"It's the future, come on!": a think aloud study exploring clinicians' use of knowledge-based AI decision support.

Purpose: AI-based clinical decision support (CDS) is hailed as the solution to many healthcare capacity problems. However, there is a known implementation gap in AI CDS. Studies exploring barriers and enablers rely on abstract definitions or participants' understanding of AI.

Which self-reported bio-psychosocial variables predict recovery in rotator cuff tendinopathy? An international prospective cohort study.

Introduction: It is unclear what baseline factors predict recovery from rotator cuff (RC) tendinopathy, making evidence-based prognostic estimates difficult. The study aimed to identify predictors of RC tendinopathy recovery to guide clinical decision-making.

Methods: People with RC tendinopathy were recruited to an international prospective cohort study.

Improving Safety, Efficiency, Cost, and Satisfaction Across a Musculoskeletal Pathway Using the Digital Assessment Routing Tool for Triage: Quality Improvement Study.

Background: Musculoskeletal (MSK) conditions are prevalent and increasing in Western-style economies, associated with an aging population and reduced physical activity levels. Prevention, early detection, and treatment can enable people to live in good health, remain independent and socially connected, and have economic advantages for society, such as reducing pressure on health and social care services. Triaging patients safely and effectively to the right care, for the first time improves outcomes and reduces costs, with digital solutions offering potential advantages over traditional methods.

Diagnostic domains, differential diagnosis and conditions requiring further medical attention that are considered important in the assessment for Achilles tendinopathy: a Delphi consensus study.

The absence of agreed methods to diagnose Achilles tendinopathy impedes research and clinical practice. This gap results in heterogeneous and/or poorly described study samples, making it challenging to apply findings in clinical practice. The aim of this Delphi study was to define consensus on (1) diagnostic domains; (2) differential diagnoses; and (3) conditions requiring further medical attention, when assessing for Achilles tendinopathy.

The efficacy of gluteal tendinopathy treatments: A systematic review.

ObjectiveTo guide clinical practice by synthesising robust evidence concerning gluteal tendinopathy management.Data sourcesFive electronic databases were searched from inception to August 2024 for randomised controlled trials (RCTs) of medium or high quality, and low risk of bias, that measured pain and function in adults with clinically diagnosed gluteal tendinopathy.Review methodsSystematic review reporting proof of efficacy.

Mechanisms influencing adult adherence to physiotherapist-delivered rehabilitation for Achilles tendinopathy: a longitudinal qualitative study.

Purpose: Achilles tendinopathy rehabilitation can be complex to deliver. Outcomes are variable, with low adherence a likely contributory factor. We aimed to identify the mechanisms influencing adult adherence behaviour to physiotherapist-delivered rehabilitation for Achilles tendinopathy.

Reinterpreting the Clinical Practice Guidelines for Plantar Heel Pain Through an International Lens.

Letter to the Editor-in-Chief in response to article "Heel Pain - Plantar Fasciitis: Revision 2023" by Koc et al. .

The association of demographic, psychological, social and activity factors with foot health in people with plantar heel pain.

Background: Plantar Heel Pain (PHP) can be a debilitating musculoskeletal condition from which only 50% recover within a year due to poor understanding of the mechanisms explaining severity and predicting outcomes specific to PHP.

Objective: To explore associations between biopsychosocial variables and the severity of people with PHP. Secondly, to determine what combination of self-reported factors distinguishes people with PHP from other foot pain (OFP).

Optimising physiotherapist delivery fidelity of exercise and physical activity advice for achilles tendinopathy: A prospective repeated-measures observational study.

Objectives: To assess physiotherapist delivery fidelity and identify factors optimising delivery fidelity of an intervention based on recommended guidelines for Achilles tendinopathy.

Design: A prospective repeated-measures observational study of physiotherapist delivery fidelity with carefully defined exercise and physical activity advice.

Setting: An inter-disciplinary clinic in Melbourne, Australia, embedded in a randomised controlled trial.

ICON 2023: International Scientific Tendinopathy Symposium Consensus - the core outcome set for Achilles tendinopathy (COS-AT) using a systematic review and a Delphi study of professional participants and patients.

To develop a core outcome set for Achilles tendinopathy (COS-AT) for use in clinical trials we performed a five-step process including (1) a systematic review of available outcome measurement instruments, (2) an online survey on truth and feasibility of the available measurement instruments, (3) an assessment of the methodological quality of the selected outcome measurement instruments, (4) an online survey on the outcome measurement instruments as COS and (5) a consensus in-person meeting. Both surveys were completed by healthcare professionals and patients. The Outcome Measures in Rheumatology guidelines with a 70% threshold for consensus were followed.

What characteristics of clinical decision support system implementations lead to adoption for regular use? A scoping review.

Introduction: Digital healthcare innovation has yielded many prototype clinical decision support (CDS) systems, however, few are fully adopted into practice, despite successful research outcomes. We aimed to explore the characteristics of implementations in clinical practice to inform future innovation.

Methods: Web of Science, Trip Database, PubMed, NHS Digital and the BMA website were searched for examples of CDS systems in May 2022 and updated in June 2023.

Evaluation of a Musculoskeletal Digital Assessment Routing Tool (DART): Crossover Noninferiority Randomized Pilot Trial.

Background: Musculoskeletal conditions account for 16% of global disability, resulting in a negative effect on patients and increasing demand for health care use. Triage directing patients to appropriate level intervention improving health outcomes and efficiency has been prioritized. We developed a musculoskeletal digital assessment routing tool (DART) mobile health (mHealth) system, which requires evaluation prior to implementation.

Can on-line gait training improve clinical practice? Study protocol for feasibility randomised controlled trial of an on-line educational intervention to improve clinician's gait-related decision-making in ambulant children and young people with cerebral palsy.

Background: Instrumented gait analysis (IGA) is an assessment and research tool with proven impacts on clinical decision-making for the management of ambulant children and young people with cerebral palsy (CYPwCP) but is underused and variably understood by relevant clinicians. Clinicians' difficulties in gaining expertise and confidence in using IGA are multifactorial and related to access for clinical decision-making, limited training opportunities and inability to translate this training into clinical practice.

Methods: The primary aim of this study is to test the feasibility of an educational intervention to advance clinicians' application of gait analysis in CYPwCP, to inform a definitive trial.

Behaviour change and rehabilitation adherence in adults with tendinopathy: a scoping review.

Purpose: This scoping review aimed to identify behaviour change strategies influencing rehabilitation adherence in adults with tendinopathy, a common musculoskeletal condition requiring prolonged rehabilitation with poor adherence and variable outcomes.

Methods: Following the Joanna Briggs Institute (JBI) methodology, seven databases were searched until April 2023. Records included reviews, intervention, and qualitative studies published in English.

Current practice, guideline adherence, and barriers to implementation for Achilles tendinopathy rehabilitation: a survey of physical therapists and people with Achilles tendinopathy.

Objective: To explore clinical practice patterns of physical therapists (PTs) who treat people with Achilles tendinopathy (AT), and identify perceived barriers and facilitators for prescribing and engaging with therapeutic exercise among PTs and people with AT.

Methods: Two cross-sectional surveys were electronically distributed between November 2021 and May 2022; one survey was designed for PTs while the second was for people with AT. Survey respondents answered questions regarding their physical therapy training and current practice (PTs), injury history and management (people with AT), and perceived barriers and facilitators (PTs and people with AT).

Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review.

Background: Numerous conditions are grouped under the generic term exercise-induced leg pain (EILP), yet clear diagnostic guidelines are lacking. This scoping review was conducted to clarify the definition and diagnostic criteria of nine commonly occurring EILP conditions.

Methods: Three online databases were searched from inception to April 2022 for any English language original manuscripts identifying, describing, or assessing the clinical presentation and diagnostic criteria of the nine most common conditions that cause EILP.

Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness.

Background: Tendinopathy is a common, painful and functionally limiting condition, primarily managed conservatively using exercise therapy.

Review Questions: (i) What exercise interventions have been reported in the literature for which tendinopathies? (ii) What outcomes have been reported in studies investigating exercise interventions for tendinopathy? (iii) Which exercise interventions are most effective across all tendinopathies? (iv) Does type/location of tendinopathy or other specific covariates affect which are the most effective exercise therapies? (v) How feasible and acceptable are exercise interventions for tendinopathies?

Methods: A scoping review mapped exercise interventions for tendinopathies and outcomes reported to date (questions i and ii). Thereafter, two contingent systematic review workstreams were conducted.

Assessing Serious Spinal Pathology Using Bayesian Network Decision Support: Development and Validation Study.

Background: Identifying and managing serious spinal pathology (SSP) such as cauda equina syndrome or spinal infection in patients presenting with low back pain is challenging. Traditional red flag questioning is increasingly criticized, and previous studies show that many clinicians lack confidence in managing patients presenting with red flags. Improving decision-making and reducing the variability of care for these patients is a key priority for clinicians and researchers.

Predicting the outcome of plantar heel pain in adults: a systematic review of prognostic factors.

Background: Plantar Heel Pain (PHP) is a common disorder with many treatment pathways and is not self-limiting, hence prognostic information concerning recovery or recalcitrance is needed to guide practice. In this systematic review, we investigate which prognostic factors are associated with favourable or unfavourable PHP outcomes.

Methods: MEDLINE, Web of Science, EMBASE, Scopus and PubMed electronic bibliographic databases were searched for studies evaluating baseline patient characteristics associated with outcomes in prospective longitudinal cohorts or after specific interventions.

Ultrasound Measurement of Local Deformation in the Human Free Achilles Tendon Produced by Dynamic Muscle-Induced Loading: A Systematic Review.

Achilles tendinopathy is the most prevalent lower limb tendinopathy, yet it remains poorly understood, with mismatches between observed structure and reported function. Recent studies have hypothesised that Achilles tendon (AT) healthy function is associated with variable deformation across the tendon width during use, focusing on quantifying sub-tendon deformation. Here, the aim of this work was to synthesise recent advances exploring human free AT tissue-level deformation during use.

Self-reported bio-psycho-social factors partially distinguish patellar tendinopathy from other knee problems and explain patellar tendinopathy severity in jumping athletes: A case-control study.

Objective: To determine what combinations of self-reported factors distinguish patellar tendinopathy (PT) from other knee problems, and explain PT severity variance.

Design: Case-control study.

Setting: Social media, private practice and National Health Service.