Although various measures of low back pain (LBP) recurrence have been proposed, none have been tested to determine if they are consistent with what those with LBP perceive a "recurrence" to be. To further the understanding of LBP recurrence and how to measure it, we examined how individuals with a history of LBP describe their back pain experiences. A qualitative approach was chosen and six mixed-gender focus groups were conducted. Discussions were facilitated by two researchers and structured around predetermined questions. All four authors were involved in the data analysis and thematic congruence was achieved through an iterative process of coding and discussion. Participants included 31 individuals (14 female, 17 male), with ages ranging from early 20s to mid 70s. When asked about LBP recurrence, participants had difficulty understanding the concept. There was a sense that, although the pain may disappear, the condition was always there. Three states were defined: "normal," "flared-up," and "attack." "Normal" could include experiencing pain, but generally represented a tolerable state. "Flared-up" was associated with increased pain, the use of strategies to overcome difficulties, and modified participation. "Attack" state was described as severely disabled: "I just have to lay there." Participants described their experiences in a way that is consistent with the idea that LBP is a fluctuating and disabling health condition. Results cast doubt on the validity of currently available measures of LBP recurrence. Focusing on recurrence of pain without consideration of broader contextual factors will result in an incomplete understanding of the meaning of the pain experience.

IntroductionCentralized intake is integral to healthcare systems to support timely access to appropriate health services. The aim of this study was to develop key performance indicators (KPIs) to evaluate centralized intake systems for patients with osteoarthritis (OA) and rheumatoid arthritis (RA).MethodsPhase 1 involved stakeholder meetings including healthcare providers, managers, researchers and patients to obtain input on candidate KPIs, aligned along six quality dimensions: appropriateness, accessibility, acceptability, efficiency, effectiveness, and safety. Phase 2 involved literature reviews to ensure KPIs were based on best practices and harmonized with existing measures. Phase 3 involved a three-round, online modified Delphi panel to finalize the KPIs. The panel consisted of two rounds of rating and a round of online and in-person discussions. KPIs rated as valid and important (≥7 on a 9-point Likert scale) were included in the final set.ResultsTwenty-five KPIs identified and substantiated during Phases 1 and 2 were submitted to 27 panellists including healthcare providers, managers, researchers, and patients in Phase 3. After the in-person meeting, three KPIs were removed and six were suggested. The final set includes 9 OA KPIs, 10 RA KPIs and 9 relating to centralized intake processes for both conditions. All 28 KPIs were rated as valid and important.ConclusionsArthritis stakeholders have proposed 28 KPIs that should be used in quality improvement efforts when evaluating centralized intake for OA and RA. The KPIs measure five of the six dimensions of quality and are relevant to patients, practitioners and health systems.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0843-7) contains supplementary material, which is available to authorized users.

The overall injury incidence in MMA competitors appears slightly higher than for boxers, but MMA fighters experience more minor contusion/bruising injuries. Boxers are more likely to experience serious injury such as concussion/head trauma involving loss of consciousness or eye injury such as retinal detachment.

Depression is common in whiplash-associated disorders (WAD). Our objectives were to identify factors associated with depressive symptomatology occurring in the initial stages of WAD, and to identify factors predicting the course of depressive symptoms. A population-based cohort of adults sustaining traffic-related WAD was followed at 6 weeks, 3, 6, 9, and 12 months. Baseline measures (assessed a median of 11 days post-crash) included demographic and collision-related factors, prior health, and initial post-crash pain and symptoms. Depressive symptomatology was assessed at baseline and at each follow-up using the Centre for Epidemiological Studies Depression Scale (CES-D). We included only those who participated at all follow-ups (n = 3,452; 59% of eligible participants).Using logistic regression, we identified factors associated with initial (post-crash) depression. Using multinomial regression, we identified baseline factors predicting course of depression. Courses of depression were no depression; initial depression that resolves, recurs or persists, and later onset depression. Factors associated with initial depression included greater neck and low back pain severity, greater percentage of body in pain, numbness/tingling in arms/ hand, dizziness, vision problems, post-crash anxiety, fracture, prior mental health problems, and poorer general health. Predictors of persistent depression included older age, greater initial neck and low back pain, post-crash dizziness, vision and hearing problems, numbness/tingling in arms/hands, anxiety, prior mental health problems, and poorer general health. Recognition of these underlying risk factors may assist health care providers to predict the course of psychological reactions and to provide effective interventions.

• Methodological Quality of Sleep Research • Disordered sleep (DS) in youth with chronic health conditions is pervasive and is important to rehabilitation therapists because DS contributes to significant functional problems across psychological, physical and emotional domains. • Rehabilitation therapists and other healthcare providers receive little education about disordered sleep and are largely unaware of the range of assessment and non-pharmacological intervention strategies that exist. An evidence-based website of pediatric sleep resources can be found at http://www.SleepRight.ualberta.ca • The current research on non-pharmacological sleep interventions (NPSI) for youth with health conditions is methodologically weak. However, consistently positive outcomes reported in the literature demonstrate that pragmatic interventions such as bright light therapy, activity, massage and behavioral interventions are promising areas. No studies found reasons that a trail of a NPSI matched to the youth's context and condition should not attempted. More rigorous clinically relevant study of pragmatic non-pharmacological interventions appropriate for therapists' and parents' needs is required.

Psychology has to deal with many interacting variables. The analyses usually used to uncover such relationships have many constraints that limit their utility. We briefly discuss these and describe recent work that uses genetic programming to evolve equations to combine variables in nonlinear ways in a number of different domains. We focus on four studies of interactions from lexical access experiments and psychometric problems. In all cases, genetic programming described nonlinear combinations of items in a manner that was subsequently independently verified. We discuss the general implications of genetic programming and related computational methods for multivariate problems in psychology.

The results suggest there are significant gaps in the preparedness and ability of LPNs to access and apply research evidence effectively in the workplace. There are several areas in which the training provided by Librarians appears either misaligned or ineffective.

Purpose Strong leadership has been shown to foster change, including loyalty, improved performance and decreased error rates, but there is a dearth of evidence on effectiveness of leadership development programs. To ensure a return on the huge investments made, evidence-based approaches are needed to assess the impact of leadership on health-care establishments. As a part of a pan-Canadian initiative to design an effective evaluative instrument, the purpose of this paper was to identify and summarize evidence on health-care outcomes/return on investment (ROI) indicators and metrics associated with leadership quality, leadership development programs and existing evaluative instruments. Design/methodology/approach The authors performed a scoping review using the Arksey and O'Malley framework, searching eight databases from 2006 through June 2016. Findings Of 11,868 citations screened, the authors included 223 studies reporting on health-care outcomes/ROI indicators and metrics associated with leadership quality (73 studies), leadership development programs (138 studies) and existing evaluative instruments (12 studies). The extracted ROI indicators and metrics have been summarized in detail. Originality/value This review provides a snapshot in time of the current evidence on ROI indicators and metrics associated with leadership. Summarized ROI indicators and metrics can be used to design an effective evaluative instrument to assess the impact of leadership on health-care organizations.