Review article: Methodology for the ‘rapid review’ series on musculoskeletal injuries in the emergency department The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. The effectiveness of exercise on recovery and clinical outcomes of soft tissue injuries of the leg, ankle, and foot: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Urban emergency department overcrowding: defining the problem and eliminating misconceptions. Application of Platelet-Rich Plasma to Disorders of the Knee Joint Treatment of borderline personality disorder in youth. Pectoral stretching program for women undergoing radiotherapy for breast cancer
Musculoskeletal injuries are a common presentation to the ED , with significant costs involved in the management of these injuries , variances in care within the ED and associated morbidity . A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED . This paper presents the methodology used across the rapid review s. PubMed , CINAHL , EMBASE , TRIP and the grey literature , including relevant organisational websites , were search ed in 2015 . The search was repeated consistently for each topic area ( injuries of the foot and ankle , knee , h and and wrist , elbow , shoulder , lumbar spine and cervical spine ) . English- language primary studies , systematic review s and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion . Data extraction of each included article was conducted , followed by a quality appraisal . The extracted data from each article was synthesis ed to group similar evidence together . For each rapid review , the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED , such as the assessment , diagnostic tests , management and follow-up considerations from ED . The series of rapid review s are design ed to foster evidence -based practice within the ED , targeting the injuries most commonly presenting . The review s provide clinicians in EDs with rapid access to the best current evidence , which has been synthesis ed and organised to assist decision-making STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers INTRODUCTION Soft tissue injuries of the leg , ankle , or foot are common and often treated by exercise . The purpose of this study was to determine the effectiveness of  exercise  for the management of soft tissue injuries of the leg , ankle , or foot . METHODS A systematic review of the literature was conducted . We search ed five data bases from 1990 to 2015 . Relevant articles were critically appraised using Scottish Intercollegiate Guidelines Network ( SIGN ) criteria . The evidence from studies with low risk of bias was synthesized using the best- evidence synthesis methodology . RESULTS We screened 7946 articles . We critically appraised ten r and omized trials and six had a low risk of bias . The evidence suggests that for recent lateral ankle sprain : 1 ) rehabilitation exercises initiated immediately post-injury are as effective as a similar program initiated one week post-injury ; and 2 ) supervised progressive exercise plus education/advice and home exercise lead to similar outcomes as education/advice and home exercise . Eccentric exercises may be more effective than an AirHeel brace but less effective than acupuncture for Achilles tendinopathy of more than two months duration . Finally , for plantar heel pain , static stretching of the calf muscles and sham ultrasound lead to similar outcomes , while static plantar fascia stretching provides short-term benefits compared to shockwave therapy . CONCLUSIONS We found little evidence to support the use of early or supervised exercise interventions for lateral ankle sprains . Eccentric exercises may provide short-term benefits over a brace for persistent Achilles tendinopathy and plantar fascia stretching provides short-term benefits for plantar heel pain STUDY OBJECTIVE To develop an operational definition and a parsimonious list of postulated determinants for urban emergency department ( ED ) overcrowding .  METHODS A panel was formed from clinical and administrative experts in pre-hospital , ED and hospital domains . Key studies and reports were review ed in advance by panel members , an experienced health services research er facilitated the panel 's discussion s , and a formal content analysis of audiotaped recordings was conducted . RESULTS The panel considered community , patient , ED and hospital determinants of overcrowding . Of 46 factors postulated in the literature , 21 were not retained by the experts as potentially important determinants of overcrowding . Factors not retained included access to primary care services and seasonal influenza outbreaks . Key determinants retained included admitted patients awaiting beds and patient characteristics .  Ambulance diversion was considered to be an appropriate operational definition and proxy measure of ED overcrowding . CONCLUSION These results help to clarify the conceptual framework around ED overcrowding , and may provide a guide for future research . The relative importance of the determinants must be assessed by prospect i ve studies Importance : The promising therapeutic potential and regenerative properties of platelet-rich plasma ( PRP ) have rapidly led to its widespread clinical use in musculoskeletal injury and disease . Although the basic scientific rationale surrounding PRP products is compelling , the clinical application has outpaced the research . Objective : The purpose of this article is to examine the current concepts around the basic science of PRP application , different preparation systems , and clinical application of PRP in disorders in the knee . Evidence Acquisition : A systematic search of PubMed for studies that evaluated the basic science , preparation and clinical application of platelet concentrates was performed . The search used terms , including platelet-rich plasma or PRP preparation , activation , use in the knee , cartilage , ligament , and meniscus . Studies found in the initial search and related studies were review ed . Results : A comprehensive review of the literature supports the potential use of PRP  both nonoperatively and intraoperatively , but highlights the absence of large clinical studies and the lack of st and ardization between method , product , and clinical efficacy . Conclusions and Relevance . In addition to the call for more r and omized , controlled clinical studies to assess the clinical effect of PRP , at this point , it is necessary to investigate PRP product composition and eventually have the ability to tailor the therapeutic product for specific indications OBJECTIVES Borderline personality disorder ( BPD ) is frequently encountered in both adult and youth population s. There is a robust literature supporting psychotherapy for adults with BPD , but the literature supporting its use for BPD in youth is more limited . METHODS A literature review was conducted using the keywords " borderline personality disorders " and " adolescence . " Relevant articles were review ed for inclusion . RESULTS Several specialized treatments have been studied with mixed results . Dialectical behaviour therapy has no r and omized controlled trials in adolescents ,  emotion regulation training  has not demonstrated superiority of treatment as usual , and  cognitive analytic therapy has demonstrated more rapid recovery but little difference at follow-up .  Mentalization-based treatment  has one study supporting its use in self-harming adolescents . Pharmacotherapy has no evidence supporting its use in this population . CONCLUSIONS Structured therapy may be the most important therapeutic component in this population Surgery and radiotherapy commonly cause adverse musculoskeletal problems , particularly loss of strength and range of motion , in the upper quadrant of breast cancer patients . Few well- design ed studies have investigated whether these impairments can be prevented . Stretching is an effective technique for increasing range of motion , hence the aim of this study was to investigate whether a stretching program reduced acute musculoskeletal impairments in patients undergoing radiotherapy for breast cancer . Sixty-four women were recruited prior to commencement of radiotherapy following breast cancer surgery . Participants were r and omised to either a control or stretch group . Participants in both groups were review ed by the physical therapist on a weekly basis for approximately 6 weeks , and were given general information about skin care and lymphedema . The control group received no advice about exercise . The stretch group received instruction on low-load , prolonged pectoral stretches , which were to be performed daily and were checked at weekly visits . Shoulder range of motion , strength , arm circumference , and quality of life measurements were taken prior to , and at completion of radiotherapy , and at 7 months after radiotherapy . There was no difference in any outcome between groups . Breast symptoms increased for both groups during radiotherapy , without loss of strength or range of movement . The incidence of lymphedema during the study was low for both groups and did not differ between groups . The pectoral stretching program did not influence the outcomes measured because the symptoms reported by patients were not a consequence of contracture
RESULTS The physiological effects of stretches may contribute to reducing discomfort and pain .
However , if other measures are not in place to remediate their causes , stretches may suppress awareness of risks , result ing in more debilitating injuries .
If inadequately performed , stretches may also cause or aggravate injuries .
The studies provided mixed findings , but demonstrated some beneficial effect of stretching in preventing work-related musculoskeletal disorders .
OBJECTIVE This article review ed the literature to clarify the physiological effects and benefits of , and misconceptions about , stretches used to reduce musculoskeletal disorders .