Faculty of Medicine and Health

Progressing Cross-Sector Collaboration for People With Eating Disorders and Higher Weight: Priority Actions From an Expert Roundtable Using a Modified Nominal Group Technique

Thu, 01 Jan 2026 00:00:00 GMT

Progressing Cross-Sector Collaboration for People With Eating Disorders and Higher Weight: Priority Actions From an Expert Roundtable Using a Modified Nominal Group Technique Jebeile, Hiba; Brennan, Leah; Burrows, Tracy; de la Piedad Garcia, Xochitl; Ralph, Angelique F; Saluja, Supreet; Atlantis, Evan; Garnett, Sarah P; Harrison, Carmel J; House, Eve T; Lister, Natalie B; Moran, Lisa; Piya, Milan K; Rieger, Elizabeth; Smith, Evelyn; Hay, Phillipa; Trobe, Sarah Introduction Eating disorders are more prevalent in people with higher weight than those with low weight. However, contention between the fields of obesity and eating disorders has prevented meaningful progress in research, prevention, identification and coordinated clinical services for people with co-occurring conditions. In Australia, public health approaches and provision of treatment services for people with eating disorders and clinical obesity are siloed, often resulting in contradictory messaging. To address this, a roundtable meeting was held in November 2024 in Sydney, Australia, with 28 experts in one or both of these fields, including researchers, clinicians and service leaders working across paediatric and adult care, and individuals with lived experience. Guided by the National Eating Disorders Collaboration stepped system of care framework, participants identified key challenges and possible solutions, and established five priority actions. Main Recommendations The priority actions across sectors are: Health Campaigns focused on raising awareness of eating disorders at higher weight, using appropriate language and reducing weight stigma; improved Screening and Assessment using standardised protocols across healthcare settings; supporting Primary Healthcare and improving the use of Medicare items; Tailored Treatment Pathways including integrated care models; and building Workforce Capacity to upskill professionals to provide safe, person-centred care. Changes in Management as a Result of the Statement These actions aim to promote improved cross-sector collaboration and effective, safe, coordinated and integrated approaches to prevention, identification and treatment across the fields of obesity and eating disorders. They address the complex medical and psychological needs of those with co-occurring eating disorders and higher weight or clinical obesity through a skilled workforce and improved access to care. Effective integration, collaboration and coordination across services is essential for long-term recovery support.

Socio-Demographic, Self-Control, Bullying, Parenting, and Sleep as Proximal Factors Associated with Food Addiction among Adolescents

Sat, 01 Jan 2022 00:00:00 GMT

Socio-Demographic, Self-Control, Bullying, Parenting, and Sleep as Proximal Factors Associated with Food Addiction among Adolescents Leary, Mark; Pursey, Kirrilly M; Verdejo-Garcia, Antonio; Smout, Scarlett; McBride, Nyanda; Osman, Bridie; Champion, Katrina E; Gardner, Lauren A; Jebeile, Hiba; Kelly, Erin V; Thornton, Louise; Teesson, Maree; Burrows, Tracy L Adolescence is considered an important period of neurodevelopment. It is a time for the emergence of psychosocial vulnerabilities, including symptoms of depression, eating disorders, and increased engagement in unhealthy eating behaviours. Food addiction (FA) in adolescents is an area of study where there has been substantial growth. However, to date, limited studies have considered what demographic characteristics of adolescents may predispose them to endorse greater symptoms of FA. Studies have found a variety of factors that often cluster with and may influence an adolescent’s eating behaviour such as sleep, level of self-control, and parenting practices, as well as bullying. Therefore, this study investigated a range of socio-demographic, trait, mental health, and lifestyle-related profiles (including self-control, parenting, bullying, and sleep) as proximal factors associated with symptoms of FA, as assessed via the Yale Food Addiction Scale for Children (YFAS-C) in a large sample of Australian adolescents. Following data cleaning, the final analysed sample included 6587 students (age 12.9 years ± 0.39; range 10.9–14.9 years), with 50.05% identifying as male (n = 3297), 48.5% as female (n = 3195), 1.02% prefer not to say (n = 67), and 0.43% as non-binary (n = 28). Self-control was found to be the most significant predictor of total FA symptom score, followed by female gender, sleep quality, and being a victim of bullying. Universal prevention programs should therefore aim to address these factors to help reduce the prevalence or severity of FA symptoms within early adolescent populations.

Mindful and Intuitive Eating Imagery on Instagram: A Content Analysis

Sat, 01 Jan 2022 00:00:00 GMT

Mindful and Intuitive Eating Imagery on Instagram: A Content Analysis Hoare, Johanna K; Lister, Natalie B; Garnett, Sarah P; Baur, Louise A; Jebeile, Hiba Non-dieting approaches, including mindful/intuitive eating, to health improvement are of increasing interest, yet little is known about young adults' social media exposure to them. Therefore, this study aimed to describe the imagery related to mindful/intuitive eating which is visible to young adult Instagram users. Images categorized under the hashtags 'mindfuleating' and 'intuitiveeating' were searched in September 2021 using the 'top posts' view. Screen captures of 1200 grid-view images per hashtag were used to construct coding frameworks and to determine saturation. Sample sizes for #mindfuleating and #intuitiveeating were 405 and 495 images, respectively. Individual images were coded collaboratively. Almost half of each sample depicted food or drink, of which 50-60% were healthy foods. Approximately 17% were single-person images, of which the majority were young, female adults with healthy weight. Approximately one-third of text suggested credibility through credentials, profession, or evidence. Messaging was similar for both hashtags, encompassing mindful/intuitive eating (~40%), nutrition/eating behaviours (~15%), physical/mental health (~20%), disordered eating (~12%), and body-/self-acceptance (~12%). Differences were observed between hashtags for weight-related concepts (20%/1%) and anti-diet/weight-neutral approaches (10%/35%). The representation on Instagram of mindful and intuitive eating portrays healthy lifestyles without a focus on weight but lacks demographical and body-type diversity. Instagram holds the potential for health professionals to disseminate culturally/demographically inclusive, evidence-based health/nutrition information to youth.

The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth

Fri, 01 Jan 2016 00:00:00 GMT

The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth Gow, Megan L; Garnett, Sarah P; Baur, Louise A; Lister, Natalie B Type 2 diabetes in children and adolescents has become a prominent clinical issue in recent decades. Increasing numbers of young people have risk factors for type 2 diabetes, particularly obesity, indicating the need for effective type 2 diabetes prevention strategies. The aim of this review was to identify specific dietary strategies that optimize improvements in risk factors for type 2 diabetes in youth and hence reduce the risk of type 2 diabetes development. Our review of the current literature indicates that dietary interventions lead to weight loss when intervention adherence is high. However, in addition to weight loss, a diet that is reduced in carbohydrates may optimize improvements in other type 2 diabetes risk factors, including insulin resistance and hyperglycemia. While further research is needed to confirm this finding, reduced carbohydrate diets may include a very low-carbohydrate diet, a very low-energy diet, a lower-glycemic-index diet, and/or an intermittent fasting diet. This array of dietary strategies provides a suite of intervention options for clinicians to recommend to young people at risk of type 2 diabetes. However, these findings are in contrast to current guidelines for the prevention of type 2 diabetes in adults which recommends a low-fat, high-carbohydrate diet.

Efficacy, safety and acceptability of a very-low-energy diet in adolescents with obesity: a fast track to health sub-study

Mon, 01 Jan 2024 00:00:00 GMT

Efficacy, safety and acceptability of a very-low-energy diet in adolescents with obesity: a fast track to health sub-study Gow, Megan; Jebeile, Hiba; House, Eve T; Alexander, Shirley; Baur, Louise A; Brown, Justin; Collins, Claire E; Cowell, Chris T; Day, Kaitlin; Garnett, Sarah P; Grunseit, Alicia; Inkster, Mary-Kate; Kwok, Cathy; Lang, Sarah; Paxton, Susan J; Truby, Helen; Varady, Krista A; Lister, Natalie B The aim of this study was to determine the efficacy, safety and acceptability of a 4-week very-low-energy diet (VLED) program for adolescents with obesity. Adolescents (13–17 years) with obesity and ≥1 obesity-related complication were Fast Track to Health 52-week randomized controlled trial participants. Adolescents undertook a 4-week micronutrient-complete VLED (800 kcal/day), with weekly dietitian support. Anthropometric data were recorded at baseline and week-4 and side-effects at day 3–4, week-1, -2, -3 and -4. Adolescents completed an acceptability survey at week-4. A total of 134 adolescents (14.9 ± 1.2 years, 50% male) had a 5.5 ± 2.9 kg (p < 0.001) mean weight loss at week-4: 95% experienced ≥1 and 70% experienced ≥3 side-effects during the VLED program, especially during the first week. Hunger, fatigue, headache, irritability, loose stools, constipation and nausea were most common. Reporting more side-effects at day 3–4 correlated with greater weight loss at week-4 (r = −0.188, p = 0.03). Adolescents reported ‘losing weight’ (34%) and ‘prescriptive structure’ (28%) as the most positive aspects of VLED, while ‘restrictive nature’ (45%) and ‘meal replacement taste’ (20%) were least liked. A dietitian-monitored short-term VLED can be implemented safely and is acceptable for many adolescents seeking weight loss, despite frequent side-effects. Investigating predictors of acceptability and effectiveness could determine adolescents most suited to VLED programs

Antenatal diet quality and perinatal depression: the Microbiome Understanding in Maternity Study (MUMS) cohort

Sun, 01 Jan 2023 00:00:00 GMT

Antenatal diet quality and perinatal depression: the Microbiome Understanding in Maternity Study (MUMS) cohort Gow, Megan L; Lam, Yei W I; Jebeile, Hiba; Craig, Maria E; Susic, Danielle; Henry, Amanda Background: Previous findings from research investigating the role of antenatal nutrition in preventing postpartum depression (PPD) are inconsistent. Our primary aim was to investigate the association between pregnancy diet quality and PPD. Our secondary aim was to investigate associations between (a) diet quality and depression during pregnancy and (b) depression during pregnancy and PPD. Methods: This analysis represents data from 73 women participating in the Microbiome Understanding in Maternity Study (MUMS) cohort in Sydney, Australia, which followed women from Trimester 1 of pregnancy to 1-year postpartum (PP). Participants' diet quality was assessed using the Australian Eating Survey at Trimester 1 and 3 to calculate diet quality, known as the Australian Recommended Food Score (lower diet quality defined as score <39; higher diet quality ≥39). Depression was assessed using the Edinburgh Depression Scale at Trimesters 1, 2, 3 and 6 weeks PP (defined as score ≥11). Results: Depression scores during pregnancy were significantly associated with depression score 6 weeks PP (Trimester 1: r = 0.66, Trimester 2: r = 0.69, Trimester 3: r = 0.67; all p < 0.001). Diet quality during pregnancy was not significantly correlated with 6-week PPD score. In unadjusted analysis, diet quality during pregnancy was not associated with pregnancy depression scores. When adjusted for age, parity and Trimester 1 body mass index, Trimester 1 physical activity levels and gestational weight gain, higher Trimester 3 diet quality was associated with reduced Trimester 3 depression only. Conclusions: Depression scores during pregnancy were positively associated with PPD, highlighting the importance of screening for depression during pregnancy and postnatally. Larger longitudinal prospective studies may elucidate the association between diet quality and PPD.

Opportunities to advance research, intervention, and policy on stigma, eating disorders, and body image

Sun, 01 Jan 2023 00:00:00 GMT

Opportunities to advance research, intervention, and policy on stigma, eating disorders, and body image Pearl, Rebecca L; Austin, S. Bryn; Jebeile, Hiba; D'Adamo, Laura; Wilfley, Denise E Stigma involves assigning labels and negative character traits (or stereotypes) to individuals who are viewed as “different.” This labeling is used to justify mistreatment and exert power over stigmatized individuals through diminished social status, discrimination, and overall devaluation as human beings [1]. Decades of research studies have documented stigmatization of people on the basis of body weight and other aspects of appearance. Weight stigma typically involves ascribing negative stereotypes to individuals with a high body weight or larger body [2]. Individuals with low body weight may also be viewed negatively and assumed to have eating disorders, which in turn are linked to stereotypes as well [3]. Stigmatization of persons with psychiatric disorders more generally can also extend to those with eating disorders. Due to misconceptions that body weight and eating disorder symptoms are entirely within an individual’s control, blame is rampant. This Special Issue aims to bring increased attention to stigma related to eating disorders, weight, and body image, including intersections with other forms of stigma, health impacts, and promising avenues for intervention.

New anti-obesity medications: Considerations and future directions in people with concurrent eating disorders

Sun, 01 Jan 2023 00:00:00 GMT

New anti-obesity medications: Considerations and future directions in people with concurrent eating disorders Sharp, Gemma; Girolamo, Teresa; Hay, Phillipa; Mitchison, Deborah; Cooper, Kelly; Sumithran, Priya; Jebeile, Hiba People with both obesity and eating disorders have complex medical needs requiring multidisciplinary care. Improved linkages and referral pathways between obesity and eating disorders are strongly needed to facilitate effective concurrent treatment of both conditions.

Participant recruitment for paediatric research using social media: A practical ‘how-to’ guide for researchers

Sun, 01 Jan 2023 00:00:00 GMT

Participant recruitment for paediatric research using social media: A practical ‘how-to’ guide for researchers Lang, Sarah; Day, Kaitlin; Gallagher, Emma; Jebeile, Hiba; Collins, Clare E; Baur, Louise A; Truby, Helen Aim: Social media platforms are being increasingly used to support participant recruitment into paediatric health-related research. This study aimed to develop a multi-phase approach for using social media as a recruitment strategy for paediatric research studies. Methods: The process was informed by the authors' prior experiences recruiting for paediatric obesity-related research studies, expertise in social media marketing and digital participant/ patient recruitment. Reflection on these experiences resulted in the iterative creation of a draft process which was further refined. A narrative literature review using a structured search was conducted to refine and augment the content and finalise the process. Results: A six-phase recruitment approach was developed that includes: (i) plan for social media use as a recruitment strategy, (ii) explore relevant ethical considerations to protect the wellbeing of potentially vulnerable groups and create an ethical management plan, (iii) identify and understand the different target audiences and develop the advertising strategy, (iv) develop and design campaign content, (v) implement, monitor and iteratively refine the recruitment campaign, (vi) evaluate the campaign success. Potential activities and key considerations relevant for paediatric research are presented within each phase. Conclusion: Due to the widespread use and diverse characteristics of social media users, social media has the potential to disseminate details of research opportunities to community members who may otherwise not hear about, engage with, and potentially benefit from research participation. Researchers should collaborate with communication experts and target audiences to generate relevant and effective recruitment campaigns. Researchers should implement processes to protect vulnerable audiences' wellbeing at each stage of the process. Recruitment via social media may support wider community participation in research studies designed to improve young people's health.

Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis

Sun, 01 Jan 2023 00:00:00 GMT

Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis Jebeile, Hiba; Libesman, Sol; Melville, Hannah; Low-wah, Timothy; Dammery, Genevieve; Seidler, Anna L; Jones, Rebecca A; McMaster, Caitlin M; Paxton, Susan J; Hill, Andrew J; Ahern, Amy L; Garnett, Sarah P; Braet, Caroline; Wilfley, Denise E; Baur, Louise A; Lister, Natalie B This systematic review examined change in eating disorder risk during weight management interventions. Four databases and clinical trials registries were searched in March and May 2022, respectively, to identify behavioral weight management intervention trials in adults with overweight/obesity measuring eating disorder symptoms at pre- and post-intervention or follow-up. Random effects meta-analyses were conducted examining within group change in risk. Of 12,023 screened, 49 were eligible (n = 6337, mean age range 22.1 to 59.9 years, mean (SD) 81(20.4)% female). Interventions ranged from 4 weeks to 18 months, with follow-up of 10 weeks to 36 months post-intervention. There was a within group reduction in global eating disorder scores (20 intervention arms; Hedges' g = -0.27; 95% CI -0.36, -0.17; I2 67.1%) and binge eating (49 intervention arms; -0.66; 95% CI -0.76, -0.56; I2 82.7%) post-intervention, both maintained at follow-up. Of 14 studies reporting prevalence or episodes of binge eating, all reported a reduction. Four studies reported eating disorder symptoms, not present at baseline, in a subset of participants (0%-6.5%). Overall, behavioral weight management interventions do not increase eating disorder symptoms for most adults; indeed, a modest reduction is seen post-intervention and follow-up. A small subset of participants may experience disordered eating; therefore, monitoring for the emergence of symptoms is important.

Dietary restraint, binge eating and adherence to an adolescent intensive behavioural weight management intervention: a Fast Track to Health sub-study

Thu, 01 Jan 2026 00:00:00 GMT

Dietary restraint, binge eating and adherence to an adolescent intensive behavioural weight management intervention: a Fast Track to Health sub-study House, Eve T; Lister, Natalie B; Baur, Louise A; Garnett, Sarah P; Gow, Megan L; Kwok, Cathy; Jebeile, Hiba Purpose Dietary restraint often increases or remains unchanged following adolescent weight management interventions. It is unknown whether dietary restraint change in such interventions is associated with binge eating risk or intervention adherence. This study examined associations between (1) dietary restraint, measured using the Eating Disorder Examination Questionnaire (EDE-Q) and Dutch Eating Behaviour Questionnaire (DEBQ); (2) changes in dietary restraint and binge eating; and (3) changes in dietary restraint, anthropometry, and adherence throughout a weight management intervention. Methods Secondary data analysis of a clinical trial of behavioural weight management interventions involving adolescents (13–17 years) with obesity and related complications. Associations between dietary restraint, binge eating, and BMI z-score were examined using Pearson or Spearman’s rank correlation. Differences in dietary restraint change between adherers and non-adherers were examined by independent samples t-tests or Mann–Whitney U tests. Results 141 adolescents (14.8 years, 49.6% female) were recruited; 136 had baseline, 130 week-4, 120 week-16, and 92 week-52 data included in analyses. EDE-Q and DEBQ restraint scores were correlated at all timepoints (r = 0.442–0.579, all p < 0.001). Changes in dietary restraint and binge eating from baseline to week-4 and week-16 were not correlated. Week-52 change in DEBQ dietary restraint was associated with change in binge eating (r = 0.347, p < 0.001). Correlations between changes in dietary restraint and BMI z-score and differences in change in dietary restraint between adherers and non-adherers were not significant. Conclusion The findings do not provide robust evidence of dietary restraint as a marker of adherence or binge eating risk during a behavioural weight management intervention.

Dieting Practices of Adolescents Seeking Obesity Treatment

Wed, 01 Jan 2025 00:00:00 GMT

Dieting Practices of Adolescents Seeking Obesity Treatment Jebeile, Hiba; House, Eve T; Baur, Louise A; Kwok, Cathy; Collins, Clare E; Garnett, Sarah P; Lister, Natalie B Background: Adolescents with obesity participate in self-directed weight loss attempts, and these may be associated with disordered eating. This study aimed to understand prior engagement with a dietitian and previous dieting practices of adolescents presenting for obesity treatment. Additionally, we aimed to understand the association between prior dieting and eating disorder risk, binge eating, weight bias internalisation and body image. Methods: This cross-sectional study included 141 adolescents (median [IQR] age: 14.8 [13.8-15.7] years) with BMI 35.28 (31.99-38.57) kg/m2 and ≥1 related complication presenting for a prescriptive dietary intervention. Adolescents were asked whether they had previously seen a dietitian (yes/no) and/or previously trialled any other diets for weight management. Associations between reported diets and the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale, the Weight Bias Internalisation scale and Body Appreciation Scale scores were assessed using multiple one-way ANOVAs. Results: A total of 68 (48.2%) adolescents had previously seen a dietitian and 106 (75.2%) had trialled at least one diet. Most adolescents had used one diet type (n = 74; 52.5%), and 29 (20.6%) had used two or three different diets. Most adolescents reported following a healthy eating pattern (n = 76; 53.9%), with 11 trying a low-carbohydrate diet (7.8%) or a specific eating plan, e.g., low sugar, vegetarian (n = 11; 7.8%). There were no associations between dieting attempts and scores of measures of disordered eating, weight bias or body appreciation. Conclusions: Many adolescents presenting for obesity treatment will have trialled diets, with or without the support of a dietitian. Clinicians providing nutrition education and prescribing dietary interventions should be aware of this and the potential influence on adolescent perceptions of dieting practices.

Facets of Dietary Restraint Associated With Disordered Eating Behaviors Among Children and Adolescents With Higher Weight

Wed, 01 Jan 2025 00:00:00 GMT

Facets of Dietary Restraint Associated With Disordered Eating Behaviors Among Children and Adolescents With Higher Weight D'Adamo, Laura; Christian, Caroline; Jebeile, Hiba; Wilfley, Denise E; Eddy, Kamryn T; Boutelle, Kerri; Zucker, Nancy; Peterson, Carol B; Celio-Doyle, Angela; Le Grange, Daniel; Goldschmidt, Andrea B Objective: Self-directed dietary restraint (i.e., outside of evidence-based weight management programs) has been associated with disordered eating in youth. This study examined associations between maladaptive facets of dietary restraint and disordered eating among youth with higher weight. Methods: Participants (N = 529; mean age = 10.8 ± 2.08; BMI ≥ 85th percentile) self-reported dietary restraint (restraint over eating, avoidance of eating, food avoidance, desire for an empty stomach, and dietary rules) and disordered eating behaviors (i.e., objective and subjective binge eating, driven exercise, and vomiting) over the past 3 months. Network analysis estimated partial correlations between restraint factors and disordered eating behaviors. Results: The restraint item most strongly associated with disordered eating behaviors was "dietary rules," which was associated with "driven exercise" and "subjective binge eating." The disordered eating behavior most strongly connected to restraint was "subjective binge eating," which was positively associated with "dietary rules," "desire for an empty stomach," and "food avoidance." Conclusions: Trying to follow definite dietary rules may be associated with disordered eating behaviors in youth with higher weight. Prospective research is needed to examine causality among youth undergoing weight management interventions, which could inform screening and monitoring of restraint prior to and during weight management.

The recruitment of adolescents with obesity to a randomised controlled trial: A Fast Track to Health sub-study

Wed, 01 Jan 2025 00:00:00 GMT

The recruitment of adolescents with obesity to a randomised controlled trial: A Fast Track to Health sub-study House, Eve T; Ghouri, Hamna; Baur, Louise A; Collins, Clare E; Gow, Megan L; Truby, Helen; Jebeile, Hiba; Lister, Natalie B Aims: Behavioural weight management interventions facilitate short to medium-term weight and cardiometabolic improvements in adolescent obesity. However, recruiting adolescents to trials of such interventions is challenging. This study describes strategies used to recruit adolescents with obesity into the Fast Track to Health (Fast Track) trial, conducted at two tertiary paediatric centres in Australia. Methods: Fast Track (HREC/17/SCHN/164) was a randomised controlled trial that recruited 13-17-year-olds with obesity and ≥ 1 cardiometabolic complication, from December 2017 to March 2022. Families underwent phone screening, followed by in-person screening appointments. Recruitment strategies were grouped and enrolment yield by strategy was calculated. Results: Of 308 inquiries received, 141 (45.8 %) adolescents were recruited. The most successful strategy was referral from specialists at participating centres (21.2 % enrolment yield), followed by referrals from family/friends (6.5 %), other doctors/general practitioners (3.6 %), and social media (3.6 %). Social media was used for 11 months only (enrolment yield - 8.5 %). Recruitment strategies with low yield were study flyers/posters (1.6 %), digital/print media (1.3 %), and the study website (1.0 %). Of 137 adolescents excluded at phone screening, most were due to disinterest in participation or inability to make contact (60.6 %). Of 171 adolescents attending in-person screening, 30 did not meet inclusion criteria (n = 7 of those excluded had no metabolic complications, n = 7 were outside the BMI range). Conclusion: Connecting with medical specialists may be important to support the engagement of treatment-seeking adolescents with obesity in clinical trials. Further research is needed to identify methods of enhancing clinical trial recruitment in primary care, community settings, and online.

Identifying Eating Disorders in Adolescents and Adults Living With Higher Weight: An Updated Systematic Review of Questionnaire Diagnostic Accuracy

Thu, 01 Jan 2026 00:00:00 GMT

Identifying Eating Disorders in Adolescents and Adults Living With Higher Weight: An Updated Systematic Review of Questionnaire Diagnostic Accuracy House, Eve T; McMaster, Caitlin M; Lister, Natalie B; Jardine, Isabelle R.; Lorien, Sasha J; Seidler, Anna Lene; Jebeile, Hiba Objective To update the evidence regarding the diagnostic accuracy of eating disorder (ED) questionnaires in adolescents and adults with higher weight. Method Five databases were systematically searched from 2020 to November 2025 (CRD420251186115). Included studies reported on the diagnostic accuracy of self-report questionnaires against a clinical interview to identify EDs and disordered eating behaviors (DEBs) in adolescents and adults with higher weight. Narrative synthesis was conducted, and findings from new studies were synthesized alongside previously identified studies. Results Thirty-two studies (5 new) were included, reporting on the diagnostic accuracy of 13 questionnaires in adults and 5 in adolescents. The diagnostic accuracy of questionnaires was examined to identify any ED (5 questionnaires in adults, 0 adolescents), binge-eating disorder (8 adult, 2 adolescent), DEBs (e.g., binge eating, purging) (4 adult, 1 adolescent), loss-of-control eating (1 adult, 2 adolescent), bulimia nervosa, atypical anorexia nervosa, purging disorder, and night eating syndrome (each n = 1 adult, 0 adolescent). The Eating Disorder Examination Questionnaire (7 studies; sensitivity 0.16–0.88; specificity 0.54–1.0), Binge Eating Scale (6 studies; sensitivity 0.37–0.98; specificity 0.48–0.96), and Questionnaire on Eating and Weight Patterns (6 studies; sensitivity 0.07–1.0; specificity 0.0–1.0) were most used. Discussion Progress in evaluation of the diagnostic accuracy of ED questionnaires in people with higher weight has been limited. There remains a lack of evidence regarding the diagnostic accuracy of questionnaires in adolescents and a lack of sufficiently sensitive questionnaires to identify EDs other than binge-eating disorder. Assessing the diagnostic accuracy of questionnaires in people with higher weight remains a research priority. Summary Eating disorders and higher weight commonly co-occur; eating disorder screening and assessment is recommended as part of care for people seeking support with weight loss; however, recommendations on which tools to use are lacking. Thirty-two studies have been identified that report on the diagnostic accuracy of self-reported eating disorder questionnaires, with the majority focused on identifying binge-eating disorder or binge-eating behaviors. To date, the diagnostic accuracy of the Binge Eating Scale has been most extensively assessed to identify binge-eating disorder in adults, generally demonstrating good sensitivity. Diagnostic accuracy studies of eating disorder questionnaires for adolescents with higher weight are lacking. Assessment of the diagnostic accuracy of existing questionnaires or development of tailored questionnaires to identify restrictive eating disorders in adolescents and adults with higher weight is needed.

The Prevalence of Eating Disorders and Disordered Eating in Adults Seeking Obesity Treatment: A Systematic Review With Meta-Analyses

Wed, 01 Jan 2025 00:00:00 GMT

The Prevalence of Eating Disorders and Disordered Eating in Adults Seeking Obesity Treatment: A Systematic Review With Meta-Analyses Melville, Hannah; Lister, Natalie B; Libesman, Sol; Seidler, Anna Lene; Cheng, Hoi Yuk; Kwan, Yuen Lam; Garnett, Sarah P; Baur, Louise A; Jebeile, Hiba Objective: To estimate the prevalence of eating disorders and disordered eating in adults seeking obesity treatment. Method: Databases, MEDLINE, Embase, and PsycINFO, were searched to 20th March 2025. Studies reporting the prevalence of eating disorders or disordered eating at presentation to obesity treatment in adults (≥ 18 years) with overweight (BMI 25 to< 30 kg/m 2) or obesity (BMI ≥ 30 kg/m 2), with ≥ 325 participants to ensure a representative sample, were included. A random-effects model was used to pool prevalence estimates of eating disorders and disordered eating. Results: 85 studies were included (n = 94,295, 75.9% female, median (IQR) age 44 (5) years, BMI 46 (10) kg/m 2). When assessed by clinical interview, the pooled prevalence of binge-eating disorder (Diagnostic and Statistical Manual of Mental Disorders-5) was 14% (95% CI: 7 to 22, prediction interval [PI]%: 0 to 43, k = 10, n = 8534), and bulimia nervosa 1% (95% CI: 0 to 1, PI%: 0 to2, k = 9, n = 9448, τ 2 = 0). When assessed using the Binge Eating Scale, the prevalence of self-reported moderate severity binge eating was 26% (95% CI: 23 to 28, PI%: 18 to 33, k = 12, n = 8113, τ 2 = 0.001) and severe binge eating was 12% (95% CI: 8 to 16, PI%:0 to 31, k = 18, n = 12,136, τ 2 = 0.01). Discussion: Obesity and eating disorders or disordered eating do co-occur. There was variability between studies and between the prevalence of eating disorders and disordered eating in adults presenting for obesity treatment. It is critical that clinicians are well resourced to effectively identify individuals with eating disorders and disordered eating and provide appropriate treatment pathways.

Experimental investigation of real-time 3D beam's eye view image-guided radiotherapy for prostate SBRT.

Wed, 01 Jan 2025 00:00:00 GMT

Experimental investigation of real-time 3D beam's eye view image-guided radiotherapy for prostate SBRT. Chrystall, D; Stewart, M; Jin, F; Sengupta, C; D'Oliveira, M; Kejda, A; Madden, L; Nguyen, D T; Keall, P; Booth, J T Background Real-time image-guided radiotherapy (IGRT) is critical for accurate dose delivery during stereotactic body radiotherapy (SBRT). Beam's eye view (BEV) imaging offers the unique advantage of reporting motion in the most dosimetrically relevant frame of reference without additional imaging dose. However, its clinical use is limited by poor contrast-to-noise ratio and marker occlusion by treatment beam apertures. Deep learning enables fast identification of indistinct marker features even in low contrast images, facilitating real-time BEV-IGRT. To support integration with standard-equipped linear accelerators, accurate 3D localization is essential—necessitating the development of a 3D BEV-IGRT system. Purpose This study aimed to develop and experimentally evaluate a novel real-time 3D BEV-IGRT system for potential clinical implementation during prostate SBRT. Methods A real-time 3D BEV-IGRT system was developed by integrating a deep learning-based 2D MV marker segmentation method with a 3D IGRT framework. Marker positions were segmented on MV images using a convolutional neural network (CNN) and used to predict 3D motion via a Gaussian maximum likelihood estimation method. A failure mode and effects analysis (FMEA) was performed by a multidisciplinary team. Mitigation strategies were implemented for high-risk failure modes, and risk priority numbers (RPN) were recalculated. Experimental system evaluation was guided by failure modes identified through the FMEA. An anthropomorphic pelvic phantom with three implanted gold markers was mounted on a 3D motion-programmable platform. System performance was assessed under static and dynamic conditions, using treatment plans of increasing complexity, ranging from open fields to patient-representative volumetric modulated arc therapy plans. Dynamic performance was evaluated using four patient-derived prostate motion traces. Localization accuracy (mean error ± 1 SD) was assessed by comparing system-reported positions to ground truth derived from known motion trajectories or static displacements. 5th/95th error percentiles were calculated. System latency was measured as the time delay between motion initiation and system-reported displacement. Clinically acceptable accuracy was defined as within ± 2 mm in the superior-inferior (SI), anterior-posterior (AP) and left-right (LR) directions, and latency ≤ 500 ms. Results Forty-six failure modes were identified through the FMEA. High-risk failure causes included algorithmic limitations, algorithmic errors, human error, and marker occlusion. Incorporation of mitigation strategies—including eligibility screening, staff training, and workflow formalization—resulted in an average RPN reduction of 43% across the top ten high-risk failure modes. A risk-informed quality assurance program was designed to support clinical implementation. Overall 3D BEV-IGRT system accuracy was 0.1 ± 0.7 mm (SI), -0.1 ± 0.8 mm (AP), and 0.1 ± 0.7 mm (LR). Accuracy remained within ± 2 mm in all directions across all individual tests. Overall 5th/95th percentile errors were [-1.0, 1.3] mm (SI), [-1.2, 0.9] mm (AP), and [-0.9, 1.0] mm (LR). System latency was 300 ± 100 ms. Conclusions The 3D BEV-IGRT system was experimentally validated, demonstrating clinically acceptable localization accuracy and latency, supporting its feasibility for clinical implementation. Integrated risk mitigation strategies effectively reduced workflow risk and promoted understanding of system vulnerabilities. Deployment is planned for a prostate SBRT clinical trial.

Misaligned Attitudes and Perceptions Among Adolescents Living With Obesity, Caregivers and Healthcare Professionals: ACTION Teens Australia Survey Study

Wed, 01 Jan 2025 00:00:00 GMT

Misaligned Attitudes and Perceptions Among Adolescents Living With Obesity, Caregivers and Healthcare Professionals: ACTION Teens Australia Survey Study Kwok, Cathy; Bentley, Nicholas; Curran, Jacqueline; Lister, Natalie; Truby, Helen; Baur, Louise A Aims: To explore perceptions, attitudes, behaviours and barriers relating to adolescent weight management in Australia.Methods: ACTION Teens was a cross-sectional, survey-based study. Adolescents with high body mass index (BMI), caregiversand healthcare professionals (HCPs) from 10 countries completed an online survey in 2021. This analysis was limited to partici-pants in Australia. Adolescents (N = 298) were aged 12–< 18 years with BMI ≥ 95th percentile for age and sex. Caregivers (N = 276)lived with an eligible adolescent and were involved in healthcare decisions. HCPs (N = 137) had ≥ 2 years' clinical experience andsaw/treated ≥ 10 adolescents with high BMI per month. Outcomes included perceptions of high BMI, weight loss (history, bar-riers, definition of success), weight-management information sources, and history/assessment of weight-related conversations.Results: Most adolescents believed their health was good/very good/excellent (83%) but worried about weight impacting their fu-ture health (69%). More caregivers indicated their adolescent's health was good/very good/excellent (92%). More adolescents thancaregivers agreed weight loss was entirely the adolescent's responsibility (72% vs. 28%), reported a recent weight-loss attempt bythe adolescent (52% vs. 21%) and believed initiating weight-related discussions with HCPs was the adolescent's responsibility(62% vs. 51%). Only 42% of adolescents had recently discussed weight with an HCP; although 66% of this subset trusted theirHCP's advice, the adolescents reported both positive (73%) and negative (44%) feelings following discussions.Conclusions: To improve adolescent obesity care in Australia, improved communication between adolescents and caregivers/HCPs is needed. We recommend HCPs raise the topic of weight with adolescents in a sensitive manner.ClinicalTrials.gov identifier: NCT05013359.

Oral Health Research Connect - June 2026 Speaker: Associate Professor Jaya Seneviratne

Tue, 30 Jun 2026 00:00:00 GMT

Oral Health Research Connect - June 2026 Speaker: Associate Professor Jaya Seneviratne liu, Siyuan; Seneviratne, Jaya Oral Microbiomics: From Biofilm Ecology to Precision Oral Health-Associate Professor Jaya Seneviratne Oral microbiomics is a broad and rapidly evolving field that has grown from the foundations of classical oral microbiology into the era of microbiome science. Moving beyond the traditional focus on individual pathogens, oral microbiomics examines complex microbial communities, their ecological interactions, and dynamic relationships with the host. This presentation will explore how knowledge from classical oral microbiology, biofilm biology, and modern OMICS driven microbiome research can be integrated to develop new ecological modulation therapies. The field is now converging on precision oral health, where prevention, diagnosis, and treatment are tailored to each individual's microbial, immunological, and clinical profile. The key questions are, where do we stand today in oral microbiomics, and how do we progress towards precision oral health?

Components of Adolescent Behavioural Interventions With Eating Disorder Outcomes: Systematic Review With Intervention Mapping

Thu, 01 Jan 2026 00:00:00 GMT

Components of Adolescent Behavioural Interventions With Eating Disorder Outcomes: Systematic Review With Intervention Mapping Lister, Natalie B; Khalid, Rabia; Jardine, Isabelle R; Pryde, Samantha; Melville, Hannah; Seidler, Anna L; Hunter, Kylie E; Ahern, Amy L; Baur, Louise A; Braet, Caroline; Garnett, Sarah P; Hill, Andrew J; Maguire, Sarah; Nicholls, Dasha; Paxton, Susan J; Piya, Milan K; Sainsbury, Amanda; Steinbeck, Katharine; Wilfley, Denise E; Cooper, Kelly; Dammery, Genevieve; Grunseit, Alicia M; Heeren, Faith Anne N; Jones, Rebecca A; Kyle, Theodore K; Quigley, Fiona; Robbins, Molly; Yourell, Jacqlyn; Bean, Melanie K; Bonham, Maxine P; Boutelle, Kerri N; Cardel, Michelle I; Darling, Katherine E; Dordevic, Aimee L; Eichen, Dawn M; Epstein, Leonard H; Goldschmidt, Andrea B; Jelalian, Elissa; Lofrano-Prado, Mara Cristina; Naets, Tiffany; Prado, Wagner L; Skjåkødegård, Hanna F; Danielsen, Yngvild Sørebø; Stein, Richard I; Tanofsky‐Kraff, Marian; Van Eyck, Annelies; Vidmar, Alaina P; Yanovski, Jack A; Johnson, Brittany J; Jebeile, Hiba Objective To understand delivery features and intervention strategies of adolescent weight management interventions which may influence eating disorder risk. Methods Systematic searches in four databases and two trial registries to identify randomised controlled trials in adolescents with overweight/obesity measuring eating disorder risk pre‐ and post‐intervention. Delivery features and intervention strategies were coded from published descriptions using a project‐specific codebook, validated by trial investigators and narratively synthesised. Results Of 11 860 records screened, 23 trials, with 54 intervention arms, were included in the analysis. Most interventions focused on weight loss and maintenance (54%) and were informed by a cognitive behavioural framework (43%). Interventions commonly targeted an individual with a support person (70%). Median intervention duration was 26 weeks, with weekly (35%) or staged (e.g., weekly, then monthly) visit (41%) frequency. Interventions had a mean (SD) of 30 (16.1) intervention strategies. Most included healthy eating education (89%), physical activity education (89%) and problem‐solving barriers to dietary change (80%). Few included mental health strategies (17%). Interventions included ‘dietary prescription’ (65%), and 78% promoted ‘healthful/helpful eating behaviours’. Conclusion Weight management interventions are complex and vary in delivery approach and strategies used to change behaviors. Characterising interventions is a critical first step to understanding how weight management interventions' influence eating disorder risk.

Changes in Psychosocial Outcomes Reported in Behavioral Intervention Trials for Children and Adolescents with Overweight and Obesity: A Scoping Review

Thu, 01 Jan 2026 00:00:00 GMT

Changes in Psychosocial Outcomes Reported in Behavioral Intervention Trials for Children and Adolescents with Overweight and Obesity: A Scoping Review Kwok, Cathy; Sacco, Sabrina; Lister, Natalie B; Alberga, Angela S; Baur, Louise A; Booij, Linda; Carrière, Kimberly; Garnett, Sarah P; Jebeile, Hiba Background: Pediatric obesity is associated with co-occurring psychosocial conditions, which may be impacted by obesity treatment. Past systematic reviews have shown positive effects for specific psychosocial outcomes following behavioral interventions. This review aimed to extend these findings by mapping patterns of change for the totality of psychosocial outcomes reported. Methods: We conducted a scoping review following published guidelines. We searched 11 databases to identify behavioral intervention trials for children and adolescents living with overweight or obesity that measured at least one psychosocial outcome pre–post. Outcomes were grouped into categories thematically, and data were synthesized based on the timepoint (post-intervention, latest follow-up), intervention arm (active, no-intervention control), and type of change reported (difference between arms, change over time). Results: Of 1172 articles screened, 197 articles (169 trials) met the inclusion criteria, with a combined sample of 18,694 children and adolescents. A total of 372 outcomes were identified and grouped into eight constructs. Across all outcomes and timepoints, many trials reported no difference or a difference favoring the active intervention arm over the no-intervention control arm. Likewise, most active intervention arms showed improvements or no change over time, though five of 169 trials reported worsening in a psychosocial outcome at post-intervention. Most no-intervention control arms showed no change over time. Conclusions: Behavioral interventions are associated with improvements or no change in psychosocial health across a broad range of outcomes assessed. Consensus on core psychosocial outcomes is needed to reduce heterogeneity and ensure outcomes are relevant to children and adolescents living with obesity.

Eating Disorders In weight-related Therapy (EDIT) Collaboration: Rationale and study design

Sun, 01 Jan 2023 00:00:00 GMT

Eating Disorders In weight-related Therapy (EDIT) Collaboration: Rationale and study design Lister, Natalie B; Baur, Louise A; Paxton, Susan J; Garnett, Sarah P; Ahern, Amy L; Wilfley, Denise; Maguire, Sarah; Sainsbury, Amanda; Steinbeck, Katharine; Braet, Caroline; Hill, Andrew; Nicholls, Dasha; Jones, Rebecca A; Dammery, Genevieve; Grunseit, Alicia; Cooper, Kelly; Kyle, Theodore K; Heeren, Faith N; Hunter, Kylie E; McMaster, Caitlin M; Johnson, Brittany J; Seidler, Anna Lene; Jebeile, Hiba The cornerstone of obesity treatment is behavioural weight management, resulting in significant improvements in cardio-metabolic and psychosocial health. However, there is ongoing concern that dietary interventions used for weight management may precipitate the development of eating disorders. Systematic reviews demonstrate that, while for most participants medically supervised obesity treatment improves risk scores related to eating disorders, a subset of people who undergo obesity treatment may have poor outcomes for eating disorders. This review summarises the background and rationale for the formation of the Eating Disorders In weight-related Therapy (EDIT) Collaboration. The EDIT Collaboration will explore the complex risk factor interactions that precede changes to eating disorder risk following weight management. In this review, we also outline the program of work and design of studies for the EDIT Collaboration, including expected knowledge gains. The EDIT studies explore risk factors and the interactions between them using individual level data from international weight management trials. Combining all available data on eating disorder risk from weight management trials will allow sufficient sample size to interrogate our hypothesis: that individuals undertaking weight management interventions will vary in their eating disorder risk profile, based on personal characteristics and intervention strategies available to them. The collaboration includes the integration of health consumers in project development and translation. An important knowledge gain from this project is a comprehensive understanding of the impact of weight management interventions on eating disorder risk.

Psychosocial outcomes of the Fast Track to Health clinical trial in adolescents with obesity

Thu, 01 Jan 2026 00:00:00 GMT

Psychosocial outcomes of the Fast Track to Health clinical trial in adolescents with obesity Lister, Natalie B; Baur, Louise A; Gow, Megan L; House, Eve T; Kwok, Cathy; Varady, Krista A; Jebeile, Hiba Introduction: Adolescent obesity requires effective and accessible treatment. Intensive dietary interventions may be used as adjunctive therapy to behavioral interventions, and lead to weight loss. The effects of behavioural interventions on psychosocial outcomes are mixed, and the impact of intensive interventions with shifts away from normal eating habits and social norms is not clear. Methods: Adolescents (13-17years) with obesity and ≥1 complication participated in a 52-week RCT, conducted 2018-2023 (ACTRN12617001630303). The intervention compared a 4-week very low energy diet followed by intermittent or continuous energy restriction (48weeks). Anthropometry and psychosocial health were assessed at baseline, weeks-4, -16, and -52 including Dutch Eating Behaviour Questionnaire (DEBQ), Rosenberg Self-Esteem Scale (RSE), Weight Bias Internalization Scale (WBIS), Body Appreciation Scale (BAS), and Depression Anxiety and Stress Scale (DASS). Intention to treat analysis using linear mixed models investigated changes over time between intervention groups. Results: 141 adolescents (70 female) were enrolled and 97 (48 female) completed the intervention. There were significant reductions in external eating (DEBQ, p<0.001), weight bias internalization (WBIS, p<0.001), anxiety (DASS, p<0.001), and stress (DASS, p=0.082), and significant increases in self-esteem (RSE, p<0.001) and body appreciation (BAS, p<0.001) in both groups. There were increases in dietary restraint (DEBQ, p=0.595), and decreases in emotional eating (DEBQ, p=0.645) and depression (DASS, p=0.381) which returned to baseline by the end of intervention. Reductions in BMIz were significantly associated with improvements in emotional eating (r=0.215, p=0.046, n=87) and body appreciation (r=-0.235, p=0.027, n=88). Conclusion: Intensive interventions incorporating dietary and behavioural components were associated with improvements in psychosocial health among adolescents with obesity associated complication

Investigation of cardiac substructure automatic segmentation methods on synthetically generated 4D cone-beam CT images.

Wed, 01 Jan 2025 00:00:00 GMT

Investigation of cardiac substructure automatic segmentation methods on synthetically generated 4D cone-beam CT images. Gardner, M; Finnegan, R N; Dillon, O; Chin, V; Reynolds, T; Keall, P J Background: STereotactic Arrhythmia Radioablation (STAR) is a novel noninvasive method for treating arrythmias in which external beam radiation is directed towards subregions of the heart. Challenges for accurate STAR targeting include small target volumes and relatively large patient motion, which can lead to radiation related patient toxicities. 4D Cone-beam CT (CBCT) images are used for stereotactic lung treatments to account for respiration-related patient motion. 4D-CBCT imaging could similarly be used to account for respiration-related patient motion in STAR; however, the poor contrast of heart tissue in CBCT makes identifying cardiac substructures in 4D-CBCT images challenging. If cardiac structures can be identified in pre-treatment 4D-CBCT images, then the location of the target volume can be more accurately identified for different phases of the respiration cycle, leading to more accurate targeting and a reduction in patient toxicities. Purpose: The aim of this simulation study is to investigate the accuracy of different cardiac substructure segmentation methods for 4D-CBCT images. Methods: Repeat 4D-CT scans from 13 lung cancer patients were obtained from The Cancer Imaging Archive. Synthetic 4D-CBCT images for each patient were simulated by forward projecting and reconstructing each respiration phase of a chosen "testing" 4D-CT scan. Eighteen cardiac structures were segmented from each respiration phase image in the testing 4D-CT using the previously validated platipy toolkit. The platipy segmentations from the testing 4D-CT were defined as the ground truth segmentations for the synthetic 4D-CBCT images. Five different 4D-CBCT cardiac segmentation methods were investigated: 3D Rigid Alignment, 4D Rigid Alignment, Direct CBCT Segmentation, Contour Transformation, and Synthetic CT Segmentation methods. For all methods except the Direct CBCT segmentation method, a separate 4D-CT (Planning CT) was used to assist in generating 4D-CBCT segmentations. Segmentation performance was measured using the Dice similarity coefficient (DSC), Hausdorff distance (HD), mean surface distance (MSD), and volume ratio (VR) metrics. Results: The mean ± standard deviation DSC for all cardiac substructures for the 3D Rigid Alignment, 4D Rigid Alignment, Direct CBCT Segmentation, Contour Transformation, and Synthetic CT Segmentation methods were 0.48 ± 0.29, 0.52 ± 0.29, 0.37 ± 0.32, 0.53 ± 0.29, 0.57 ± 0.28, respectively. Similarly, the HD values were 10.9 ± 3.6 , 9.9 ± 2.6 , 17.3 ± 5.3 , 9.9 ± 2.8 , 9.3 ± 3.0 mm, the MSD values were 2.9 ± 0.6 , 2.9 ± 0.6 , 6.3 ± 2.5 , 2.5 ± 0.6 , 2.4 ± 0.8 mm, and the VR Values were 0.81 ± 0.12, 0.78 ± 0.14, 1.10 ± 0.47, 0.72 ± 0.15, 0.98 ± 0.44, respectively. Of the five methods investigated the Synthetic CT segmentation method generated the most accurate segmentations for all calculated segmentation metrics. Conclusion: This simulation study investigates the accuracy of different cardiac substructure segmentation methods for 4D-CBCT images. Accurate 4D-CBCT cardiac segmentation will provide more accurate information on the location of cardiac anatomy during STAR treatments which can lead to safer and more effective STAR. As the data and segmentation methods used in this study are all open source, this study provides a useful benchmarking tool to evaluate other CBCT cardiac segmentation methods.

Submission on the Exposure Draft of the Children’s Online Privacy Code 2026

Thu, 11 Jun 2026 00:00:00 GMT

Submission on the Exposure Draft of the Children’s Online Privacy Code 2026 Humphry, Justine; Gray, Joanne; Mrva-Montoya, Agata; Hutchinson, Jonathon; Ahmadpour, Naseem; Lal, Shalini; Peralta, Louisa; Egliston, Ben; Page Jeffery, Catherine The submission responds to the Exposure Draft of the Privacy (Children’s Online Privacy) Code 2026. The draft Code represents a meaningful step towards protecting children’s privacy online, including the best interests test, privacy-by-default requirements, the consent framework, transparency requirements, and the right to destruction of personal information. In this submission, we address a number of areas that can be further strengthened in relation to the sale or commercial transfer of children’s personal information, accessibility requirements for children with disabilities, operation of consent practices, privacy by design, just-in-time requirements for handling personal information, privacy safeguards for age assurance systems, and definitions that are flexible and fit for purpose. To address these issues and strengthen the Code, we have made nine recommendations for consideration.

Research engagement by occupational therapists survey

Wed, 10 Jun 2026 00:00:00 GMT

Research engagement by occupational therapists survey Mackenzie, Lynette This survey was sent to WFOT member organisations for them to distribute to their members

Oral Health Research Connect - May 2026

Mon, 01 Jun 2026 00:00:00 GMT

Oral Health Research Connect - May 2026 Mancuso, Edoardo; Miletic, Vesna • Current trends in adhesive cementation: A research-based analysis of materials and clinical protocols- Dr Edoardo Mancuso The rapid evolution of restorative dentistry has introduced an extensive array of materials boasting superior mechanical and aesthetic properties. However, this progress necessitates a parallel advancement in adhesive systems and cementation protocols. With the market currently saturated by a plethora of luting options, clinicians frequently encounter challenges in selecting the most appropriate material for specific clinical scenarios. This presentation aims to provide a comprehensive, literature-based framework for the cementation of prosthodontic restorations, with a specific focus on substrate-driven selection. Recognizing that no universal "gold standard" protocol exists, as the properties of the abutment and the restorative material vary significantly, this session emphasizes the necessity of individualized clinical considerations for each case. Dr Edoardo Mancuso will analyze recent research and emerging materials, offering evidence-based guidelines to bridge the gap between laboratory data and chairside application. By synthesizing contemporary research with clinical technique, this session aims to guide clinicians in precise decision-making to enhance the predictability and success of adhesive restorations in routine practice. • Research priorities across academic career pathways in Sydney Dental School - Professor Vesna Miletic The OHRC invites Dr Vesna Miletic, recently re-appointed Director of Academic Career Development, for a discussion on how academics in Sydney Dental School can prioritise their research in the context of different academic careers (research, research-education, and education-focused) to meet and surpass expectations set by the University Academic Excellence Framework. The talk will be centred on how academics can set their goals, drawing on current scholarship and research opportunities aligned with the perspectives of the School and the University.

Climate Change, Place and Mental Health Incubator Submission to the NSW Minimum Energy Efficiency Rental Standards Consultation 2026

Fri, 29 May 2026 00:00:00 GMT

Climate Change, Place and Mental Health Incubator Submission to the NSW Minimum Energy Efficiency Rental Standards Consultation 2026 Bower, Marlee; Smout, Scarlett; Dawkins, Jacqueline; Sedgwick, Camilla; Haddad, Shamila; Brambilla, Arianna; Bryant, Gareth; Daniel, Lyrian; Lynch, A; Palmer, S; Cheung, A; K, C; Howard, Amanda; Jegasothy, Edward; McClellan, Jo; McGrath, Laura; O'Sullivan, Kimberley; Stapinski, Lexine; Swain, Jon; Teesson, Maree We are pleased to see that the NSW Department of Climate Change, Energy, the Environment and Water and NSW Fair Trading are seeking feedback on the introduction of minimum energy efficiency rental standards, and we welcome the opportunity to provide input. Our submission seeks to highlight the importance of considering mental health in the design, implementation, and evaluation of MEERS. The submission combines empirical evidence collated by the Investigator team with rich insights from the real-world experiences of the Lived Experience Advisory Group. Rather than being structured by consultation questions, the submission is organised by 1. The potential impacts of MEERS on mental health, 2. Other considerations for the design and implementation of MEERS, 3. Learnings from other jurisdictions, and a final note on measurement and evaluation.

Problems in comparing tobacco regulatory models and excise when only two countries are considered.

Thu, 14 May 2026 00:00:00 GMT

Problems in comparing tobacco regulatory models and excise when only two countries are considered. Chapman, Simon; Egger, Sam; Freeman, Becky Preprint of a response to: Borland R, Martin J, Jegasothy E, Youdan B, Hall W. Has Australia lost control of its tobacco and nicotine markets? Addiction 2026; https://doi.org/10.1111/add.70428

The promise of public health ethics for precision medicine: the case of newborn preventive genomic sequencing

Sat, 01 Jan 2022 00:00:00 GMT

The promise of public health ethics for precision medicine: the case of newborn preventive genomic sequencing Newson, A.J. Precision medicine aims to tailor medical treatment to match individual characteristics and to stratify individuals to concentrate benefits and avoid harm. It has recently been joined by precision public health-the application of precision medicine at population scale to decrease morbidity and optimise population health. Newborn preventive genomic sequencing (NPGS) provides a helpful case study to consider how we should approach ethical questions in precision public health. In this paper, I use NPGS as a case in point to argue that both precision medicine and precision public health need public health ethics. I make this argument in two parts. First, I claim that discussions of ethics in precision medicine and NPGS tend to focus on predominantly individualistic concepts from medical ethics such as autonomy and empowerment. This highlights some deficiencies, including overlooking that choice is subject to constraints and that an individual's place in the world might impact their capacity to 'be responsible'. Second, I make the case for using a public health ethics approach when considering ethics and NPGS, and thus precision public health more broadly. I discuss how precision public health needs to be construed as a collective enterprise and not just as an aggregation of individual interests. I also show how analysing collective values and interests through concepts such as solidarity can enrich ethical discussion of NPGS and highlight previously overlooked issues. With this approach, bioethics can contribute to more just and more appropriate applications of precision medicine and precision public health, including NPGS.

Policy Analysis of the Virtual Hospital Model: A Case Study of Sydney Local Health District Virtual Hospital

Tue, 05 May 2026 00:00:00 GMT

Policy Analysis of the Virtual Hospital Model: A Case Study of Sydney Local Health District Virtual Hospital Gallo, Enrico This research study was conducted within 8 months and was part of Enrico Gallo’s PhD research. It was supported by A/Prof. Philip Haywood from the Leeder Centre for Health Policy, Economics and Data and Miranda Shaw, General Manager at Sydney Local Health District Virtual Hospital (Sydney Virtual)

Perceptions of best practice, pain science and structure-focused education for rotator cuff-related shoulder pain: a content analysis of qualitative data from a randomised experiment

Thu, 01 Jan 2026 00:00:00 GMT

Perceptions of best practice, pain science and structure-focused education for rotator cuff-related shoulder pain: a content analysis of qualitative data from a randomised experiment Zhang, Z.; Ferreira, G.E.; Muller, R.; Sousa, F.; Malliaras, P.; West, C.A.; O'Keeffe, M.; Maher, C.; Zadro, J. OBJECTIVES: To explore how people perceive different forms of education for rotator cuff-related shoulder pain in terms of words or feelings evoked by the education and treatments they feel are needed. SETTING: We performed a content analysis of qualitative data collected in a randomised experiment. PARTICIPANTS: 2237 participants with rotator cuff-related shoulder pain were randomly assigned to receive three forms of education: best practice education, best practice education plus pain science messages and structure-focused education. PRIMARY AND SECONDARY OUTCOMES: After receiving the education, participants answered two questions regarding (1) words or feelings evoked by the education and (2) treatments they felt were needed. RESULTS: 2232 responses for each question were analysed (99.7% response rate). Participants who received best practice education more frequently expressed feelings of unhappiness/frustration. The addition of pain science messages to best practice education resulted in slightly more emotional responses and a greater sense of being validated or cared for. In contrast, participants who received structure-focused education more frequently expressed trust in the clinician's expertise and the need for medication, activity modification, rest, diagnostic imaging, injections and surgery. These participants also less frequently considered exercise as a viable treatment option. CONCLUSION: Participants with rotator cuff-related shoulder pain expressed generally similar emotional responses across groups, with small differences in treatment preferences favouring self-management in the best practice education groups compared with those who received structure-focused education. Those in the best practice education also less frequently reported needing potentially unnecessary treatments (eg, imaging, injections and surgery). TRIAL REGISTRATION NUMBER: Australia New Zealand Clinical Trials Registry (ACTRN12623000197639).

PhyCARE reporting guidelines for physiotherapy case reports: a consensus-based development?

Thu, 01 Jan 2026 00:00:00 GMT

PhyCARE reporting guidelines for physiotherapy case reports: a consensus-based development? Naqvi, W.M.; Mishra, G.V.; Shaikh, S.Z.; Pashine, A.A.; Romero, E.A.S.; Swaminathan, N.; Jiandani, M.P.; Herrero, P.; Zazulak, B.; Macpherson, C.E.; Goyal, C.; Zadro, J.R.; Sahni, P.; Innocenti, T.; Syed, Z.Q.; Hoogeboom, T.; Kiekens, C. OBJECTIVES: Case reports (CRs) are essential in physiotherapy, yet reporting remains heterogeneous and insufficiently standardised. The 2013 CAse REport (CARE) guideline improves transparency but lacks physiotherapy-specific detail. This study aimed to develop a consensus-driven extension of the CARE reporting guideline to support structured reporting of physiotherapy CRs, encompassing physiotherapy-specific assessments and interventions. DESIGN: An e-Delphi consensus process study following the ACcurate COnsensus Reporting Document (ACCORD) guidelines. SETTING: Online. PARTICIPANTS: Forty-four international experts in physiotherapy practice, research and education, along with six core committee members. METHODS: Experts objectively scored items for relevance (5-point Likert scale) and provided open-ended responses for each item of the drafts. Scores and responses were analysed to facilitate iterative refinement of the Physiotherapy CAse REport (PhyCARE) reporting guidelines. Consensus was predetermined at over 70% agreement. RESULTS: Round 1 had the majority of items achieving ?70% agreement, except two items that did not meet the threshold were revised and replaced with an alternative. Five new items addressing physiotherapy-specific reporting needs were added, and 10 items were relocated. In round 2, all 35 items across 13 domains achieved 84%-100%?agreement. The nomenclature of one domain was revised to 'Outcomes and Follow-up'. Following two e-Delphi rounds, consensus was achieved, and suggestions from online meeting, piloting led to item rephrasing, after which the PhyCARE guidelines were finalised. CONCLUSION: The PhyCARE guidelines have the potential to provide a physiotherapy-specific extension of CARE to support structured, transparent and reproducible reporting of physiotherapy CRs.

Diagnostic labels used by health professionals for patellofemoral pain: A cross-sectional online survey

Thu, 01 Jan 2026 00:00:00 GMT

Diagnostic labels used by health professionals for patellofemoral pain: A cross-sectional online survey Zhang, Z.; Ferreira, G.E.; Pappas, E.; Maher, C.G.; Zadro, J.R. OBJECTIVES: To explore what diagnostic labels are commonly used by health professionals in managing patellofemoral pain (PFP), to investigate management preferences for PFP, and whether imaging findings, patient characteristics, and clinicians' expertise influence the diagnostic labels used by health professionals for PFP. METHOD: We conducted an online cross-sectional survey of health professionals with experience in managing knee pain to explore what diagnostic labels health professionals use for PFP. Demographic and outcome data were summarised using descriptive statistics. Logistic regression analyses were performed to explore whether years of experience and clinicians' expertise influence the use of diagnostic labels. RESULTS: 156 participants provided data for our primary outcome (use of diagnostic labels) and 139 completed the survey. The most used diagnostic labels for PFP were 'patellofemoral pain' (83 %), 'anterior knee pain and/or syndrome' (54 %), and 'patellofemoral pain syndrome' (44 %). The most common management strategies for PFP included exercise therapy (98 %), patient education (85 %), manual therapy (63 %), and patellar taping (58 %). Around one-third of health professionals would modify their diagnosis of PFP if imaging found a meniscal tear (37 %) or inflamed bursa/fat pad (38 %). Health professionals with self-reported excellent/good diagnostic skills or who had more years of experience were less likely to change their label based on imaging findings. CONCLUSION: Health professionals' use of diagnostic labels and management strategies for PFP mostly align with current recommendations. More research is needed to investigate the relationship between diagnostic labels and patients' management preferences, and the reasons for health professionals' choice of diagnostic labels for PFP.

Effects of diagnostic labels on management intentions for patellofemoral pain: An online randomised experimental study

Thu, 01 Jan 2026 00:00:00 GMT

Effects of diagnostic labels on management intentions for patellofemoral pain: An online randomised experimental study Zhang, Z.; Ferreira, G.; Pappas, E.; Hall, S.; Malliaras, P.; Maher, C.; Zadro, J.R. OBJECTIVES: To investigate whether different labels for patellofemoral pain influence peoples' perceived need for imaging (primary outcome), surgery, an injection, a second opinion, and relative rest and activity modification, perceived seriousness of the conditions, concern about exercise and physical activity engagement, and recovery expectations; and whether being engaged in recreational sport influenced the effect of labels on outcomes. DESIGN: Online randomised experiment. METHODS: 1080 adults with self-reported non-traumatic anterior knee pain read a vignette describing a patient with patellofemoral pain and were randomised to one of four terms describing patellofemoral pain: patellofemoral pain, anterior knee pain, runner's knee, and chondromalacia patella. Outcomes included perceived need for imaging (primary), surgery, an injection, a second opinion, and relative rest and activity modification, perceived seriousness of the conditions, concern about exercise and physical activity engagement, and recovery expectations. Participants were categorised as being engaged in recreational sports (Tegner Activity Scale ?6) or not (Tegner Activity Scale <6) for sub-group analyses. Linear regression models were used for analyses of outcomes and interaction analyses. RESULTS: Labelling did not influence any outcomes for the total sample. Labelling as anterior knee pain decreased perceived need for relative rest and activity modification compared to labelling as runner's knee and chondromalacia patella among those not engaged in recreational sports, but had no effect for those engaged in recreational sports. No other analyses were statistically significant. CONCLUSIONS: The labels patellofemoral pain, anterior knee pain, runner's knee, and chondromalacia patella have similar effects on patient management preferences for patellofemoral pain.

The feasibility of delivering and evaluating stratified care integrated with telehealth ('Rapid Stratified Telehealth') for patients with low back pain: a feasibility and pilot randomised controlled trial

Thu, 01 Jan 2026 00:00:00 GMT

The feasibility of delivering and evaluating stratified care integrated with telehealth ('Rapid Stratified Telehealth') for patients with low back pain: a feasibility and pilot randomised controlled trial Gamble, A.R.; Needs, C.; Maher, C.G.; McKay, M.J.; Anderson, D.B.; Hutton, J.M.; Campos, T.F.d.; Foster, N.E.; Martens, D.; Coombs, D.M.; Machado, G.C.; Han, C.S.; Zadro, J.R. OBJECTIVES: Establish the feasibility of delivering and evaluating stratified care integrated with telehealth ('Rapid Stratified Telehealth') to reduce waiting times for people with low back pain seeking care at Australian public hospitals. METHODS: We conducted a single-blinded, single site, 2:1 ratio, two-arm parallel feasibility and pilot randomised controlled trial (RCT) with nested qualitative interviews. Usual clinic-based care for low back pain was compared to Rapid Stratified Telehealth which matched the mode and type of care to participant's risk of persistent disabling pain based on the Keele STarT MSK Tool and potential radiculopathy. Key process outcomes include acceptability of the model, intervention fidelity and adherence, appointment details, response, recruitment and consent rates, and missing data. Additional outcomes included waiting time to access care, clinical outcomes, healthcare utilisation, and adverse events. Quantitative outcomes were summarised descriptively. Qualitative data were analysed using thematic analysis. RESULTS: Of 133 people screened, 101 were eligible (76%), and 40 (30%) were randomised (intervention 26, usual care 14). Feasibility targets were met for acceptability, fidelity, and missing data but not met for recruitment, consent, and response rates. Adherence data was uncertain due to poor reporting. Intervention participants waited a median of 13 days less for their first appointment vs. usual care participants (16 days vs. 29 days). Small sample size and differences in baseline characteristics mean additional outcomes should be interpreted with caution. CONCLUSION: This study provides important information to guide modifications to our Rapid Stratified Telehealth model of care and planning of a large multisite RCT across hospital outpatient clinics. Key Points Our new model of care is feasible to deliver and evaluate in a fully powered RCT. No intervention participant was at low risk of persistent disabling pain. More than half of the intervention participants received clinic-based care.

The Effect of Diagnostic Labels on Treatment Preferences and Beliefs in People With Musculoskeletal Pain. A Systematic Review of Randomized Trials

Thu, 01 Jan 2026 00:00:00 GMT

The Effect of Diagnostic Labels on Treatment Preferences and Beliefs in People With Musculoskeletal Pain. A Systematic Review of Randomized Trials Martin, S.; Smith, M.; Wilson, D.A.; Zadro, J.R.; Ferreira, G.E.; O'Keeffe, M. OBJECTIVE: To assess how different diagnostic labels affect treatment preferences and beliefs in people with musculoskeletal pain. DESIGN: Systematic review of randomized trials. LITERATURE SEARCH: PubMed, Web of Science, MEDLINE, CINAHL, SPORTDiscus, PsycINFO, ClinicalTrials.gov, and the Australian New Zealand Clinical Trials Registry (ANZCTR) (from inception to September 17, 2025). STUDY SELECTION CRITERIA: Randomized trials evaluating the impact of diagnostic labels for musculoskeletal pain on treatment preferences and beliefs. Studies using hypothetical vignettes were eligible. DATA SYNTHESIS: The primary outcomes were patient treatment preferences and beliefs. Due to heterogeneity of labels and accompanying explanations, a narrative synthesis approach was conducted. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Five vignette-based randomized trials involving 7575 participants were included. Risk of bias was rated as low to some concerns across all outcomes. Low-certainty evidence suggested that specific diagnostic labels may increase patient preferences for imaging and surgery and may increase the perceived seriousness of the condition. Non-specific labels may lead to more positive recovery beliefs and reduced perceived need for invasive treatments, and to lower patient satisfaction. The information accompanying these labels (eg, explanations, reassurance) may have influenced outcomes. CONCLUSION: Based on low-certainty evidence, specific diagnostic labels may increase demand for invasive care and foster more negative recovery expectations. Non-specific labels may encourage non-invasive management but can contribute to patient dissatisfaction. J Orthop Sports Phys Ther 2026;56(1):4-15. Epub 3 December 2025. doi:10.2519/jospt.2025.13759.

Efficacy and Harms of Opioid Analgesics for Acute Pain: Overview of Systematic Reviews and Meta-analyses

Thu, 01 Jan 2026 00:00:00 GMT

Efficacy and Harms of Opioid Analgesics for Acute Pain: Overview of Systematic Reviews and Meta-analyses Mathieson, S.; Zadro, J.R.; Narayan, S.W.; McLachlan, A.J.; Ballantyne, J.C.; Blyth, F.M.; Day, R.O.; Maher, C.G.; McLachlan, H.; Lin, C.C.; Kamper, S.J.; Shaheed, C.A. BACKGROUND: Opioids are commonly prescribed for acute pain. However, there is no overarching synthesis on their efficacy. AIM: We set out to conduct an overview review of the efficacy and harms of opioid analgesics for acute pain. METHODS: Electronic databases were searched until 4 March 2025 without restriction for systematic reviews of randomised trials comparing opioids to placebo/no active treatment for any acute, non-malignant pain condition published since 2010. Screening, extraction and quality assessment were conducted independently by two authors. The primary outcome was pain. Secondary outcomes were adverse events. Data timepoints were immediate (??3 h after administration-primary timepoint), short (>?3 to ??6 h), intermediate (>?6 to ??48 h) and long term (>?48 h). Random effect meta-analyses were conducted. AMSTAR 2 described review quality. Grading of Recommendations Assessment, Development and Evaluation determined evidence certainty. RESULTS: We included 59 reviews. There was high certainty some opioids (morphine, oxycodone, tramadol, papaveretum) reduced acute abdominal pain at immediate term (mean difference [MD] -?18.4, 95% CI -?31.9 to -?5.0) compared with placebo. However, there were no harms data. At immediate term, there was moderate certainty opioids reduced pain including dental surgery (MD -?19.5, 95% CI -?25.0 to -?14.0), and myringotomy (MD -?15.0, 95% CI -?19.6 to -?10.4). However, harms data were only available for dental surgery, finding no increased risk of adverse events. Oral opioids provided only very small pain relief for acute musculoskeletal pain at intermediate term (MD -?8.9, 95% CI -?13.5 to - 4.3; moderate certainty) but increased the risk of adverse events (risk difference [RD] 0.1, 95% CI 0.0 to 0.2; moderate certainty). LIMITATIONS: Some opioids are not consistently efficacious across timepoints. CONCLUSIONS: Opioid analgesics are efficacious in reducing pain in some acute conditions. REGISTRATION: ROSPERO CRD42018109733.

Development and acceptability of a patient decision aid for people with degenerative cervical myelopathy: an international mixed-methods study

Thu, 01 Jan 2026 00:00:00 GMT

Development and acceptability of a patient decision aid for people with degenerative cervical myelopathy: an international mixed-methods study Gamble, A.R.; Anderson, D.B.; McKay, M.J.; Davies, B.; Macpherson, S.; Gelder, J.V.; Hoffmann, T.; McCaffery, K.; Stevens, S.X.; Ammendolia, C.; Chauhan, R.V.; Zipser, C.M.; Boerger, T.F.; Tetreault, L.A.; Fehlings, M.G.; Dustan, E.; Nugent, C.; Holmgren, H.; Demetriades, A.K.; Lantz, J.M.; Dhillon, R.; Maher, C.G.; Zadro, J.R. OBJECTIVES: To develop and user-test a patient decision aid for people diagnosed with degenerative cervical myelopathy and who are considering surgery. DESIGN: Mixed-methods study describing the development of a patient decision aid. SETTING: A draft decision aid was developed by a multidisciplinary steering group (including study authors with degenerative cervical myelopathy, health professionals and researchers) informed by the best available evidence, authorship consensus and existing patient decision aids. PARTICIPANTS: Patient-participants and health professional-participants who manage people with degenerative cervical myelopathy were recruited through social media and the steering group's research and practice network. Quantitative questionnaires were used to gather baseline data, descriptive feedback, refine the decision aid and assess its acceptability. Qualitative semi-structured interviews were conducted online to gather feedback on the decision aid and were analysed using reflexive thematic analysis. RESULTS: We conducted 32 interviews: 19 patient-participants and 13 health professional-participants who manage people with degenerative cervical myelopathy (neurosurgeons, neurologists, physiotherapists, orthopaedic surgeons, general practitioners, rehabilitation and pain specialists and consultant occupational physicians and chiropractors). Participants were from 10 countries (Australia, Canada, Cyprus, Germany, Ireland, New Zealand, Sweden, Switzerland, United Kingdom and USA). Most participants rated the decision aid's acceptability as good-to-excellent and agreed with most aspects of the decision aid (eg, defining degenerative cervical myelopathy, management recommendations, potential benefits and harms, questions to consider asking a health professional). CONCLUSION: Our patient decision aid was rated as an acceptable tool by both health professional-participants who treat degenerative cervical myelopathy and patient-participants with lived experience of degenerative cervical myelopathy. This decision aid can be used by clinicians and people with degenerative cervical myelopathy to help with shared decision making following a diagnosis of degenerative cervical myelopathy. A study testing the potential benefits of this decision aid in a clinical setting is recommended.

Co-Designing the Early Pain Intervention After Knee Replacement (EPIK) Model of Care for People With Persistent Pain After Knee Replacement

Thu, 01 Jan 2026 00:00:00 GMT

Co-Designing the Early Pain Intervention After Knee Replacement (EPIK) Model of Care for People With Persistent Pain After Knee Replacement Chadha, N.; Zadro, J.R.; Adie, S.; Tchan, M.; Harris, I.A.; Ackerman, I.N.; Jenkin, D.E.; Dear, B.F.; Maher, C.G.; Buchbinder, R.; Billot, L.; Cameron, I.D.; Gregson, T.; Luck, B.; Ferreira, G.E. BACKGROUND: Approximately one in five Australians who undergo total knee replacement (TKR) experience persistent postoperative pain. There are currently no known effective and cost-effective multidisciplinary models of care in Australia to address this. We are developing the 'Early Pain Intervention after Knee Replacement' (EPIK) model of care, adapted from 'Support and Treatment After Replacement' (STAR) care pathway. STAR was developed in the United Kingdom (UK) and shown to be effective and cost-effective in the UK context. Extensive consumer and clinician engagement informed the development of the EPIK model of care, tailored to the Australian health system and geographical context to address this critical gap. OBJECTIVE: To co-design the 'Early Pain Intervention after Knee replacement' (EPIK) model of care for people with persistent pain after TKR. METHODS: We used Experience-Based Co-Design (EBCD) methodology to co-design EPIK, a telehealth model of care providing remote care coordination for people with persistent pain after TKR. Three online Zoom workshops were conducted with key stakeholders, including consumers with lived experience, clinicians (orthopaedic surgeons, physiotherapists, general practitioners, psychologists and a rehabilitation physician), and EPIK investigators. Workshop 1 explored consumer perspectives on the EPIK model of care assessment and follow-up. Workshop 2 determined the feasibility and roles of clinicians in the EPIK model of care delivery. Workshop 3 brought together consumers, clinicians, and researchers to refine and finalise the EPIK model of care. Using EBCD methodology and inductive framework analysis, themes were derived iteratively. Across consumer and clinician workshops, consensus was reached through facilitated discussions where stakeholders actively contributed to prioritisation activities and iterative refinement of model components. RESULTS: Twenty-one individuals participated in the workshops, comprising nine consumers and 12 clinicians from the Australian Capital Territory, New South Wales, Tasmania, and Western Australia, alongside five EPIK Investigators. Workshop 1 with consumers highlighted the need for clearer definition of communication processes, patient education and coaching strategies, and the role of the EPIK care coordinator to ensure consistent information and coordinated support throughout the model of care delivery. Workshop 2 with clinicians focused on telehealth assessments, escalation of clinical pathways, referrals, and psychological support. The final workshop reached consensus on its components and delivery, emphasising the importance of patient advocacy, reassurance and continuity of personalised care. CONCLUSION: Through meaningful end-user involvement, co-design informed the development of the EPIK model of care. The effectiveness, cost-effectiveness and safety of EPIK will be evaluated in a randomised controlled trial. PATIENT OR PUBLIC CONTRIBUTION: Two consumer co-authors (T.G. and B.L.) guided the development of the preliminary model of care and trial protocol. Consumers with lived experience of persistent pain after TKR participated throughout the co-design process. TRIAL REGISTRATION: ACTRN12625001029482p (Australian and New Zealand Clinical Trials Registry). Registered on 17 September 2025.

The effectiveness of education for people with shoulder pain: A systematic review

Wed, 01 Jan 2025 00:00:00 GMT

The effectiveness of education for people with shoulder pain: A systematic review Zhang, Z.; Ferreira, G.E.; Downes, J.S.; Cockburn, J.V.; Burke, W.J.; Malliaras, P.; Filho, L.F.S.; Maher, C.G.; Zadro, J.R. OBJECTIVES: To investigate the effectiveness of education for people with shoulder pain. DESIGN: Systematic review LITERATURE SEARCH: We searched several databases (e.g. MEDLINE, EMBASE, CENTRAL, CINAHL) and trial registries from inception to May 25, 2023. STUDY SELECTION CRITERIA: Randomised controlled trials investigating any education for people with shoulder pain. DATA SYNTHESIS: Pain and disability were primary outcomes. The Physiotherapy Evidence Database (PEDro) scale was used to assess methodological quality. Meta-analysis was not appropriate due to heterogeneity. RESULTS: We included 14 trials (8 had high methodological quality). The one trial on rotator-cuff related shoulder pain did not assess pain or disability but found best practice education (vs. structure-focused education) increased reassurance and intentions to stay active. The one trial on adhesive capsulitis found daily reminders, encouragement, and education about exercise via text did not improve pain and disability compared to no education. For post-operative shoulder pain, two (of four) trials found education reduced some measure of pain, but none found an effect on disability or any other outcomes. For 'shoulder complaints' (i.e. mixed or unclear diagnosis), no trials found education was more effective than home exercise or no education for improving pain or disability. CONLUSION: Some forms of education appear to improve reassurance, treatment intentions, perceived treatment needs, recovery expectations, and knowledge, but their effect on pain and disability is unclear. High-quality trials are needed to resolve uncertainty surrounding the benefit of education for shoulder pain, particularly rotator-cuff related shoulder pain and adhesive capsulitis.

Appraisal of Clinical Practice Guideline: Commonly used interventional procedures for non-cancer chronic spine pain

Wed, 01 Jan 2025 00:00:00 GMT

Appraisal of Clinical Practice Guideline: Commonly used interventional procedures for non-cancer chronic spine pain Zadro, J.R.

Mapping the Choosing Wisely campaigns in physical therapy: Are we missing an opportunity to reduce low-value care?

Wed, 01 Jan 2025 00:00:00 GMT

Mapping the Choosing Wisely campaigns in physical therapy: Are we missing an opportunity to reduce low-value care? Yi, L.C.; Zadro, J.R.; Soares, R.J.; Meziat-Filho, N.; Reis, F.J.J. BACKGROUND: The Choosing Wisely campaign (CWC) aims to reduce low-value care by encouraging healthcare professionals and patients to discuss unnecessary tests and treatments. While this campaign has been adopted in various medical fields, its implementation in physical therapy is still emerging. OBJECTIVES: To (i) identify physical therapy associations participating in the CWC and (ii) characterize the content of their recommendations. METHODS: We identified physical therapy associations affiliated with World Physiotherapy and conducted a search on their websites or contacted them via email to identify existing Choosing Wisely recommendations. The identified recommendations were categorized into musculoskeletal, neurology, cardiorespiratory, women's health, and mixed themes. RESULTS: Out of 127 physical therapy associations, seven (5.5 %) had Choosing Wisely recommendations, representing associations from Brazil, the USA, Norway, Italy, Australia, Spain, and Switzerland. We identified 62 recommendations, with the majority (48.4 %) related to musculoskeletal physical therapy, followed by mixed themes (27.4 %), women's health (14.5 %), cardiorespiratory (6.4 %), and neurology (3.2 %). CONCLUSION: The adoption of the Choosing Wisely campaign among physical therapy associations appears to be limited. Most recommendations focus on musculoskeletal physical therapy, indicating an opportunity for broader engagement with the campaign. Efforts to promote awareness and adoption of this campaign is needed to support evidence-based practices and reduce low-value care in physical therapy.

Social Media Posts About Medical Tests With Potential for Overdiagnosis

Wed, 01 Jan 2025 00:00:00 GMT

Social Media Posts About Medical Tests With Potential for Overdiagnosis Nickel, B.; Moynihan, R.; Gram, E.G.; Copp, T.; Taba, M.; Shih, P.; Heiss, R.; Gao, M.; Zadro, J.R. IMPORTANCE: Social media is an influential source of medical information, but little is known about how posts discuss medical tests that carry potential for overdiagnosis or overuse. OBJECTIVE: To investigate how social media posts discuss 5 popular medical tests: full-body magnetic resonance imaging, the multicancer early detection test, and tests for antimullerian hormone, gut microbiome, and testosterone. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study assessed posts on Instagram and TikTok between April 30, 2015, and January 23, 2024, that discussed full-body magnetic resonance imaging, the multicancer early detection test, and tests for antimullerian hormone, gut microbiome, and testosterone. Using keywords on newly created accounts, posts were searched and screened until 100 posts for each test on each platform were identified (n?=?1000). Posts were excluded if they did not discuss 1 of the 5 tests or were not in English or if the account holders had fewer than 1000 followers. MAIN OUTCOMES AND MEASURES: The main outcome was information about benefits, harms, and overall tone discussed in the post. All outcomes were summarized descriptively. Logistic regression was used to assess whether the use of evidence or the account holder being a physician or having financial interests influenced how tests were discussed. RESULTS: A total of 982 posts from account holders with a combined 194?200?000 followers were analyzed. Across all tests, benefits were mentioned in 855 posts (87.1%) and harms in 144 (14.7%), with 60 (6.1%) mentioning overdiagnosis or overuse. Overall, 823 posts (83.8%) had a promotional (vs neutral or negative) tone. Evidence was explicitly used in 63 posts (6.4%), personal anecdotes were used in 333 (33.9%), 498 posts (50.7%) encouraged viewers to take action and get the test, and 668 account holders (68.0%) had financial interests. Posts from physicians were more likely to mention harms (odds ratio, 4.49; 95% CI, 2.85-7.06) and less likely to have an overall promotional tone (odds ratio, 0.53; 95% CI, 0.35-0.80). CONCLUSIONS AND RELEVANCE: In this cross-sectional study of social media posts about 5 popular medical tests, most posts were misleading or failed to mention important harms, including overdiagnosis or overuse. These data demonstrate a need for stronger regulation of misleading medical information on social media.

The smallest worthwhile effect of surgery versus non-surgical treatments for sciatica: a benefit-harm trade-off study

Wed, 01 Jan 2025 00:00:00 GMT

The smallest worthwhile effect of surgery versus non-surgical treatments for sciatica: a benefit-harm trade-off study Salame, A.; Ferreira, M.L.; Hansford, H.J.; Maher, C.G.; Zadro, J.R.; Lin, C.W.C.; Diwan, A.; McAuley, J.H.; Hancock, M.J.; Harris, I.A.; Ferreira, G.E. QUESTION: What is the smallest worthwhile (SWE) effect of discectomy compared with non-surgical treatments amongst people with sciatica? DESIGN: Benefit-harm trade-off study. PARTICIPANTS: People with sciatica of any duration living in Australia and recruited through social media. OUTCOME: The outcome of interest was leg pain intensity. Participants were asked to nominate the additional percentage reduction in leg pain from discectomy--above the reduction anticipated from non-surgical treatments--that would make discectomy worthwhile for them. The SWE was estimated as the median (IQR) of the smallest percentage reduction in leg pain with discectomy (compared with non-surgical treatment) that participants considered worthwhile. The SWE was estimated for the overall sample and those with acute (? 6 weeks), subacute (> 6 to 12 weeks) and chronic (> 12 weeks) sciatica, and investigated factors associated with the SWE. RESULTS: Two hundred participants with a mean age of 59 years (SD 12) were included. The SWE was estimated to be an additional 15% (IQR 10 to 40) reduction in leg pain with discectomy, beyond any reduction in leg pain achieved by non-surgical treatments. Dissatisfaction with previous non-surgical treatments and low pain self-efficacy were associated with smaller SWE estimates. CONCLUSION: People with sciatica would require discectomy to provide an additional 15% reduction in their leg pain beyond the expected 50% improvement in leg pain from non-surgical treatments in the short term to consider discectomy worthwhile. These results can inform the interpretation of the effects of discectomy in randomised trials and meta-analysis from the perspective of consumers.

What are people's perspectives on different labels for neck pain after a motor vehicle crash? A content analysis of randomized study data

Wed, 01 Jan 2025 00:00:00 GMT

What are people's perspectives on different labels for neck pain after a motor vehicle crash? A content analysis of randomized study data Xie, Y.; Mescouto, K.; Liimatainen, J.; Zadro, J.R.; Andersen, T.; Curatolo, M.; Grant, G.; Jull, G.; Kasch, H.; MacDermid, J.; Malmström, E.M.; Ravn, S.L.; Rebbeck, T.; Söderlund, A.; Treleaven, J.; Westergren, H.; Sterling, M. BACKGROUND: Labels for neck pain after a motor vehicle crash (MVC) influenced recovery expectations and management preferences. Research is needed to understand why these expectations and preferences varied based on the label given. AIM: To explore how people perceive different labels for neck pain after an MVC. METHODS: We performed a content analysis of qualitative data from a randomised controlled study. 2229 participants with and without neck pain read a vignette describing a patient with neck pain after an MVC, using one of five labels: whiplash injury, whiplash-associated disorder, post-traumatic neck pain, neck pain, or neck strain. Participants provided free-text responses on the label's meaning, associated words/feelings, required health services/treatments, and any confusion about the label. RESULTS: Compared to neck strain, post-traumatic neck pain, whiplash-associated disorder, and neck pain more commonly evoked negative feelings about symptom severity and prognosis (4.7 % for neck strain versus 7.2 %-16.0 % for other labels) and psychological distress (7.3 % versus 13.0 %-30.3 %). Regarding treatment preference, neck pain most commonly promoted need for passive physical therapies (21.6 %) and imaging (9.8 %), whereas neck strain most often promoted need for exercise (11.6 %) and rarely imaging (3.4 %). Neck pain was the most confusing label (39.9 %), while whiplash injury was the least (14.8 %), with confusion arising from vagueness or a mismatch with diagnostic expectations. CONCLUSION: The meanings, feelings and confusions evoked by neck pain labels after an MVC may explain their impact on recovery expectations and management preferences. Clinicians may consider avoid labels associated with negative feelings and lower preferences for guideline-recommended treatments.

Do infographics 'spin' the findings of health and medical research?

Wed, 01 Jan 2025 00:00:00 GMT

Do infographics 'spin' the findings of health and medical research? Muller, R.; Ferreira, G.; Bejarano, G.; Gamble, A.R.; Kirk, J.; Sindone, J.; Zadro, J.R. OBJECTIVE: To compare the prevalence of 'spin', and specific reporting strategies for spin, between infographics, abstracts and full texts of randomised controlled trials (RCTs) reporting non-significant findings in the field of health and medicine and to assess factors associated with the presence of spin. DESIGN: Cross-sectional observational study. DATA SOURCE: Publications in top quintile health and medical journals from August 2018 to October 2020 (Journal Citation Reports database). ELIGIBILITY CRITERIA: Infographics, abstracts and full texts of RCTs with non-significant results for a primary outcome. MAIN OUTCOMES AND MEASURES: Presence of spin (any spin and spin in the results and conclusions of infographics, abstracts and full texts). EXPOSURES: Conflicts of interest, industry sponsorship, trial registration, journal impact factor, spin in the abstract, spin in the full text. RESULTS: 119 studies from 40 journals were included. One-third (33%) of infographics contained spin. Infographics were not more likely to contain any spin than abstracts (33% vs 26%, OR 1.4; 95%?CI 0.8 to 2.4) or full texts (33% vs 26%, OR 1.4; 95%?CI 0.8 to 2.4). Higher journal impact factor was associated with slightly lower odds of spin in infographics and full texts, but not abstracts. Infographics, but not abstracts or full texts, were less likely to contain spin if the trial was prospectively registered. No other significant associations were found. CONCLUSIONS: Nearly one-third of infographics spin the findings of RCTs with non-significant results for a primary outcome, but the prevalence of spin is not higher than in abstracts and full texts. Given the increasing popularity of infographics to disseminate research findings, there is an urgent need to improve the reporting of research in infographics.

The Clinical Course of Hip and Knee Osteoarthritis in Adults Attending Two Hospital Outpatient Physiotherapy Clinics in NSW: An Evaluation of the Osteoarthritis Chronic Care Program (OACCP)

Wed, 01 Jan 2025 00:00:00 GMT

The Clinical Course of Hip and Knee Osteoarthritis in Adults Attending Two Hospital Outpatient Physiotherapy Clinics in NSW: An Evaluation of the Osteoarthritis Chronic Care Program (OACCP) Melman, A.; Menz, F.; Needs, C.; Campos, T.F.d.; Marabani, M.; Bostock, K.; Dick, R.; Hayes, S.; Zadro, J.R.; Machado, G.C.; Maher, C.G. BACKGROUND: Osteoarthritis (OA) affects over 700,000 individuals in NSW, with projections estimating an increase to 1 million by 2030. This has led to a significant rise in joint replacement surgeries and associated healthcare costs. Despite guidelines recommending non-surgical care as first line treatment, many patients remain on surgical waiting lists without accessing these treatments. AIM: The aims of this study were to describe the characteristics and clinical outcomes of people with hip and knee OA attending two Sydney Local Health District (SLHD) Osteoarthritis Chronic Care Program (OACCP) clinics, and to identify whether baseline measures are associated with achieving Minimal Clinically Important (MCI) difference in outcomes. METHODS: This retrospective study (n = 1402) evaluated the OACCP's implementation within two SLHD hospitals between Oct 2018 and Sept 2023, describing patient characteristics, patient reported outcomes, physical performance measures, and allied health access. Changes in clinical outcomes in the short-term (3 months) and long-term (12 months) assessment as well as associations of patient's baseline measures with MCI improvements in clinical outcomes were analysed. RESULTS: Most self-reported outcomes and physical performance measures improved at both 3 and 12 months. 38.6% of patients reached the MCI threshold for KOOS total score at 3 months, which rose to 52.1% at 12 months. None of the baseline characteristics predicted outcomes. CONCLUSION: Following multidisciplinary non-surgical care, people with hip and/or knee OA experience improved quality of life and function that is sustained for up to 12 months. However, analysis was limited by low long-term follow-up rates and no control group.

Do Italian Physiotherapists Follow Evidence-Based Guidelines When Managing Patients With Low Back Pain? A Cross-Sectional Survey

Wed, 01 Jan 2025 00:00:00 GMT

Do Italian Physiotherapists Follow Evidence-Based Guidelines When Managing Patients With Low Back Pain? A Cross-Sectional Survey Muller, R.D.; Schut, S.M.; Perna, P.; Ferrara, A.; Banchetto, D.; Zadro, J.R. INTRODUCTION: Guideline-recommended management of low back pain (LBP) is associated with improved patient outcomes and costs. This study aimed to assess Italian physiotherapists' attitudes towards and adherence to LBP clinical practice guidelines (CPGs). METHODS: We conducted an online cross-sectional survey of Italian physiotherapists. Participants' demographics, attitudes towards, and familiarity with CPGs were collected. Six vignettes of patients with LBP were presented. For each, participants selected management options from a pre-specified list. Management options were categorised as recommended, not recommended, and no recommendation based on CPG recommendations and systematic reviews. Ordinal logistic regression assessed associations between participant characteristics and the number of vignettes for which recommended and not recommended care options were selected (stratified by non-specific LBP and red flag vignettes). RESULTS: Of the 272 participants completing the demographic section of the survey, 142 completed all vignettes. Care that was recommended, not recommended, and had no recommendation was selected by 87%, 32%, and 93% of participants on average in the six vignettes, respectively. Working in a hospital setting was associated with a reduced likelihood of selecting recommended care for non-specific LBP (coefficient: -1.28; 95% CI: -2.20, -0.36). Stronger self-reported familiarity with three published CPGs was associated with decreased likelihood of selecting not recommended care but was not associated with selecting recommended care for non-specific LBP. All other variables were not associated with selecting recommended and not recommended care. CONCLUSIONS: Physiotherapists commonly selected recommended care options for patients with LBP, yet there remains considerable scope to reduce selection of care which is not recommended.

Equity in Choosing Wisely and beyond: the effect of health literacy on healthcare decision-making and methods to support conversations about overuse

Wed, 01 Jan 2025 00:00:00 GMT

Equity in Choosing Wisely and beyond: the effect of health literacy on healthcare decision-making and methods to support conversations about overuse Muscat, D.M.; Cvejic, E.; Smith, J.; Thompson, R.; Chang, E.; Tracy, M.; Zadro, J.; Linder, R.; McCaffery, K. OBJECTIVE: To (a) examine whether the effect of the Choosing Wisely consumer questions on question-asking and shared decision-making (SDM) outcomes differs based on individuals' health literacy and (b) explore the relationship between health literacy, question-asking and other decision-making outcomes in the context of low value care. METHODS: Preplanned analysis of randomised trial data comparing: the Choosing Wisely questions, a SDM video, both interventions or control (no intervention). Randomisation was stratified by participant health literacy ('adequate' vs 'limited'), as assessed by the Newest Vital Sign. MAIN OUTCOME MEASURES: Self-efficacy to ask questions and be involved in decision-making, and intention to engage in SDM. PARTICIPANTS: 1439 Australian adults, recruited online. RESULTS: The effects of the Choosing Wisely questions and SDM video did not differ based on participants' health literacy for most primary or secondary outcomes (all two-way and three-way interactions p>0.05). Compared with individuals with 'adequate' health literacy, those with 'limited' health literacy had lower knowledge of SDM rights (82.1% vs 89.0%; 95% CI: 3.9% to 9.8%, p<0.001) and less positive attitudes towards SDM (48.3% vs 58.1%; 95% CI: 4.7% to 15.0%, p=0.0002). They were also more likely to indicate they would follow low-value treatment plans without further questioning (7.46/10 vs 6.94/10; 95% CI: 0.33 to 0.72, p<0.001) and generated fewer questions to ask a healthcare provider which aligned with the Choosing Wisely questions (?(2) (1)=73.79, p<.001). On average, 67.7% of participants with 'limited' health literacy indicated that they would use video interventions again compared with 55.7% of individuals with 'adequate' health literacy. CONCLUSION: Adults with limited health literacy continue to have lower scores on decision-making outcomes in the context of low value care. Ongoing work is needed to develop and test different intervention formats that support people with lower health literacy to engage in question asking and SDM.