Older adults with low back pain (LBP) experience challenges when seeking rehabilitation; a comprehensive view of structural factors to access is needed to inform rehabilitation delivery. We aimed to systematically map the experiences regarding structural barriers and facilitators to accessing rehabilitation among adults aged 50 years and older with LBP; and explore whether experiences vary by social factors. We conducted a scoping review based on Joanna Briggs Institute methodology. Eligible studies were qualitative and mixed-method studies (qualitative component) on structural barriers or facilitators to rehabilitation access among adults ≥ 50 years with LBP. Structural factors included socioeconomic and political contexts, governance, policies, and cultural/societal values. We searched databases from inception to February 2025. Paired reviewers independently screened citations and extracted data. We conducted a descriptive synthesis to map the structural barriers/facilitators and identify knowledge gaps. An Advisory Committee including people with lived experience, family members, and healthcare practitioners provided critical input across stages. Of the 8550 citations screened, 16 studies were relevant (3 from middle-income countries, 12 from high-income countries, 1 covering both; 12 studies on LBP, 4 studies on lumbar spinal stenosis). Common domains of structural barriers/facilitators to access were mapped for LBP and lumbar spinal stenosis in middle- or high-income countries: (1) finances (e.g., costs, insurance coverage, financial support from family); (2) location, transportation, inaccessibility or service unavailability (e.g., inadequate public transportation, wait-times, close proximity to services and resources); (3) lack of knowledge, perceptions, or stigma with certain rehabilitation approaches (e.g., limited education of treatment options provided to patients). Some older adults described ageism from providers (e.g., advised to accept back pain as part of aging) or stigma with certain rehabilitation approaches (e.g., mobility aids) as barriers. Studies in high-income countries also explored healthcare-related factors (e.g., referrals, collaboration across providers) as structural barriers/facilitators to access. Findings varied by rurality, socioeconomic strata, and disabilities. In middle- and high-income countries, older adults with LBP or lumbar spinal stenosis experience many structural barriers to rehabilitation access that vary across social factors. Structural factors relate to finances, location/transportation, availability of services, healthcare provider-related factors, ageism, and stigma. Findings inform future work towards strategies for equitable rehabilitation delivery in middle- and high-income countries. Research is needed in low-income countries.

OBJECTIVES:To determine the accuracy for progressing records to full-text screening using one vs two reviewers to screen title and abstracts in 3 reviews of the effectiveness of interventions for chronic primary low back pain. Secondary objectives include computing inter-rater reliability, describing misclassified records and reviewer performance across reviews, and conducting sensitivity analysis limited to English records and falsely excluded records. STUDY DESIGN AND SETTING:One reviewer screened title and abstracts using standardized eligibility criteria and results were compared to consensus screening from two reviewers. We computed sensitivity, specificity, positive (PPV) and negative predictive values (NPV) with 95% confidence intervals using the two reviewers as the comparison. We calculated the inter-rater reliability, proportion of misclassified citations, and the reasons for misclassification. We conducted sensitivity analyses by restricting the analysis to English records. RESULTS:The sensitivity of one reviewer ranged from 48.8% to 66.3% and the specificity ranged from 88.0% to 93.3%. The PPV ranged from 40.6% to 51.8% and NPV 93.6% to 95%. The inter-rater reliability ranged from 0.39 to 0.50. Between 5.0% and 6.3% of records were misclassified as false negative by a single reviewer. Reasons for misclassification were primarily related to the assessment of relevant interventions and comparators, such as whether the intervention could be isolated. Our sensitivity analysis showed that screening English records only compared to all languages improved sensitivity and PPV, with no change in specificity and NPV. CONCLUSION:Using a single reviewer to screen titles and abstracts may lead to the exclusion of eligible records during title and abstract screening in rapid reviews of the literature. We caution against using Kappa alone as an indicator of the quality of screening, as it is influenced by classification imbalances and suggest including accuracy measures to describe the potential for differences between reviewer screening classifications. PLAIN LANGUAGE SUMMARY:This study investigated whether one reviewer can accurately screen research articles for inclusion in a systematic review, compared to the usual approach of having 2 people do the screening. This was tested in three reviews of common treatments for chronic primary low back pain. The single reviewer who screened titles and abstracts was likely to miss relevant articles that were identified as relevant by 2 reviewers. However, the single reviewer was good at correctly excluding irrelevant articles. Between 5% and 6% of eligible articles were incorrectly excluded by the single reviewer. Most mistakes happened when the single reviewer was uncertain about a treatment's eligibility. Limiting screening to English language articles slightly improved the accuracy of the screening but it did not eliminate the risk of missing relevant research. Since artificial intelligence was used to translate Chinese studies to English, further research on the usefulness for this approach is warranted. In summary, restricting screening of articles to one reviewer may save time, but it increases the probability that important evidence will be overlooked. Researchers should be cautious about relying on a single reviewer and should use additional quality assurance to limit bias.

Objective: Rapid reviews streamline systematic review methods to provide evidence for decision-makers more efficiently. A common methodological trade-off is the restriction of database selection. Therefore, we aimed to determine the proportion of citations retrieved and recall when restricting the database selection in three systematic reviews of interventions for the management of chronic primary low back pain (LBP). We also describe where missed studies were indexed, duplication across databases and the incremental yield of each database.Design and Setting: We used original search files from three systematic reviews of interventions (acupuncture, education, and TENS) conducted to inform the WHO guideline on non-surgical management of chronic primary LBP. Databases searched were CENTRAL, MEDLINE, Embase, CINAHL, and ICTRP. The acupuncture review also included CNKI and WangFang, and the education and TENS reviews included PEDro. Following Cochrane Rapid Review Methods Group recommendations, the restricted search included CENTRAL, MEDLINE and Embase. We report the proportion of citations retrieved compared to the full search, and recall, the proportion of relevant studies in the restricted search compared to the full search. We also calculated incremental yield of each database and cumulative number needed to screen (NNS) (number of cumulative citations/number of cumulative relevant studies).Results: The restricted searches retrieved 54.7% to 86.0% of citations compared to the full search. Recall ranged from 65.4% to 100.0%, missing up to 34.6% of relevant studies. All studies missed in the acupuncture review were indexed in Chinese databases and the study missed in the TENS review was indexed in PEDro. Across reviews, when added to CENTRAL and MEDLINE, Embase, CINAHL and ICTRP had 0% incremental yield while increasing cumulative NNS. Adding CNKI increased screening work (419 citations) in the acupuncture review due to the screening burden but yielded 31% additional studies. PEDro added minimal screening burden and contributed 6.7% incremental yield in the TENS review.Conclusions: Restricting database selection reduces the workload while retrieving most studies, but risks missing relevant studies when topic-specific databases are key contributors. Excluding such databases may introduce selection bias. Inclusion of topic-specific databases should be determined on a case-by-case basis and may be prioritized over databases such as Embase in restricted search strategies.

Objective To determine whether methodological trade-offs used in rapid reviews result in changes in treatment effects or GRADE certainty of the evidence (COE) compared to systematic reviews. Design and Setting We used three systematic reviews on acupuncture, education, and TENS for the management of chronic low back pain (LBP) conducted to inform the WHO guideline on non-surgical management of chronic primary LBP and simulated the conduct of three rapid reviews. We assessed the impact of three commonly used trade-offs: restricted database selection, single reviewer screening and single reviewer risk of bias (ROB) assessment. We meta-analysed studies included for each rapid review and compared them to the results of the WHO systematic reviews and identified when treatment effects would change recommendations. We used evidence profiles to update any changes to GRADE criteria and resulting COE. Results Compared to the WHO systematic reviews, our rapid reviews resulted in no changes to recommendations based on the meta-analyses in the acupuncture or TENS reviews and 15.4% in the education review. Further, between 2.9% to 51.6% of descriptive syntheses were not performed because the single study in the analysis were excluded from the rapid review, 25.8% of descriptive syntheses became meta-analyses because of false positives from single reviewer screening, and 6.45% to 13.33% of meta-analyses became descriptive syntheses because the review was reduced to a single study. The COE was affected in 13.3% in the TENS review and 51.6% in the education review due to descriptive syntheses that were not performed (exclusion of the single study in the analysis). In the acupuncture review, the COE changed in 23.5% of analyses. Conclusions Rapid review methodological trade-offs led to few changes in treatment effects and COE. However, it is difficult to predict how they will impact quantitative and descriptive syntheses and COE because multiple factors are involved, including the breadth of the research question, volume and quality of studies, and review topic. When possible, review authors should consider few comparators and outcomes, well defined eligibility criteria and using fewer methodological trade-offs.

INTRODUCTION:Healthcare providers in rural and remote (R&R) areas of Canada do not have the same access to skills development and maintenance opportunities as those in urban areas. Simulation-based education (SBE) is an optimal technique to allow healthcare providers to develop and maintain skills. However, SBE is currently limited mainly to universities or hospital-based research laboratories in urban areas. The purpose of this scoping review is to identify a model, or components of a model, that outline how a university research laboratory can collaborate with a for profit and not-for-profit organization to facilitate the diffusion of SBE into R&R healthcare provider training. METHODS AND ANALYSIS:This scoping review will be guided by the methodological framework introduced by Arksey and O'Malley in 2005 and the Methodology for Joanna Briggs Institute Scoping Reviews. Ovid MEDLINE, PsycINFO, Scopus, Web of Science, and CINAHL will be searched for relevant articles published between 2000 and 2022, in addition to grey literature databases and manual reference list searches. Articles describing a partnership model or framework between academic institutions and non-profit organizations with a simulation or technology component will be included. Titles and abstracts will be screened, followed by a full-text screening of articles. Two reviewers will participate in the screening and data extraction process for quality assurance. Data will be extracted, charted, and summarized descriptively to report key findings on potential partnership models. CONCLUSION:This scoping review will provide an understanding on the extent of existing literature regarding the diffusion of simulators for healthcare provider training through a multi-institutional partnership. This scoping review will benefit R&R parts of Canada by identifying gaps in knowledge and determining a process to deliver simulators to train healthcare providers. Findings from this scoping review will be submitted for publication in a scientific journal.

Background Advancements in technology have enhanced education, training, and application in health care. However, limitations are present surrounding the accessibility and use of simulation technology (eg, simulators) for health profession education. Improving the accessibility of technology developed in university-based research centers by nonprofit organizations (NPOs; eg, hospitals) has the potential to benefit the health of populations worldwide. One example of such technology is 3D-printed simulators. Objective This scoping review aims to identify how the use of open-source databases for the distribution of simulator designs used for 3D printing can promote credible solutions for health care training while minimizing the risks of commercialization of designs for profit. Methods This scoping review will follow the Arksey and O’Malley methodological framework and the Joanna Briggs Institute guidance for scoping reviews. Ovid MEDLINE, CINAHL, Web of Science, and PsycINFO will be searched with an applied time frame of 2012 to 2022. Additionally, gray literature will be searched along with reference list searching. Papers that explore the use of open-source databases in academic settings and the health care sector for the distribution of simulator designs will be included. A 2-step screening process will be administered to titles and abstracts, then full texts, to establish paper eligibility. Screening and data extraction of the papers will be completed by 2 reviewers (MS and SS) for quality assurance. The scoping review will report information on the facilitation of distributing 3D-printed simulator designs through open-source databases. Results The results of this review will identify gaps in forming partnerships with NPOs and university-based research centers to share simulator designs. The scoping review will be initiated in December 2024. Conclusions The information collected will be relevant and useful for stakeholders such as health care providers, researchers, and NPOs for the purpose of overcoming the gaps in research regarding the use and distribution of simulation technology. The scoping review has not been conducted yet. Therefore, there are currently no findings to report on. International Registered Report Identifier (IRRID) PRR1-10.2196/53167

Background Little is known about lived experience of synchronous telehealth in patients with musculoskeletal (MSK) disorders. Objective We conducted a rapid systematic review to answer: (1) what are the lived experiences and/or perspectives of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth; and (2) what clinical implications can be inferred from qualitative studies focusing on lived experiences for how telehealth is delivered in the management of MSK disorders? Data sources A comprehensive search of MEDLINE, CINAHL, PsycINFO, ProQuest, and Google Scholar from June 2010 to July 2023. Eligible qualitative and mixed methods studies capturing lived experiences of adults with MSK disorders receiving non-pharmacological interventions via synchronous telehealth were included. Study methods Systematic rapid review conducted according to WHO guidelines. Titles and abstracts screened by reviewers independently, eligible studies critically appraised, and data was extracted. Themes summarized using the Consolidated Framework for Implementation Research (CFIR). GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) used to assess confidence in synthesis findings. Results We identified 9782 references, screened 8029, and critically appraised 22, and included 17 studies. There is evidence to suggest that the experience of telehealth prior to and during the pandemic was shaped by (1) patient perception of telehealth, (2) existing relationships with practitioners, (3) availability and accessibility of telehealth technologies, and (4) perceptions about the importance of the role of the physical exam in assessing and treating MSK disorders. Conclusion The five identified implications could be used to inform future research, policy, and strategy development.

Introduction: The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear. Research question: To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH. Material and methods: This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach. Results: This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events. Discussion and conclusion: Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, whole-body magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).

Abstract Background A significant proportion of children and adolescents experience back pain. However, a comprehensive systematic review on the effectiveness of rehabilitation interventions is lacking. Objectives To evaluate benefits and harms of rehabilitation interventions for non-specific low back pain (LBP) or thoracic spine pain in the pediatric population. Methods Seven bibliographic electronic databases were searched from inception to June 16, 2023. Moreover, reference lists of relevant studies and systematic reviews, three targeted websites, and the WHO International Clinical Trials Registry Platform were searched. Paired reviewers independently conducted screening, assessed risk of bias, and extracted data related to study characteristics, methodology, subjects, and results. Certainty of evidence was evaluated based on the GRADE approach. Results We screened 8461 citations and 307 full-text articles. Ten quantitative studies (i.e., 8 RCTs, 2 non-randomized clinical trials) and one qualitative study were included. With very low to moderate certainty evidence, in adolescents with LBP, spinal manipulation (1–2 sessions/week over 12 weeks, 1 RCT) plus exercise may be associated with a greater likelihood of experiencing clinically important pain reduction versus exercise alone; and group-based exercise over 8 weeks (2 RCTs and 1 non-randomized trial) may reduce pain intensity. The qualitative study found information provided via education/advice and compliance of treatment were related to effective treatment. No economic studies or studies examining thoracic spine pain were identified. Conclusions Spinal manipulation and group-based exercise may be beneficial in reducing LBP intensity in adolescents. Education should be provided as part of a care program. The overall evidence is sparse. Methodologically rigorous studies are needed. Trial registration CRD42019135009 (PROSPERO)

Purpose Evaluate benefits and harms of needling therapies (NT) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods Electronic databases were searched for randomized controlled trials (RCTs) assessing NT compared with placebo/sham, usual care, or no intervention (comparing interventions where the attributable effect could be isolated). We conducted meta-analyses where indicated and graded the certainty of evidence. Results We screened 1831 citations and 109 full text RCTs, yeilding 37 RCTs. The certainty of evidence was low or very low across all included outcomes. There was little or no difference between NT and comparisons across most outcomes; there may be some benefits for certain outcomes. Compared with sham, NT improved health-related quality of life (HRQoL) (physical) (2 RCTs; SMD = 0.20, 95%CI 0.07; 0.32) at 6 months. Compared with no intervention, NT reduced pain at 2 weeks (21 RCTs; MD = − 1.21, 95%CI − 1.50; − 0.92) and 3 months (9 RCTs; MD = − 1.56, 95%CI − 2.80; − 0.95); and reduced functional limitations at 2 weeks (19 RCTs; SMD = − 1.39, 95%CI − 2.00; − 0.77) and 3 months (8 RCTs; SMD = − 0.57, 95%CI − 0.92; − 0.22). In older adults, NT reduced functional limitations at 2 weeks (SMD = − 1.10, 95%CI − 1.71; − 0.48) and 3 months (SMD = − 1.04, 95%CI − 1.66; − 0.43). Compared with usual care, NT reduced pain (MD = − 1.35, 95%CI − 1.86; − 0.84) and functional limitations (MD = − 2.55, 95%CI − 3.70; − 1.40) at 3 months. Conclusion Based on low to very low certainty evidence, adults with CPLBP experienced some benefits in pain, functioning, or HRQoL with NT; however, evidence showed little to no differences for other outcomes.

Chronic primary low back pain (CPLBP) is a prevalent and disabling condition that often requires rehabilitation interventions to improve function and alleviate pain. This paper aims to advance future research, including systematic reviews and randomized controlled trials (RCTs), on CPLBP management. We provide methodological and reporting recommendations derived from our conducted systematic reviews, offering practical guidance for conducting robust research on the effectiveness of rehabilitation interventions for CPLBP. Our systematic reviews contributed to the development of a WHO clinical guideline for CPLBP. Based on our experience, we have identified methodological issues and recommendations, which are compiled in a comprehensive table and discussed systematically within established frameworks for reporting and critically appraising RCTs. In conclusion, embracing the complexity of CPLBP involves recognizing its multifactorial nature and diverse contexts and planning for varying treatment responses. By embracing this complexity and emphasizing methodological rigor, research in the field can be improved, potentially leading to better care and outcomes for individuals with CPLBP.

Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE. We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = − 0.33, 95

As commissioned by the WHO, we updated and expanded the scope of four systematic reviews to inform its (in development) clinical practice guideline for the management of CPLBP in adults, including older adults. Methodological details and results of each review are described in the respective articles in this series. In the last article of this series, we discuss methodological considerations, clinical implications and recommendations for future research.

Rural and remote (R&R) healthcare providers experience difficulties accessing continuing medical education, including simulation, to improve their clinical competencies to address the diverse health needs of the rural Canadian population. At the same time, the College of Family Physicians of Canada (CFPC) has identified a need to shift toward a competency-based curriculum to increase access to clinical training using innovative, flexible methods, such as simulation. Simulation is a strategy that can be applied to facilitate this learning by allowing learners to practice clinical skills on a simulator. However, the high cost of simulators is not a practical solution to address the training needs of R&R healthcare providers. In accordance with one of the CFPC's policy considerations, establishing partnerships between relevant sectors such as university research and innovation centers, for-profit organizations (FPO), and not-for-profit organizations (NPOs) to develop and distribute simulators to R&R healthcare providers can help reduce costs and address gaps in health professions education. Modern, Industry 4.0-related technologies such as three-dimensional (3D) printing allow for sustainable and affordable manufacturing of simulators, however, the tools and "know-how" to develop these simulators are currently limited mainly to university research and innovation centers in urban areas. To date, no simulation-focused partnership model exists that addresses how Industry 4.0 augmented simulation technology can make its way from university research and innovation centers into R&R healthcare settings. The proposed solution is to create a simulation-focused partnership model between university research and innovation centers, FPOs, and NPOs to improve the diffusion of Industry 4.0 augmented simulation technology to the R&R Canadian healthcare sector. Diffusing simulators from a research lab to R&R healthcare providers is a sustainable approach aligned with CFPC's policy considerations to strengthen rural medical education, subsequently strengthening rural medical practice.

To evaluate benefits and harms of transcutaneous electrical nerve stimulation (TENS) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. We searched for randomized controlled trials (RCTs) from various electronic databases from July 1, 2007 to March 9, 2022. Eligible RCTs targeted TENS compared to placebo/sham, usual care, no intervention, or interventions with isolated TENS effects (i.e., combined TENS with treatment B versus treatment B alone) in adults with CPLBP. We extracted outcomes requested by the WHO Guideline Development Group, appraised the risk of bias, conducted meta-analyses where appropriate, and graded the certainty of evidence using GRADE. Seventeen RCTs (adults, n = 1027; adults ≥ 60 years, n = 28) out of 2010 records and 89 full text RCTs screened were included. The evidence suggested that TENS resulted in a marginal reduction in pain compared to sham (9 RCTs) in the immediate term (2 weeks) (mean difference (MD) = -0.90, 95

Purpose Evaluate benefits and harms of education/advice for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods Electronic databases were searched for randomized controlled trials (RCTs) assessing education/advice compared with placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of education/advice could be isolated). We conducted meta-analyses and graded the certainty of evidence. Results We screened 2514 citations and 86 full text RCTs and included 15 RCTs. Most outcomes were assessed 3 to 6 months post-intervention. Compared with no intervention, education/advice improved pain (10 RCTs, MD = -1.1, 95% CI -1.63 to -0.56), function (10 RCTs, SMD = -0.51, 95% CI -0.89 to -0.12), physical health-related quality of life (HRQoL) (2 RCTs, MD = 24.27, 95% CI 12.93 to 35.61), fear avoidance (5 RCTs, SMD = -1.4, 95% CI -2.51 to -0.29), depression (1 RCT; MD = 2.10, 95% CI 1.05 to 3.15), and self-efficacy (1 RCT; MD = 4.4, 95% CI 2.77 to 6.03). Education/advice conferred less benefit than sham Kinesio taping for improving fear avoidance regarding physical activity (1 RCT, MD = 5.41, 95% CI 0.28 to 10.54). Compared with usual care, education/advice improved pain (1 RCT, MD = -2.10, 95% CI -3.13 to -1.07) and function (1 RCT, MD = -7.80, 95% CI -14.28 to -1.32). There was little or no difference between education/advice and comparisons for other outcomes. For all outcomes, the certainty of evidence was very low. Conclusion Education/advice in adults with CPLBP was associated with improvements in pain, function, HRQoL, and psychological outcomes, but with very low certainty.

ObjectivesIn November 2020, a series of reports, In Plain Sight, described widespread Indigenous-specific stereotyping, racism and discrimination limiting access to medical treatment and negatively impacting the health and wellness of Indigenous Peoples in British Columbia, Canada. To address the health inequalities experienced by Indigenous peoples, Indigenous healing practices must be integrated within the delivery of care. This rapid scoping review aimed to identify and synthesise strategies used to integrate Indigenous healing practices within collaborative care models available in community-based primary healthcare, delivered by regulated health professionals in Canada.Eligibility criteriaWe included quantitative, qualitative and mixed-methods studies conducted in community-based primary healthcare practices that used strategies to integrate Indigenous healing practices within collaborative care models.Sources of evidenceWe searched MEDLINE, Embase, Indigenous Studies Portal, Informit Indigenous Collection and Native Health Database for studies published from 2015 to 2021.Charting methodsOur data extraction used three frameworks to categorise the findings. These frameworks defined elements of integrated healthcare (ie, functional, organisational, normative and professional), culturally appropriate primary healthcare and the extent of community engagement. We narratively summarised the included study characteristics.ResultsWe identified 2573 citations and included 31 in our review. Thirty-nine per cent of reported strategies used functional integration (n=12), 26% organisational (n=8), 19% normative (n=6) and 16% professional (n=5). Eighteen studies (58%) integrated all characteristics of culturally appropriate Indigenous healing practices into primary healthcare. Twenty-four studies (77%) involved Indigenous leadership or collaboration at each phase of the study and, seven (23%) included consultation only or the level of engagement was unclear.ConclusionsWe found that collaborative and Indigenous-led strategies were more likely to facilitate and implement the integration of Indigenous healing practices. Commonalities across strategies included community engagement, elder support or Indigenous ceremony or traditions. However, we did not evaluate the effectiveness of these strategies.

Background This overview and analysis of UK datasets was commissioned by the UK government to address concerns about children's consumption of caffeinated energy drinks and their effects on health and behaviour. Methods We searched nine databases for systematic reviews, published between 2013 and July 2021, in English, assessing caffeinated energy drink consumption by people under 18 years old (children). Two reviewers rated or checked risk of bias using AMSTAR2, and extracted and synthesised findings. We searched the UK Data Service for country-representative datasets, reporting children's energy-drink consumption, and conducted bivariate or latent class analyses. Results For the overview, we included 15 systematic reviews; six reported drinking prevalence and 14 reported associations between drinking and health or behaviour. AMSTAR2 ratings were low or critically low. Worldwide, across reviews, from 13% to 67% of children had consumed energy drinks in the past year. Only two of the 74 studies in the reviews were UK-based. For the dataset analysis, we identified and included five UK cross-sectional datasets, and found that 3% to 32% of children, across UK countries, consumed energy drinks weekly, with no difference by ethnicity. Frequent drinking (5 or more days per week) was associated with low psychological, physical, educational and overall well-being. Evidence from reviews and datasets suggested that boys drank more than girls, and drinking was associated with more headaches, sleep problems, alcohol use, smoking, irritability, and school exclusion. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) assessment suggests that the evidence is weak. Conclusions Weak evidence suggests that up to a third of children in the UK consume caffeinated energy drinks weekly; and drinking 5 or more days per week is associated with some health and behaviour problems. Most of the evidence is from surveys, making it impossible to distinguish cause from effect. Randomised controlled trials are unlikely to be ethical; longitudinal studies could provide stronger evidence. PROSPERO registrations CRD42018096292 - no deviations. CRD42018110498 - one deviation - a latent class analysis was conducted.

Background This systematic overview was commissioned by England’s Department of Health and Social Care (DHSC) to assess the evidence on direct (previously ‘novel’) oral anticoagulants (OACs), compared with usual care, in adults, to prevent stroke related to atrial fibrillation (AF), and to prevent and treat venous thromboembolism (VTE). Specifically, to assess efficacy and safety, genotyping, self-monitoring, and patient and clinician experiences of OACs. Methods We searched MEDLINE, Embase, ASSIA, and CINAHL, in October, 2017, updated in November 2021. We included systematic reviews, published from 2014, in English, assessing OACs, in adults. We rated review quality using AMSTAR2 or the JBI checklist. Two reviewers extracted and synthesised the main findings from the included reviews. Results We included 49 systematic reviews; one evaluated efficacy, safety, and cost-effectiveness, 17 assessed genotyping, 23 self-monitoring or adherence, and 15 experiences (seven assessed two topics). Generally, the direct OACs, particularly apixaban (5 mg twice daily), were more effective and safer than warfarin in preventing AF-related stroke. For VTE, there was little evidence of differences in efficacy between direct OACs and low-molecular-weight heparin (prevention), warfarin (treatment), and warfarin or aspirin (secondary prevention). The evidence suggested that some direct OACs may reduce the risk of bleeding, compared with warfarin. One review of genotype-guided warfarin dosing assessed AF patients; no significant differences in stroke prevention were reported. Education about OACs, in patients with AF, could improve adherence. Pharmacist management of coagulation may be better than primary care management. Patients were more adherent to direct OACs than warfarin. Drug efficacy was highly valued by patients and most clinicians, followed by safety. No other factors consistently affected patients’ choice of anticoagulant and adherence to treatment. Patients were more satisfied with direct OACs than warfarin. Conclusions For stroke prevention in AF, direct OACs seem to be more effective and safer than usual care, and apixaban (5 mg twice daily) had the best profile. For VTE, there was no strong evidence that direct OACs were better than usual care. Education and pharmacist management could improve coagulation control. Both clinicians and patients rated efficacy and safety as the most important factors in managing AF and VTE. Systematic review registration PROSPERO CRD42017084263—one deviation; efficacy and safety were from one review.

Introduction/Background: Sleep problems, including disrupted sleep, are increasingly recognized as a risk factor for many mental health problems. Students pursuing post-secondary education are a population at risk for both significant sleep problems and poor mental health outcomes such as depression and anxiety. Interventions such as sleep hygiene education and cognitive behavioural therapy (CBT) are commonly used treatments for sleep problems and have been effective in improving sleep and mental health in the university student population. Digitallydelivered CBT has also shown to be effective in improving sleep in youth, however it has not been evaluated in the post-secondary student population. In an effort to address the growing sleep challenges faced by students, some institutions have moved to providing care through a digital platform. However, the effectiveness of delivering sleep interventions digitally to post-secondary students to improve sleep and mental health outcomes is unknown. Objectives: We aimed to systematically search, critically appraise and synthesize the quantitative and qualitative evidence on the effectiveness and user experiences of digitally delivered sleep interventions to improve sleep and mental health outcomes in post-secondary students. Our specific questions are: 1) What is the effectiveness of sleep interventions delivered digitally for improving sleep and mental health outcomes in post-secondary students? 2) What are the students’ experiences, views, expectations and beliefs of sleep interventions delivered digitally? 3) What can be hypothesized from the integration of the quantitative and qualitative evidence about the effectiveness of sleep interventions delivered digitally to post-secondary students? Method and analysis: We searched MEDLINE, CINAHL, Embase, and APA PsycInfo for peerreviewed empirical studies published from 2000. We will include randomized controlled studies (RCTs), cohort studies, case-control studies, qualitative studies, and mixed methods studies. We will assess risk of bias using appropriate critical appraisal tools and extract data about study and participant characteristics, interventions, context and setting, sleep and mental health outcomes, themes and methodological quality assessment. We will use a use a sequential approach at the review level to synthesize and integrate the different types of data: a thematic synthesis of findings from the qualitative studies will be performed to develop evidence statements. These findings will be triangulated with the findings of the quantitative synthesis to understand the fit between the end-user perspective (e.g., student, provider) of interventions delivered digitally and the appropriateness of the tested interventions to address those perspectives. Ethics and Knowledge Dissemination: Ethical approval is not required for this knowledge synthesis. Findings will be disseminated through knowledge translation activities including: 1) presentations at national and international conferences and scientific meetings; 2) presentations to provincial and national stakeholders; 3) publications in peer-reviewed journals; and 4) dissemination through posts on organizational websites. Conclusion: Our review provides knowledge users (post-secondary students, healthcare providers and managers, administrators, mental health advocacy groups, and researchers) with the best and most up-to-date available evidence regarding effective sleep interventions delivered digitally. Moreover, as the COVID-19 situation evolves, this synthesis allows us to be proactive in adapting methods to deliver sleep-related mental health services. Our study addresses an important existing gap, since no systematic reviews located to date have examined the effectiveness and appropriateness of sleep interventions delivered digitally in post-secondary students. Furthermore, our review is the first to combine quantitative and qualitative evidence to better understand not only “what works” for this population, but also “how” and “why” it works. OSF (Open Science Framework): https://osf.io/td3pc