Research Canada

Data are available upon reasonable request to the corresponding author.

BackgroundThe digital health research field is growing rapidly, and a summary of the available digital tools for triaging musculoskeletal conditions is needed. Effective and safe digital triage tools for musculoskeletal conditions could support patients and clinicians in making informed care decisions and may contribute to reducing emergency department overcrowding and health care costs.ObjectiveThe aim of the study is to identify and describe digital health tools for use by adults to triage musculoskeletal conditions across primary, urgent, or emergency care settings.MethodsOur scoping review was conducted following the Johanna Briggs Institute recommendations for scoping reviews and Arksey and O’Malley’s framework. Systematic searches in MEDLINE (OVID), Embase (OVID), CENTRAL (OVID), CINAHL (EBSCO), Compendex, Web of Science, OpenGrey, Google Scholar, arXiv, medRxiv, and an extensive gray literature search were conducted with a librarian scientist from inception to September 18, 2025. Studies had to recruit adults (aged 18 years and older) with musculoskeletal conditions that identified a digital health tool designed to triage or diagnose in primary, urgent, or emergency care settings and report primary data to be included. In total, 2 reviewer pairs independently screened abstracts and full-text papers. Relevant data were extracted in duplicate, and results were summarized descriptively.ResultsThe search yielded 5695 records, and we screened 189 full-text papers. In total, 34 studies (n=37,509 patients) met the inclusion criteria. The most common musculoskeletal conditions reported were rheumatoid or inflammatory arthritis (13/34, 38%). In total, 19 (19/34, 56%) studies reported on symptom checkers, 13 (13/34, 38%) studies on triage or diagnosis tools, and 2 (2/34, 6%) were studies of diagnostic predictor tools. There were 16 unique digital health tools. A total of 2 tools were built for triaging musculoskeletal conditions and were not publicly available outside the UK National Health Service. Most tools were generic tools designed to screen for general health problems, including musculoskeletal conditions. The most common approach to evaluating performance (eg, accuracy) of the tools was to compare the concordance of the tool to a clinician diagnosis or triage recommendation. Sensitivity and specificity ranged from 39% to 91% and 23% to 80%, respectively. The reported accuracy of the included tools ranged from 33% to 98%.ConclusionsMusculoskeletal conditions remain a blind spot for people designing, implementing, and evaluating digital health for triage: few tools were specifically designed for musculoskeletal conditions, and most existing tools performed poorly when applied to musculoskeletal populations. We recommend health systems and clinicians use a multimodal approach, integrating both digital health tools and clinical decision-making to safely triage and diagnose until a more robust tool for musculoskeletal conditions is available. Future tool developers need to use transparent, standardized processes that prioritize tool safety, clinical value, and trustworthiness when designing for clinicians and patients.

IntroductionThis study investigated whether playing two or more matches less than 72 hours apart was associated with an increase in young handball players' knee injury rates the following week compared with playing one or no matches.Materials and Methods 731 Danish handball players aged 11-17 years (47% boys) reported weekly on handball exposure (match and training hours) and any new handball related knee injury over 30 weeks using the Oslo Sports Trauma Research Center Health 2 questionnaire.Match congestion was categorized as: (Low) 1 match (reference group) or (High) 2 matches played within 72 hours, based on data from the Danish Handball database.Cox proportion hazard models were used to estimate (HRs) and 95% confidence intervals (95% CI) using calendar week as time scale and adjusting for weekly handball exposure, team gender, and previous knee injury.Results 157 new knee injuries were reported in the weeks following 20.285 matches.Of these matches, 2.193 matches were played within a 72-hour interval.In the high congestion group, 24 new knee injuries occurred.High match congestion was associated with a 71% higher knee injury rate (HR=1.71[95% CI; 1.23-2.40])compared with those in the low congestion group with a longer recovery period between matches.Conclusion Playing two or more matches within a 72-hour period increases the new knee injury rate the following week in young handball players.This suggests handball matches to be scheduled at least 72 hours apart to reduce knee injury risk in young players.

Female, woman and/or girl athletes’ sport participation rates are rising and associated with high injury rates and burden. Using best-practice consensus methodology, we developed recommendations to guide injury prevention for female/woman/girl athletes. The Female/woman/girl Athlete Injury pRevention (FAIR) International Olympic Committee Consensus meeting was held from 31 March to 2 April 2025 (Lausanne, Switzerland).The FAIR Consensus followed an eight-step hybrid method. 109 authors from six continents conducted: (1) systematic reviews synthesising evidence on injury prevention strategies and modifiable risk factors for lower-extremity and upper-extremity injuries, concussions and spine/chest/abdominal/pelvic injuries/pain, (2) a scoping review synthesising dissemination and implementation (D&I) approaches; and (3) a concept mapping project generating knowledge on gender/sex-related factors for injury prevention. These projects underpinned draft recommendations subsequently voted on by a steering committee (n=24) and an external advisory committee chair over two anonymous survey rounds. Recommendations, Round 1 voting results and suggestions/dissenting comments were discussed between Round 1 and 2 voting. Consensus was defined as ‘critical to include’ (≥70% scored recommendation as 7–9 (9-point Likert scale, 1=not important; 9=critically important) AND ≤15% scored recommendation as 1–3).The 56 FAIR recommendations address: primary injury prevention (n=16) (policy/rules/laws=6; personal protective equipment=8; training=2); secondary injury prevention (n=4); modifiable risk factors (n=12); approaches to D&I (n=14); and promoting gender/sex-supportive environments (n=10).The FAIR Consensus informs evidence-based best practices and policy for injury prevention, approaches to implementation and creation of supportive environments for female/woman/girl athletes. Every person at all levels of sport can, and should, take responsibility for actions that positively influence female/woman/girl athlete health and safety.

ObjectiveTo determine the most important barriers, facilitators and resources identified by rheumatology healthcare providers (HCPs) to supporting physical activity (PA) among individuals with rheumatoid arthritis (RA).MethodsNominal group technique (NGT) sessions were conducted with rheumatology HCPs following a structured process of idea generation, discussion and independent rating. Determinants and resources were grouped into themes and mapped to the Behaviour Change Wheel.ResultsA total of 14 rheumatology HCPs participated in four NGT sessions. RA HCPs identified 14 facilitators and 14 barriers to PA promotion, along with 12 helpful resources and 13 additional resource needs. The most important facilitators were patient-centred PA discussions, reassurance around movement safety and delegating PA counselling to exercise professionals. Key barriers included limited time, patient information overload and ineffective handouts. Six overarching themes were emphasised after grouping and theoretical mapping: patient–provider conversations, interdisciplinary teamwork, counselling skills, monitoring and feedback, time and capacity and resource quality. The six categories of key resources were tailored programmes, educational handouts, referral tools, exercise professionals, online tools and professional development.ConclusionThis study identified key barriers and facilitators influencing how rheumatology HCPs support PA among RA patients, highlighting the importance of tailored discussions, interdisciplinary teamwork, counselling skills and supportive resources. HCPs emphasised the need for high-quality, RA-specific resources such as allied health networks and RA-specific programmes. Theoretical mapping pinpointed targets within capability, opportunity and motivation to enhance PA promotion. Ongoing work is underway to codevelop evidence-based tools addressing these determinants to improve PA support for individuals with RA.

<bold>Background:</bold> Repeated exacerbations can accelerate the progression of COPD. Dupilumab is a human monoclonal antibody that blocks signaling of interleukin-4/13, key and central drivers in type 2 inflammation. In BOREAS and NOTUS, dupilumab reduced exacerbations and improved lung function in patients with COPD and type 2 inflammation. Safety was consistent with the known dupilumab safety profile. However, the impact of dupilumab on recurrent exacerbations is still unknown. <bold>Aims & objectives:</bold> To examine the association between dupilumab and recurrent moderate or severe exacerbations within 30 days of the first exacerbation in patients with COPD. <bold>Methods:</bold> Patients from BOREAS (<ext-link>NCT03930732</ext-link>) and NOTUS (<ext-link>NCT04456673</ext-link>) with COPD, moderate-to-severe airflow limitation, and type 2 inflammation (screening blood eosinophils ≥300 cells/µL) on triple therapy, received add-on dupilumab 300 mg q2w or placebo for 52 weeks. The frequency of repeat exacerbation within 30 days of the end of the index exacerbation was assessed in the pooled intention-to-treat population subgroup who experienced ≥2 exacerbations. <bold>Results:</bold> Of the patients receiving dupilumab who experienced ≥2 exacerbations (n=132), 16 (12.1%) had repeated moderate (15 [11.4%]) or severe (1 [0.8%]) exacerbations within 30 days of the end of the first exacerbation. Of the patients receiving placebo who had ≥2 exacerbations (n=190), 33 (17.4%) experienced repeated moderate (30 [15.8%]) or severe (3 [1.6%]) exacerbations within 30 days. <bold>Conclusion:</bold> Dupilumab reduced the number of recurrent moderate or severe exacerbations within 30 days in patients with COPD and type 2 inflammation with ≥2 exacerbations.

Examine potentially modifiable risk factors (MRFs) for female/woman/girl athletes' lower-extremity injuries. Systematic review with meta- or semiquantitative analyses and Grading of Recommendations, Assessment, Development and Evaluation. MEDLINE, CINAHL, APA PsycINFO, Cochrane Systematic Review Database, CENTRAL, SPORTDiscus, EMBASE, ERIC searched 30 October or 23 November 2023. Primary data studies with comparison group(s) assessing the association of MRFs for sport-related lower-extremity injury(s) with ≥1 female/woman/girl per study group. Across 195 studies (n=115; 58.9% female/woman/girl-specific estimates) including 1 525 662 participants (2.4% females/women/girls), eight injury outcomes were assessed (n=75 general lower-extremity, n=3 groin, n=6 hip, n=17 thigh, n=88 knee, n=17 lower-leg, n=27 ankle, n=9 foot). Sixty-six MRF categories were identified. Substantial heterogeneity in MRFs and injury outcomes exists, with high risk of bias present in 37.4% of studies. Considering female/woman/girl specific estimates, we performed meta-analyses for 10 MRFs (body mass, x (BMI), weekly training distance, muscle strength, artificial turf, off-season plyometric training, readiness to return-to-sport, single-leg hop asymmetry, vertical drop jump peak knee flexion angle and ground reaction force) and semiquantitative analyses for 26 MRFs for a variety of injuries. Meta-analyses suggest no association between any lower-extremity strength outcome (g=0.01, 95% CI -0.11 to 0.14; I2=37.3%; very low certainty evidence) or artificial turf (Incidence Rate Ratio=0.97, 95% CI 0.88 to 1.07; I2=2.4%; low certainty evidence) and various lower-extremity injuries. Higher body mass (g=0.19, 95% CI 0.00 to 0.38; I2=71.7%) and/or BMI (g=0.22, 95% CI 0.09 to 0.36; I2=37.0%) are associated with several lower-extremity injuries (very low certainty evidence). This review synthesises a large body of exploratory research, exposes important knowledge gaps and provides a foundation for understanding MRFs for female/woman/girl athlete lower-extremity injuries. PROSPERO CRD42024486715.

The field of rheumatoid arthritis (RA) is moving towards identification of and intervention in people at risk of RA, but a validated risk stratification method is lacking. This work was undertaken to develop a risk stratification method for persons presenting with arthralgia considered to be at risk of RA. A joint European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) expert committee was established. Risk factor and outcome data from 10 arthralgia cohorts (including clinically suspect arthralgia and autoantibody-positive arthralgia) were studied. The work focused on differentiating the risk of progression to clinically apparent inflammatory arthritis (IA) within 1 year, using clinical and serologic variables, without and with subclinical joint inflammation detected by ultrasound (US) or magnetic resonance imaging (MRI). Developing RA according to the 2010 EULAR/ACR criteria within 1 year was a secondary outcome. A set of validated risk stratification criteria was developed. Using data from 2293 symptomatic at-risk individuals, a stratification method was derived consisting of 6 clinical and serologic variables (morning stiffness, patient-reported joint swelling, difficulty making a fist, C-reactive protein, rheumatoid factor, and anti-citrullinated peptide antibody) yielding an area under the curve (AUC) of 0.80 (95% CI, 0.77-0.83) for IA development. The inclusion of US variables did not increase the discriminative ability. When MRI-detected subclinical inflammation variables were included, the AUC was 0.87 (95% CI, 0.82-0.90). In the presence of clinical, serologic, and MRI variables, a sensitivity and specificity of >75% was achieved. For RA development, the AUC of the criteria with MRI was 0.93 (95% CI, 0.90-0.97). EULAR/ACR risk stratification criteria have been developed for people with arthralgia in secondary care who are considered at risk for RA. They can be applied in the absence or presence of imaging data and have been developed to define homogeneous risk groups for future prevention trials.