PURPOSE:The purpose was to identify how the ICECAP-A and ICECAP-O have been used with adults who have neurological health conditions. METHODS:Following the Joanna Briggs Institute framework, a scoping review was conducted, searching five databases (Scopus, CINAHL, MEDLINE, Embase, and PsycINFO). Studies were included if participants were adults (age 18+ years) with neurological health conditions, and ICECAP-A or ICECAP-O were used in the study. Exclusions included studies about mental health conditions, protocols, and abstracts. Two authors screened abstracts and full texts independently. Conflicts were resolved through consensus. Data were categorized and synthesized. RESULTS:Search results included 1163 articles and 571 studies were screened. The team reviewed 37 full-text articles, with 14 studies included. Eleven studies utilized ICECAP-O; three utilized ICECAP-A. Nine studies were from Europe, three from Canada, and two from Australia. The uses of ICECAP measures included psychometric studies (9), economic evaluation (3), program evaluation (1), and testing associations (1). Nine studies focused on dementia, with 7 of those including proxy evaluations, two studies involved individuals with spinal cord injury, and one study each focused on individuals with Parkinson's disease, epilepsy, and various neurological conditions. Both ICECAP-O and ICECAP-A were referred to in the studies as measures of well-being, capability, quality of life or some combination. CONCLUSIONS:ICECAP-O has not been thoroughly examined in neurological health conditions outside of dementia. There is potential for further psychometric testing of both ICECAP-A and ICECAP-O in neurological conditions and research into the application of capability measures in clinical and research settings.

Objective: To summarize the current literature that describes gendered environments of women's sports, and determine whether the existing literature relates gendered aspects of the sport environment to injury risk, experiences, and outcomes. Design: Scoping review. Data Sources: Electronic search of MEDLINE, EMBASE, CINAHL, SPORTDiscus, SCOPUS, and Women's Studies International databases from inception to March 2024. Eligibility Criteria: Studies were included if at least 50% of the study participants were adult women participating in organized Olympic program sports. Results: Of the initially identified 17,148 studies, 854 underwent full text review, of which 73 were included in this scoping review. We identified three repeating patterns describing the gendered sport environments that women athletes encounter. Fifty-five studies described ingrained stereotypes that devalue women and women's sport. Forty-five studies described ways the sport environment reproduces restrictive gender norms for women. Forty-six studies reported that gendered inequities, including gendered wage inequality and provision of subpar training facilities, were structurally embedded in women's sport environments. In 19 studies, reference to injury was restricted to one or two direct quotes from an athlete and the other 54 studies had no mention of injury. Conclusion: Existing literature describes a range of gendered inequities that exist for women in their sport environments; however, there has been no concerted effort to date to link those gendered environmental factors to sports injury. Such research is needed if we are serious about eliminating sport injury rate disparities between women and men.

Purpose: The objective was to synthesize outdoor winter walking programmes and resources for older adults, identified as a priority by the Winter Walk team comprised of older adults and researchers and trainees from the rehabilitation and geography sciences. Method: A scoping review of web-based grey literature was conducted. Teams of two reviewers independently assessed eligibility and extracted data. Web-based resources were included if their content dealt with adults ≥65 years of age; an outdoor winter walking programme, intervention, or general resource; and was written in English. Results: Twenty-seven website resources were eligible and included in the review. Resources were from Canada or the United States and included information provided by government, non-profit organizations, media, and businesses. All resources focused on some aspect of winter walking safety and only one mentioned a winter walking programme. Conclusions: Web-based resources for outdoor winter walking were synthesized to assist older adults and clinicians with access to safe outdoor winter walking information.

Introduction: Poor outcomes following the transition from hospital back to community living are common, especially for older adults with complex health and social care needs. Some health care systems now have multiple interprofessional teams (in hospital and community) to support care transitions. These teams will need to be well coordinated to improve care transition outcomes. Methods: We conducted a scoping review to identify and map peer-reviewed literature on how interprofessional teams are working together to support older adults transitioning from hospital back to the community. We used the six-stage framework developed by Levac and colleagues (2010). Procedures were guided by the Joanna Briggs Institute scoping review guidelines. Results: Our structured search and screening process resulted in 70 articles, published between 2000 and 2022, from 14 counties. Within these articles, 26 programs were described that used interprofessional teams in both the hospital and community. Discussion: The qualitative articles suggested that effective teamwork is very important for promoting care transition quality, but the quantitative research did not report on team-related outcomes. Quantitative research has described, but not evaluated, strategies for promoting interprofessional collaboration. Conclusion: Future research should focus on evaluating processes used to promote effective interprofessional teamwork in care transition interventions.

Background Telemonitoring and telerehabilitation can support home-based pulmonary rehabilitation (PR) and benefit patients with lung diseases or COVID-19. This study aimed to (1) identify which telemonitoring and telerehabilitation interventions (e.g. videoconferencing) are used to provide telehealth care for people with chronic respiratory conditions or COVID-19, and (2) provide an overview of the effects of telemonitoring and telerehabilitation on exercise capacity, physical activity, health-related QoL (HRQoL), and healthcare use in patients with lung diseases or COVID-19. Methods A search was performed in the electronic databases of Ovid MEDLINE, EMBASE, and Cinahl through 15 June 2021. Subject heading and keywords were used to reflect the concepts of telemonitoring, telerehabilitation, chronic lung diseases, and COVID-19. Studies that explored the effect of a telerehabilitation and/or telemonitoring intervention, in patients with a chronic lung disease such as asthma, chronic obstructive pulmonary diseases (COPD), or COVID-19, and reported the effect of the intervention in one or more of our outcomes of interest were included. Excluding criteria included evaluation of new technological components, teleconsultation or one-time patient assessment. Results This scoping review included 44 publications reporting the effect of telemonitoring (25 studies), telerehabilitation (8 studies) or both (11 studies) on patients with COPD (35 studies), asthma (5 studies), COPD and asthma (1 study), and COVID-19 (2 studies). Patients who received telemonitoring and/or telerehabilitation had improvements in exercise capacity in 9 out of 11 (82%) articles, better HRQoL in 21 out of 25 (84%), and fewer health care use in 3 out of 3 (100%) articles compared to pre-intervention. Compared to controls, no statistically significant differences were found in the intervention groups’ exercise capacity in 5 out 6 (83%) articles, physical activity in 3 out of 3 (100%) articles, HRQoL in 21 out of 25 (84%) articles, and healthcare use in 15 out of 20 (75%) articles. The main limitation of the study was the high variability between the characteristics of the studies, such as the number and age of the patients, the outcome measures, the duration of the intervention, the technological components involved, and the additional elements included in the interventions that may influence the generalization of the results. Conclusion Telemonitoring and telerehabilitation interventions had a positive effect on patient outcomes and appeared to be as effective as standard care. Therefore, they are promising alternatives to support remote home-based rehabilitation in patients with chronic lung diseases or COVID-19.

Objective: To summarize the current literature that describes the gendered environments of women′s sports which are higher risk for ACL injury, and determine whether the existing literature relates gendered aspects of the sport environment to injury. Design: Scoping review. Data sources: Electronic search of Medline, Embase, CINAHL, SPORTDiscus, SCOPUS, and Women′s Studies International databases from inception to March 2024. Eligibility criteria: Studies were included if at least 50% of the study participants were adult women participating in organized sports with higher risk for ACL injury. Results: Of the initially identified 17,148 studies, 854 underwent full text review, and 73 were included in this scoping review. In 19 studies, reference to injury was restricted to one or two direct quotes from an athlete and the other 54 studies had no mention of injury. We identified three repeating patterns describing the gendered sport environments that women athletes encounter. Fifty-five studies described embedded stereotypes that devalue women and women′s sport. Forty-five studies described ways the sport environment reproduces restrictive gender norms for women. Forty-six studies reported that gendered inequities including gendered wage inequality and provision of subpar training facilities were structurally embedded in women′s sport environments. Conclusion: Existing literature describes a range of gendered inequities that exist for women in their sport environments; however, there has been no concerted effort to date to link those gendered environmental factors to ACL injury. Such research is needed if we are serious about eliminating the ACL injury rate disparity between women and men. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This work was supported by the Social Sciences and Humanities Research Council through the UM/SSHRC Explore Grants Program ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript

Background:Chronic cough is a frequent reason for seeking consultation with primary care providers. The recent widespread adoption of virtual care offers a promising alternative that can be used to optimize the assessment and management of this condition. The objective of this review was to map and identify the strategies used to assess and/or manage chronic cough virtually, and to explore their impact on cough severity and patient satisfaction with virtual care.Methods:A scoping review was conducted in MEDLINE, EMBASE, and CINAHL in May 2023. Research questions were defined based on the Population, Concept, Context mnemonic, and literature search was conducted using a three-step approach. Study selection involved the steps of identification, screening, eligibility, and inclusion. A descriptive synthesis was performed, and quantitative variables were presented as absolute and relative frequencies.Results:A total of 4953 studies were identified and seven met the inclusion criteria. The following mHealth and telehealth strategies were identified: diagnostic website, specialized online clinic, online speech language therapy, and remote follow-up to assess the effectiveness of in-person interventions. Results indicated that these virtual strategies can be useful to assess chronic cough, treat, and track chronic cough symptoms. Overall, patients were satisfied with the approaches.Conclusion:Although literature is scarce, evidence suggests that virtual strategies for the assessment and management of chronic cough may be effective and are well-received by patients. However, further research is needed to identify the type and characteristics of virtual approaches leading to optimize and facilitate the care of patients with this condition. This will also help develop a strong body of evidence to support their incorporation into guidelines and clinical practice.

The purpose of this study was to identify internal and external factors associated with outdoor winter walking in older adults. In this scoping review, 12 databases were searched. Inclusion criteria included English language, focus on adults 65 years of age or older, and evaluation of factors associated with outdoor winter walking. Two authors screened titles/abstracts and full text. Conflicts were resolved by consensus. Data were extracted, organized into tables, and summarized as pertaining to barriers/facilitators and internal/external factors associated with outdoor winter walking. A total of 6,843 articles were identified, 1,898 duplicates were removed, 4,789 were excluded during title/abstract screening, and 148 were excluded during full-text review. Eight studies were included. Four categories of factors affecting outdoor winter walking in older adults were identified: adverse weather conditions, physical environment, physical function, and perceptions relating to winter walking conditions. Rehabilitation and exercise professionals can use the results to educate their clients and implement the facilitators of and alternatives and solutions to barriers to outdoor winter walking.

Limited community ambulation, defined as independent mobility outside the home, predicts adverse outcomes in older adults. We performed a systematic review and meta-analysis to examine outdoor community ambulation intervention effectiveness in older adults. We searched six databases until October 2021. Studies with an evaluative research objective, older adult population, and outdoor community ambulation interventions were eligible. After reviewing 23,172 records, five studies were included. The meta-analysis found no significant difference in walking endurance and depression outcomes between outdoor community ambulation and comparison interventions. For outcomes not suitable for meta-analysis, studies showed no significant difference in walking activity, anxiety, and general and health-related quality of life, and possible improvements in gait speed and lower extremity function and strength. Most evidence was of low to very low certainty. Considering the limited evidence base, the design, implementation, and evaluation of outdoor community ambulation interventions in older adults should be prioritized in primary research.

Background: The long-term sequela of COVID-19 on young people is still unknown. This systematic review explored the effect of COVID-19 on lung imaging and function, cardiorespiratory symptoms, fatigue, exercise capacity and functional capacity in children and adolescents ≥ 3 months after infection. Methods: A systemic search was completed in the electronic databases of PubMed, Web of Science and Ovid MEDLINE on 27 May 2022. Data on the proportion of participants who had long-term effects were collected, and one-group meta-analysis were used to estimate the pooled prevalence of the outcomes studied. Results: 17 articles met the inclusion criteria, presented data on 124,568 children and adolescents. The pooled prevalence of abnormalities in lung imaging was 10% (95% CI 1–19, I2 = 73%), abnormal pulmonary function was 24% (95% CI 4–43, I2 = 90%), chest pain/tightness was 6% (95% CI 3–8, I2 = 100%), heart rhythm disturbances/palpitations was 6% (95% CI 4–7, I2 = 98%), dyspnea/breathing problems was 16% (95% CI 14–19, I2 = 99%), and fatigue was 24% (95% CI 20–27, I2 = 100%). Decreased exercise capacity and functional limitations were found in 20% (95% CI 4–37, I2 = 88%) and 48% (95% CI 25–70, I2 = 91%) of the participants studied, respectively. Conclusion: Children and adolescents may have persistent abnormalities in lung imaging and function, cardiorespiratory symptoms, fatigue, and decreased functional capacity between 3 to 12 months after infection. More research is needed to understand the long-term effect of COVID-19 on young people, and to clarify its causes and effective management.

Objective. Many survivors of COVID-19 experience ongoing signs and symptoms affectingmultiple body systems that impair function and negatively affect participation and quality of life. The purpose of this review was to identify and synthesize outpatient rehabilitation assessment and treatment recommendations for adults in postacute COVID-19 stages. Methods. MEDLINE (Ovid), EMBASE (Ovid), Central, CINAHL, and Scopus were searched from January 1, 2020, to December 7, 2020. Teams of 2 reviewers independently assessed study eligibility and extracted data. All study designs that included rehabilitation recommendations were included. Study design, country, study population, purpose, and rehabilitation recommendations were recorded. Select questions from the Appraisal of Guidelines for Research and Evaluation instrument were used to evaluate the quality of consensus guidelines. Results. Forty-eight articles fit the inclusion and exclusion criteria (11 systematic reviews, 1 scoping review, 6 original research studies, 4 consensus guidelines, 26 narrative reviews, and editorials/commentaries). Recommended outcomes included exercise tolerance, respiratory function, muscle strength, and activities of daily living or functional independence. Recommended treatments included respiratory rehabilitation, exercise therapy, education, psychological support, activities of daily living and gait training, traditional Chinese medicine, and cognitive and vocational rehabilitation. Conclusion. There were incongruities between what is known about postacute COVID-19 and what was recommended in the literature. Given the relatively large proportion of survivors who experience ongoing symptomatic COVID-19 or post-COVID-19 syndrome, it is important to quickly develop tools for self-management and access to rehabilitation specialists in multidisciplinary teams. Impact. Physical therapists, occupational therapists, and respiratory therapists have an important role to play. Clinicians should focus on epidemiological evidence and emerging information on late sequelae of COVID-19 to inform rehabilitation programming and future research.

Background: Increased awareness of the efficacy of MTX in rheumatic disease is leading to more MTX use in patients from HIV endemic areas. While HIV related immunosuppression may contribute to improvement of some rheumatic diseases, immune reconstitution from highly active antiretroviral therapy (HAART) may lead to exacerbation or presentation of autoimmune disorders for which MTX therapy may be warranted. Most management guidelines for rheumatic disease do not address MTX use in the context of HIV. Objectives: To systematically review the published literature on the safety of using MTX ≤30 mg per week in HIV. Methods: We searched CINAHL, Embase, Global, MEDLINE and World of Science databases (Jan 1990 to May 2018) for terms including ‘methotrexate’ and ‘human immunodeficiency virus’. We also searched citations from review articles. Titles, abstracts or full manuscripts were screened independently by 2 reviewers to identify studies reporting HIV in patients taking MTX. Study quality was assessed using the McGill Mixed Methods Appraisal Tool (MMAT). Data was extracted on MTX and HIV adverse events (MTX toxicity, HIV viral load, CD4 count). Descriptive summaries are presented for studies providing outcomes in patients taking MTX ≤30 mg per week. Results: After removing duplicates and studies not meeting criteria or not providing sufficient information, 42 of the 2714 identified reports were included (1 clinical trial, 2 cohort, 1 cross-sectional study, 38 case reports/case series). Most reports (81%) originated from USA or Europe. Study quality was generally good with most studies fulfilling 50-100% of MMAT criteria. The randomized controlled trial (USA) assessing MTX on atherosclerotic disease in HIV showed that adverse events were more common in MTX versus placebo (12.8% vs 5.6%, p non-inferiority <0.05) and included infection, transient CD4 and CD8 drop, pulmonary toxicity, and death (1 attributed to MTX/HIV, 1 unrelated). One cohort study (South Africa) reported 43 RA patients on MTX who acquired HIV. In this cohort, RA generally improved despite only 5 individuals continuing MTX. No data on MTX adverse event rates was reported. One cohort study (USA) reported 13 HIV patients with myositis. One received MTX (with other immunosuppression) without MTX adverse effects but died due to AIDS. A cross-sectional study (France) of 43 HIV pts with autoimmune disease reported one patient on MTX (and other immunosuppression) developed an adverse event (cytopenia) compared to 5/33 patients not on MTX (cytopenia). The 38 case reports/series described 54 individuals with HIV receiving MTX. Of these studies, 27 (describing 42 subjects) reported on MTX adverse events and 35 (describing 46 subjects) reported on HIV adverse events. MTX adverse events developed in 29 subjects (hematologic 13, renal/hepatic 1, opportunistic infections 10, other events 2). HIV adverse events were noted in 23 subjects (Kaposi’s sarcoma 4, CD4 decrease 16, HIV viral titer increase 4). Five deaths were reported (2 infection, 1 infection and wasting, 2 HIV related deaths). Most subjects also received corticosteroids or other immunosuppressants including biologics. Conclusion: There remains limited data on the safety of low dose MTX in HIV. Surveillance for HIV is warranted for individuals on MTX who are at risk for acquiring HIV. Caution and careful monitoring for MTX toxicity, opportunistic infections and HIV state is suggested if MTX is used in the setting of HIV particularly if combined with other immunosuppression. References: [1] Clin Infectious Disease 2019:68 [2] J Rheumatology 2014:41 [3] Arthritis and Rheumatism 2003:49 [4] Medicine 2017:96 Acknowledgments : Funding from International League Against Rheumatism McGill University Global Health Scholar Awards Disclosure of Interests: Alize Gunay: None declared, Anna Davidson: None declared, Ines Colmegna: None declared, Diane Lacaille: None declared, Hal Loewen: None declared, Michele Meltzer: None declared, Yewondwossen Mengistu: None declared, Rosie Scuccimarri: None declared, Zenebe Yirsaw: None declared, Sasha Bernatsky: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada

Background: Dialectical Behavior Therapy (DBT) Skills Training (DBT-ST) is one of the four core elements of standard DBT. Studies show that standalone DBT-ST appears to be a promising treatment in patients with emotion dysregulation by teaching them skills needed to change patterns associated with problems in living. It is not clear who benefits from this treatment and which components are most beneficial. Relevant studies will be easily navigated once mapped and summarized in this proposed scoping review. Methods: The proposed scoping review will be conducted following Joanna Briggs Institute (JBI) methodology for scoping reviews. Medical literature databases including MEDLINE, PsycINFO, EMBASE, CINAHL, SCOPUS, Web of Science, and Cochrane will be searched. Papers retrieved will be screened for inclusion by two independent reviewers and data will be extracted and reported in a summary table with supporting narrative. We aim to include all English academic papers addressing standalone DBT-ST including studies utilizing quantitative, qualitative, and mixed methods approaches. Discussion: The objective of this scoping review is to explore the literature, map, and summarize evidence pertaining to DBT-ST to help guide future research and treatment.

Background: Increased awareness of the importance of MTX in rheumatic disease is leading to more MTX use in patients from TB-endemic areas. Current management guidelines for rheumatic disease address TB in the context of biologics but not MTX use. Objectives: To systematically review the published literature on TB rates with MTX ≤30 mg per week. Methods: We searched CINAHL, Embase, Global, MEDLINE and World of Science databases (Jan 1990 to May 2018) for terms including ‘methotrexate’ and ‘tuberculosis’. We also searched citations from review articles. Titles, abstracts or full manuscripts of the 4707 reports identified were screened independently by 2 reviewers to identify studies reporting TB in patients taking MTX. Study quality was assessed using the McGill Mixed Methods Appraisal Tool (MMAT). Data was extracted on TB incidence (new TB diagnosis vs reactivation of latent TB), and outcomes (pulmonary, dissemination, death) and safety of isoniazid, INH. Descriptive summaries are presented on studies providing outcomes in patients taking MTX ≤30 mg per week. Results: After removing duplicates and studies not meeting criteria or providing sufficient information, 31 studies were included (8 cohort, 7 case-control, 1 clinical trial, 15 case reports/case series). Only 27% of articles reported data from low to moderate human development index countries. Studies were of moderate quality. Seven case control studies were heterogeneous but most demonstrated a modest increased risk of TB with MTX (Table). Five cohort studies reported TB incidence rates in rheumatic disease (treated with MTX +/- biologics) ranging from 102-367.9/100,000 patient-years. These rates were generally higher than comparator general population rates. Two cohort studies of MTX in RA (without biologic) reported cumulative TB incidence in Maldova (12 TB cases in 44 RA patients, 27%) and in China (9/114, 7.9%). Other cohort studies generated rates of overt infection (143/100,000 patient years in Spain, higher if co-prescribed with corticosteroids and other immunosuppressants in South Africa), and latent TB rates detection (16/922 RA screened, 1.7%, in Canada). When reported, rates of extra-pulmonary TB were higher than comparator general population rates. One clinical trial (China), 2 cohorts (Japan, USA) and 2 case-series (Belgium, USA) evaluated safety of INH and MTX. Isoniazid-related hepatotoxicity and neutropenia were generally more common when taken with MTX, but were usually reversible. Conclusion: Despite a paucity of high-quality data, this review confirms that TB screening and clinical surveillance are needed in patients from TB-endemic areas who are prescribed MTX, particularly with co-administration of corticosteroids or other immunosuppressants. Isoniazid, if monitored, appears safe and prevents TB reactivation. References: Table . Case control studies Region (Year) Diagnosis TB with MTX TB without MTX Odds Ratio Mexico (1999) Mixed (4 RA) 1/6 5/75 2.76 Japan (2004) RA 3/47 17/154 0.56 Canada (2009) RA 29/483 21/1046 3.12 Brazil (2010) Lupus 2/3 1/57 112 Taiwan (2012) Psoriasis 33/144 464/2341 1.2 Taiwan (2015) JIA 4/357 4/1026 2.90 South Africa (2017) RA 0/134 0/18 NA JIA=juvenile idiopathic arthritis Acknowledgments: Funded by the International League Against Rheumatism and McGill University Global Health Scholar Awards Disclosure of Interests: Anna Davidson: None declared, Alize Gunay: None declared, Ines Colmegna: None declared, Diane Lacaille: None declared, Hal Loewen: None declared, Michele Meltzer: None declared, Rosie Scuccimarri: None declared, Yewondwossen Mengistu: None declared, Sasha Bernatsky: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada

BACKGROUND:During the COVID-19 pandemic, the use of telemedicine by oncology physicians in Manitoba, Canada, has increased to limit the risk of exposure to the virus for both patients and health care providers. It is not clear how telemedicine impacts the information needs of patients or the experience of receiving cancer care.OBJECTIVE:The objective of this study is to describe how the use of telemedicine impacts the information needs and experience of patients with cancer and their informal caregivers (ie, family and friends) and identify directions for future research.METHODS:This review will include all studies addressing telemedicine in the cancer context including those using quantitative, qualitative, and mixed methods approaches. This scoping review will be conducted using the methodology described by the Joanna Briggs Institute. In collaboration with a librarian scientist specializing in health sciences, a comprehensive search will be undertaken to identify and retrieve relevant reports published in English from 1990 to the present. Databases searched will include MEDLINE, CINAHL, EMBASE, Scopus, Cochrane Library, and PsycINFO. Data will be extracted by two independent reviewers, synthesized, and reported in a summary table and in a narrative format describing what has been reported regarding the impact of telemedicine by physicians in oncology on the experience of patients and their informal caregivers and their receipt of information.RESULTS:The results from this scoping review are expected to be available by late spring 2021.CONCLUSIONS:The results from this scoping review will be useful for informing practice as well as directing future research, both in the context of COVID-19 and beyond.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):PRR1-10.2196/25501.

Objective Most recommendations for the use of methotrexate (MTX) in rheumatoid arthritis (RA) are issued by developed countries. It is unknown whether they are relevant globally. We reviewed existing recommendations on the use of MTX for the treatment of RA and summarized areas of agreement that could be relevant for least developed countries (LDCs). Methods Electronic databases and registries were searched for recommendations on MTX use in RA, duplicates were eliminated, and the most updated version adopted when there were several versions on the same recommendation. Reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument for study quality assessment. Similarities and discrepancies of recommendations are reported. Results After deduplication, 1693 unique citations were found; 25 full texts were screened and 12 included in the narrative synthesis. Average scores for the AGREE II domains ranged from 33.3 to 83.3%. Recommendations targeted rheumatologists and health care providers involved in RA care. Most covered some but not all of the following areas: baseline “pre-MTX” assessment (7/12;58%), prescription of MTX (10/12;83.3%), management of MTX side effects (6/12;50%), and special considerations (e.g., peri-operative management) (8/12; 66.7%). Recommendations agreed on baseline tests prior to starting MTX, monitoring, and need for folic acid supplementation. These aspects can serve as the foundation for the development of MTX recommendations relevant to LDCs. Recommendations disagreed on the MTX starting dose, optimal route, titration, and intervals to monitor toxicity. Conclusion Existing recommendations do not uniformly address all aspects related to the use of MTX and disagree in relevant aspects of MTX use. Adaptations to these recommendations are needed to facilitate their implementation in LDCs. Key Points • This paper summarizes current recommendations on the use of methotrexate for the treatment of rheumatoid arthritis. • Areas of agreement between recommendations include the following: pre-methotrexate patient assessment, need for folic acid supplementation, and toxicity monitoring. • Areas of disagreement relate to methotrexate starting and maximal dose, titration, and frequency of assessments.

INTRODUCTION: Results of several recent studies suggest that tendon/muscle vibration treatment may improve motor performance and reduce spasticity in individuals with stroke. We performed a systematic review and meta-analysis to assess the efficacy of tendon/muscle vibration treatment for upper limb functional movements in persons with subacute and chronic stroke. EVIDENCE ACQUISITION: We searched MEDLINE (Ovid), EMBASE (Ovid). and the Cochrane Central Register of Controlled Trials (Wiley) from inception to September 2017. We included randomized controlled trials comparing upper limb tendon/muscle vibration to sham treatment/ rest or conventional interventions in persons with subacute and chronic stroke. Our primary outcome was upper limb functional movement at the end of the treatment period. EVIDENCE SYNTHESIS: We included eight trials, enrolling a total of 211 participants. We found insufficient evidence to support a benefit for upper limb functional movement (standard mean difference -0.32, 95% confidence interval (CI) -0.74 to 0.10, I-2 25 %. 6 trials, 135 participants). Movement time for reaching tasks significantly decreased after using tendon/muscle vibration (standard mean difference -1.20. 95% CI -2.05 to -0.35, I-2 65%, 2 trials, 74 participants). We also found that tendon/muscle vibration was not associated with a significant reduction in spasticity (4 trials). CONCLUSIONS: Besides shorter movement time for reaching tasks, we did not identify evidence to support clinical improvement in upper limb functional movements after tendon/muscle vibration treatment in persons with subacute and chronic stroke. A small number of trials were identified; therefore, there is a need for larger, higher quality studies and to consider the clinical relevance of performance-based outcome measures that focus on time to complete a functional movement such as a reach.

Background: Most guidelines on the use of methotrexate (MTX) in rheumatoid arthritis (RA) are issued by developed countries. MTX use in African 'least developed countries' (LDCs) requires considering costs of medical care, limited manpower and patients' beliefs. It is unknown whether current available MTX guidelines are relevant to LDCs. Objectives: To review existing guidelines/recommendations on the use of MTX for the treatment of RA prior to developing recommendations for LDCs. Methods: Electronic databases and guideline registries were searched for guidelines on MTX use in RA. Reviewers eliminated duplicates and selected the most updated guidelines. Similarities and discrepancies among recommendations are reported. Results: From 2111 citations, 23 full texts were screened and 13 included in the qualitative synthesis. Guidelines targeted rheumatologists (3/13) and other physicians involved in RA care (7/13). Half (6/13) of the guidelines comment on patient education. MTX is suggested as the first DMARD choice by 5/13 guidelines. Screening for risk factors associated with a higher risk of MTX toxicity (e.g. alcohol) is suggested in 4/13 guidelines. Eight guidelines discuss pre-MTX tests: all recommend baseline CBC, liver (mainly albumin and liver function tests), renal function tests (mainly serum creatinine) and HBV/HCV serologies. Seven recommend a baseline chest X-ray. Only 4/8 and 2/8 guidelines recommend HIV and TB screening respectively. Pneumococcus and influenza immunization are suggested by 3/13 guidelines that comment on vaccines, whereas HBV and HZV vaccines by 2/13. Pregnancy and lactation are stated as MTX contraindications by 5/13 guidelines; four recommend MTX discontinuation 3 months prior to conception in females. Only 2/13 guidelines comment on the need of contraception in patients of reproductive age on MTX. MTX starting dose is discussed by 7/13 guidelines: ≥10mg/wk (5/7); 12.5 -15 mg/week (1/7); and 6-8mg/week (1/7, guideline from Japan). The maximal dose of MTX recommended by 8/9 guidelines is 20-30mg/week. Dose escalation (2-5 mg) every 2-6 weeks is discussed by 4/9 guidelines. There is no uniformity on the initial administration route of MTX (3/6 oral, 3/6 either oral or parenteral). The use of higher MTX doses, increasing adherence, and inadequate clinical responses or intolerance are suggested indications for switching from oral to parenteral route (8/13). Folic acid supplementation is recommended by 8/13 guidelines; however specific dose and time intervals are not defined. CBC, liver and kidney monitoring are recommended for MTX treated patients by 8/13 guidelines. Specific laboratory investigations and monitoring intervals vary between guidelines. Eight guidelines agree that MTX could be continued throughout the perioperative period of elective orthopedic surgery. Three guidelines recommend MTX discontinuation in case of severe infection. MTX dose reduction is discussed by 3/13 guidelines, which recommend considering reduction with sustained remission (≥ 6 months). Conclusion: Existing guidelines do not uniformly address all aspects related to the MTX use in RA, and do not include a cost-effectiveness analysis. Adaptation of these guidelines for their implementation in LDCs is needed. Disclosure of Interests: Valeria Valerio Guillen: None declared, CArol Hitchon Grant/research support from: Pfizer, UCB (unrelated studies), Hal Loewen: None declared, Girish Mody: None declared, Ines Colmegna: None declared

OBJECTIVE:Rheumatologic disease patients receiving immunomodulating drugs such as methotrexate (MTX) have increased infection rates. Strongyloides, a global endemic intestinal parasite, can cause significant or fatal disease in immunocompromised patients. The risk of serious Strongyloides infection with MTX dosed for rheumatologic disease is unknown.METHODS:We performed a systematic literature review searching EMBASE, Medline and Web of Science databases. All studies reporting humans exposed to MTX and tested for Strongyloides were reviewed. Exclusion criteria were bone marrow transplantation, intrathecal route and MTX exposure completed >1 year prior to clinically apparent Strongyloides disease.RESULTS:After excluding duplicates, 294 articles were reviewed. Of these, 29 cases were described in 27 papers. Twenty cases (69%) had an underlying rheumatologic or dermatologic disease, the rest had a haematologic disease. Hyperinfection or dissemination was found in 59% of cases (52% low-dose MTX; 75% high-dose MTX). Death occurred in 34% of cases (19% low-dose MTX; 75% high-dose MTX, P < 0.01). All eight patients on high-dose MTX received other immunosuppressants. Corticosteroids were taken in 18/21 patients on low-dose MTX. One of the three patients on MTX monotherapy had hyperinfection syndrome. None had disseminated Strongyloides.CONCLUSIONS:Serious Strongyloides infection can occur with low-dose MTX particularly when given with other immunosuppression. Global travel and greater awareness of rheumatologic conditions in low- to middle-income countries will increase the exposure of individuals prescribed MTX (with or without corticosteroids) to Strongyloides. Strongyloides screening and treatment should be considered for individuals receiving low-dose MTX therapy, particularly if combined with additional immunosuppression.