BACKGROUND:Podiatrists are the primary health professionals associated with assessment, diagnosis and management of lower limb problems. Research is critical in informing evidence-based practice. As part of a national research priorities project, this bibliometric review aimed to map all Australian podiatry-relevant research from 1970 to 2024 and explore volume over time, authors, institutions, level of evidence, funding sources and categories of research. METHODS:Podiatry-relevant research was categorised into 10 streams: dermatology, diabetes-related foot disease, gerontology, musculoskeletal and sports, paediatrics, rheumatology, surgery, workforce and education, First Nations foot health and neurological and vascular disease. A systematic search of the literature was conducted in each stream up until December 2024. Meta-data from Scopus were analysed in Biblioshiny, where publications volume, authors, institutions, journals and collaborations were described. Each publication was also categorised for level of evidence using the National Health and Medical Research Council criteria, research type using the United Kingdom Clinical Research Collaboration Health Research Classification System and funding source using Higher Education Research Data Collection specifications. RESULTS:A total of 1641 publications were included across all research streams. Steady increases in publication volume occurred over the past 20 years, with diabetes-related foot disease yielding the highest volume (n = 335), followed by musculoskeletal (n = 308) and paediatrics (n = 280). Musculoskeletal and sports research demonstrated the highest proportion of level I evidence (22%), whereas most streams were dominated by level IV evidence. The majority of research across all streams received no funding support, ranging from 32% unfunded in First Nations foot health research to 87% in surgical research. Rheumatology achieved the highest proportion of competitive funding (47% Category 1). The most frequent research categories were aetiology, detection and screening and evaluation of treatments. The Journal of Foot and Ankle Research was the most frequent publication source, with 140 (8%) of total publications. CONCLUSION:Australian podiatry-relevant research has grown substantially, particularly over the past 2 decades. However, significant disparities exist in volume, evidence quality and funding across different streams, with most research conducted without external funding support, highlighting the need for strategic investment to enhance evidence generation in key areas of podiatry practice.

OBJECTIVES:This study aimed to investigate the impact of 'who' delivers a health message (general practitioner or community representative), and the 'visual stimulus' (animation or talking head) used on influencing attitudes toward safe behaviours in the context of the COVID-19 pandemic, across six vulnerable population subgroups STUDY DESIGN: A 'helix' randomised controlled trial with 2x2 factorial design. METHODS:Participants (40 per subgroup) were randomly allocated within their subgroup to an intervention sequence. They completed a factorial, counter-balanced allocation of four intervention combinations across four safe behaviour contexts. Exposure to each intervention was followed by online survey questions investigating intention to undertake, and encourage family and friends to undertake, the context-specific behaviour using a 5-point Likert-style scale RESULTS: A total of 358 participants responded to requests to participate in the study, of whom 298 (83%) fully completed and 58 (16%) partially completed surveys. Participants were more likely to report higher intention to perform COVID-safe behaviours when exposed to animation compared to talking head visual stimuli (Coef = -0·12, 95% CI = -0·22 to -0·01, p = 0·03; β = -0.12, 95% CI -0.22 to -0.01, p = .03, animation > talking head) There was no main effect of 'who' provided the message; however, several interaction effects were noted across population subgroups for each intervention. CONCLUSION:The approach best suited for different vulnerable subgroups varies across each, indicating a one-size-fits-all approach should not be used and is inequitable. However, the additional costs and time-delays that would be encountered in preparing subgroup-specific materials also warrant consideration.

RATIONALE:Lower limb apophyseal injuries are common in children and adolescents. The most common are traction apophysitis of the tibial tubercle and calcaneal apophysis. Various treatments are used for apophyseal conditions. This review provides information for health professionals and families who are deciding on treatment. OBJECTIVES:To assess the benefits and harms of non-surgical treatment versus placebo, no treatment, or another treatment on overall pain, physical function, or participation in physical activity in children and adolescents with lower limb apophyseal injuries. SEARCH METHODS:We searched the following databases with no language restrictions up to 4 January 2025: Cochrane Central Register of Controlled Trials (CENTRAL; 2025, Issue 1) via Ovid, MEDLINE Ovid, Embase Ovid, CINAHL Plus, ClinicalTrials.gov (clinicaltrials.gov), and World Health Organization's International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/en/). ELIGIBILITY CRITERIA:We searched for randomised controlled trials (RCTs) reported in full text, abstract form, or as unpublished data. OUTCOMES:Our critical outcomes were overall pain, physical function, participation in sport, withdrawals due to adverse events, and serious adverse events. The primary time point was up to three months for overall pain, physical function, and participation in sport (measured in days), and the end of the trial period for adverse event outcomes. RISK OF BIAS:We assessed the risk of bias (RoB) in the findings using the Cochrane tool RoB 2. SYNTHESIS METHODS:We calculated the standardised mean difference (SMD) or mean difference (MD) for continuous outcomes. We used the random-effects model to combine data and quantified heterogeneity using the I² statistic. When we were unable to pool data, we described results narratively. We assessed the certainty of the evidence using GRADE. INCLUDED STUDIES:We included 10 RCTs, seven on calcaneal apophysitis and three on traction apophysitis of the tibial tubercle. The studies involved 654 children, whose mean age was 10.3 to 13.3 years. Most of the participants were male (73%). Six studies compared intervention versus placebo or no treatment (or both), and five studies compared one intervention versus another. In the studies reporting our critical outcomes, there were five intervention groups: pharmaceutical interventions (e.g. dexamethasone), taping, foot orthoses/heel straps, heel lifts, and heel cushioning. Placebo interventions were lidocaine injections, saline via iontophoresis, or non-stretch tape. 'Usual care' comparators were poorly described but included exercise, stretches, nonsteroidal anti-inflammatories, and massage. SYNTHESIS OF RESULTS:Pharmaceutical intervention versus placebo for children with traction apophysitis of the tibial tubercle Compared to placebo, the evidence is very uncertain about the effects of dexamethasone on overall pain (MD -0.52, 95% CI -1.24 to 0.20; 1 study, 23 participants; very low-certainty evidence), physical function (MD -1.76, 95% CI -16.08 to 12.56; 1 study, 19 participants; very low-certainty evidence), and participation in sport (MD 7.90, 95% CI -0.41 to 16.21; 1 study, 16 participants; very low-certainty evidence) in the short term. The evidence is very uncertain about adverse events in the studies of dexamethasone or dextrose versus placebo (RR 1.31, 95% CI 0.88 to 1.96; 2 studies, 74 participants; very low-certainty evidence). Withdrawals due to adverse events were not measured. Pharmaceutical intervention versus usual care for children with traction apophysitis of the tibial tubercle Compared to usual care, the evidence is very uncertain about the effects of dexamethasone on overall pain (MD -0.80, 95% CI -1.73 to 0.13; 1 study, 21 participants; very low-certainty evidence), physical function (MD 2.68, 95% CI -17.56 to 22.92; 1 study, 16 participants; very low-certainty evidence), and participation in sport (MD 0.85, 95% CI -7.13 to 8.83; 1 study, 11 participants; very low-certainty evidence) in the short term. The evidence is very uncertain about adverse events in the study of dexamethasone versus usual care (RR 1.36, 95% CI 0.88 to 2.10; 1 study, 30 participants; very low-certainty evidence). Withdrawals due to adverse events were not measured. Taping versus placebo for children with calcaneal apophysitis Compared to placebo, the evidence is very uncertain about the effects of Kinesio tape on overall pain (MD 0.10, 95% CI -1.25 to 1.45; 1 study, 22 participants; very low-certainty evidence) and physical function (MD 6.10, 95% CI -0.08 to 12.28; 1 study, 22 participants; very low-certainty evidence) in the short term. Participation in sport, adverse events, and withdrawals due to adverse events were not measured. Foot orthoses versus heel lifts for children with calcaneal apophysitis Compared to heel lifts, foot orthoses likely result in little to no difference in overall pain (MD 0.00, 95% CI -0.44 to 0.44; 1 study, 123 participants; moderate-certainty evidence) or physical function (MD -1.30, 95% CI -7.58 to 4.98; 1 study, 124 participants; moderate-certainty evidence) in the short term. There were no adverse events reported (11 studies, 101 participants; moderate-certainty evidence). Participation in sport and withdrawals due to adverse events were not measured. Heel cushioning versus heel braces for children with calcaneal apophysitis Compared to a heel strap, the evidence is very uncertain about the effect of heel cushioning on physical function in the short term (MD -2.00, 95% CI -12.48 to 8.48; 1 study, 43 participants; very low-certainty evidence) and on adverse events (RR 1.05, 95% CI 0.07 to 15.69; 1 study, 43 participants; very low-certainty evidence). Overall pain, participation in sport, and withdrawals due to adverse events were not measured. Certainty of the evidence We downgraded our certainty level for most of the evidence because of risk of bias, imprecision, and possible publication bias. AUTHORS' CONCLUSIONS:Evidence for non-surgical treatment of lower limb apophyseal injuries is limited. We rated it mostly low to very low certainty. The studies included in this review had heterogeneous outcomes, which restricted meaningful synthesis. Outcomes were primarily focused on pain, physical function, or activity participation, and the studies did not specifically target children who had persistent symptoms of apophysitis causing functional limitations. None of the trials measured quality of life, even though cohort studies have previously reported that apophyseal injuries can impact this long-term. Nor did the trials examine economic impacts, despite the costs of non-surgical treatments for apophyseal conditions to families and healthcare systems. FUNDING:None REGISTRATION: Protocol DOI: https://doi.org/10.1002/14651858.CD015156.

ABSTRACT Background To conduct a bibliographic analysis of English language research pertaining to podiatry workforce and education by Australian authors. Methods The Scopus database search was conducted to identify all Australian workforce and education‐related articles published by podiatric authors in English from 1970 to 2024. Bibliometric analysis was performed using Biblioshiny, a web‐based graphical interface for the bibliometric R package. Citations, journals, authors, institutions, and countries were described. Publications were manually categorised according to research type, level of evidence and funding source. Results The search strategy yielded 105 eligible articles, which received a total of 975 citations and were published by 338 authors in 33 journals. The most frequent journal was Journal of Foot and Ankle Research (34 articles; 32%), and the most frequently cited was the University of South Australia (affiliation of 85 authors). Most Australian workforce and education articles published by podiatrists focused on health and social care services research (n = 60; 57%) and only five articles (5%) provided level I evidence. Fifty‐six articles (53%) reported no research funding. Research generally fell under four themes. Conclusion Workforce and education research make up a small percentage of podiatry‐related research. Most are published in low‐impact journals with low citations. The articles are highly collaborative, with multiple authors nationally and internationally. Studies are driven by academics with a vested interest in workforce and education issues, with little or no funding. There is a lack of research in continuing professional development educational activities and workforce in the private sector. Being a small profession, podiatry data may be missed in large allied health workforce studies. Podiatry workforce and education research must be driven by the profession, thereby creating opportunities for sustainable podiatry career growth.

BACKGROUND:Manual transcription can be resource-consuming and time-consuming, while software-based audio coding offers a potentially cheaper and faster alternative. OBJECTIVES:This study aimed to compare the time efficiency, cost effectiveness, and researcher experience of thematic analysis of audio recordings versus transcripts. METHODS:This was a mixed-methods crossover study with two conditions (audio coding and transcript coding) and three categories of coders (novice, competent, and expert). Ten researchers coded 18 interview segments using NVivo, half in each format. Demographics, coding times, and coding experiences were collected. RESULTS:On average, transcript coding took less time than audio coding, and NVivo experience was negatively associated with coding time across conditions. Economic analysis showed that audio was <60% the cost of transcript coding. Audio coding was perceived as being more difficult, yet coders agreed that both methods led to similar code quality. Audio coding may be a cost-saving alternative to transcript coding. DISCUSSION:The potential cost savings, coupled with the more "naturalistic" source of audio data, may make audio coding an appropriate approach to consider for the qualitative researcher, despite coder perceptions of its greater difficulty. Audio coding should be considered as part of a qualitative project to enhance immersion in the data or improve coding efficiency. However, this approach should be preceded by careful consideration of the most effective computer-assisted qualitative data analysis software and extensive training and familiarization with audio coding procedures before analysis.

BACKGROUND:This study aimed to evaluate the impact of the Community Care Program, which was the amalgamation of three outreach services-post-acute care, Residential In-Reach, and the Hospital Admission Risk Program-into a single integrated care model. Specifically, we assessed its effects on unplanned hospital readmissions and emergency department re-presentations at 30-, 60- and 90-days post-enrolment. METHODS:A pragmatic, real-world, population-based observational study was conducted using an interrupted time series analysis. The study included 4708 adult patients across two periods: pre-amalgamation (November 2014-October 2016), and post-amalgamation (May 2017-October 2018). Data were sourced from the National Centre for Healthy Ageing Data Platform, with statistical analyses conducted using Generalised Least Squares models to account for autocorrelation. RESULTS:The study observed a significant increase in quarterly program enrolments post-amalgamation, from 578 to 1011 per quarter. The 30-day readmission rate decreased from 11.8% to 8.52% post-amalgamation. However, interrupted time series analysis revealed no statistically significant changes in the slopes of readmission and emergency department re-presentation rates after the program's amalgamation. The program did not result in significant changes in 60- or 90-day outcomes. CONCLUSIONS:The amalgamation of post-acute care, Residential In-Reach, and the Hospital Admission Risk Program into the Community Care Program led to increased service utilisation without a significant impact on reducing unplanned hospital readmissions or emergency department re-presentations. Although the program amalgamation demonstrated improved accessibility, its longer-term impact remains inconclusive, highlighting the need for continuous refinement and further evaluation to optimise system efficiency. No patient or public contribution occurred in this study. REPORTING METHOD:This study adhered to the STROBE guidelines for observational research.

PURPOSE:To explore how children and adolescents with chronic pain describe their pain experiences. METHOD:A systematic search of OVID Medline, CINAHL Complete, OVID Embase and APA PsycINFO (database inception to 19th August 2024) was conducted for qualitative or mixed-method studies investigating children's chronic pain experiences. Studies were excluded if focused on post-surgical or acute pain. Two independent reviewers screened studies, and disagreements resolved by a third reviewer. Methodological quality was assessed with the CASP checklist. Data from included studies were extracted and analysed using qualitative analysis. RESULTS:Forty studies were included, and 4 main themes were identified: 1. 'I'm missing out because of my pain'; in which children described frustration and isolation due to missing activities. 2. 'Things that help me to get by with my pain'; described a variety of children's coping mechanisms. 3. 'It hurts and no one else understands my pain'; where children felt frequently disbelieved about their pain severity, and 4. 'I keep trying to make sense of my pain'; in which children identified ways they seek to understand the cause and possible outcomes of their pain, including accessing health care services. CONCLUSIONS:This review highlights how children describe their pain challenges in managing their day to day while emphasising the necessity of understanding and incorporating children's perspectives into research and practice. PRACTICE IMPLICATIONS:This review found that children were primarily concerned by how their pain affects their day-to-day activities and highlights the need to equip children with multiple strategies and promote autonomy in managing their pain. Additionally, further research is warranted into the ways that children understand their pain experience and seek information about their pain.

Flexible flat feet are one of the most common musculoskeletal concerns presenting to paediatric health services, despite this being an expected finding in children under 10 years and only requiring management when symptoms are associated. Understanding which symptoms are associated with symptomatic presentations of flexible flat foot in children will provide clarity in identifying those that require further assessment and/or intervention. A scoping review of the literature was conducted to gather all known symptoms related to symptomatic flexible flat foot in the child. Data was mapped using the 'F-words' framework, a child friendly, six-item tool based on the International Classification of Functioning, Disability and Health Framework 11 (ICF-11). This review identified 42 individual symptoms relative to symptomatic presentations of flexible flat foot, which were allocated into five of the six 'F-words' categories (fitness, functioning, friends, family and future). Of these, pain was the most reported symptom, identified in 124 (of 133) included citations, followed by symptoms associated with reduced lower limb function (altered gait patterns, reduced balance and stability and increased tripping), fatigue and reduced participation. Other less frequently reported symptoms include callus formation, night pain and cramps. When present, these symptoms may occur independently or may co-exist at the same time. No symptoms were allocated to the fun category of the 'F-words'. A multitude of symptoms are reportedly associated with symptomatic flexible flatfoot in the child, with no discernible pattern or coherence noted. Further research should examine development and progression of symptoms and seek to better understand causality of relationship between symptoms and foot posture.

ObjectivesTo explore the correlations/relationships between foot posture, equity and diversity, employment, and time in Barbie Land.DesignA retrospective audit of the Barbie population (or their data from online catalogues) using a customised FEET system. That is Foot posture (flat or equinus); Equity (diversity and inclusion (EDI)); Employment (fashion vs employed); and Time period (decade of manufacture).SettingBarbie Land (Online Barbie catalogues of doll types).Participants2750 Barbies and friends who lived in Barbie Land between 1959 to June 2024.Main outcome measuresOver time there was a decreased prevalence in equinus foot posture from 100% in the first time period to 40% in the last. Barbie's flat foot posture had a very strong positive correlation with employment (r = 0.89, 95% Confidence Interval (95%CI) = 0.50 to 1.29), and time point (r = 0.85, 95%CI = 0.40 to 1.31), while equinus foot posture had a very strong positive correlation with fashion (r = 0.99, 95%CI = 0.87 to 1.11). Similarly, equity (diversity) had a very strong positive correlation with fashion (r = 0.98, 95%CI = 0.82 to 1.15), and strong positive correlation with employment (r = 0.79, 95%CI = 0.26 to 1.33).ConclusionBarbie's equinus foot posture is directly related to her high heel wearing. Barbie models her footwear choice based on task demands, being flat footed and wearing flat shoes when she needs to work on her feet, be physically active or more stable. Given Barbie is known to reflect societal norms, we contend this is most likely true for most high-heel wearers. While Barbie has moved with the times, it appears footwear health messaging about high heel wearing needs to catch up. Health professionals castigating high heels through public messaging, should remember that emphasising health benefits consistently drives positive behaviour change, over highlighting negative consequences. Barbie clearly makes sensible determinations regarding her body autonomy; high heel wearers should have that same ability.

Avascular necrosis is a condition that results from disruption of the blood supply to bone. It can develop idiopathically or secondary to disease or corticosteroid use. To facilitate consistent clinical and research practice, this review aimed to identify methods used to assess, diagnose, and determine outcomes of non-femoral head (non-FH) lower limb avascular necrosis in children and adolescents. We conducted a scoping review up to January 2024, searching Ovid Medline, Embase, CINAHL, and Scopus databases. Studies were included if they had 10 or more individuals aged 0-17 yr with non-FH lower limb avascular necrosis, and included assessment, diagnostic criteria, or outcome measures. Measures identified were grouped according to the International Classification of Functioning, Disability, and Health framework of impairments of body function and structure, activity limitations, and participation restrictions. Following full-text screening, 31 studies met the inclusion criteria: 24 of these studies were retrospective (77%). Twenty-three studies involved secondary avascular necrosis (74%) and 8 studies involved primary avascular necrosis (26%). MRI and radiographs were most frequently used for diagnosis. Impairments were predominantly assessed via patient report, and use of validated measures was limited. There was also limited consideration of activity limitations and participation restrictions in both assessment and outcome measures. Where present, these were patient reported. The findings highlight a strong focus on impairments despite a need to consider the conditions impact on activity limitations and participation restrictions. Obtaining consensus on assessments and outcome measures, with increased use of validated measures to improve rigor, would facilitate collation of results in future research.

OBJECTIVE:To explore the parent experience of finding information on websites to support their child with chronic lower limb pain and explore the quality of information available on those websites. METHODS:Parents of children with chronic lower limb pain conducted real-time searching of websites followed by semi-structured interviews via Zoom. Interviews were recorded, transcribed verbatim, and analysed thematically using an inductive approach. Websites were evaluated by two reviewers across seven domains using the Health Information Website Evaluation Tool. RESULTS:Fourteen parents of children impacted by chronic lower limb pain searched and viewed 34 websites. Four themes were identified: (i) aesthetics matter; (ii) trust builds trust; (iii) something is better than nothing, but it's never enough; (iv) improving accessibility. Nine websites (26 %) were considered 'good' quality and 25 (74 %) were considered 'moderate' quality. The Readability domain achieved maximum scores across 88 % of websites, and the Accuracy domain, reflecting referencing and evidence search processes, scored the most minimum scores on 74 % of websites. CONCLUSION:Parents accessing online resources for their child's chronic lower limb pain seek accessible and in-depth information. While parents find easy to understand quality websites, there is a need for more paediatric-specific resources that reflect current evidence.

BACKGROUND:Chronic lower limb pain is common in children and adolescents and is frequently managed by podiatrists. Due to the complexities of understanding the cause of chronic pain, clinicians may experience uncertainty around the diagnosis, which in turn may impact their communication and management approaches. Limited research explores how podiatrists manage chronic lower limb pain in children, especially in the presence of diagnostic uncertainty. This study aimed to explore the management strategies including language that podiatrists report using to address the pain experience of children with chronic lower limb pain and to investigate if and how the reported management strategies used by podiatrists to address the pain experience of children with chronic lower limb pain vary based upon the level of diagnostic uncertainty. METHODS:Eight focus groups were conducted with a total of 48 podiatrists. Participants were presented with three vignettes, each describing a child with chronic lower limb pain. They were then asked to discuss their certainty in the child's diagnosis presented and their approaches to explain and manage the child's pain. Audio data were recorded, transcribed and analysed using thematic analysis. Three key themes were generated: Language strategies, non-verbal communication strategies and treatment strategies. RESULTS:Podiatrists were overall certain in the diagnosis presented in vignettes 1 (calcaneal apophysitis) and 2 (juvenile idiopathic arthritis); however, they expressed significant uncertainty in vignette 3, which was written to elicit uncertainty presenting a case with generalised lower limb pain. Many groups fixated on the Beighton score of 5/9 and interpreted this to mean hypermobility, which is inconsistent with the current clinical guidance. Podiatrists used similar language strategies across all 3 vignettes and supported their language strategies with non-verbal communication strategies. Podiatrists also discussed activity modification, passive and self-care strategies and building a team as the treatment strategies they would use. CONCLUSIONS:This study highlights the variety of clinical management strategies used by approaches and highlights how their approach may change depending on their certainty in the diagnosis.

Background Miscommunication in health care is a major source of poor health outcomes, complaints about health care professionals, and poor patient satisfaction. Recordings from real-life consultations provide valuable data for communication research and education. Additionally, recordings from simulation-based education of health care students can provide valuable data for health care education research. Objective The Digital Library is a data repository supporting high-quality health care communication research. This is the single-source citation for all projects that use the Digital Library in Australia. Methods This protocol outlines the logistics and consent process for recording and safely storing the recordings of health care consultations and simulation-based education. The processes are outlined for primary health care settings and health care educational settings as well as for health care narratives from consumers. The repository will be used to answer research questions about health care communication and provide a valuable resource for health care education. Results Data collection for the Digital Library commenced in 2023 and is ongoing at the time of submission of this protocol. The Digital Library has been approved by Monash University’s Human Research Ethics Committee. Conclusions The Digital Library will provide a national resource for the study of health care communication in community settings, general practice, and other environments. The health care narratives may be a valuable resource for sharing the patient perspective when living with different conditions. The research that uses this repository will be shared through regular academic channels as well as the community-based dissemination strategies of the National Centre for Healthy Ageing. International Registered Report Identifier (IRRID) DERR1-10.2196/67910

Background Approximately 500 million people worldwide live with type 2 diabetes mellitus. The UK's 'Diabetes Remission Clinical Trial' (DiRECT) is a potential novel method for care. An Australian trial of DiRECT (DiRECT-Aus) showed that 56% of participants achieved diabetes remission at 12months. We explored the experiences of patients, clinicians and trial partners involved in DiRECT-Aus to ascertain the acceptability and feasibility of DiRECT-Aus, as well as factors influencing implementation, to inform recommendations for sustainable scale up into mainstream primary care. Methods This qualitative implementation research conducted within a constructivist paradigm involved semi-structured interviews with key stakeholders. Data analysis followed an inductive thematic approach, informed by the Consolidated Framework for Implementation Research. Results Patients (n =14), general practitioners (n =3), practice nurses (n =6), dietitians (n =7) and DiRECT-Aus trial partners (n =5) were interviewed. We identified four core components of DiRECT-Aus that are essential for implementation and scale up. They were: (1) access to very low-energy diet products; (2) high frequency of contact with the dietitian; (3) dietitian's clinical knowledge and patient-centred practice; and (4) absence of financial costs to patients. Several additional factors that could support implementation and suggested funding models are described. Conclusions This study concludes that DiRECT-Aus was acceptable and feasible to patients and clinicians.

OBJECTIVE:This study aimed to identify the top 10 international research priorities for musculoskeletal health of people with generalized joint hypermobility. METHODS:A three-round Delphi method using an online survey was implemented. Three participant stakeholder groups were eligible for inclusion: (1) people with lived experience of joint hypermobility or their carers, (2) health care professionals, and (3) researchers with experience working with individuals with hypermobility. Participants provided up to three priority research questions in round 1. In round 2, participants prioritized 10 research questions from the unique questions proposed in round 1. In round 3, participants were presented with the top 10 questions from the overall cohort and for their stakeholder group(s) and asked to rank these in order of importance. RESULTS:Round 1 commenced with 396 participants who provided 958 individual questions, which reduced to 210 unique questions following data cleaning. There were 257 participants (65% of 396) in round 2, and 249 participants (63% of 396, lived experience n = 230, health care professionals n = 73, and researchers n = 21) in round 3. The overall top-ranked question was, "How can we prevent disability, pain, and poor quality of life associated with the musculoskeletal comorbidities of symptomatic generalized joint hypermobility?" Specific stakeholder group priority research questions varied. People with lived experience prioritized treatment questions, whereas health care professionals and researchers prioritized service-impact and utilization research questions. CONCLUSION:Priority research questions relating to musculoskeletal health of people with generalized joint hypermobility have been internationally identified. These questions provide a future focus for meaningful and necessary research in this field.

Background: Childhood chronic musculoskeletal pain affects the lower limbs more than any other part of the body[1]. Children with chronic lower limb pain may experience delayed diagnosis, misdiagnosis, or insufficient or inappropriate treatment initiation or type[2]. This pain may be primary or secondary to other health conditions.Our team was funded by the Medical Research Future Fund in Australia to understand how we can better support clinical care through the development of consistent approaches when assessing, diagnosing and treating children who have chronic musculoskeletal lower limb pain. Objectives: To identify the breadth of conditions reported in peer-reviewed literature that may result in chronic musculoskeletal lower limb pain in children and adolescents and prioritise the top 10 of these conditions that would benefit from the development of clinical practice guidelines. Methods: Five electronic databases were searched (Medline, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for articles involving children under 18 years and reporting on chronic musculoskeletal pain of the lower limb. All studies were screened for eligibility by two reviewers. Extracted data items included study characteristics, lower limb location of pain, and specific condition(s) that were reported to be associated with chronic musculoskeletal pain of the lower limb.Secondly, a modified two round Delphi with a final confirmatory round was conducted. Three separate panels (allied health professionals, medical specialists, and general practitioners) initially rated their agreement on the need for clinical practice guidelines for all conditions found in the scoping review, and then ranked the top 10 conditions requiring guideline development. In the final confirmatory round, parents of children with chronic lower limb musculoskeletal pain rated the appropriateness of the development of guidelines for the top 10 conditions. Results: From 10,951 records, 384 papers were included. There were 124 unique conditions associated with chronic lower limb pain, the most common being chronic widespread musculoskeletal pain (21 studies) and juvenile idiopathic arthritis (24 studies). For the prioritisation modified Delphi, 42 health professionals (22 allied health, 7 medical specialists, and 13 general practitioners) across Australia participated in Rounds 1 and 2 with a retention rate of 100%. Sixteen parents participated in a confirmatory Round 3. All 124 conditions were presented to the health professional panel for rating in Round 1, with the top 10 ranked in Round 2. The top 10 conditions prioritised for clinical practice guideline development relating to chronic pain were generalised joint hypermobility, growing pains, musculoskeletal pain, juvenile idiopathic arthritis, joint instability, avascular necrosis, Legg-Calve-Perthes disease, flat foot, slipped capital femoral epiphysis, and patellofemoral pain syndrome. Conclusion: There was a breadth of conditions associated with chronic musculoskeletal lower limb pain in children and adolescents. During this process, the limited guidance for health professionals to consistently provide evidence-based care in the face of chronic pain was clear. While this research was conducted in Australia, expert health professionals and parents prioritised conditions for guideline development which are likely to have international impact. REFERENCES: [1] King S, Chambers CT, Huguet A, et al. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain 2011;152(12):2729-38. doi: 10.1016/j.pain.2011.07.016 [published Online First: 2011/11/15].[2] Shebeshi D, Allingham S, Tardif H, et al. Electronic persistent pain outcomes collaboration annual data report 2021. Australian Health Services Research Institute: University of Wollongong, 2022. Acknowledgements: Kids Leg Pain Steering Group - Dr Emre Ilhan, A/Prof Jane Munro, Prof Craig Munns, A/Prof Elizabeth Sturgiss, A/Prof Nicole Williams, Dr Louise Tofts, Dr Vance Locke, Prof Terry Haines, Dr Sue Brennan, Prof Stephen Maloney, Dr Mitchell Sarkies, Prof Lisa Nissen, Ms Ornella Clavisi and Mr Dan Miles. Disclosure of Interests: None declared.

Background: Paediatric chronic lower limb pain is common, and often distressing and disabling for children and adolescents. Recently, the classification of chronic pain conditions changed within the International Classification of Diseases 11 (ICD-11)[1]. One significant new inclusion is 'chronic primary musculoskeletal pain'. This is the diagnosis given for chronic pain in the muscles, bones, joints, or tendons associated with significant emotional distress and/or functional disability, but which cannot be better accounted for by another condition[2]. There are many conditions and diagnoses known to result in chronic lower limb pain in children, some of which describe similar or overlapping clinical presentations. Some of these existing terminologies may be able to be better described within the new classification system, or be considered under these broad parent terms for the purpose of future research. Objectives: To categorise chronic lower limb pain conditions in children as chronic primary or secondary musculoskeletal pain based on expert consensus. Methods: An international panel of experts in paediatric lower limb pain were invited to participate in a three round online Delphi survey. Participants were presented with a list of 124 conditions known to result in chronic lower limb pain in children and adolescents, sourced from a recent scoping review. Participants were asked to select whether they believed each condition could be categorised as either chronic primary or chronic secondary musculoskeletal pain, or to abstain, based on the International Association for the Study of Pain (IASP) descriptions. Conditions achieving >70% agreement were deemed to have reached consensus for categorisation, while conditions achieving 50-69% agreement were taken to the following round to be re-rated. Conditions achieving <50% agreement were excluded from future rounds. Participants were given the opportunity after Round 1 to suggest additional conditions which were not present in the initial list, of which seven were included in Round 2. Results: There were 21 medical and allied health professionals from eight countries who participated. Four conditions were categorised as chronic primary musculoskeletal pain across three founds. These were 'growing pains', 'musculoskeletal pain' (a banner term including 'regional fibromyalgia', 'chronic musculoskeletal pain', 'idiopathic pain'), 'persistent lower limb pain in the presence of restless leg syndrome', and 'persistent lower limb pain in the presence of functional neurological disorder'. There were 117 conditions categorised as chronic secondary musculoskeletal pain. Nine conditions were uncategorised due to not reaching 50% agreement in Round 1 or 2, while only one condition did not reach consensus or agreement over all three rounds – 'persistent lower limb pain in the presence of generalised joint hypermobility'. Conclusion: Experts categorised four paediatric lower limb pain conditions as chronic primary musculoskeletal pain through this Delphi panel. These share features of resulting in chronic pain without a clear underlying pathophysiological process, or historically being diagnoses of exclusion. By considering these conditions under the umbrella of 'chronic primary musculoskeletal pain', there is opportunity for further development of combined clinical guidance and a reduction in unnecessary variation in care to address chronic pain. REFERENCES: [1] Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Kosek E, Lavand'homme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, Vlaeyen JWS, Wang SJ. A classification of chronic pain for ICD-11. Pain. 2015 Jun;156(6):1003-1007. doi: 10.1097/j.pain.0000000000000160. [2] Nicholas, M., Vlaeyen, J. W. S., Rief, W., Barke, A., Aziz, Q., Benoliel, R., Cohen, M., Evers, S., Giamberardino, M. A., Goebel, A., Korwisi, B., Perrot, S., Svensson, P., Wang, S.-J., Treede, R.-D., & Pain, T. I. T. f. t. C. o. C. (2019). The IASP classification of chronic pain for ICD-11: chronic primary pain. PAIN, 160(1), 28-37. https://doi.org/10.1097/j.pain.0000000000001390. Acknowledgements: NIL. Disclosure of Interests: None declared.

Introduction Lower limb apophyseal injuries commonly occur in children and adolescents with unknown incidence and prevalence. These conditions are considered benign, but impact children and adolescents quality of life and can lead to sport withdrawal at a crucial time. The primary aim of this research was to develop self-administered tools for two of the most common apophyseal injuries. The secondary aim was to test the sensitivity and specificity of the tools. Methods Study 1 used a three round online Delphi panel (n = 8), with expert consensus supported by robust literature. This panel developed a self-administered screening tool for calcaneal (Sever’s disease) and tibial tuberosity (Osgood-Schlatter’s disease) apophysitis. Study 2 tested the sensitivity and specificity of these developed tools with parents and children (n = 63) with concurrent clinical examination by a health professional. An initial sample size for Study 2 was set at 155 children however this was impacted by COVID-19 and recruitment was halted. Results Both tools had excellent diagnostic accuracy with an area under the curve of 83% (95% confidence interval = 0.70 to 0.95) for the posterior heel (calcaneal apophysitis) tool and 93% (95% confidence interval = 0.80 to 1.00) for the anterior of knee (tibial tuberosity apophysitis) tool using the pilot data from the 63 children. Conclusions These tools may also enhance opportunities for clinicians and health service providers with pre-clinical screening to reduce wait list time and encourage low cost, self-administered management where indicated. These findings may enable large epidemiological studies to identify populations and calculate incidence and prevalence of these conditions using self report.

Current international consensus of the appropriate Beighton score cut-off to define if a child has generalised joint hypermobile or not is based upon expert opinion. Our aim was to determine the prevalence of Beighton scores of children worldwide to provide a recommendation for establishing the Beighton score cut-off to identify generalised joint hypermobility in children. We used AMED, OVID Medline, Embase and CINAHL to find published articles from inception to April 2024 describing Beighton scores of children up to and including 18 years from the general population. We extracted study demographics including country of publication, total number of participants, summary data about the age and sex of participant, Beighton scores and any cut-off used where authors deemed children hypermobile and how many children were rated at the corresponding Beighton scores. There were 37 articles reporting on the prevalence or incidence of hypermobility at cut-off scores from 28,868 participants. Using the cut-off of ≥ 6 resulted in a prevalence of 6

OBJECTIVE:To explore consultation patterns, management practices, and costs of foot, ankle, and leg problems in Australian primary care. STUDY DESIGN:We analyzed data from the Bettering the Evaluation and Care of Health program, April 2000 to March 2016. Foot, ankle, and leg problems were identified using the International Classification of Primary Care, Version 2 PLUS terminology. Data were summarized using descriptive statistics examining general practitioner (GP) and patient characteristics associated with a foot, ankle, or leg problem being managed. Cost to government was estimated by extracting fees for GP consultations, diagnostic imaging, and pathology services from the Medicare Benefits Schedule (MBS) database. Costs for prescription-only medicines were extracted from the Pharmaceutical Benefits Schedule and for nonprescribed medications, large banner discount pharmacy prices were used. RESULTS:GPs recorded 1,568,100 patient encounters, at which 50,877 foot, ankle, or leg problems were managed at a rate of 3.24 (95% confidence intervals [CIs] 3.21-3.28) per 100 encounters. The management rate of foot, ankle, or leg problems was higher for certain patient characteristics (older, having a health care card, socioeconomically disadvantaged, non-Indigenous, and being English speaking) and GP characteristics (male sex, older age, and Australian graduate). The most frequently used management practice was the use of medications. The average cost (Australian dollars) per encounter was A$52, with the total annual cost estimated at A$256m. CONCLUSIONS:Foot, ankle, and leg problems are frequently managed by GPs, and the costs associated with their management represent a substantial economic impact in Australian primary care.