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Indoor bouldering is a popular and rapidly growing sport in which climbers fall repeatedly from walls up to 4–5 m high, making lower-limb injuries common. It is therefore essential to understand fall kinematics and impact conditions, yet fall kinematics remain poorly documented because laboratory motion capture is impractical in gyms. This study aimed to validate a markerless multi-camera pipeline (Pose2Sim) against a 2D video annotation tool (Kinovea) for displacement and velocity measurement, and against IMUs for peak acceleration. Ten teenage athletes (3 males, 7 females; 14–17 years) performed 40 falls recorded with five cameras (GoPro HERO12, USA, 2.7 K, 240 fps) and three IMUs (Blue Trident, Vicon, UK; ±200 g, 1600 Hz). Cut-off frequencies were set using Yu’s method (13 Hz for video, 39 Hz for IMUs). Pose2Sim’s results closely matched those of Kinovea for fall height and peak velocity with non-significant differences but underestimated peak acceleration. At the forehead, no significant difference was found, likely due to smaller accelerations at the head. Markerless video analysis is appropriate for studying fall kinematics and typology in indoor bouldering. IMUs remain necessary to quantify impact intensity, and future work should explore the combination of both IMUs and video to overcome this limitation.

Oblique lateral head impacts are common in motorcycle accidents and roll-over crashes. However, the neck injury mechanisms following this impact have not been thoroughly described. This work aimed to characterize the head kinematics and cervical spine injuries from oblique lateral helmeted head impacts. Five post-mortem human surrogates (3 females) were hit laterally on the head with a 37 kg impactor with an oblique plane generating a compressive load. The impact velocities were 4 m/s (3 surrogates) and 5.1 m/s (2 surrogates). The surrogates were equipped with accelerometers on the helmets, in the mouth and at the sternum. Stereography was used to follow the 3D displacements of markers on the helmet. CT-scans and dissection were performed after the impact to assess injuries. The most frequent injuries were posterior ligament ruptures (2 occurrences) and vertebral lamina fractures (2 occurrences). The head maximal accelerations were between 13 and 51 g, and the peak impact forces ranged from 1800 to 5600 N. The head maximal lateral bending was around 30 degrees (4 m/s) or 50 degrees (5.1 m/s). While the measured lateral rotations were under the physiological threshold, they were sufficient to cause injuries at the tested impact energy level. This suggests that the dynamic aspect of the impact and the combination of compression and lateral bending delivered by the oblique impactor are essential in the injury mechanism. This novel data will be determinant in understanding cervical spine injuries and improving the behavior of human body models.

Background: Syndesmotic injuries have a higher prevalence in athletes and can present long-term complications particularly in pediatric population. Early diagnosis is necessary and can be done using various modalities, but, they either present poor sensitivity, poor clinical feasibility or are exclusively static. Ultrasound (US) could compensate for those drawbacks. Hypothesis/Purpose: The aim of this study was to determine (1) the benefit of direct visualization of the anterior-inferior tibiofibular ligament (AiTFL) and (2) tibiofibular clear space (TFCS) cut-off points regarding the integrity of the syndesmotic ligaments using US imaging. Methods: A prospective cohort study including all suspected syndesmotic injury in a pediatric population was done. Participants had both ankles assessed with US imaging for description of AiTFL integrity as our static assessment and for TFCS measures as our dynamic evaluation. For dynamic assessment, the distance between the distal tibia and fibula was first measure in neutral position then in external rotation for each ankle. This providing a total of five different TFCS combinations for receiver operating characteristics (ROC) curves analysis. Afterward, the syndesmotic ligament complex and deltoid ligament of the injured ankle were examined using MRI as the gold standard. Results: A total of 26 participants with suspected syndesmotic injuries were included. Mean age was 14.8 years (SD = 1.3 years). Mean time between trauma and US imaging was 56 days (SD = 43.9 days). Sensitivity and specificity of direct visualization of the AiTFL were respectively 0.79 and 1.00 with four false negative tests only found on partial tears. Only two TFCS combinations had an area under the curve (AUC) greater than 0.7 and were then considered for further analysis. The two combinations were the TFCS difference between the injured and uninjured ankle in neutral position (TFCS N I-U) and external rotation (TFCS ER I-U). Cut-off points were ranging from 0.23 mm to 0.37 mm for TFCS N I-U and from 0.11 mm to 0. 30 mm for TFCS ER I-U using ROC curve analysis. Conclusion: US imaging does bring an added value as a screening tool for direct visualization of the AiTFL in pediatric patients by having a good sensitivity, an excellent specificity, a low cost and being easily accessible. The complementary use of dynamic evaluation using TFCS measures could also identify dynamic instability. Cut-off points determined in this study had good sensitivity and specificity but, by being under one millimeter, further studies using dynamic US imaging are needed.

Doc number: 17 Abstract Background: Routine screening of scoliosis is a controversial subject and screening efforts vary greatly around the world. Methods: Consensus was sought among an international group of experts (seven spine surgeons and one clinical epidemiologist) using a modified Delphi approach. The consensus achieved was based on careful analysis of a recent critical review of the literature on scoliosis screening, performed using a conceptual framework of analysis focusing on five main dimensions: technical, clinical, program, cost and treatment effectiveness. Findings: A consensus was obtained in all five dimensions of analysis, resulting in 10 statements and recommendations. In summary, there is scientific evidence to support the value of scoliosis screening with respect to technical efficacy, clinical, program and treatment effectiveness, but there insufficient evidence to make a statement with respect to cost effectiveness. Scoliosis screening should be aimed at identifying suspected cases of scoliosis that will be referred for diagnostic evaluation and confirmed, or ruled out, with a clinically significant scoliosis. The scoliometer is currently the best tool available for scoliosis screening and there is moderate evidence to recommend referral with values between 5 degrees and 7 degrees. There is moderate evidence that scoliosis screening allows for detection and referral of patients at an earlier stage of the clinical course, and there is low evidence suggesting that scoliosis patients detected by screening are less likely to need surgery than those who did not have screening. There is strong evidence to support treatment by bracing. Interpretation: This information statement by an expert panel supports scoliosis screening in 4 of the 5 domains studied, using a framework of analysis which includes all of the World Health Organisation criteria for a valid screening procedure.

Accurately predicting functional recovery is an asset for all clinicians and decision makers involved in the care of patients with acute traumatic spinal cord injury (TSCI). Unfortunately, there is a lack of information on the relative importance of significant predictors of global functional outcome. There is also a need for identifying functional predictors that can be timely optimized by the medical and rehabilitation teams throughout the hospitalizations phases. The main objective of this work was to systematically review and rate early factors that are consistently and independently associated with global functional outcome in individuals with TSCI. A literature search using MEDLINE, EMBASE, and Cochrane databases from January 1, 1970 to April 1, 2017 was performed. Two authors independently reviewed the titles and abstracts yielded by this literature search and subsequently selected studies to be included based on predetermined eligibility criteria. Disagreements were resolved by a consensus-based discussion, and if not, by an external reviewer. Data were extracted by three independent reviewers using a standardized table. The quality of evidence of the individual studies was assessed based on the Oxford Center for Evidence-Based Medicine modified by Wright and colleagues (2000) as well as the National Institutes of Health (2014). Fifteen articles identifying early clinical predictors of functional outcome using multiple regression analyses were included in this systematic review. Based on the compiled data, this review proposes a rating of early factors associated to global functional outcome according to their importance and their potential to be modified by the medical/rehabilitation team throughout the early phases of hospitalization. It also proposes a new conceptual framework that illustrates the impact of specific categories of factors and their interaction with each other. Ultimately, this review aims to guide clinicians and researchers in improving the continuum of care throughout early phases post-SCI.

Adolescent Idiopathic Scoliosis (AIS) is the most common orthopedic condition requiring surgery, affecting 4% of adolescents. There is currently no proven method or prognostic test to identify symptomatic patients at risk of developing severe scoliosis who could benefit from growth-guided devices or minimally invasive non-fusion instrumentation surgeries. These innovative treatments must be performed at an early disease stage in younger patients to benefit from their growth potential. In this prospective cross-sectional study, we investigated the clinical utility of circulating microRNAs (miRNAs), an important class of small non-coding RNA, as biomarkers to predict the risk of developing severe scoliosis in AIS. Blood samples and clinical data were collected from 116 AIS patients who were followed until skeletal maturity and stratified according to their clinical outcome. Genome-wide expression profiling of miRNAs was performed with plasma obtained at the time of diagnosis of AIS (mean age of 13.3 ± 1.7 years with a mean Cobb angle of 24.4° ± 12.4°). This approach led to the identification of 15 circulating miRNAs that are upregulated in AIS patients who developed a severe scoliosis (Cobb angle ≥ 45°) at skeletal maturity compared to moderate and mild scoliosis groups (Cobb angle between 25°-44° and < 25° respectively). After optimization and the application of Random Forest Models a panel of six miRNAs (miR-1-3p, miR-19a-3p, miR-19b-3p, miR-133b, miR-143-3p, and miR-148b-3p) out of 15 led us to develop an algorithm predicting the risk of developing a severe scoliosis with great accuracy (100%), sensitivity (100%) and specificity (100%). Having a scoliosis predictive bioassay and decision-making tools to predict curve progression in order to find the best treatment plan will undoubtedly transform the orthopedic care system in the field of pediatric scoliosis by integrating innovative precision medicine approaches. In addition, investigation of genes targeted by these miRNAs could fill our gaps in our understanding of AIS pathogenesis and reveal new actionable targets.

Purpose Brace treatment for adolescent idiopathic scoliosis is recognized as effective if the brace is worn as prescribed (20 to 23 hrs/day). Because of its negative biopsychosocial impact on adolescent patients’ quality of life, brace adherence is a common problem (average bracewear of 12 hrs/day). The purpose of this paper is to develop an interprofessional support intervention model to enhance brace adherence in adolescents with scoliosis. Methods We enrolled 9 health professionals working with braced patients to participate in individual interviews. Interview guides were built following the Information-Motivation-Strategy Model (DiMatteo et al., Health Psychol Rev 6:74-91, 2012) and the Interprofessional Care Competency Framework (Education UoTCfI, Toronto Acad Health Sci Network, 2017). Thematic analysis was performed to identify the most relevant concepts for designing the intervention model. A panel of 5 clinical experts was recruited to review and validate the intervention model. Results Participants suggested educational, motivational, functional, psychological and interprofessional teamwork strategies to improve the support provided to patients and parents and potentially increase brace adherence. Using the emerging themes and their relationships, we designed an Interprofessional Adherence Support (IPAS) intervention model that identifies the actors, activities, structure and intended impacts of the intervention. According to the expert panel, the IPAS model is highly relevant to respond to the brace adherence problem and has potential for implementation in practice. Conclusion We designed an interprofessional support intervention model based on professional perspectives in response to the brace adherence problem in adolescents with scoliosis. Plans for implementation of the IPAS model at our scoliosis clinic are under development and considered essential for improving brace treatment outcomes.

Low back pain is the leading contributor to disability worldwide and a major cause of primary care visits. Alternative models of care delivery drawing on musculoskeletal experts’ skills and knowledge have received increasing attention for their potential ability to improve timely access to appropriate healthcare for patients with musculoskeletal disorders. The aim of this study was to evaluate diagnostic and management concordance between chiropractors, known as musculoskeletal experts, and neurosurgeons for patients with low back pain. Before being seen by a neurosurgeon, 101 eligible participants (mean age: 60.32 years) were evaluated by a chiropractor. Overall diagnostic agreement between chiropractors and neurosurgeons was 74.7%, with a moderate inter-rater diagnosis agreement (κ = 0.51; 95%CI [0.35–0.68]). Chiropractors were significantly less likely to attribute a diagnosis of non-specific LBP to participants (31.6%) compared to neurosurgeons (43.2%) ( p  = 0.02), with an agreement proportion of 80.0%. Overall management agreement was 82.0%, indicating that chiropractors possess good skills in triaging patients with low back pain, which can optimize patient trajectories by accelerating management of non-surgical cases and reducing waiting lists for spine surgery consultations. Prospective studies are needed to evaluate the impact of a chiropractor-informed triage on clinical outcomes and healthcare utilization for patients with low back pain.

Objective Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities. Methods We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted. Results Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy (n = 11), occupational therapy (n = 2), prosthetics (n = 1), exercise physiology (n = 1) and multidisciplinary (n = 4) services. The methodological quality varied (n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services. Conclusions This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.