Karen McCreesh

Background: Management of a degenerative meniscal tear (DMT) or symptoms consistent with early knee osteoarthritis (OA) frequently deviates from international clinical practice guidelines, which recommend education and exercise as first‐line treatments and strongly advise against arthroscopic partial meniscectomy. There is a need for implementation strategies to support the uptake of evidence‐based care. Methods: A systematic, four‐step intervention development process was used to guide development of a multi‐faceted implementation intervention targeting both individuals with a DMT or early knee OA and their general practitioners (GPs). The process integrated behavioural theory, stakeholder perspectives and evidence on intervention effectiveness. Target behaviours were identified through a literature review and stakeholder consultation. Previously conducted qualitative interviews with 17 GPs and 11 people with DMT were re‐analysed and mapped to the Theoretical Domains Framework (TDF) to identify behavioural barriers and enablers to the targeted behaviours. Behaviour change techniques (BCTs) and intervention components were then selected to address these determinants. Stakeholder input was incorporated to enhance acceptability and feasibility. Results: The resulting intervention aims to promote guideline‐concordant management of a DMT and early knee OA. A programme theory to guide implementation was developed to describe hypothesised mechanisms of action, and candidate outcome measures were identified to support future evaluation and assess the mediating mechanisms of behaviour change. Conclusion: Using a systematic, theory‐informed and stakeholder‐engaged approach, we developed a multi‐faceted intervention to support delivery and uptake of evidence‐based care for DMT and early knee OA. The intervention comprised GP educational workshops and resources to support an ‘enhanced consultation’, alongside referral to an early ‘best practice’ physiotherapy session. Patients received both components. The intervention was designed to be feasible, acceptable and locally relevant, but requires further testing to assess implementation and potential for scale‐up in clinical practice. Lived Experience or Public Contribution: Stakeholder contributions played a central role in this study. People with lived experience of degenerative meniscal tears and/or knee OA ( n = 6) and healthcare professional stakeholders ( n = 15) were consulted during group discussions and individual meetings. Stakeholders informed every step of the development process, aiming to ensure the final intervention was feasible, acceptable and adapted to the local context.

Background Living with chronic pain is associated with an increased risk of social isolation and loneliness. The ‘Pain Café’ in the United Kingdom (UK) is an example of a community-based intervention for increasing social connection, improving quality of life and supporting longer-lasting coping in people living with chronic pain. Interventions should be adapted prior to implementation in new settings. The aim of this study is to adapt the UK-based Pain Café model prior to implementation testing of prototype pain cafés in an Irish setting. Methods We will conduct this intervention adaptation study following a Community-based participatory research and co-design approach. Our intervention adaptation methods will be guided by established frameworks for adapting complex intervention. Using a generic qualitative research (GQR) approach we will collect multiple sources of qualitative data from semi-structured co-design workshops, existing health-related community café implementation documentation and project-related field notes. Data will be analysed using framework analysis. Qualitative verification strategies will be applied to enhance the trustworthiness of our findings. Results Our project deliverables are the i. specification of a prototype pain café adapted to the Irish setting, ii. creation of a Pain Café Implementation Handbook and iii. Identification of core health outcome domains of importance to people with chronic pain attending pain cafés. Discussion This study aims to adapt a Pain Café model for an Irish setting and identify core outcome domains of importance. Its findings will inform a subsequent implementation study.

Background Menopause is a major life transition with diverse physical, psychological, and social symptoms. More than 70% of women experience musculoskeletal (MSK) pain during the menopausal transition, and around 25% are disabled by it; this symptom cluster was recently characterised as the musculoskeletal syndrome of menopause. These symptoms are frequently normalised as an inevitable consequence of ageing rather than recognised as treatable, contributing to underdiagnosis and limited management. Mobile health (mHealth) applications increasingly deliver education, symptom tracking, and self-management support to menopausal women, yet the evidence base is fragmented, and how well this research captures MSK symptoms, rather than leaving them embedded within broader symptom measures, remains unclear. Methods This scoping review will follow JBI methodology and be reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Six bibliographic databases (Embase, Web of Science, Scopus, PubMed/MEDLINE, CINAHL, and IEEE Xplore) will be searched, with reference-list hand-searching of included studies. Records will be screened in duplicate in Covidence; title/abstract screening will retain records indicating symptom monitoring or tracking with a potential MSK link (including composite menopause symptom measures) or strength-oriented exercise, with MSK relevance confirmed at full text. A structured charting form will capture intervention characteristics, symptom-tracking functionality, study design, and outcomes, alongside an MSK-directness classification distinguishing direct measurement from indirect coverage (within composite measures, or exercise/physical-activity components). Reported acceptability, usability, and engagement will be organised through the Technology Acceptance Model. Findings will be synthesised narratively using tables and thematic summaries. Conclusions This review will map how published, menopause-related mHealth research represents MSK symptoms, and whether they are assessed directly or only within broader symptom measures, rather than evaluating the applications themselves, which are the focus of a separate, complementary review. Results will be submitted to a peer-reviewed journal and presented at national and/or international conferences.

Background Menopause is a major life transition with diverse physical, psychological, and social symptoms. More than 70% of women experience musculoskeletal (MSK) pain during the menopausal transition, and around 25% are disabled by it; this symptom cluster was recently characterised as the musculoskeletal syndrome of menopause. These symptoms are frequently normalised as an inevitable consequence of ageing rather than recognised as treatable, contributing to underdiagnosis and limited management. Mobile health (mHealth) applications increasingly deliver education, symptom tracking, and self-management support to menopausal women, yet the evidence base is fragmented, and how well this research captures MSK symptoms, rather than leaving them embedded within broader symptom measures, remains unclear. Methods This scoping review will follow JBI methodology and be reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Six bibliographic databases (Embase, Web of Science, Scopus, PubMed/MEDLINE, CINAHL, and IEEE Xplore) will be searched, with reference-list hand-searching of included studies. Records will be screened in duplicate in Covidence; title/abstract screening will retain records indicating symptom monitoring or tracking with a potential MSK link (including composite menopause symptom measures) or strength-oriented exercise, with MSK relevance confirmed at full text. A structured charting form will capture intervention characteristics, symptom-tracking functionality, study design, and outcomes, alongside an MSK-directness classification distinguishing direct measurement from indirect coverage (within composite measures, or exercise/physical-activity components). Reported acceptability, usability, and engagement will be organised through the Technology Acceptance Model. Findings will be synthesised narratively using tables and thematic summaries. Conclusions This review will map how published, menopause-related mHealth research represents MSK symptoms, and whether they are assessed directly or only within broader symptom measures, rather than evaluating the applications themselves, which are the focus of a separate, complementary review. Results will be submitted to a peer-reviewed journal and presented at national and/or international conferences.

Introduction The Advanced Practice Physiotherapy (APP)bmodel of care is implemented internationally, with notable variations in its application across different healthcare systems. Nonetheless, APP has been shown as a means of mitigating against emergency department (ED) crowding and reducing pressure on EDs. This protocol outlines the methods in conducting a scoping review to identify the extent of APP roles in urgent care and ED settings, their expertise levels, the profile of patients they treat and the components of care they provide. Methods This scoping review will be conducted in line with the Joanna Briggs Institute framework for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting of this review. This review will include published studies of any design that are focussed on APP assessment and/ or subsequent treatment in the ED or urgent care setting among adults. The electronic databases: Medline (Ovid), Pubmed, CINAHL Complete, EMBASE, Epistemonikos, Central Register of Controlled Trials in the Cochrane Library and Scopus, trial registries and grey literature databases will be searched. The reference list of included sources of evidence in the review will be searched for additional sources. The methodological quality of the studies will not be formally explored. Relevant data will be extracted from each article using a predefined data extraction form by two independent reviewers. Data synthesis will be derived from the ‘PCC’ framework (population, concept, and context). Conclusions This scoping review will serve to characterise the roles, responsibilities, levels of expertise and the specific components of care that APP offers in urgent and emergency care settings.

Background The Knowledge Translation and Exercise for Degenerative Meniscal Pathology and Early Knee Osteoarthritis (KNEE-DEeP) intervention was designed to promote greater uptake of evidence-based non-surgical treatments for knee pain attributed to degenerative meniscal pathology and early knee osteoarthritis (OA) in primary care, by tackling barriers at a service, clinician and patient level. Evidence indicates that patients frequently do not access first-line treatments, namely exercise and patient education, prior to specialist referral. The KNEE-DEeP intervention supports general practitioners (GPs) and physiotherapists to enhance their skills and confidence in managing patients with this type of knee pain through professional development workshops. In turn, patients will receive an ‘enhanced consultation’ from their GP and be referred to an early ‘best practice’ physiotherapy session. Physiotherapists will work with patients to develop a collaborative action plan focussing on self-management and exercise. Methods This protocol outlines a single arm non-randomised feasibility study with a mixed method process evaluation. The study intends to recruit 15 GPs, five physiotherapists and 36 patients from general practices in the South-West of Ireland. Eligible patients, will be aged between 35 years and 69 years inclusive, and attend their GP with an episode of non-traumatic knee pain attributed to a degenerative meniscal tear (DMT) or early OA. Physiotherapists and GPs will be trained in intervention delivery. Within two weeks of receiving an ’enhanced consultation‘ from their participating GP, patients will attend the one-hour ‘best practice’ physiotherapy session. Patient data will be collected via online questionnaires at baseline, 12 weeks and 6 months. Qualitative interviews to assess the feasibility and acceptability of the intervention will be conducted with a purposive sample of GPs, physiotherapists and their enrolled patients. Ethics and Dissemination Approved by Clinical Research Ethics Committee of the Cork Teaching Hospitals. Results will be presented in peer-reviewed journals and at international conferences. Registration clinicaltrials.gov ( NCT06576557 )

Objective: The objective was to identify the priorities of individuals with musculoskeletal shoulder pain and their health care providers (HCPs) that are perceived to foster multistakeholder adherence to evidence-based recommendations. Methods: The study used a mixed-methods design, informed by concept mapping. Patients with shoulder pain (ie, ≥6 weeks) and HCPs involved in their care (recruited via social media, email, etc) were invited to complete an initial survey to identify perceived priorities to foster adherence to evidence-based recommendations. Preliminary data sorting resulted in a final priority list, with a subset (n = 20) of respondents rating their importance using a Likert scale. A public and patient involvement (PPI) panel (N = 8) assisted in this rating phase, further sorting of priorities based on thematic similarities (ie, into categories and then domains), analysis, interpretation, and developing a concept map illustrating relationships between them. Results: One hundred and fifty-four participants (HCPs = 133; patients = 21) responded to the initial survey, generating 77 priorities, grouped into 13 categories, and then into 3 domains: (1) Education, (2) Patient-centered care, and (3) Health care communication. Patients prioritized categories relating to the provision of a specific diagnosis, the establishment of a strong therapeutic relationship, and the need for education on progress and recovery timelines, as well as treatment options. HCPs prioritized these same educational categories, also prioritizing the need for tailoring exercise therapy and providing a unified message on best management. PPI panelists identified education on treatment options coupled with a strong therapeutic alliance and a unified message on best management to be of pivotal importance in fostering adherence. Panelists also stressed that future knowledge translation resources must provide tailored education. Conclusion: HCPs and patients agree on the need to prioritize education related to progress and recovery timelines as well as treatment options, with a strong therapeutic alliance and a unified message on best management also considered of pivotal importance for adherence to evidence-based recommendations. Impact: To the knowledge of the authors, this is the first study, including a broad range of stakeholder groups spanning across 11 different countries, to explore the priorities that stakeholders perceived to support stricter adherence to evidence-based recommendations for musculoskeletal shoulder pain, with the relationship between these priorities visually illustrated using a concept map. Patients and HCPs were united in their prioritization of education relating to expected progress and recovery timelines, as well as treatment options and supporting evidence. Stakeholders also identified the need for greater emphasis to be placed on establishing a therapeutic relationship and on integrating shared decision-making into clinical practice to further facilitate adherence. Education relating to treatment options and supporting evidence, a strong therapeutic relationship, and a unified message on best management were perceived by the PPI panel as being pivotal in facilitating adherence to evidence-based treatment. The findings of this study highlight the need for improved tailoring of educational resources for shoulder pain, as well as more cohesive messaging from health care providers, both assisting in supporting first-line treatments, such as exercise therapy, for musculoskeletal shoulder pain.

Background Chronic musculoskeletal pain is a key societal challenge in Ireland, affecting one in three adults over the age of 50, with societal and healthcare costs of over €5.34 billion per year. Physical activity can form a key part of the management of people living with chronic pain, along with providing a myriad of health-enhancing and disease-prevention benefits for older adults. However, pain can limit engagement in physical activity, leading to the negative effects of chronic pain in older adults. Public and Patient involvement in this study identified that people with chronic pain fear exacerbation of their symptoms with exercise, and value having an experienced exercise leader who understands their needs. The primary aim of this study was to examine the feasibility and acceptability of a community-based exercise intervention, ComEx Pain, specifically tailored to older adults with chronic musculoskeletal pain. This paper reports a protocol designed to evaluate the feasibility of conducting a two-arm randomized controlled trial (RCT). Methods ComEx Pain is a randomised controlled feasibility trial with embedded economic and process evaluations. Community-dwelling adults aged ≥50 years living with chronic musculoskeletal pain will be recruited in the mid-western region of Ireland. Randomisation will be conducted using a 1:1 allocation ratio into two groups: (1) an intervention group receiving a community-based exercise program led by trainers educated in supporting people with chronic pain and (2) a control group who will receive a paper-based education manual. Primary outcomes for feasibility include recruitment rate, retention rate, and adherence to the intervention. The secondary outcomes will include changes in pain, physical function, emotional function, and physical activity. Discussion If this pilot feasibility study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of ComEx Pain in older adults living with chronic musculoskeletal pain. Trial registration number: Registered at Clinical Trials.gov NCT06535633.

Training load monitoring is employed to quantify training demands, to determine individual physiological adaptions and to examine the dose–response relationship, ultimately reducing the likelihood of injury and making a meaningful impact on performance. The purpose of this study is to explore the relationship between training load and injury in competitive swimmers, using the session rate of perceived exertion (sRPE) method. Data were collected using a prospective, longitudinal study design across 104 weeks. Data were collected from 34 athletes centralised in two of Swim Ireland’s National Centres. Bayesian mixed effects logistic regression models were used to analyse the relationship between sRPE-TL and medical attention injuries. The average weekly swim volume was 33.5 ± 12.9 km. The weekly total training load (AU) averaged 3838 ± 1616.1. A total of 58 medical attention injury events were recorded. The probability of an association between training load and injury ranged from 70% to 98%; however, evidence for these relationships was deemed weak or highly uncertain. The findings suggest that using a single training load metric in isolation cannot decisively inform when an injury will occur. Instead, coaches should utilise monitoring tools to ensure that the athletes are exposed to an appropriate training load to optimise physiological adaptation. Future research should strive to investigate the relationship between additional risk factors (e.g., wellbeing, lifestyle factors or previous injury history), in combination with training load and injury, in competitive swimmers.