‘Excellent’. Our service insights from carers highlight how they support patients, shape their care experience, and offer valuable feedback. We identified six key insights that improve patient and carer experience including reassurance, effective communication, consistent availability, supportive healthcare workers, person-centred clinical service, and usable technology. Conclusions Findings from this study can highlight ways virtual hospital models can be more inclusive and centred around both patients and carers, using data that is already being collected through routine surveys. Plain English abstract Carers such as family members and companions play a vital, but often under-recognised role in care by supporting patients emotionally, practically, and through communication. Their influence is especially important in virtual hospital models, where patients receive remote hospital-level care using digital technologies. However, there is limited evidence examining what carers think about virtual hospitals or how their experiences could be improved. In this study, we have explored patient-reported experience measure surveys completed by 3047 patients and 235 carers to better understand their experiences with a virtual hospital service. This study identified service insights from carers that highlight how they support patients, shape their care experience, and offer valuable feedback. We identified six key insights that improve patient and carer experience including reassurance, effective communication, consistent availability, supportive healthcare workers, person-centred clinical service, and usable technology. Findings from this study can help improve virtual hospital models to be more inclusive and centred around both patients and carers, using data that is already being collected as part of standard care.
Background/Objectives: (P)rehabilitation, comprising structured exercise, nutritional optimisation, and/or psychological support delivered pre- or postoperatively, has demonstrated efficacy in improving outcomes across the cancer care continuum. However, access remains limited. Technology-enabled (p)rehabilitation offers a novel solution with the potential to enhance equity and continuity of care. This systematic review aimed to evaluate the efficacy of technology-enabled (p)rehabilitation on perioperative and patient-reported outcomes among individuals undergoing thoracic and/or abdominopelvic cancer surgery. Methods: Six databases were search from inception to October 2024. Eligible studies were randomised controlled trials (RCTs) comparing technology-enabled (p)rehabilitation with usual care, placebo, or non-technology-based interventions in adults undergoing thoracic and/or abdominopelvic cancer surgery. Outcomes included postoperative complications, hospital readmissions, hospital length of stay (LOS), quality of life (QoL), pain, anxiety, depression, fatigue, distress, and satisfaction. Higher scores indicated improved QoL or worse symptom severity. Risk of bias was assessed using the revised Cochrane tool, and evidence strength was determined using GRADE methodology. Relative risks (RR) and mean differences (MD) were calculated using random-effects meta-analysis. Results: Seventeen RCTs (18 publications, n = 1690) were included. Trials most commonly evaluated application-based platforms (n = 8) and the majority exhibited some risk of bias. Technology-enabled (p)rehabilitation was associated with a significant reduction in LOS (MD = 1.33 days; 95% CI: 0.59-2.07; seven trials), and improvements in pain (MD = 6.12; 95% CI: 3.40-8.84; four trials), depression (MD = 2.82; 95% CI: 0.65-4.99; five trials), fatigue (MD = 10.10; 95% CI: 6.97-13.23; three trials) and distress (MD = 1.23; 95% CI: 0.30-2.16; single trial) compared with controls. Conclusions: Technology-enabled (p)rehabilitation shows promise in reducing LOS and improving selected patient-reported outcomes following thoracic and abdominopelvic cancer surgery. Although evidence is limited due to the small number of studies, modest sample sizes, methodological heterogeneity, and intervention variability, the overall findings justify further investigation. Large-scale, adequately powered clinical trials are required to confirm efficacy and guide clinical effectiveness and implementation studies.
PURPOSE:Using digital devices to enhance the dose and type of physiotherapy exercises improved mobility and physical activity among adults undertaking rehabilitation in a previous randomised trial. The objective of this study was to determine the feasibility of implementing this intervention in routine practice in a public hospital to inform the conduct of a large-scale implementation trial. MATERIALS AND METHODS:Feasibility hybrid type II implementation-effectiveness trial. Patients from an inpatient rehabilitation ward were randomised into control or intervention groups. Both groups received usual care. The intervention group received additional exercises using digital devices provided by trained physiotherapists. Primary feasibility outcomes were: exercise dose documented, rate of recruitment, and provision of ≥30 min daily exercise using digital devices. RESULTS:Twenty-two patients were randomised; 11 in each group. Exercise dosage was documented 100% of the time, one participant was recruited every 5 weeks, and 36% of intervention participants received ≥30 min of daily exercise using digital devices over 14 days. CONCLUSIONS:Exercises using digital devices can be delivered within usual rehabilitation staffing levels, with intended dosage achieved for one third of participants. A large-scale implementation trial is feasible if trial processes and intervention challenges are addressed, and more study sites are included. TRIAL REGISTRATION:Australian and New Zealand Clinical Trial Registry; ACTRN12621000938808.
Background Neuronal apoptosis is a hallmark of ischaemic stroke, yet effective neuroprotective therapies remain scarce. Recent studies suggest that Sox10-lineage cells (SOL) can transfer nuclear material to neurons. However, whether this process contributes to neuronal survival after stroke remains unknown.Methods Sox10-iCreERT2:Ai9 mice subjected to distal middle cerebral artery occlusion (dMCAO) were used to investigate SOL to neuron material transfer after ischaemic injury. High-resolution confocal imaging, AAV-based lineage tracing and single-nucleus RNA sequencing were employed to identify tdTomato-positive neurons and characterise their transcriptional profiles. Behavioural tests and histological analyses were performed to evaluate the neuroprotective effects of tamoxifen treatment.Results A subset of neurons from cortical layer 6 expressed tdTomato protein derived from SOL, suggesting intercellular material transfer. Notably, tdTomato+ neurons exhibited enhanced Bcl2 expression. High-dose tamoxifen (160 mg/kg) increased the number of tdTomato+ neurons by approximately fourfold compared with low-dose treatment. Correspondingly, the proportion of apoptotic neurons (TUNEL+/NeuN+) in the high-dose tamoxifen group was reduced from 33.4% to 19.3%, and infarct volume decreased from 11.68% to 7.26% of the ipsilateral hemisphere after ischaemic stroke. Functionally, high-dose tamoxifen significantly improved sensorimotor recovery, as evidenced by faster adhesive removal (6.9 s vs 22.2 s) and reduced forelimb error rates in the grid-walk test.Conclusions We identify Sox10 lineage-associated tdTomato+ neurons in the ischaemic cortex, with their prevalence higher under high-dose tamoxifen and associated with reduced neuronal loss and improved neurological outcomes. These findings suggest a potential link between Sox10 lineage-related cellular plasticity and neuroprotection.
