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In 2010, the World Health Organization released benchmarks for training in osteopathy in which they considered cranial osteopathy as an important osteopathic skill. However, the evidence supporting the reliability of diagnosis and the efficacy of treatment in this field appears scientifically weak and inconsistent. To identify and critically evaluate the scientific literature dealing with the reliability of diagnosis and the clinical efficacy of techniques and therapeutic strategies used in cranial osteopathy. Relevant keywords were used to search the electronic databases MEDLINE, PEDro, OSTMED.DR, Cochrane Library, and in Google Scholar, Journal of American Osteopathy Association and International Journal of Osteopathic Medicine websites. Searches were conducted up to end June 2016 with no date restriction as to when the studies were completed. As a complementary approach we explored the bibliography of included articles and consulted available previous reviews dealing with this topic. Regarding diagnostic processes in cranial osteopathy, we analyzed studies that compared the results obtained by at least two examiners or by the same examiner on at least two occasions. For efficacy studies, only randomized-controlled-trials or crossover-studies were eligible. We excluded articles that were not in English or French, and for which the full-text version was not openly available. We also excluded studies with unsuitable study design, in which there was no clear indication of the use of techniques or therapeutic strategies concerning the cranial field, looked at combined treatments, used a non-human examiner and subjects or used healthy subjects for efficacy studies. There was no restriction regarding the type of disease. In our electronic search we found 1280 references concerning reliability of diagnosis studies plus four references via our complementary strategy. Based on the title 18 articles were selected for analysis. Nine were retained after applying our exclusion criteria. Regarding efficacy, we extracted 556 references from the databases plus 14 references through our complementary strategy. Based on the title 46 articles were selected. Thirty two articles were not retained on the grounds of our exclusion criteria. Risk of bias in reliability studies was assessed using a modified version of the quality appraisal tool for studies of diagnostic reliability. The methodological quality of the efficacy studies was assessed using the Cochrane risk of bias tool. Two screeners conducted these analyses. For reliability studies, our analysis leads us to conclude that the diagnostic procedures used in cranial osteopathy are unreliable in many ways. For efficacy studies, the Cochrane risk of bias tool we used shows that 2 studies had a high risk of bias, 9 were rated as having major doubt regarding risk of bias and 3 had a low risk of bias. In the 3 studies with a low risk of bias alternative interpretations of the results, such as a non-specific effect of treatment, were not considered. Our results demonstrate, consistently with those of previous reviews, that methodologically strong evidence on the reliability of diagnostic procedures and the efficacy of techniques and therapeutic strategies in cranial osteopathy is almost non-existent.

Background The Script Concordance Test (SCT) is an assessment tool for clinical reasoning that incorporates uncertainty and depends on expert judgment to identify valid responses. Accurate calibration of expert judgment is important for maintaining validity and reliability; however, the literature has rarely addressed this issue and only through statistical methods. This study aimed to compare calibration strategies using statistical moderation and qualitative inspection. Methods Sixteen experts ( n  = 16) were recruited to complete 21 clinical vignettes, providing justification for each response. Seven calibration strategies—quantitative, qualitative, and mixed—were then analyzed using the Rasch Facet Model, with particular attention to expert homogeneity, data–model fit, and the quality of expert responses. Results None of the strategies improved expert homogeneity. However, mixed strategies enhanced data–model fit and response quality, and helped address issues related to response process and content validity. Conclusions Calibrating expert judgment using a mixed strategy appears valuable for improving the quality of expert-generated data within an SCT framework. This calibration may address specific psychometric limitations of SCTs and enhance training quality through Learning by Concordance methods.

Contextual factor use by healthcare professionals has been studied mainly among nurses and physiotherapists. Preliminary results show that healthcare professionals use contextual factors without specifically labelling them as such. The main objective of this study was to evaluate knowledge and explore voluntary contextual factor use among various healthcare professions. The results aim to facilitate hypothesis-generation, to better position further research to explain and characterise contextual factor use. We conducted a web-based questionnaire cross-sectional observational study on a non-probabilistic convenience sample. Face and content validity were tested through cognitive interviews. Data were analysed descriptively. The target population was the main healthcare profession, or final year students, defined by the French public health law. The countries of distribution of the questionnaire were the French-speaking European countries. Among our 1236 participants, use of contextual factors was widespread. Those relating to the therapeutic relationship (e.g., communication) and patient characteristics (e.g., past experiences) were reportedly the most used. Meanwhile, contextual factors related to the healthcare providers’ characteristics and their own beliefs were reported as less used. Despite high variability, respondents suggested contextual effects contribute to approximately half of the overall effect in healthcare and were perceived as more effective on children and elderly adults. Conceptual variations that exist in the literature are also present in the way healthcare providers consider contextual effects. Interestingly, there seems to be common ground between how physiotherapists, nurses and physicians use different contextual factors. Finally, in the present study we also observed that while there are similarities across usage, there is lack of both an epistemological and ethical consensus among healthcare providers with respect to contextual factors.

Background Physical inactivity and sedentary behaviours (PiA/SED) are among the major modifiable risk factors for chronic diseases. Behaviour change models for PA can shape personalised interventions leading to sustainable lifestyle changes. We hypothesise that screening for PiA/SED by a general practitioner, followed by a personalised intervention by a physiotherapist, could reduce PiA/SED in inactive adults. Methods We designed a prospective, multicentre, cluster-randomised, controlled, step-wedge study. Adult patients without chronic illnesses will be recruited in 8 multi-professional health centres. They will receive educational content on PiA/SED. During the intervention periods, patients will see a physiotherapist for a functional assessment, and an intervention aimed at improving PiA/SED using a serious game. Two follow-up appointments at months 2 and 4 (M2-4) are planned to maintain patient motivation. At M6, a 7-day actimetry will be performed, and at M6-12, questionnaires and semi-structured interviews will close the study. Two primary endpoints will be analysed using a pre-specified hierarchical sequential analysis: the proportion of patients changing PiA/SED at M6. Secondary objectives include: 1-describing changes in PiA/SED at M6 and M12, 2-exploring the link between patient characteristics and changes in PiA/SED, 3-describing participants’ quality of motivation, satisfaction of basic psychological needs, feelings of self-efficacy, perceived levels of vitality and energy, and self-esteem, 4-describing the strategies, barriers and facilitators of behavioural changes, 5-studying the correlation between questionnaires measuring physical activity and actimetry, 6-identifying the perceived barriers and facilitators to implement this care pathway. Assuming that 10% of patients in the control period will improve their PA and that the intervention will increase it by 20%, 160 patients provides 82% power to observe a significant difference. Discussion This design will harmonise the skills of all professionals in the field of motivational support for PiA/SED and providing information about the risks associated with PiA/SED. Patients in the intervention group will also receive individual support for behaviour changes related to PiA/SED. Considering public health, this study will contribute to increase primary prevention by healthcare professionals. Finally, this study will assess the effectiveness, adherence, satisfaction of the stakeholders involved in this pathway allowing to consider its implementation in routine primary care. SPIRIT 2025 checklist of items see supplement files. Trial registration ClinicalTrials n° NCT06678906, https://clinconnect.io/trials/NCT06678906#about-company-tab , first registration October 14, 2024, Trial updated February 05, 2025.

Background and Objectives: The relevance of red flags in serious spinal pathology (SSP) has evolved throughout the last years. Recently, new considerations have been proposed to expand the consideration of red flags. The purpose of this study was to determine, approve and test a model for the triage and management process of SSPs based on the latest data available in the literature. Materials and Methods: The SSP model was initially built on the basis of a literature review. The model was further determined and approved by an expert panel using a Delphi process. Finally, clinical scenarios were used to test the applicability of the model. Results: After three rounds of the Delphi process, panellists reached a consensus on a final version of the model. The use of clinical scenarios by experts brought about reflexive elements both for the determined model and for the SSPs depicted in the clinical cases. Conclusions: The validation of the model and its implementation in the clinical field could help assess the skills of first-line practitioners managing spinal pain patients. To this end, the development of additional clinical scenarios fitting the determined model should be further considered.

Background A new model of care enables French physiotherapists (PT) working in collaboration with family physicians (FP) to expand their usual scope of practice for patients with acute low back pain (LBP). The aim of our study is to evaluate the impact of this new first-contact physiotherapy (FCP) advanced practice model compared to usual FP care. Methods A multicentre pragmatic non-inferiority cluster randomised controlled trial (RCT) has been conducted in six multidisciplinary primary healthcare centres in France. Patients from 20 to 55 years old with acute LBP consulted either the PT or the FP. PT independently assessed and managed patients including medication prescription. The primary outcome measure was disability at six weeks (Roland Morris Disability Questionnaire, range 0–24). Secondary outcomes include pain, risk disability prognosis, satisfaction with care, healthcare resources use and wait times. Data were collected at baseline, six and twelve weeks. Outcomes across arms were compared using mixed models regression analysis. Except for non-inferiority analysis of the primary outcome measure, other analyses were performed with a two-sided significance level of 0.05. Results Sixty patients were recruited (PT: 32, FP: 28). The adjusted mean difference between groups for disability at 6 weeks was 0.39 in favour of the FP group (95%CI: -2.03; 2.81, p  = 0.753). Considering a 5 points minimal clinically important difference, the FCP-led model of care was not inferior to usual FP care for the primary outcome. There was no statistically significant difference between groups in disability at 3 months and pain at 6 weeks and 3 months. PTs prescribed significantly less medications than FPs ( p  < 0.001). No statistically significant difference was found for other healthcare resource use outcomes, patients’ satisfaction and wait times. Conclusion This is the first RCT to evaluate the impact of a FCP advanced practice model of care including medical delegated acts in a primary care setting. Our results suggest that the FCP-led model of care is not inferior to usual FP care regarding disability at 6 weeks. The FCP model could result in possible benefits in terms of healthcare resources use. Further adequate powered studies with larger sample size are needed to draw stronger conclusions. Trial registration The study has been registered in ClinicalTrials.gov (NCT05200533) on the 20th of January 2022.

Access to care for patients with musculoskeletal disorders (MSKDs) remains a significant challenge. Telehealth has emerged as a promising solution to improve access to care. However, conducting initial evaluations of MSKDs remotely raises concerns about patient safety and clinical efficacy due to the necessary adaptations required for a clinical examination and the challenges of obtaining an accurate and reliable diagnosis. We aim to explore the use of telehealth for the initial evaluation of MSKDs in the province of Quebec, Canada. Through semistructured interviews with selected patients, health care providers, and other key stakeholders involved in telehealth, this study aims to provide a comprehensive and detailed understanding of its application, benefits, and challenges. Semistructured interviews were conducted in the province of Quebec with patients, clinicians, telehealth software specialists, and professional bodies' representatives. Five tailored interview guides were developed using the Consolidated Framework of Implementation Research and the Framework of Mathieu-Fritz and Esterle for the study of telehealth interventions. The themes explored included participants' prior experiences with telehealth, perceived strengths and limitations of telehealth, particularly regarding the initial evaluation and diagnosis of new patients, and the current global environment of telehealth use. All interviews were transcribed verbatim, and a reflexive thematic analysis was performed using the Mathieu-Fritz Framework. Thirty-eight participants, including patients (n=11), health care providers (family physicians and musculoskeletal medical specialists: n=11; and physiotherapy professionals: n=10), telehealth software specialists (n=2), and representatives from professional bodies (n=4), shared their perspectives on telehealth for the initial evaluation of MSKDs. Five key themes emerged: (1) several participants viewed telehealth, including remote evaluations, as a solution to improve access to care; (2) patients and health care providers reported that a remote evaluation was more appropriate for simpler MSKD presentations; (3) some health care providers expressed concerns about the potential for an increase in diagnostic errors and the challenges of performing all usual components of a standard MSKD physical examination remotely; (4) patients expressed doubts about their ability to effectively perform certain tasks or tests on themselves; and (5) broader challenges were also highlighted by all participants, such as the impact on the patient-clinician relationship, access to appropriate hardware, digital literacy, and confidentiality concerns. Telehealth is seen as a valuable solution to improve access to care for patients with MSKDs, especially for simpler cases or urgent needs. However, remote physical examination poses challenges associated with concerns about diagnostic accuracy and limited remote physical examination procedures and components. Effective implementation will likely require more evidence-based guidelines, provider training on remote techniques and strategies to maintain patient-provider relationships. Addressing access to technology, digital literacy, and privacy concerns is also essential to ensure equitable adoption and to optimize telehealth in musculoskeletal care.

The present study focused on the effects of trunk extensor muscles fatigue on postural control during quiet standing under different somatosensory conditions from the foot and the ankle. With this aim, 20 young healthy adults were asked to stand as immobile as possible in two conditions of No fatigue and Fatigue of trunk extensor muscles. In Experiment 1 (n = 10), somatosensation from the foot and the ankle was degraded by standing on a foam surface. In Experiment 2 (n = 10), somatosensation from the foot and ankle was facilitated through the increased cutaneous feedback at the foot and ankle provided by strips of athletic tape applied across both ankle joints. The centre of foot pressure displacements (CoP) were recorded using a force platform. The results showed that (1) trunk extensor muscles fatigue increased CoP displacements under normal somatosensatory conditions (Experiment 1 and Experiment 2), (2) this destabilizing effect was exacerbated when somatosensation from the foot and the ankle was degraded (Experiment 1), and (3) this destabilizing effect was mitigated when somatosensation from the foot and the ankle was facilitated (Experiment 2). Altogether, the present findings evidenced re-weighting of sensory cues for controlling posture during quiet standing following trunk extensor muscles fatigue by increasing the reliance on the somatosensory inputs from the foot and the ankle. This could have implications in clinical and rehabilitative areas.

The aim of the present study was to assess the effects of plantar–flexor muscle fatigue on postural control during quiet standing under normal, altered and improved vestibular and neck somatosensory conditions. To address this objective, young male university students were asked to stand upright as still as possible with their eyes closed in two conditions of No Fatigue and Fatigue of the plantar–flexor muscles. In Experiment 1 ( n  = 15), the postural task was executed in two postures: Neutral head and Head tilted-backward postures, recognized to degrade vestibular and neck somatosensory information. In Experiment 2 ( n  = 15), the postural task was executed in two conditions of No tactile and Tactile stimulation of the neck provided by the application of strips of adhesive bandage to the skin over and around the neck. Centre of foot pressure displacements were recorded using a force platform. Results showed that (1) the Fatigue condition yielded increased CoP displacements relative to the No Fatigue condition (Experiment 1 and Experiment 2), (2) this destabilizing effect was more accentuated in the Head tilted-backward posture than Neutral head posture (Experiment 1) and (3) this destabilizing effect was less accentuated in the condition of Tactile stimulation than that of No tactile stimulation of the neck (Experiment 2). In the context of the multisensory control of balance, these results suggest an increased reliance on vestibular and neck somatosensory information for controlling posture during quiet standing in condition of altered ankle neuromuscular function.

ObjectivesThe rising prevalence of musculoskeletal disorders increases pressure on primary care services. In France, patients with musculoskeletal disorders are referred to physiotherapist (PT) by family physician (FP). To improve access to musculoskeletal care, a new model of task sharing and shifting is implemented between FPs and PTs for patients with acute low back pain. This new model enables French PTs to expand their usual scope of practice by receiving patients as first-contact practitioner, diagnosing low back pain, prescribing sick leave and analgesic medication. The aim of this study is to investigate the acceptability of FPs and PTs regarding this new model.DesignA cross-sectional survey design was used. Acceptability was measured using a questionnaire on the perception of the model and the perception of PTs’ skills to manage low back pain. Descriptive analyses were performed to compare results among participants.SettingFrench FPs and PTs working in multidisciplinary primary healthcare centres were invited to complete an online survey.ParticipantsA total of 174 respondents completed the survey (81 FPs and 85 PTs).ResultsA majority of participants had a positive perception of the task sharing and shifting model. A majority of the participants were mostly or totally favourable towards the implementation of the model (FPs: n=46, 82% and PTs: n=40, 82%). The perceived level of competencies of PTs to manage acute low back pain was high. The confidence level of FPs was higher than that of PTs regarding PTs’ ability to adequately diagnose low back pain, refer patient to physiotherapy and prescribe sick leave or analgesic medication.ConclusionBased on this limited sample of participants, there appears to be good acceptability of the task sharing and shifting model for acute low back pain. Additional studies are needed to better determine the factors affecting the acceptability of such a model.