BACKGROUND:Ascites is a common and debilitating complication of decompensated cirrhosis that frequently requires therapeutic paracentesis (TP) for symptom relief. Limited outpatient procedural capacity may contribute to avoidable hospital readmissions. The use of registered nurses (RNs) to perform TP remains uncommon, with few models described internationally. OBJECTIVE:To evaluate the safety of an RN-led outpatient TP model and describe the potential geographic reach of patients accessing care at a Canadian tertiary liver clinic. METHODS:A retrospective chart review was conducted of all outpatient TP procedures performed at Toronto General Hospital between 6 June 2022 and 28 February 2023. Procedures were performed either in the Medical Day Unit (MDU; performed by physicians/nurse practitioners) or in the Liver Clinic (LC) procedure room by trained RNs. The primary outcome was the occurrence of predefined procedure-related adverse events. Adverse events were identified through review of clinical documentation, including emergency department visits within the institutional health network and patient-reported events documented in the electronic medical record. A secondary analysis examined geographic patterns of access using patient residential postal codes. RESULTS:A total of 124 patients underwent 580 TP procedures, of which 55.2% were performed by RNs. Alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease were the most common underlying etiologies. No procedure-related complications were identified (0%; 95% CI: 0-0.52%). Most patients resided within the Greater Toronto Area; however, some travelled up to 360 km, often bypassing closer hospitals, to access outpatient services. CONCLUSIONS:An RN-led outpatient TP model demonstrated reassuring safety signals and contributed to expanded procedural capacity within an ambulatory liver programme. These findings support the feasibility of nurse-led procedural models as a strategy to improve access to care for patients with decompensated cirrhosis. Further evaluation is needed to assess the impact of this approach on healthcare utilisation and patient-reported outcomes.
RELEVANCE TO THE JOURNAL:Responding to the Journal of Evaluation in Clinical Practice's emphasis on person-centered care, this study examines how pain, functional capacity and vitality influence lived disability and rehabilitation needs in individuals with chronic chikungunya. RATIONALE:Chikungunya is an arbovirus transmitted by the Aedes aegypti and Aedes albopictus mosquitoes and is the second most prevalent pathogen related to acute febrile illnesses in Latin America. Among the three possible phases of the disease (acute, subacute, and chronic), the chronic phase occurs when symptoms persist for more than 90 days. During this period, many individuals may experience functional deficits in their upper limbs, compromising daily activities and affecting their quality of life. AIMS AND OBJECTIVES:The aim of this study was to analyze upper limb functional disability based on health-related quality of life components in individuals with chronic chikungunya. METHOD:This cross-sectional observational study, with a quantitative approach, was carried out in the municipality of Santa Cruz, Rio Grande do Norte, Brazil, from April to November 2023. Seventy-four individuals with chronic chikungunya sequelae participated in the study and were assessed using three instruments: a sociodemographic and health status questionnaire, developed by the research team; the Short Form-36 (SF-36); and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Data were analyzed using descriptive statistics and multiple linear regression to examine the independent association between SF-36 domains and upper limb disability, adopting a significance level of 5%. RESULTS:Pain (β = -0.410), functional capacity (β = -0.274) and vitality (β = -0.233) were independently associated with upper-limb disability. Together, these variables explained 52.3% of the variability in DASH scores (R2 = 0.523). CONCLUSION:Pain, functional capacity and vitality were independently associated with upper limb disability in individuals with chronic chikungunya. These findings support a person-centered approach to rehabilitation by highlighting key domains that may guide individualized assessment and rehabilitation strategies for people living with chronic chikungunya.
BACKGROUND:Quantitative measurements are commonly interpreted using raw values, standardised scores, or interval-based summaries. However, these approaches do not provide a unified and directly interpretable representation of how observations relate to their underlying variability, particularly across variables with different scales and distributional forms. OBJECTIVE:This paper introduces a dispersion-based transformation, termed the Dispersion-Based Value (DBV), which expresses observed values on a continuous and direction-sensitive scale relative to their dispersion structure. Building on standardised deviation, the DBV framework maps values onto a bounded interpretive scale defined by a reference dispersion limit, enabling consistent classification of deviation magnitude across variables and analytical contexts. METHODS:Through illustrative and data-informed examples, the proposed representation is shown to preserve the structure of standardised deviation while enhancing interpretability, particularly for extreme observations. The framework is compatible with classical statistical practice and can be implemented using standard measures of central tendency and dispersion, including mean-standard deviation, median-interquartile range and transformation-based approaches. CONCLUSION:By embedding deviation within a unified and scalable interpretive space, the DBV framework provides a structured tool for improving clarity, comparability and communication of quantitative measurements. While the formulation is general and potentially applicable across diverse domains, its use depends on appropriate specification of reference parameters and context-specific validation.
OBJECTIVE:To evaluate the performance and consistency of Large Language Models (LLMs) in core systematic review (SR) tasks and to introduce open-source tools for automated batch processing that provide decision rationales. METHODS:We assessed GPT-4o, Kimi-K2, DeepSeek-V3, and DeepSeek-R1 on five SR tasks: title/abstract screening (3550 records), full-text screening (233 texts), data extraction (112 RCTs), Risk of Bias (ROB) assessment (112 RCTs), and AMSTAR-2 assessment (20 SRs). Each model was evaluated twice to measure consistency. All outputs required supporting rationales and verbatim evidence. RESULTS:LLMs demonstrated proficiency across tasks, with generally high intra-model but lower inter-model consistency. In screening, models showed lower precision (0.27-0.40) but high recall (0.83-0.91) and specificity (0.83-0.91). DeepSeek-R1 and DeepSeek-V3 excelled in title/abstract and full-text screening, respectively. Data extraction accuracy was similar across models (0.78-0.82). Kimi-K2 achieved the highest ROB F1 score (0.71). AMSTAR-2 assessments were generally acceptable. DISCUSSION:While effective, LLMs showed variable performance across SR tasks. The mandatory output of rationales and evidence enhances transparency and allows for human verification of AI decisions. CONCLUSION:We provide a suite of automated tools for key SR tasks. By leveraging these tools to validate model outputs rather than starting manually, reviewers can significantly improve workflow efficiency while maintaining methodological rigour.
RATIONALE:Clinician distress has been progressively reframed over the past decade: from burnout, construed as an individual failure of resilience, to moral injury, construed as a systemic failure that betrays the practitioner's commitment to the patient. The reframing has correctly relocated responsibility from the individual to the institution, but it has stopped at the level of the injured individual and has not traced what injury does to the composition of the profession itself. AIMS AND OBJECTIVES:This paper takes that further step, asking how the distribution of moral residue within clinical teams affects which practitioners remain in the workforce and which leave. METHOD:Conceptual analysis drawing together three established but largely disconnected literatures: moral distress and its accumulation as moral residue, moral injury, and the normalisation of deviance. Results Felt moral residue is allocated across a clinical team not by causal contribution or culpability but by self-ascribed answerability: the practitioner who construes himself as answerable absorbs the residue, while the practitioner whose omission lay in the causal chain may register nothing. Because accumulated residue drives attrition, and because insensitivity to deviance confers persistence, the institution tends to retain its least morally responsive members and to shed its most responsive. Conscience thus behaves as a trait under negative institutional selection, degrading the moral composition of the workforce as a structural matter and independently of any individual's choices. CONCLUSION:On this account, interventions directed at the distress of the conscientious, absent structural change, may accelerate rather than arrest the drift. Implications for professional self-governance and for the design of clinical institutions are drawn.
RATIONALE:Type 2 diabetes mellitus affects more than 500 million adults worldwide, yet up to 80% of related complications are preventable through evidence-based care. Clinical practice guidelines function as key prevention policy instruments; however, their implementation and integration into health systems vary substantially, with important implications for prevention access and health equity. AIMS AND OBJECTIVES:This study aimed to examine how national policy integration architecture within diabetes management guidelines influences access to preventive care and health equity across diverse health system contexts. METHODS:A comparative qualitative policy analysis evaluated national diabetes management guidelines from seven countries (United States, United Kingdom, Japan, India, Ghana, Colombia, Australia) using the Health Policy Triangle and Integration Continuum Framework. Guidelines were scored on integration strength (1 to 5 scale) across clinical, financial and administrative domains. Equity analysis examined financing barriers, workforce distribution and cultural adaptations. Inter-rater reliability testing achieved substantial agreement (Cohen's kappa 0.68). RESULTS:All guidelines converged on evidence-based clinical content, yet integration scores varied threefold (range 2 to 5). High-integration systems (United Kingdom, Australia; scores 5) achieved prevention medication access rates exceeding 80% among eligible populations through unified financing and zero cost-sharing. Partial-integration systems (United States, India, Ghana; scores 2 to 3) showed 30% to 50% access despite comparable clinical recommendations. Integration strength correlated strongly with implementation effectiveness (Spearman ρ = 0.89, p < 0.01). Financing structure emerged as the primary equity determinant. Countries with fragmented payment systems preserved disparities despite equity language in guidelines. CONCLUSIONS:Preventing diabetes complications at scale requires integrated health systems where financing, workforce, and monitoring align with guideline intent. Policy priorities should emphasise unified financing, elimination of cost-sharing for preventive therapies, and mandatory equity monitoring in quality frameworks.
RATIONALE:Post-test probabilities are reported as precise numbers even though the pretest probabilities they depend on are uncertain and, for an individual patient, unobservable. Clinicians need a way to tell the mathematical question-how strongly is a change in the pretest estimate carried through to the post-test probability-apart from the clinical question of whether the remaining uncertainty is wide enough to alter management. AIMS AND OBJECTIVES:To show that the prevalence threshold ( ϕ e ) marks the tipping point at which uncertainty expressed in percentage points is passed on unchanged by a positive test result, and to combine that result with exact conversion of pretest ranges and with the clinician's own action threshold. METHOD:Conceptual and analytic study, supported by a targeted narrative overview of pretest-probability estimation and of cognitive influences on diagnostic reasoning. We derived how strongly the positive-result screening curve responds to a change in the pretest probability, examined how that result depends on the scale used, distinguished ϕ e from testing and treatment thresholds, and applied the framework to a primary care example. RESULTS:For a positive likelihood ratio LR + > 1 , ϕ e = 1 ∕ ( 1 + LR + ) is the single pretest probability at which one percentage point of pretest uncertainty becomes one percentage point of post-test uncertainty. Below ϕ e such changes are magnified; above it they are damped. The tipping point exists only when uncertainty is measured in percentage points, because a positive result multiplies the odds by the same factor at every pretest probability. In a worked primary care example ( LR + = 8 , the order of magnitude of a positive urinary nitrite), a pretest estimate of 15% gives a post-test probability of 58.5%, and a plausible pretest range of 10%-25% converts exactly to 47.1%-72.7%. That range straddles a 50% action threshold but not a 40% or an 80% one; ϕ e itself settles nothing. CONCLUSION:The prevalence threshold is a closed-form description of how uncertainty travels through a positive test result, not a decision rule and not a guarantee of precision. Its useful role is to prompt clinicians to state a pretest range, convert it, and compare the result with the probability at which they would act differently. Vignette and human-factors studies with clinicians are needed before clinical implementation.
RATIONALE:Hip and Knee Osteoarthritis (HKOA) is a growing public health challenge, associated with high disability and socioeconomic burden. Current literature indicates that care provided to people with HKOA does not follow evidence-based recommendations, is sub-optimal, reactive, and fragmented. This suggests the need to develop structured approaches to guarantee high-value care and ensure the sustainability of healthcare systems. Models of Service Delivery (MoSD), that is, how a model of care should be adapted and implemented in a local setting or health service at an operational level, have been increasingly recognised as a potential solution to overcome this existing gap. However, the reporting on MoSD for the management of HKOA remains limited. AIMS AND OBJECTIVES:Therefore, this scoping review aims to map the existing literature on the development and implementation of MoSD for the management of HKOA in primary care, exploring how these models are organised and implemented in real-world settings. METHODS:This scoping review will be developed according to the Joanna Briggs Institute guidance and follow the PCC framework for the establishment of the eligibility criteria-Population (people with HKOA), Concept (MoSD for the management of HKOA), Context (primary care). A detailed search will be conducted in several health sciences (i.e., PubMed, CINAHL, EMBASE, CENTRAL, PsycINFO, Scopus and Web of Science) and grey literature (i.e., Bielefeld academic search engine and MedNar Search Engine) databases. Studies with quantitative, qualitative or mixed-methods methodology published since 2000 will be considered for inclusion. Two researchers will independently perform screening of titles/abstracts and full texts, followed by data charting. Finally, the charted data will be analysed through a deductive content analysis and presented in graphic, diagrammatic or tabular form, accompanied by a narrative summary. CONCLUSION:This scoping review may have important implications for HKOA care, providing a comprehensive overview of how care is currently organised and delivered. It will also highlight key opportunities and gaps in available primary care-based MoSD and inform their future design and implementation.
OBJECTIVES:To compare the burden and stress levels of two groups of informal caregivers: those assisting patients undergoing treatment for cirrhosis (Group 1) and those caring for liver transplant recipients (Group 2). METHODS:This cross-sectional study included 223 informal caregivers of cirrhosis and liver transplant patients monitored at the Liver Transplant Unit. Participants completed a sociodemographic questionnaire, a patient disease history form, and the Burden Scale for Family Caregivers (BSFC). RESULTS:Caregiver burden was influenced by specific factors: being younger than 40 years, having children, caring for emotionally distressed patients, and lower per capita income and women were the most burdened. CONCLUSIONS:These findings highlight the need for public health strategies that recognize and support the essential, yet often invisible, role of informal caregivers. A more equitable redistribution of caregiving responsibilities between families, Society, and the State is critical to reducing caregiver strain and improving outcomes for both caregivers and patients.
RATIONALE:Patient-provider communication quality, measured through the CAHPS programme that underpins Medicare value-based purchasing for over 200 million Americans, is among the most consequential evaluation metrics in healthcare. Although clinician and patient predictors of CAHPS scores have been studied, structural features of healthcare systems-in particular the administrative burden patients navigate through forms, prior authorisations, and billing bureaucracy-remain unexamined. This gap has direct implications for clinical practice evaluation: if administrative burden independently predicts the metric used to assess provider performance, risk-adjustment models may systematically disadvantage providers serving high-burden populations. AIMS AND OBJECTIVES:To provide the first national estimate of the burden-communication association, to evaluate robustness through a multi-framework sensitivity architecture, and to quantify equity implications across education and insurance subgroups. METHOD:Cross-sectional analysis of 9 MEPS waves (2012-2023; N = 110,459 US adults). Administrative burden was operationalised as a four-grade exposure from healthcare form encounters, with Grade 1 as the methodologically justified reference. We deployed IPTW via generalised boosted models, complemented by five sensitivity frameworks: negative control calibration, E-values benchmarked against CAHPS determinants, Oster bounds, health literacy calibration, and reverse-specification analysis. RESULTS:Heavy administrative burden was independently associated with 10.8 to 13.3 percentage points lower probability of optimal communication across all four CAHPS domains (all p < 0.001), exceeding disparities by education and insurance. Negative control associations were 3-4x weaker; E-values (1.58-1.71) exceeded the strongest CAHPS determinants. The gap was steepest among lower-education (-15.2 pp) and publicly insured (-14.3 pp) adults. Reverse-specification analysis demonstrated asymmetric directionality. CONCLUSION:In this first national quantification, administrative burden was independently and robustly associated with substantially lower communication quality. These findings position administrative complexity as a structural correlate of clinical encounter quality, and identify administrative simplification-grounded in SQUIRE-guided quality improvement-as a modifiable pathway for improving patient experience in disadvantaged populations served by clinical practice evaluation frameworks.
BACKGROUND:Hip fracture in frail older adults is commonly managed surgically, but non-operative management may be appropriate for selected patients with extreme frailty, limited life expectancy, severe cognitive impairment, multimorbidity or limited expected benefit from surgery. However, when 'no surgery' is chosen, documentation of consent or refusal may complete a procedural requirement without ensuring ethically sufficient decision-making. METHODS:A structured, literature-informed conceptual ethical analysis was conducted using PubMed and Scopus searches, citation tracking and synthesis guided by the four principles of biomedical ethics. RESULTS:Four ethical gaps are identified: non-operative burdens are often naturalised, 'conservative treatment' may be mistaken for comfort care, family signatures may not fully represent patient values, and refusal of surgery does not end clinical responsibility. These recurring concerns are organised into a five-domain framework: Burden, Goal, Voice, Balance and Commitment. CONCLUSIONS:Non-operative hip fracture care should move from procedural consent to ethical consent. The proposed framework may support balanced risk communication, goal clarification, patient-centred decision making and continued care planning when 'no surgery' is chosen.
RATIONALE:Healthcare providers are influenced by several factors that affect their performance. However, no such work has been presented to organise or clarify this growing body of literature. AIM AND OBJECTIVES:This study aimed to identify frameworks for measuring factors affecting healthcare providers' performance. METHODS:This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions for Scoping Reviews (PRISMA-ScR). This review was guided by the Population, Concept, and Context framework recommended by the Joanna Briggs Institute (JBI). Searches were conducted in several databases and search engines, including PubMed, Web of Science, and Google Scholar. We included research articles of any design. A standardised data sheet was used for data extraction by each reviewer. The data extracted from the studies were related to the details of frameworks (name, country of origin, dimensions, indicator used, and setting of framework). The analysis of this review included variables from the framework details using ranges, medians, and counts, as appropriate. Furthermore, various interpretations of the results were presented in narrative form. RESULTS:We found 17 frameworks for measuring HCPP in terms of domains, subdomains, indicators, and depth of detail. Asia accounted for the majority of framework origins (70%). Most frameworks were published around 2020 (88.23%). The domains of the frameworks varied from 2 to 8, with a median score of 5. The findings were synthesised into 8-categories covering aspects related to feedback, work environment, motivation, performance, well-being, organisation, work-life interface, and personal attributes. CONCLUSION:The results of this review provide useful resources for the government, health institutes, and hospitals to inform them of the factors that affect the HCPP-specifically, choosing a framework that is systematically relevant to their institutions' contexts and settings.
OBJECTIVE:This study aimed to examine the relationship between loneliness and geriatric feelings of burdensomeness in hospitalized older adults. METHODS:The study was conducted with 337 older adults hospitalized in a province in Türkiye. Data were collected through face-to-face interviews between April and July 2025 using the Sociodemographic Information Form, the Loneliness Scale for Older Adults, and the Geriatric Feelings of burdensomeness Scale. Data analysis included descriptive statistics (mean, standard deviation, minimum, and maximum), Pearson correlation analysis, and simple linear regression analysis. RESULTS:The mean score on the Loneliness Scale for Older Adults was 10.40 ± 6.31, indicating an acceptable level of loneliness, while the mean score on the Geriatric Feelings of burdensomeness Scale was 55.38 ± 22.57, reflecting a below-average level of burden. A positive, moderate, and statistically significant relationship was found between loneliness and geriatric feelings of burdensomeness (r: 0.529; p < 0.05). Loneliness explained 28% of the variance in geriatric feelings of burdensomeness. CONCLUSION:The findings indicate that increased loneliness among hospitalized older adults is associated with heightened geriatric feelings of burdensomeness. In this context, providing psychological assessment and care services for hospitalized older adults with medical conditions through a holistic nursing approach within the scope of Consultation-Liaison Psychiatric Nursing may support mental well-being. In particular, it is recommended to implement empowerment programs aimed at reducing loneliness and perceived burden and to conduct qualitative studies that allow for an in-depth exploration of hospitalization experiences.
RATIONALE:Delirium in the Intensive Care Unit (ICU) is an acute neurocognitive syndrome affecting up to 80% of patients on mechanical ventilation. While traditionally defined by biomedical criteria (DSM-5), these metrics often overlook the profound ontological rupture and subjective alienation experienced by the patient. AIMS AND OBJECTIVES:This study aims to integrate clinical evidence with phenomenological reflection to evaluate how delirium alters patient identity and to define the resulting ethical responsibilities for the clinical team. METHOD:An interdisciplinary conceptual analysis was conducted, merging pathophysiological data and clinical meta-analyses with philosophical frameworks, including the phenomenology of perception, narrative identity and the ethics of vulnerability. RESULTS:Delirium suspends the 'intentional arc', leading to a collapse of the lived world, fragmented temporality and distorted otherness. Subphenotypes like hypoactive delirium often result in 'epistemic injustice' by silencing the patient's subjective testimony. Post-Intensive Care Syndrome (PICS) is identified as a 'biographical disruption' and a wound to selfhood. CONCLUSION:Clinical evaluation must transcend pathophysiology to include 'narrative competence', enabling the reconstruction of the patient's fractured history. Bioethics should shift from abstract rational autonomy toward a model of 'relational autonomy' grounded in vulnerability.
BACKGROUND:Traditional rehabilitation medicine, primarily dependent on qualitative clinical assessment and static therapeutic protocols, faces significant challenges in scalability, objectivity, and dynamic adaptability. The integration of Artificial Intelligence (AI) is catalyzing a paradigm shift from "experience-driven" to "data-driven" precision rehabilitation. OBJECTIVE:This narrative review delineates the current landscape of AI innovations in rehabilitation, evaluates their clinical integration across the patient lifecycle, and identifies the socio-technical barriers to widespread adoption. METHODS:We narratively synthesized recent advancements in four foundational technological pillars: Computer Vision (CV) for markerless motion capture, Reinforcement Learning (RL) for intention-aware robotics, Digital Twins (DT) for prognostic simulation, and Explainable AI (XAI) for clinical decision support. RESULTS:Our analysis reveals that AI-driven models enhance rehabilitative efficiency by providing highly objective functional assessments, demonstrating high accuracy in specific controlled validation datasets. Clinical evidence suggests that AI-integrated interventions can potentially reduce certain motor recovery cycles by up to 20%-30% through real-time assist-as-needed (AAN) paradigms. Furthermore, the deployment of AI-mediated remote monitoring and virtual assistants has demonstrated up to a 25% relative improvement in patient adherence post-discharge based on selected pilot studies, effectively bridging the "rehabilitation gap" between hospital and home. CONCLUSION:While AI offers transformative potential for personalized and accessible care, its maturation depends on overcoming challenges related to data heterogeneity, algorithmic "black-box" distrust, and systemic interoperability. We propose a multidisciplinary roadmap to establish unified regulatory frameworks and standardized APIs. Ultimately, the transition to AI-augmented rehabilitation is highly promising for achieving equitable and evidence-based functional recovery in the era of digital medicine.
BACKGROUND:Clinical practice guidelines (CPGs) are intended to support evidence-based clinical decision-making. However, the extent to which physical therapists' clinical decisions align with guideline recommendations remains uncertain, particularly in Brazil. OBJECTIVE:To evaluate the alignment of Brazilian physical therapists' clinical decisions with recommendations from CTS clinical practice guidelines and to examine whether general evidence-based practice (EBP) knowledge, self-reported guideline use, and condition-specific guideline knowledge are associated with this alignment. METHODS:A cross-sectional study was conducted using an online questionnaire comprising two clinical vignettes representing mild and moderate CTS. Participants selected assessment and treatment strategies, which were scored using a weighted guideline-alignment system based on the strength of the supporting evidence. Scores were expressed as percentages. Between-group comparisons were performed using Welch's independent t-tests, and effect sizes were estimated using Cohen's d. RESULTS:A total of 282 physical therapists were included. Overall alignment with guideline recommendations was low (mean 46.2%, SD 10.7), with similarly low scores for assessment (45.9% ± 14.5) and intervention (46.5% ± 11.7). No significant associations were observed between guideline alignment and any of the investigated variables (all p > 0.05). Effect sizes were uniformly small. All participants selected at least one non-recommended intervention, and 66.7% selected at least one non-recommended assessment procedure. CONCLUSION:Clinical decisions made by Brazilian physical therapists showed limited alignment with CTS clinical practice guideline recommendations. General EBP knowledge, self-reported guideline use, and condition-specific guideline knowledge were not significantly associated with guideline alignment, and all observed effect sizes were small. These findings suggest that improving guideline implementation requires addressing factors beyond individual knowledge and highlight the importance of behavioural, organizational, and contextual determinants of clinical decision-making.
RATIONALE:Musculoskeletal physiotherapy, including the exercise prescription element, should be patient-centred with an active patient involved in the decision making. Currently, exercise prescription relies heavily on published literature and clinical expertise, however there is limited published research on the patient's experience with the exercise prescription process in a one-on-one outpatient setting. AIMS AND OBJECTIVES:This study aimed to explore patients' experiences of the exercise prescription process in musculoskeletal physiotherapy and to develop a grounded understanding of the elements that are important considerations to patients in a one-on-one rehabilitation setting. METHODS:Twenty participants who had recently completed outpatient physiotherapy for a musculoskeletal condition took part in a semi-structured interview. Data collection and analysis occurred concurrently, with recruitment continuing until theoretical saturation was reached. Data were analysed using published grounded theory methods. RESULTS:Two main categories emerged describing the patient experience of exercise prescription, WHY and HOW, with individualisation of the program to the patient acting as the core concept. WHY encompassed education, feedback and collaboration, which built patients' understanding, trust and confidence in their exercise program and supported a therapeutic alliance. HOW encompassed exercise selection, prescription method, dosage parameters, progressive overload and prescription tools, reflecting how the program was practically developed and delivered. These elements were interdependent, with the WHY elements informing the HOW elements, all converging on individualisation as the core concept for an effective exercise prescription process. CONCLUSION:Patients value an individualised, collaborative approach to exercise prescription that integrates education, ongoing feedback and prescription methods tailored to their goals and context. These findings offer physiotherapists patient-informed insight to complement existing clinician focused literature to guide the exercise prescription process.
