Background: In 2022, the Australian Commission on Safety and Quality in Healthcare released clinical care standards for managing low back pain (LBP), including in emergency departments (EDs), where guideline non-adherent care has been reported. This study aimed to describe LBP care in a tertiary hospital ED against these new clinical standards. Methods: A 12-month retrospective review of medical records from a random sample of adults with LBP presenting to a tertiary hospital ED. Outcomes focused on key aspects of LBP care aligned with the eight quality statements in the Low Back Pain Clinical Care Standards (LBPCCS). Descriptive statistics were used to describe care against the quality indicators. Results: Of the 1974 ED presentations with a LBP-related discharge diagnosis in 2023, 550 were randomly selected for review. After exclusions, 374 were assessed against the LBPCCS. All presentations were assessed against the clinical assessment outcomes (quality statements 1-3), and 335 presentations were assessed against the ED management outcomes (quality statements 4-8). Clinical assessment and screening for serious/specific pathology was documented in 278 cases (74%); appropriate imaging in 66 (56%); self-management advice in 56 (17%); and psychosocial risk screening with referral in 56 cases (17%). Opioids were administered in 208 cases (62%) and anti-convulsants in 52 (16%). Conclusion: In a tertiary hospital ED, adherence to the LBPCCS is varied. The ED performed well against the clinical assessment/screening outcomes. However, findings suggest strategies are needed to improve performance against the management outcomes, including management advice, identification of psychosocial risk factors, and opioid use.

BACKGROUND:Abdominal pain, gastrointestinal symptoms and pelvic pain are common complaints of young females seeking healthcare. These symptoms can co-exist and become recurrent, impacting on quality of life. AIM:This study investigated the relationships between abdominal pain and gastrointestinal symptoms at 17-years of age and pelvic pain bothersomeness (PPB) at 22-years of age in young females. MATERIALS AND METHODS:A cross-sectional observational study utilising 17 and 22-year Gen2 female data of the Raine Study (n = 584). Abdominal pain and gastrointestinal symptoms at 17 years were: frequency, consistency and/or pain of bowel movements, bloating, nausea, vomiting, analgesia for cramps and laxative use in the preceding 3 months. At 22 years, PPB was determined by the Urogenital Distress Inventory Short Form (UDI-6). Additional health-related variables were analysed to understand the symptom patterns of participants. RESULTS:17-year-old females, with abdominal pain and gastrointestinal data who answered the UDI-6 for PPB (n = 450); 347 (77%) were not bothered by PPB, 64 (14%) reported mild PPB and 39 (9%) reported moderate-severe PPB at 22-years (p = 0.168). Symptoms of varied stool consistency, vomiting, nausea and laxative use, but not isolated abdominal pain, at 17-years were significantly associated with PPB at 22-years. Co-variants of depression, anxiety, bullying, living with a partner, poor sleep and smoking showed increased prevalence with severity of PPB. CONCLUSION:Gastrointestinal symptoms in adolescence were associated with pelvic pain bothersomeness (PPB) in young adulthood. Early detection of abdomino-pelvic symptoms may be useful to allow early, targeted and multi-disciplinary management to optimise physical and mental health outcomes.

The prevalence of chronic pain in young people increases with age, approaching rates observed in adults. Utilizing Australiasian electronic Persistent Pain Outcomes Collaboration (ePPOC) data for young people, we previously derived three phenotypes ("low", "moderate", "high") characterized by an increasing symptom-severity gradient in multi-dimensional pain-related variables measured at referral to pain service. In this study, we explored whether health outcomes varied by phenotypes at the end of care episode. We included young people captured in the Australian adult ePPOC data registry representing 68 tertiary and private pain services, within a 5-year period (2018 to 2022) if previously phenotyped and had episode end patient reported outcome measures. Self-reported global rating of change was measured at episode end, while pain severity and interference, pain-related worry (quasisurrogate 'catastrophizing'), emotional functioning and pain self-efficacy were measured at referral and episode end. Differences in outcomes across phenotypes were estimated using logistic regression for binary indicators and clinically significant improvements, and linear regression for mean change. Of 3518 young people initially phenotyped from adult service data, 477 (13.6%) aged 15-25 years had episode end outcomes. The proportion of participants reporting meaningful improvement in outcomes ranged from 24.0%-74.2%, with differences observed across phenotypes. Although the limited proportion of participants with episode end data may have introduced bias, those with and without end episode outcomes were broadly comparable on baseline demographics. Results suggests tailoring care to symptom-severity may be important for optimising outcomes, particularly for young people with "high" symptom-severity whose care needs are more complex. PERSPECTIVE: This study reports unique exploration of whether the outcomes following specialized pain service care supporting young people living with chronic pain varied according to their symptom-severity phenotype. This evidence provides impetus for system and service improvements to more equitably and efficiently meet young people's needs by providing timely, differential care.

INTRODUCTION:Most clinical practice guidelines (CPGs) for assessing and managing people's chronic pain focus on specific pain conditions, body sites or life course stages. This creates complexity for clinicians making care choices in the absence of a diagnosis and/or where a person experiences more than one pain condition. Specific to this context is the ICD-11 classification of chronic primary pain where an experience of pain cannot be better accounted for by another condition. CPGs for chronic primary pain, agnostic to condition or body part, may support clinicians towards best pain care since many of the principles of person-centred chronic pain care are transdiagnostic. The two aims of this systematic review are to (1) identify and appraise CPGs for chronic primary pain, relevant across the life course and (2) map the CPG content against a pain care priority framework to evaluate the extent to which the CPG content aligns with the priorities of people with lived chronic pain experience. METHODS AND ANALYSIS:We will systematically search nine scholarly databases, the Epistemonikos database and international and national guidelines clearinghouses. CPGs published within 2015-2025, in any language, that offer recommendations about assessment and/or management of chronic primary pain for people of any age, excluding hospitalised inpatients or institutionalised populations, will be included. Pairs of reviewers will independently screen citations for eligibility and appraise CPG quality and implementation potential using the Appraisal of Guidelines for Research and Evaluation (AGREE)-II and the AGREE-Recommendations Excellence tools, respectively. Data extraction will include the citation and scope characteristics of each CPG, methods used to develop recommendations, verbatim recommendations, guiding principles or practice information and narrative excerpts related to the GRADE Evidence-to-Decision (EtD) considerations (or equivalent). We will use the PROGRESS-PLUS framework as a checklist to identify whether determinants of health equity were considered by guideline developers. CPG recommendations will be organised according to common topics and categorised in a matrix according to strength and direction. Qualitative content analysis will be used to synthesise excerpts relating to GRADE EtD considerations (or equivalent), and we will map extracted data against an established chronic pain care priority framework to determine the extent to which the CPGs align with values and preferences of people with lived experience. Interpretation will be informed by an interdisciplinary Advisory Group, including lived experience partners. ETHICS AND DISSEMINATION:Ethical approval is not required for this systematic review. Results will be disseminated through publication in an open-access peer-reviewed journal, through professional societies, and integrated into education curricula and public-facing resources. Reporting will be consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. PROSPERO REGISTRATION NUMBER:CRD420251000482.

ABSTRACT:Using the Australiasian electronic Persistent Pain Outcomes Collaboration, a binational pain registry collecting standardized clinical data from paediatric ePPOC (PaedsePPOC) and adult pain services (AdultePPOC), we explored and characterized nationally representative chronic pain phenotypes and associations with clinical and sociodemographic factors, health care utilization, and medicine use of young people. Young people ≥15.0 and <25.0 years captured in PaedePPOC and AdultePPOC Australian data registry were included. Data from 68 adult and 12 paediatric pain services for a 5-year period January 2018 to December 2022 (first episode, including treatment information) were analysed. Unsupervised latent class analysis was applied to explore the existence of distinct pain phenotypes, with separate models for both services. A 3-phenotype model was selected from both paediatric and adult ePPOC data, with 693 and 3518 young people included, respectively (at least one valid indicator variable). Indicator variables for paediatric models were as follows: pain severity, functional disability (quasisurrogate "pain interference"), pain count, pain duration, pain-related worry (quasisurrogate "catastrophizing"), and emotional functioning; and, for adult models: pain severity, pain interference, pain catastrophizing, emotional functioning, and pain self-efficacy. From both services, 3 similar phenotypes emerged ("low," "moderate," "high"), characterized by an increasing symptom-severity gradient in multidimensional pain-related variables, showing meaningful differences across clinical and sociodemographic factors, health service utilization, and medicines use. Derived phenotypes point to the need for novel care models that differentially respond to the needs of distinct groups of young people, providing timely, targeted, age-appropriate care. To effectively scale such care, digital technologies can be leveraged to augment phenotype-informed clinical care.

Hamstring strain injuries (HSIs) are the most common time loss injury sustained in male Australian Football League (AFL) athletes, causing significant financial cost, time cost, and impaired team and individual performance. In a squad of 42 players, HSIs accounted for 4.86 new injuries sustained by players per club per AFL season in 2020. This is consistent with injury reporting over the last decade in AFL, despite best efforts to reduce the rate. This scoping review sought to firstly identify the reported hamstring injury prevention risk factors in elite AFL, discern the impact of these factors, and map the gaps in the current literature using a biopsychosocial understanding of injury prevention. The scoping review process was based on the Askey and O’Malley framework. Five relevant online databases (MEDLINE, Proquest, CINAHL, SPORTdiscuss, and EMBASE) were systematically searched using a series of Boolean and operator terms following the PRISMA-ScR protocol using the criteria: (1) assessing male professional/elite athletes in AFL; (2) written in English and peer-reviewed; (3) full text available; and (4) published after 2006. Only manuscripts that fit the search terms and inclusion criteria were retained in the scoping review. Following an initial search, 246 potential studies were identified, with 12 studies meeting the inclusion criteria after full-text screening. The risk factors examined were subclassified into modifiable and non-modifiable categories. Modifiable factors include high-speed running exposure, gluteus medius activation, eccentric hamstring strength, shorter bicep femoris fascicle length, use of interchange, and hamstring stiffness. Non-modifiable factors include previous history of HSI and limb injury, age, and size of injury on MRI. This scoping review highlights the need for continued monitoring of high-speed running volumes as rapid increases in completed distances present as a substantial risk factor. The modifiable mechanistic risk factors of eccentric hamstring strength and hamstring stiffness were identified as important components of player screening to reduce the risk of future HSI. Risk factors identified throughout will help develop comprehensive injury profiling for athletes. Further research is warranted to develop a holistic approach to injury profiling.

An educational philosophy is traditionally a personal statement regarding beliefs in how learning occurs and how best to facilitate that learning. An educational philosophy can also be expanded and co-designed by a team to be the foundation and compass that underpins and authentically informs collaborative design and renewal of program curriculum. This study reports the appraisal of the relevance of a co-designed pre-registration physiotherapy educational philosophy for post-registration physiotherapy learning and the use of the educational philosophy to inform curriculum renewal. An explanatory mixed methods approach was used with data gathered from multiple stakeholders via a survey and collaborative workshop. This research using co-design principles has shown the co-designed pre-registration educational philosophy and its four associated pillars (collaborate, construct, reflect and solve) were considered appropriate for postgraduate physiotherapy curriculum. Thematic analysis of workshop data revealed the skills, attributes, capabilities, and knowledge Master of Clinical Physiotherapy students should acquire and strengthen during the degree. The graduate attributes and course learning outcomes for the post graduate physiotherapy program were reconceptualized to include contemporary skills, attributes, capabilities, and knowledge. The co-designed educational philosophy and skills, attributes, capabilities and knowledge, and renewed course learning outcomes were used to underpin and authentically inform the collaborative review and renewal of the Master of Clinical Physiotherapy curriculum. Co-designing the educational philosophy was integral to a cohesive and connected curriculum renewal process. Health education disciplines should consider exploring the suitability of a co-designed educational philosophy to enhance student learning experiences and graduate outcomes, and strengthen staff engagement and collegiality.

BACKGROUND:This study examined the association between epigenetic genome-wide DNA methylation with mechanism-based phenotypes of spinal pain from adolescence through early adulthood, accounting for confounders. RESEARCH DESIGN AND METHODS:We investigated the relationship between the timing of spinal pain at 14, 17, 22, and 27 years and blood DNA methylation at 17 years in the Raine Study Gen2 cohort. We analyzed three phenotypes of spinal pain (neck pain only, low back pain only, neck and low back pain) compared to participants with no spinal pain using linear mixed effects models. RESULTS:We identified four genome-wide significant loci (3 neck, 1 back), all at age 22, and none from the other time points or with the combined neck and low back pain. The top locus for neck pain age 22 was cg06573902 (β = 0.0058, p-value 1.34E-8) in the gene TOP1 (DNA Topoisomerase I). The top locus for low back pain at age 22, was cg14080518 (β = 0.0072, p-value = 5.36E-8), located in the gene SMURF1 (SMAD Specific E3 Ubiquitin Protein Ligase 1). CONCLUSION:While more basic research is required, the existence of mechanistic links could facilitate better screening and novel management strategies for those with spinal pain.

OBJECTIVE:Patients with musculoskeletal conditions (MSKCs) are highly prevalent in ED. This project explores the impact of the pilot phase of a 'diversion pathway', which directed patients with MSKCs from the ED waiting room to an outpatient clinic led by advanced-scope physiotherapists. METHODS:A prospective intervention study comparing care outcomes between patients in the 'diversion pathway' with usual ED care. The characteristics of patients considered eligible and non-eligible are described. RESULTS:Between May and December 2022, 1099 patients were diverted. For diverted patients, mean length of stay (LOS) in ED was reduced by 110 (95% confidence interval [CI]: 99-120) min and 4 h rule compliance improved by 19.3% compared to usual ED care. There were fewer patients who 'did not wait' (DNW) with the diversion pathway. The diverted group was young (median age 22 years and 41% paediatric), mostly low urgency, self-referred and arrived by private transport with minor limb trauma. The diversion pathway triage process appropriately identified 182 patients ineligible for diversion. 96.7% of patients reported satisfaction with care received from the diversion pathway. There was no change in ED representation rates for diverted patients. CONCLUSIONS:A new pathway resulted in reduced LOS, reduced DNW, high patient satisfaction and more people being discharged within 4 h for diverted patients compared to usual ED care. The pathway increased ED capacity, improved key ED performance metrics and safely expedited care delivery for patients.

Abstract Chronic musculoskeletal pain (CMP) and coexisting mental health conditions impact young people; however, little is known about their lived and care experiences. In a prospectively registered systematic review with qualitative evidence synthesis (PROSPERO: CRD42022369914), we explored the following: (1) lived physical, psychological, and social experiences; and (2) care experiences/preferences of young people living with CMP and mental health conditions. Inclusion criteria: studies using qualitative methods; participants aged 16 to 24 years with CMP and coexisting mental health condition(s); phenomenon explored included lived and/or care experiences. Seven databases were searched (inception to 19-May-2024), study quality was assessed, data were extracted and analysed thematically, and GRADE-CERQual was used to assess confidence in findings. Twenty-two studies (23 reports) were included (>239 participants, 82% women). Lived experiences yielded 4 themes (9 findings): 2-way relationship between CMP and mental health (2 findings, low to moderate confidence); psychosocial implications of CMP (3 findings, very low-moderate confidence); uncertainty about future (2 findings, low-moderate confidence); coping with CMP and mental health conditions (2 findings, low-moderate confidence). Care experiences/preferences yielded 3 themes (8 findings): navigating healthcare systems (2 findings, moderate confidence); receiving appropriate care (3 findings, very low-moderate confidence); point-of-care experiences and care preferences (3 findings, very low-moderate confidence). Chronic musculoskeletal pain and mental health conditions are interconnected, significantly impacting young people's lives, identities, and socialisation, yet services for CMP and mental health are often inadequate and poorly integrated. The mechanisms and interplay of CMP and mental health require deeper exploration, including how young people may be better supported with personalised, holistic, developmentally and/or life-stage-appropriate integrated care.

Low back pain (LBP) is a common reason people visit Emergency Departments (ED). However, the care provided is often not aligned with guideline recommendations. Despite increasing research aiming to promote guideline-based care in EDs, interventions to best implement recommendations are unknown. This study aimed to identify ED LBP implementation interventions that have been trialed and evaluate their effects on ED-relevant outcomes. A systematic review and meta-analysis, including studies that evaluated interventions to improve the quality of care provided to adults presenting to ED with LBP. Databases searched until May 2023 were Cochrane Library, CINAHL, EMBASE (via OVID), and PEDro. Interventions were categorized according to whether they had a patient, clinician, health service, or multiple-level focus. Where possible, meta-analysis was undertaken. Certainty around the results was assessed using the GRADE criteria. Twenty-eight studies were included. Interventions were categorized as patient (n = 2), clinician (n = 8), health service (n = 12), or multiple-level (n = 6) targeted. Overall, interventions successfully reduced the likelihood of receiving an opioid in ED (OR 0.65; 95

The agents of deterioration (AoD) offer a structured categorization of hazards to collections: they are a basis for risk-informed preservation management. In drawing up the AoD their creators were not ignorant of wider societal issues of concern to conservators, but they envisaged them to be part of a broader institutional activity located beyond the scope of preventive conservation. Within conservation, there have been discussions about additional agents: social, cultural, or political causes of loss. Their continued exclusion from the AoD may mistakenly be interpreted as a lack of consideration of such concerns. There are reasons to limit the scope of an institution's preventive conservation system but not everyone agrees that those reasons are sufficient to justify this limitation. This paper is a discussion and disagreement by two authors. Henderson argues that dissociation should capture any loss of meaning resulting from any aspect of conservation practice, including cleaning, documentation, failure to respect beliefs, etc. She argues that dissociation from context may stop preventive conservators from identifying and respecting optimal traditional sustainable methods and techniques. Waller argues that the threat of losing context information about collection items should be managed as part of the wider cultural heritage institution's role and resolved through its engagement with the community. He acknowledges that preventive conservation can contribute to understanding and mitigating this form of loss, but advocates that primary responsibility must be situated at a higher level than the preventive conservation remit. Los agentes de deterioro (AdD) ofrecen una categorizaci & oacute;n estructurada de los peligros para las colecciones: son una base para una gesti & oacute;n de la preservaci & oacute;n informada sobre los riesgos. Al redactar la AdD, sus creadores no ignoraban cuestiones sociales m & aacute;s amplias que preocupaban a los conservadores-restauradores, pero las previeron como parte de una actividad institucional m & aacute;s amplia ubicada m & aacute;s all & aacute; del alcance de la conservaci & oacute;n preventiva. Dentro de la conservaci & oacute;n-restauraci & oacute;n, ha habido discusiones sobre agentes adicionales; causas sociales, culturales o pol & iacute;ticas de la p & eacute;rdida. Su continua exclusi & oacute;n de los diez agentes puede interpretarse err & oacute;neamente como una falta de consideraci & oacute;n de tales preocupaciones. Hay razones para limitar el alcance del mandato de conservaci & oacute;n preventiva, pero no todos est & aacute;n de acuerdo en que esas razones sean suficientes para justificar esta limitaci & oacute;n. Este art & iacute;culo es una discusi & oacute;n y desacuerdo entre dos autores. Henderson sostiene que la disociaci & oacute;n debe capturar cualquier p & eacute;rdida de significado resultante de cualquier aspecto de la pr & aacute;ctica de conservaci & oacute;n-restauraci & oacute;n, incluida la limpieza, la documentaci & oacute;n, la falta de respeto a las creencias, etc. Sostiene que la disociaci & oacute;n del contexto puede impedir que los conservadores preventivos identifiquen y respeten m & eacute;todos y t & eacute;cnicas tradicionales sostenibles & oacute;ptimos. Waller sostiene que la amenaza de perder informaci & oacute;n contextual sobre los elementos de la colecci & oacute;n debe gestionarse como parte del papel m & aacute;s amplio de la instituci & oacute;n del patrimonio cultural y resolverse a trav & eacute;s de su compromiso con la comunidad. Reconoce que la conservaci & oacute;n preventiva puede contribuir a comprender y mitigar esta forma de p & eacute;rdida, pero defiende que la responsabilidad primaria debe situarse en un nivel m & aacute;s alto que el mandato de conservaci & oacute;n preventiva.

Established in 2020, the Promoting Exhibit Access and Safety (PEAS) Working Group was formed by cultural heritage, safety, and health professionals with a shared interest in finding multidisciplinary solutions to “detrimental visitor interactions (DVI),” defined as “any incident where an individual engages with an exhibit and harms themselves, others, or a collection item.” The Working Group is composed of individuals from various private and non-profit organizations that connect to international, national, regional, local, and tribal audiences. In 2021, the Working Group surveyed attendees at four cultural heritage conferences to get a broader perspective on what institutions are already doing at the intersection of access and safety. The following article is a presentation and analysis of the survey results which comprises both quantitative and qualitative data.

BACKGROUND:Low urgency, non-traumatic musculoskeletal presentations are common in emergency departments. Although care is safe, it is expensive, and low priority. Pathways diverting these patients from emergency departments to physiotherapy care may improve hospital outcomes. Identifying the suitable patient profile for these pathways is important. METHODS:A mixed prospective and retrospective, descriptive, cross-sectional study investigated adults aged 18-65 presenting to two emergency departments. Suitable patients were diverted directly to a physiotherapy outpatient diversion pathway. Three groups were compared, diverted patients, patients suitable but not diverted, and patients unsuitable for diversion. RESULTS:Diverted patients were aged 43 (median, inter-quartile range 34-53.5) years, triaged as low-urgency, self-referred, self-transported, and had few concerning features of serious pathology. Diverted patients had a 113-minute shorter emergency stay at 79 (median) minutes compared to suitable but not diverted patients, and both groups had a similar profile. Most (93.4 %) diverted patients were discharged within 4- hours, compared to suitable but not diverted patients (72.9 %). Key factors preventing diversion were concern for serious pathology or diversion capacity restraints. CONCLUSION:A group of patients with non-traumatic musculoskeletal conditions who can be safely diverted to physiotherapy outpatients are described. Diversion impact was high quality care and improved emergency department metrics.

A key challenge in managing collections is optimizing the value to society they offer, both now and in the future. This challenge can be framed as an issue requiring compromise, or, it can be considered as an opportunity to optimize. The goal is to help heritage professionals engage in constructive decision-making. By focusing on high-level institutional gains and benefits, while avoiding picking battles over less significant issues, a compromise and win-lose mindset can be avoided. The multiple objectives involved in creating a safe and effective exhibit can lead to conflict and unhelpful digging in of positions among team members. Understanding factors that contribute to conflict and identifying some means of avoiding or minimizing those factors can lead to teamwork at a higher level. Collection management challenges are explored, in a practical way, to reveal how simple changes in thinking habits and perspective can improve decisions and outcomes. A range of heuristics that shape our instinctive decision-making are explained and illustrated to create the opportunity for insight into how these unconsciously create an unnecessarily conflict-based response. Strategies for shifting perspective are discussed and offered as a route to identifying mutually beneficial outcomes.

Objective To investigate the reasons patients with non-traumatic musculoskeletal pain (NTMSP) present to an emergency department (ED), their experience of care and perceptions about managing their condition in the future. Methods A qualitative study using semi-structured interviews with patients with NTMSP presenting to a suburban ED. A purposive sampling strategy included participants with different pain characteristics, demographics and psychological factors. Results Eleven patients with NTMSP who presented to an ED were interviewed, reaching saturation of major themes. Seven reasons for ED presentation were identified: (1) desire for pain relief, (2) inability to access other healthcare, (3) expecting comprehensive care at the ED, (4) fear of serious pathology/outcome, (5) influence of a third party, (6) desire/expecting radiological imaging for diagnosis and (7) desire for 'ED specific' interventions. Participants were influenced by a unique combination of these reasons. Some expectations were underpinned by misconceptions about health services and care. While most participants were satisfied with their ED care, they would prefer to self-manage and seek care elsewhere in the future. Conclusions The reasons for ED presentation in patients with NTMSP are varied and often influenced by misconceptions about ED care. Most participants reported that, in future, they were satisfied to access care elsewhere. Clinicians should assess patient expectations so misconceptions about ED care can be addressed.

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Waller, Robert; Smith, Anne Julia; Graven-Nielsen, Thomas; Arendt-Nielsen, Lars; Sterling, Michele; Karppinen, Jaro Ilari; O'Sullivan, Peter Bruce; Straker, Leon Melville; Slater, Helen Author Information