Objective This systematic review aimed to describe the prevalence, incidence, and associated factors of unmet health care needs among adults with osteoarthritis. Methods We searched Medline (Ovid), Embase (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid) from inception through May 15, 2024. Eligible studies were cross‐sectional, cohort, and case‐control studies investigating the prevalence, incidence, associated factors, or risk factors of unmet health care needs in adults with osteoarthritis. We restricted to articles published in English, French, Italian, and Chinese for feasibility. Reviewers independently screened articles, assessed risk of bias using the Joanna Briggs Institute Checklists, and extracted data. We descriptively synthesized results from low/moderate risk‐of‐bias studies, stratifying results by age (<60 vs ≥60 years). Results Of 3,589 citations screened, 7 cross‐sectional studies with low/moderate risk‐of‐bias were included in the synthesis (3 from South Korea, 4 from the United States). In South Korea, the 12‐month prevalence of unmet health care needs was 31.6% (95% confidence interval [CI] 29.9%–33.3%) among adults aged ≥50 years with osteoarthritis and 31% (95% CI 30.9%–31.1%) among those aged ≥65 years with arthritis. In the United States, the 12‐month prevalence of unmet needs in the general population due to unaffordability ranged from 15% to 30% in adults with osteoarthritis or arthritis. Prevalence was higher among those who exclusively used complementary and alternative medicine and varied during the COVID‐19 pandemic, peaking in the summer of 2020. Evidence suggests that unmet needs are associated with lower income, no insurance, and activity limitations. Conclusion Unmet health care needs are common in adults with osteoarthritis, particularly those facing socioeconomic disadvantages or functional limitations. Given the paucity of high‐quality studies, additional research is needed.

INTRODUCTION:This study aims to explore use trajectories of rehabilitation services among ageing Canadians (45-85 years) with osteoarthritis. METHODS AND ANALYSIS:We will conduct a population-based cohort study using data from the Canadian Longitudinal Study on Aging (CLSA). We will describe rehabilitation use among respondents with osteoarthritis of the knee, hip or hand at baseline, 3-year and 6-year follow-up. Rehabilitation service use is measured via a single self-reported item capturing contact with a physiotherapist, occupational therapist or chiropractor in the past 12 months. We will use latent class growth analysis to identify 6-year trajectories of rehabilitation use, assigning participants to a single trajectory based on their highest probability of trajectory membership. All analyses will be stratified by income and within each income bracket by sex, gender and age. CLSA sampling weights will be applied to produce population estimates. ETHICS AND DISSEMINATION:Ethics approval for this study was obtained from the Research Ethics Board of Western University (REB #128991), Ontario Tech University (REB #17980) and the Canadian Memorial Chiropractic College (REB# 242014). Informed consent was obtained from all CLSA participants at the time of recruitment. Findings will be disseminated through peer-reviewed publications and presentations at national and international conferences, with relevance for researchers, clinicians and policymakers working to improve equitable access to rehabilitation for ageing Canadians.

OBJECTIVES:To determine the prevalence and factors associated with pain-related disabilities among First Nations people living off-reserve in Canada in 2017. DESIGN AND SETTING:Secondary analysis of the 2017 Aboriginal Peoples Survey, a cross-sectional survey of individuals living in private dwellings throughout Canada. PARTICIPANTS:First Nations people living off-reserve aged 15 years and older (n=9115; weighted n=482 066). OUTCOME MEASURE:Pain-related disabilities, defined as pain-related activity limitations lasting ≥6 months. RESULTS:Overall, 22.1% (95% CI 20.9% to 23.4%) of First Nations people living off-reserve reported pain-related disabilities. Prevalence was higher among females (26.1%; 95% CI (24.3% to 28.0%)), increased with age (34.3%; 95% CI (30.3% to 38.5%) among those 45 to 54 years) and was similar across geographic areas (ranging from 21.0%; 95% CI (18.3% to 23.9%) to 22.5%; 95% CI (20.8% to 24.2%)). Pain-related disabilities increased with the number of coexisting disabilities (96.2%; 95% CI (94.3% to 97.5%) among those with >3 disabilities) and was highest among those reporting physical disabilities (ranging from 88.2%; 95% CI (85.6% to 90.4%) for those with mobility disabilities to 91.0%; 95% CI (88.6% to 92.9%) for those with disability related to flexibility). Regression models suggested that individuals with unmet basic needs, housing dissatisfaction, unmet healthcare needs, a history of mental health consultations, part-time or no employment, chronic conditions, residential school attendance or a low sense of belonging were more likely to report pain-related disabilities. CONCLUSIONS:Pain-related disabilities are common among First Nations people living off-reserve, and their aetiology may be multifactorial. Continued collaboration with Indigenous partners is required to contextualise findings and to inform culturally responsive clinical and rehabilitation strategies.

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.

BACKGROUND:Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews that synthesize current available evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four pillars of HPSR as identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. This overview examined implementation strategies, defined by EPOC as interventions designed to bring about changes in healthcare organizations, the behavior of healthcare professionals, or the use of health services by healthcare recipients. OBJECTIVES:This overview aimed to synthesize current evidence on implementation strategies in rehabilitation from a health policy and systems research (HPSR) perspective. Our series of four overviews have the following overarching objectives. • To offer a broad synthesis of the existing evidence on health policy and systems interventions' effects. • To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint the needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist. METHODS:We searched the Epistemonikos database, the Health Systems Evidence database, and EPOC Group systematic reviews to identify reviews published between 1 January 2015 and 17 November 2024. We applied no language limitations. We included Cochrane and non-Cochrane systematic reviews of randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) that evaluated the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to implementation strategies as defined in the EPOC taxonomy. All four overview teams collaborated to screen reviews and extract data. We used AMSTAR 2 to critically appraise the quality of the reviews. Results were analyzed descriptively and are based on reviews with ratings of high-to-moderate confidence, with low-confidence reviews reported separately. MAIN RESULTS:We identified 7882 systematic reviews, of which 15 met our inclusion criteria. Three reviews overlapped substantially with other reviews, and eight received low- or critically low-confidence ratings. Ultimately, four moderate- to high-confidence reviews contributed to the synthesis; two were Cochrane systematic reviews. Most primary studies were from high-income countries; none were from low-income countries. Most strategies targeting healthcare professionals (e.g. guideline dissemination, interactive workshops, opinion leaders, audit and feedback) or healthcare recipients (e.g. structured monitoring, telehealth support, counseling, motivational interviewing) included more than one component. Strategies targeting healthcare recipients' use of health services in cardiac rehabilitation may show small benefits in terms of participation (enrollment, adherence, completion), but effects on other outcomes are uncertain. The effects of strategies targeting older healthcare recipients via telehealth are uncertain. Strategies targeting healthcare professionals may have little to no effect on professional or patient and carer outcomes in stroke rehabilitation. For musculoskeletal conditions, there were no evidence-certainty ratings, so intervention effects are unclear. We found no reviews of strategies targeting health service organizations or specific types of rehabilitation practice. The evidence certainty was generally low; evidence of adverse events was missing or uncertain; and reporting on organizational, implementation, economic, and equity outcomes was scarce. AUTHORS' CONCLUSIONS:Current evidence on implementation strategies in rehabilitation is limited, mostly of low certainty, and derived from high-income countries. Multicomponent, patient-targeted strategies may modestly improve cardiac rehabilitation participation, but effects in other areas remain uncertain. Further high-quality research using well-defined frameworks is needed, especially in low- and middle-income countries, to identify effective strategies and evaluate organizational, implementation, and equity outcomes. Future Cochrane overviews of reviews in HPSR should consider including a broader range of study designs, such as observational, qualitative, and mixed-methods evidence, to better capture evidence on implementation strategies in rehabilitation. FUNDING:This Cochrane review was funded by the Italian Ministry of Health (Ricerca Corrente). The funder played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. REGISTRATION:The protocol was first published in the European Journal of Physical and Rehabilitation Medicine online on 27 January 2025. The manuscript was received on 11 November 2024 and was accepted on 26 November 2024. PROTOCOL:DOI 10.23736/S1973-9087.24.08833-6.

Introduction:Musculoskeletal and mental health conditions are common, often coexist and may lead to disability among young adults. We aimed to: (1) estimate the 3-month incidence of coexisting function-limiting musculoskeletal problems and psychological distress among university students in Sweden, (2) estimate recovery from coexisting conditions (resolution of one or both conditions) and (3) determine whether incidence and recovery vary by sociodemographic factors. Methods:We followed 4262 university students in Sweden (17-65 years; 62% women) over 3 months, assessing function-limiting musculoskeletal problems and psychological distress (moderate or worse depression and/or anxiety) using the Nordic Musculoskeletal Questionnaire and the Depression Anxiety Stress Scales-21. The 3-month incidence of coexisting conditions was estimated among 3642 students without coexisting conditions at baseline. We used risk ratios (RRs) to describe the variation of coexisting conditions across sociodemographic strata, comparing categories within each variable. Recovery at 3 months was estimated among 620 students with both conditions at baseline. Results:The 3-month incidence of coexisting function-limiting musculoskeletal problems and psychological distress was 8% (n=302, 95% CI 7% to 9%), higher among women (RR: 1.51, 95% CI 1.19 to 1.92), non-Europeans (RR: 1.55, 95% CI 1.17 to 2.06) and students whose parents lacked a university degree (RR: 1.31, 95% CI 1.04 to 1.64). Among students with coexisting conditions at baseline, 42% (n=258, 95% CI 38% to 46%) recovered from at least one condition at 3 months. Recovery did not clearly vary by age group, civil or socioeconomic status, country of origin or parental education. Conclusion:The 3-month incidence of coexisting function-limiting musculoskeletal problems and psychological distress was 8%, higher in women, non-Europeans and those whose parents had no university degree. Just under half of those with coexisting conditions recovered from at least one condition within 3 months, with no meaningful variation across sociodemographic groups. These findings underscore the need for targeted prevention, integrated student health support and further research.

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.

Abstract Poor sleep quality is a health concern in older adults, with low back pain (LBP) as a hypothesized risk factor. We aimed to synthesize evidence on the association between LBP and sleep quality among adults ≥ 60 years. We conducted a systematic review, registered protocol (Open Science framework #u7bc4) and reported it according to PRISMA. We searched MEDLINE, Embase, CINAHL, and PsycINFO (inception to December 2025). We included cross-sectional, cohort, and case–control studies on LBP and sleep quality among adults ≥ 60 years. We utilized a combination of OpenAI’s ChatGPT and fluent members in our team to translate non-English studies after which we screened and assess their quality. We synthesized evidence from low and moderate risk of bias studies. Our search retrieved 2394 articles. After removing duplicates, we screened 2237 citations for eligibility, with 191 studies eligible for full-text screening. 13 studies were relevant and appraised. Our synthesis includes five studies of moderate to low risk of bias (three cross-sectional and two cohort studies). Although measures of LBP and sleep quality varied across the included studies, all demonstrated an overall positive small association between the two constructs. Chronic LBP is positively associated with poor sleep quality in aging adults. Our study highlights methodological limitations in existing research and calls for more rigorous epidemiological studies.

BACKGROUND:Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews synthesizing evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four HPSR pillars identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery, financial, and governance arrangements; and implementation strategies. This overview addresses delivery arrangements, which Cochrane EPOC defines as how health services are organized and delivered, including who provides care, how care is coordinated and managed, and where services are provided. OBJECTIVES:This overview aimed to synthesize current evidence on delivery arrangements in rehabilitation from an HPSR perspective. Our series of four overviews has the following overarching objectives. • To offer a broad synthesis of existing evidence on health policy and systems interventions' effects. • To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist. METHODS:We searched Epistemonikos Health Systems Evidence databases and EPOC Group systematic reviews with no language limitations to identify reviews published between 2015 and 17 November 2024. We included Cochrane systematic reviews (CSRs) and non-CSRs of randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) evaluating the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to delivery arrangements as defined in the EPOC taxonomy. All four overview teams screened reviews and extracted data. We used AMSTAR 2 to critically appraise the reviews, and we analyzed the results descriptively. MAIN RESULTS:We included 25 systematic reviews. Three overlapped, and for 17 the AMSTAR 2 rating was low or critically low confidence. Five systematic reviews (2 CSRs and 3 non-CSRs) contributed to our synthesis. Most outcomes focused on patients, caregivers, or service use (e.g. access to rehabilitation). Equity-related outcomes were absent, and quality of care, adverse events, and our important outcomes were rarely reported. Below, we report the results of three of the five reviews judged to have moderate to high confidence for our outcomes of interest, in which authors conducted meta-analysis and assessed the certainty of the evidence. Who provides care One review analyzed advanced practice physiotherapy (APP) models, which may result in little to no difference in health-related outcomes measured by the Pain Disability Index and EuroQol 5-Dimension questionnaire after the intervention, compared with usual care in adults with spinal pain (standardized mean difference [SMD] 0.05, 95% confidence interval [CI] -0.32 to 0.42; 2 studies, 225 participants; low certainty). Information and communication technology We included two reviews in this category. One compared telerehabilitation with usual care in older adults, finding that telerehabilitation may have little or no effect on quality of life after seven to 20 weeks (SMD -0.09, 95% CI -0.23 to 0.40; 3 studies, 179 participants; low certainty). There was very low-certainty evidence on mobility after seven to 26 weeks (SMD 0.63, 95% CI -0.25 to 1.51; 5 studies, 302 participants), strength after 12 and 26 weeks (SMD 0.73, 95% CI -0.10 to 1.56; 4 studies, 226 participants), and balance after seven to 26 weeks (SMD 0.40, 95% CI -0.35 to 1.15; 3 studies, 199 participants). Another review on stroke survivors living in the community found that telerehabilitation compared with usual care probably has little or no effect on independence in activities of daily living (ADL) after 24 weeks (SMD 0.00, 95% CI -0.15 to 0.15; 2 studies, 661 participants; moderate certainty), self-reported quality of life after six to 24 weeks (SMD 0.03, 95% CI -0.14 to 0.20; 3 studies, 569 participants; moderate certainty), and depression after six to 24 weeks (SMD -0.04, 95% CI -0.19 to 0.11; 6 studies, 1145 participants; moderate certainty); and may have little or no effect on upper limb function after 12 weeks (SMD 0.33, 95% CI -0.21 to 0.87; 2 studies, 54 participants; low certainty) and mobility after six weeks (mean difference 0.01, 95% CI -0.12 to 0.14; 1 study; 144 participants; low certainty). This review also compared telerehabilitation with in-person rehabilitation and found that there may be little to no difference in independence in ADL, measured with the Modified Barthel Index at four to 12 weeks (MD 0.59, 95% CI -5.50 to 6.68; 2 studies, 75 participants; low certainty); balance, measured with the Berg Balance Scale at four to 12 weeks (MD 0.48, 95% CI -1.36 to 2.32; 3 studies, 106 participants; low certainty); and upper limb function, evaluated with the Fugl-Meyer Assessment (Upper Extremity) four weeks after intervention (MD 1.23, 95% CI -2.17 to 4.64; 3 studies, 170 participants; low certainty). AUTHORS' CONCLUSIONS:Current evidence on delivery arrangements in rehabilitation is limited, mostly of low certainty, and derived from high-income countries. Reviews covered five EPOC categories, but reliable evidence for our outcomes of interest was available for only two categories. Most evidence was on telerehabilitation. Compared with usual care, APP models may have little to no effect on health outcomes in adults with spinal pain. In people with stroke, telerehabilitation compared with usual care probably has little or no effect on independence in daily living, quality of life, and depression, and may have little to no effect on upper limb function and mobility. Compared with in-person care, telerehabilitation may have little to no effect on ADL, balance, and upper limb function. Further high-quality research using well-defined frameworks is needed, especially in low- and middle-income countries, to identify effective strategies and evaluate organizational, implementation, and equity outcomes. Future Cochrane overviews in HPSR should consider a broader range of study designs, such as observational, qualitative, and mixed-design evidence, to better capture evidence on delivery arrangements in rehabilitation. FUNDING:PC, CK, and SN were supported and funded by the Italian Ministry of Health (Ricerca Corrente). The funder played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. REGISTRATION:Protocol (2025): DOI 10.23736/S1973-9087.24.08833-6.

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 This study aims to investigate how authors attribute causality in case reports and case series describing ischaemic stroke following cervical manual therapy. Methods This qualitative, document-based study is nested within a larger epidemiological investigation evaluating the association between cervical manual therapy and ischaemic stroke (PROSPERO ID: CRD42024602659). Eligible case reports and case series will be identified through a systematic review of biomedical databases. A software-assisted qualitative content analysis will be undertaken in MAXQDA, combining deductive coding, guided by counterfactual theory and the concept of hypothesis generation, with inductive coding to capture linguistic patterns. Conclusion This research protocol presents a novel approach to examining how causality is attributed in case reports and case series, addressing the relationship between ischemic stroke following cervical manual therapy for headaches or neck pain. The anticipated findings have implications for improving the clarity and responsibility of scientific communication and informing the interpretive boundaries and appropriate use of descriptive research designs in clinical and policy contexts.

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.

Background LBP is common among chiropractic students; however, little is known about its etiology. Therefore, we explored the association between individual characteristics and low back pain (LBP) in chiropractic students at the Canadian Memorial Chiropractic College (CMCC). Methods We conducted a cross-sectional study of all CMCC students from September to November 2017. Eligible participants were students aged 18 years and older, enrolled in year 1–4 of the chiropractic program. Individual characteristics included sociodemographic, lifestyle behaviours, and health-related factors. The outcomes were: 1) self-reported LBP in the past week, and 2) LBP ≥3/10 on the 11-point Numeric Rating Scale. We used univariable modified Poisson regression to explore the association between characteristics and stated outcomes in the entire sample and stratified by gender. Results Our sample included 510 participants (67% response rate), with a mean age of 24.6 years (SD 2.8) and 60% women. Sixty-nine percent reported LBP in the past week and 47.4% had LBP ≥3/10 in intensity. Sociodemographic characteristics associated with LBP of any intensity included women, second year of studies, and the number of paid work hours per week. Lifestyle behaviours associated with LBP of any intensity included poor to fair sedentary behaviour and longer commute times to the college. Health-related factors associated with LBP of any intensity were symptoms of psychological distress, functional limitations related to psychological symptoms, neck pain, poor sleep quality, and low student satisfaction, with stronger associations observed with LBP ≥3/10. Gender-stratified analysis showed slight variations in these associations. Conclusion Our study provides preliminary evidence on factors associated with LBP in Canadian chiropractic students, informing future studies investigating LBP in this population.

Working with an Indigenous Advisory Committee, including an Inuit Health Advisor and Researcher, we analyzed the 2017 Aboriginal Peoples Survey to examine prevalence and factors associated with pain-related disabilities (PRDs) among Inuit in Canada. Self-reported data were collected from Inuit ≥15 years. PRDs were defined as ‘sometimes’, ‘often’, or ‘always’ experiencing activity limitations due to pain from a long-term condition lasting ≥ six months. We computed PRD prevalence [95% CI] overall, and by geographic location, age, sex, type and number of co-existing disabilities. Modified Poisson regression with robust variance estimation modelled associations between Inuit social determinants of health and PRDs. Person-level and bootstrap weights were applied for all analyses. Among Inuit, 11.1% [10.0, 12.4] reported PRDs. Females [13.4% (11.8, 15.1)], individuals 55 + [23.7% (21.6, 25.9)], and those who lived outside Inuit Nunangat [17.1% (14.1, 20.5)] experienced higher prevalence of PRDs. Prevalence increased with the number of disabilities—highest among those with co-existing physical disabilities. Additionally, higher education, residential school attendance, and those who experienced difficulties related to food, housing, employment, and health were more likely to report PRDs. Characteristics which may increase the risk of PRDs need to be shared with Inuit stakeholders to guide next steps for awareness, advocacy, services and interventions.

Low back pain (LBP) is a major contributor to disability and rehabilitation needs globally. A proportion of patients with LBP undergo surgery and require postsurgical rehabilitation to optimize functioning. However, many encounter barriers to accessing rehabilitation due to structurally generated inequities linked to socioeconomic position. Structural barriers to accessing rehabilitation intersect with diversity-related factors (e.g., gender, ethnicity) to perpetuate stigma and marginalization, leading to tremendous consequences. This literature needs to be reviewed to identify key themes and knowledge gaps focused on structural factors to accessing post-surgical rehabilitation. Our objectives are to conduct a scoping review of the literature to (1) systematically map the literature on the experiences with structural barriers and facilitators to accessing post-surgical rehabilitation of adults who were treated with surgery for LBP (including with or without radiculopathy, symptomatic spinal stenosis); (2) investigate whether these experiences differ when grouped by diversity-related factors (e.g., gender, ethnicity, geographic region). We will conduct a scoping review of the literature based on Joanna Briggs Institute (JBI) scoping review guidance and report it according to PRISMA-Scoping Reviews. We will search multiple databases from inception to 2025 for qualitative research exploring experiences with structural barriers or facilitators to rehabilitation access after surgery among adults with LBP. Drawing upon the World Health Organization (WHO) Action on Social Determinants of Health framework, structural factors to accessing rehabilitation will include socioeconomic and political contexts; governance; macroeconomic, social and public policies; and cultural and societal values/norms. Paired reviewers will independently screen articles and extract data. Results will be summarized and grouped by type of LBP and rehabilitation, and by intersections with diversity-related factors (e.g., gender, age, ethnicity, disabilities, geographic region). Our interdisciplinary team will engage with an Advisory Committee of knowledge users with lived experience throughout. Aligned with WHO and EUROSPINE priorities, our scoping review will elucidate the structural barriers and facilitators influencing access to post-surgical rehabilitation for LBP more inclusively. Findings will advance knowledge of structural challenges experienced by adults needing post-surgical rehabilitation, informing rehabilitation and other healthcare strategies to remove barriers and improve functioning globally. Systematic review registration: Open Science Framework (OSF) https://osf.io/26h9w