Arianne P. Verhagen

Background: Cervical radiculopathy (CR) is a clinical condition caused by compression of the nerve root. In clinical practice, the diagnosis of CR is based on information from the patient’s history, physical examination, and diagnostic imaging. This systematic review aimed to update and summarise the evidence reported in a systematic review published in 2018 on the diagnostic performance of physical examination tests. Methods: A literature search was performed in six electronic databases. Selection, assessment of risk of bias (using the QUADAS-2) and data extraction were performed independently by two reviewers. Sensitivity and specificity were calculated, and the certainty of the evidence was assessed using the GRADE framework. For the meta-analysis, a hierarchical bivariate random-effects model was used and, in line with recommendations for sparse data, models were interpreted as bivariate fixed-effect Generalized Linear Mixed Models. Results: In total, eight studies were included. Diagnostic value was assessed for six physical examination tests. Slightly different versions of Spurling’s test were assessed in five studies, with a reported high specificity ranging from 0.84 to 1.00 (95% CI range: 0.56–1.00) and sensitivity values ranging from 0.38 to 0.98 (95%CI range: 0.22–0.99). There is low certainty evidence of pooled sensitivity of 0.70 (95%CI 0.60–0.79) and specificity of 0.71 (95%CI 0.63–0.79) for Upper Limb Neurodynamic Test (ULNT) 1. Similary there was low certainty evidence of pooled sensitivity of 0.97 (95%CI 0.88–0.99) and pooled specificity of 0.51 (95%CI 0.40–0.62) for combined ULNTs, and of pooled sensitivity of 0.49 (95%CI 0.39–0.60) and pooled specificity of 0.76 (95%CI 0.66–0.84) for the shoulder abduction relief test. All other tests were assessed in a single study only. Conclusions: Clinicians may use the outcome of Spurling’s test and the outcome of the combination of four ULNTs to assist their clinical reasoning in diagnosing CR. However, evidence on the diagnostic accuracy of all physical tests for the diagnosis of CR is sparse, and the certainty of the evidence was very low for all outcomes of all tests, implying that new studies of high methodological value are still required to strengthen these results. Because of the small number of studies, the pooled estimates are valid only for the populations and tests studied in the specific studies included in this review.

Health professional engagement ensures relevant, clinically focused research that informs evidence‐based care. Research shows health professionals may not engage optimally in research. Understanding barriers and enablers influencing participation is necessary to enhance engagement. This systematic review explores these factors among primary healthcare professionals. We searched peer‐reviewed studies using CINAHL, Medline, and SCOPUS in February 2023, updated in June 2024. The review followed PRISMA and the ENTREQ checklist. Studies included those published in English, reporting factors influencing engagement among primary healthcare professionals. Qualitative data were extracted and thematically synthesized. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Nineteen studies were included. Enablers include individual positive attitudes and a scholarly environment. Barriers include negative attitudes, an unconducive environment, and system constraints. Primary health professionals view research engagement positively, recognizing its potential to enhance health outcomes, professional growth, and business performance. Balancing clinical responsibilities, workload and research is challenging. Targeted strategies promoting partnerships and stakeholder involvement can foster a scholarly environment and empower research engagement.

Objectives: To assess perceived changes in children’s understanding of the pain–damage relationship and the brain’s influence on pain following exposure to sham and pain science education (PSE) books. Methods: A series of single‐case experimental designs were replicated across 17 children (8–12 years), with and without chronic pain, over six weeks. Following baseline, participants received a sham book and then a PSE book. The Concept of Pain Inventory (COPI) (total and selected items) and qualitative interviews (child and interviewer) assessed conceptual change and book acceptability. Results: COPI scores for three targeted items fluctuated but generally increased after the PSE book for both groups, suggesting improved understanding. Discrepancies between COPI responses and interview data occurred in 88% of children, indicating varied perspectives on the nature and extent of conceptual change. The PSE book was found to be acceptable and was preferred by most children. Discussion: Children’s understanding of core pain science concepts can improve with targeted, book‐based PSE. The dynamic nature of conceptual change and observed discrepancies between quantitative and qualitative assessment methods underscore the value of using multiple approaches to evaluate learning in pediatric PSE.

Objective To develop and evaluate a new patient-reported outcome measure (PROM) to assess people’s knowledge and beliefs about low back pain. Methods This study followed the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. An 18-item preliminary version of the Back pain Knowledge and beliefs Survey (BacKS) was generated based on evidence-based key messages and current clinical guidelines for low back pain. Four items were added following input from three consumers and seven experts. Focus groups (n=9) confirmed content validity. The 22-item version was completed by 258 Australian-based adults (>18 years) with self-reported low back pain. A follow-up survey was sent 1 week later. The following measurement properties were evaluated to produce, and then assess the final version of BacKS: structural validity (exploratory factor analysis); internal consistency (Cronbach’s alpha); test–retest reliability (intraclass correlation coefficient); measurement error (Smallest Detectable Change); construct validity (hypothesis tested: moderate positive Pearson correlation between BacKS and Back Beliefs Questionnaire); plus, interpretability and feasibility. Results The final BacKS comprised 20 items with a 2-factor structure (biomedical factor: 9 items, score ranging from 9 to 45, and self-care factor: 11 items, score ranging from 11 to 55). Internal consistency and reliability were adequate (>0.70) for each factor. Smallest detectable change was 4.4 (biomedical factor) and 7.0 (self-care factor). Our construct validity hypothesis was confirmed (Pearson correlation=0.53). No floor or ceiling effects were detected. Conclusion The BacKS is a valid, reliable and feasible PROM to measure knowledge and beliefs about low back pain in clinical practice and research settings.

Background: StrokeLine is a stroke‐specific helpline used by stroke survivors and their families in Australia to access professional support. There has been little research exploring stroke survivors' experiences of using helplines and their perceived impact on their stroke recovery.Aim: The aim of this study is to explore the reasons prompting stroke survivors to call StrokeLine and their experiences and to describe the perceived impact of calling StrokeLine on their recovery.Methods: An exploratory descriptive qualitative study was undertaken using thematic analysis of data collected through semi‐structured interviews of stroke survivors between December 2020 and May 2022. Participants were recruited using purposive sampling. Interviews were conducted via audio‐recorded Zoom conference calling and transcribed verbatim for thematic analysis.Results: A total of eight callers (four men and women women) participated, with the time since stroke ranging from 3.5 months to 5 years. Four major themes were identified, including 17 sub‐themes. Key themes included (1) factors prompting use of StrokeLine; (2) experience of using StrokeLine; (3) perceived impact of using StrokeLine; and (4) conceptualising StrokeLine service provision.Conclusions: Participants perceived their experience of contacting StrokeLine as having a positive impact on their stroke recovery, leaving them feeling empowered and motivated to self‐manage their condition.Patient or Public Contribution: Stroke survivors with lived experience influenced the conceptualisation of this study through conversations with consumers and the Stroke Foundation. Eight stroke survivors were involved as participants in the research study.