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Perspectives20 May 2003Medical Professionalism in the New Millennium: A Physician Charter 15 Months LaterFREELinda Blank, Harry Kimball, MD, Walter McDonald, MD, and Jaime Merino, MD, for the ABIM Foundation, ACP Foundation, and European Federation of Internal Medicine (EFIM)*Linda BlankFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., Harry Kimball, MDFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., Walter McDonald, MDFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., and Jaime Merino, MDFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., for the ABIM Foundation, ACP Foundation, and European Federation of Internal Medicine (EFIM)*Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-10-200305200-00012 SectionsAboutVisual AbstractAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail AbstractFor a list of members of these organizations, see the Appendix.As we mark the 15-month anniversary of the physician charter that was published simultaneously in Annals of Internal Medicine and The Lancet in 2002 (1, 2), the members of the Medical Professionalism Project are pleased by the level of interest and activity the charter has engendered. Several hundred U.S. and international newspapers cited the charter in related stories; more than 70 radio, television, and online interviews have been conducted with individual project members; over 65 000 reprints have been requested from around the world; and, collectively, the Annals, Medical Professionalism Project and European Federation of Internal Medicine (EFIM) Web sites have logged more than 70 000 related visits. In addition, this issue of Annals features a collection of provocative Letters about the charter. Building on this level of responsiveness, the ABIM (American Board of Internal Medicine) Foundation and the ACP (American College of Physicians) Foundation will sponsor phase II of the Project, planned as a 2-year initiative. Phase II will encompass reviewing the charter's initial impact and, within that context, explore the opportunity to define the health rights and responsibilities of patients, physicians, and society.Background and RationaleThe Medical Professionalism Project, jointly sponsored by the ABIM Foundation and the ACP Foundation, began in November 1999 as a collaborative effort designed to raise the concept of professionalism within the consciousness of internal medicine, both in the United States and Europe. The two foundations, in partnership with the European Federation of Internal Medicine, are well positioned to influence the ethical and professional standards of medicine and encourage the profession to reaffirm its civic commitment.Impetus for the Project stemmed from the following question: Why is raising awareness about the core values of medical professionalism important? As the pace of change in health care accelerated and the future of medical practice became increasingly uncertain, the ABIM and ACP Foundations and European Federation of Internal Medicine saw the need to convene this collaborative project because medical professionalism is universally endangered. Physician unionization, waning ability to self-regulate, medical errors, bioterrorism, compromised access and health care delivery, conflicts of interest precipitated by managed care and for-profit medicine, and the pharmaceutical industry's role in patient care and medical education reflect the range of issues that challenge the medical profession globally. At this crossroads, the medical profession urgently needs a united front to influence and inform the culture and context of both clinical practice and medical training. The charter's three fundamental principles and set of professional responsibilities are intended to encourage such dedication and debate (Table).Table. Charter on Medical Professionalism: Fundamental Principles and Professional Responsibilities PublicationsTo date, in addition to Annals of Internal Medicine and The Lancet, the charter has been published in the following journals: Clinical Medicine (formerly Journal of the Royal College of Physicians), European Journal of Internal Medicine, American Journal of Obstetrics and Gynecology, The American Journal of Surgery, Journal of the American College of Dentists, Annals of the Royal College of Physicians and Surgeons of Canada, Canadian Medical Association Journal, The Medical Journal of Australia, Bollettino Ordine Provinciale Medici Chirurghi e Odontoiatri-Milano, La Revue de Mdecine Interne, and La Radiologia Medica. The charter has been translated into Italian, French, Spanish, Portuguese, German, and Polish. The Health Ministry of Italy also published the charter and distributed it to every medical student and faculty member throughout the country. Translations into Dutch, Swedish, Japanese, and Turkish should lead to future publication in journals written in these languages.PresentationsSince the charter's publication, project members and others have collectively given more than 100 related presentations in a variety of formats: named lectures, grand rounds, medical school graduation addresses, plenary sessions at national and international meetings, workshops, and seminars. National meetings have included those of the Association of American Medical Colleges, ACP, American College of Obstetricians and Gynecologists, American Medical Association, Arnold P. Gold Foundation, Council of Medical Specialty Societies, Accreditation Council for Graduate Medical Education, American Board of Medical Specialties, American College of Surgeons, Association for Hospital Medical Education, and Federation of State Medical Boards. International meetings have included those of the Association for Medical Education in Europe and the European School of Internal Medicine; the European Federation of Internal Medicine Congresses in Edinburgh and Berlin; the International Society of Internal Medicine Congress in Kyoto; and the Association of Canadian Medical Colleges, Ottowa Conference, and Royal College of Physicians and Surgeons of Canada.EndorsementsTo date, the following 90 professional associations, colleges, societies, and certifying boards have endorsed the charter: Accreditation Council for Graduate Medical Education; American Academy of Allergy, Asthma & Immunology; American Academy of Dermatology; American Academy of Family Physicians; American Academy of Neurology; American Academy of Ophthalmology; American Academy of Orthopaedic Surgeons; American Academy of OtolaryngologyHead and Neck Surgery; American Academy of Pediatrics; American Academy of Physical Medicine and Rehabilitation; American Board of Medical Specialties; American Board of Allergy and Immunology; American Board of Anesthesiology; American Board of Colon and Rectal Surgery; American Board of Dermatology; American Board of Emergency Medicine; American Board of Family Practice; American Board of Internal Medicine; American Board of Medical Genetics; American Board of Neurological Surgery; American Board of Nuclear Medicine; American Board of Obstetrics and Gynecology; American Board of Ophthalmology; American Board of Orthopedic Surgery; American Board of Otolaryngology; American Board of Pathology; American Board of Pediatrics; American Board of Physical Medicine and Rehabilitation; American Board of Plastic Surgery; American Board of Preventive Medicine; American Board of Psychiatry and Neurology; American Board of Radiology; American Board of Surgery; American Board of Thoracic Surgery; American Board of Urology; ABIM Foundation; American College of Dentists; American College of Medical Genetics; American College of Obstetricians and Gynecologists; ACP; American College of Radiology; American College of Surgeons; ACP Foundation; American Psychiatric Association; American Society of Anesthesiologists; American Society of Clinical Pathologists; American Society of Plastic Surgeons; American Urological Association; Association of Academic Physiatrists; Association of Physicians of Ireland; Association of Physicians of Malta; Austrian Society of Internal Medicine; Belgian Society of Internal Medicine; College of Physicians and Surgeons of British Columbia; Council of Deans, Association of Canadian Medical Colleges; Council of Medical Specialty Societies; Czech Society of Internal Medicine; Danish Society of Internal Medicine; Estonian Society of Internal Medicine; European Federation of Internal Medicine; Federation of Royal Colleges of Physicians of United Kingdom; Federation of State Medical Boards; Finnish Society of Internal Medicine; French Society of Internal Medicine; German Society of Internal Medicine; Hellenic Society of Internal Medicine; Hungarian Society of Internal Medicine; Israeli Society of Internal Medicine; Italian Society of Internal Medicine; Latvian Society of Internal Medicine; Lithuanian Society of Internal Medicine; Luxembourg Society of Internal Medicine; Ministero della Salute; Netherlands Society of Internal Medicine; Polish Society of Internal Medicine; Portuguese Society of Internal Medicine; Royal Australasian College of Physicians and Surgeons; Royal College of Physicians of Edinburgh; Royal College of Physicians of Ireland; Royal College of Physicians of London; Royal College of Physicians and Surgeons of Canada; Slovak Society of Internal Medicine; Slovenian Society of Internal Medicine; Society of Neurological Surgeons; Society of Nuclear Medicine; Society of Thoracic Surgeons; Spanish Society of Internal Medicine; Swedish Society of Internal Medicine; Swiss Society of Internal Medicine; and Turkish Society of Internal Medicine. During the remainder of the year, additional endorsements will be sought from state medical societies, educational organizations, and other national and international medical associations.Future ActivitiesThe ABIM Foundation has launched a series of targeted activities to promote the charter: 1) an attractive charter publication for distribution at medical school and residency orientation, white coat ceremonies, and graduation; 2) a charter wall poster suitable for framing; 3) Putting the Charter into Practice [small seed grants for implementation were awarded to McGill University; New York University School of Medicine; University of California, San Francisco; University of Michigan Medical School; and University of Texas Medical Branch, Galveston]; 4) Medical Professionalism Project colloquia and conferences; 5) professionalism portfolios designed to promote self-reflection and use of self-assessment tools; 6) inclusion of the charter with each ABIM diplomate's Board certificate; 7) a proposed charter series in peer-reviewed journals; and 8) a proposed award recognition program. The past, present, and future activities stimulated by the charter are being chronicled and will be essential in determining its short- and long-term impact toward promoting and empowering an action agenda for the profession of medicine that is universal in scope and purpose.Appendix: Project MembersABIM Foundation: Troyen Brennan, MD, JD (Project Chair); Linda Blank (Project Staff); Jordan Cohen, MD; Harry Kimball, MD; and Neil Smelser, PhD.ACP Foundation: Robert Copeland, MD; Risa Lavizzo-Mourey, MD, MBA; and Walter McDonald, MD.European Federation of Internal Medicine: Gunilla Brenning, MD; Chris Davidson, MA, MB, FRCP; Philippe Jaeger, MB, MD; Alberto Malliani, MD; Hein Muller, MD, PhD; Daniel Sereni, MD; and Eugene Sutorius, JD.Special Consultants: Richard Cruess, MD; Sylvia Cruess, MD; and Jaime Merino, MD.References1. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136:243-6. [PMID: 11827500] LinkGoogle Scholar2. Medical professionalism in the new millennium: a physicians' charter. Lancet. 2002;359:520-2. [PMID: 11853819] CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands.Disclosures: None disclosed.Corresponding Author: Linda Blank, ABIM Foundation, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106; e-mail, [email protected]org.Current Author Addresses: Ms. Blank and Dr. Kimball: ABIM Foundation, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106.Dr. McDonald: ACP Foundation, 190 N. Independence Mall West, Philadelphia, PA 19106.Dr. Merino: Depart. Medicina y Psiquiatria, Universidad Miguel Hernandez, Campus de San Juan, Cta. 332 Alicante-Valencia Km. 87, 03550 San Juan de Alicante, Spain. 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AIM: In the last 40 years, physical and rehabilitation medicine (PRM) has made significant steps forward in Europe with the foundation of the European Federation of Physical Medicine and Rehabilitation (EFPMR) (1963) which gave rise to the European Society of Physical and Rehabilitation Medicine (ESPRM) (2004) the European Academy of Rehabilitation Medicine (1970), the PRM Section of the European Union of Medical Specialists (1974), and the European Board of PRM (1991). Our journal, formerly Europa Medico-physica (1964), the official journal of the EFPMR, now European Journal of Physical and Rehabilitation Medicine (EJPRM) and official journal of the ESPRM since 2008, is distinct for its steadfast European vocation, long-standing Mediter-ranean interests and connections with various national scientific societies. Jointly with the ESPRM, efforts are under way to set up the European Physical and Rehabilitation Medicine Journal Network (EPRMJN). The aim of this article is to present a profile of the national journals in the EPRMJN so as to give a better overview of how the scientific part of PRM in Europe has developed within a national perspective. METHODS: A profile of the following national journals is presented: Annals of Physical and Rehabilitation Medicine (France), Fizikalna i rehabilitacijska medicina (Physical and Rehabilitation Medicine) (Croatia), Neurorehabilitation (Bulgaria), Physical and Rehabilitation Medicine Portuguese Society Journal (Portugal), Physical Medicine, Rehabilitaton, Health (Bulgaria), Physikalische Medizin - Rehabilitationsmedizin - Kurort-medizin/Journal of Physical and Rehabilitation Medicine (Germany and Austria) Prevention and Rehabilitation (Bulgaria), Rehabilitacija (Rehabilitation) (Slovenia), Rehabilitación (Madr) (Spain), Turkish Journal of Physical Medicine and Rehabilitation (Turkey). CONCLUSION: Some national journals in Europe have a very long history and tradition of research and education. Having a better knowledge of these realities, usually hidden to the international readership owing to the English language barrier, could promote science in our specialty.

BACKGROUND: Widespread application of pulmonary rehabilitation (also known as respiratory rehabilitation) in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function (health-related quality of life, functional and maximal exercise capacity) attributable to the programmes. This review updates the review reported in 2006. OBJECTIVES: To compare the effects of pulmonary rehabilitation versus usual care on health-related quality of life and functional and maximal exercise capacity in persons with COPD. SEARCH METHODS: We identified additional randomised controlled trials (RCTs) from the Cochrane Airways Group Specialised Register. Searches were current as of March 2014. SELECTION CRITERIA: We selected RCTs of pulmonary rehabilitation in patients with COPD in which health-related quality of life (HRQoL) and/or functional (FEC) or maximal (MEC) exercise capacity were measured. We defined 'pulmonary rehabilitation' as exercise training for at least four weeks with or without education and/or psychological support. We defined 'usual care' as conventional care in which the control group was not given education or any form of additional intervention. We considered participants in the following situations to be in receipt of usual care: only verbal advice was given without additional education; and medication was altered or optimised to what was considered best practice at the start of the trial for all participants. DATA COLLECTION AND ANALYSIS: We calculated mean differences (MDs) using a random-effects model. We requested missing data from the authors of the primary study. We used standard methods as recommended by The Cochrane Collaboration. MAIN RESULTS: Along with the 31 RCTs included in the previous version (2006), we included 34 additional RCTs in this update, resulting in a total of 65 RCTs involving 3822 participants for inclusion in the meta-analysis.We noted no significant demographic differences at baseline between members of the intervention group and those who received usual care. For the pulmonary rehabilitation group, the mean forced expiratory volume at one second (FEV1) was 39.2% predicted, and for the usual care group 36.4%; mean age was 62.4 years and 62.5 years, respectively. The gender mix in both groups was around two males for each female. A total of 41 of the pulmonary rehabilitation programmes were hospital based (inpatient or outpatient), 23 were community based (at community centres or in individual homes) and one study had both a hospital component and a community component. Most programmes were of 12 weeks' or eight weeks' duration with an overall range of four weeks to 52 weeks.The nature of the intervention made it impossible for investigators to blind participants or those delivering the programme. In addition, it was unclear from most early studies whether allocation concealment was undertaken; along with the high attrition rates reported by several studies, this impacted the overall risk of bias.We found statistically significant improvement for all included outcomes. In four important domains of quality of life (QoL) (Chronic Respiratory Questionnaire (CRQ) scores for dyspnoea, fatigue, emotional function and mastery), the effect was larger than the minimal clinically important difference (MCID) of 0.5 units (dyspnoea: MD 0.79, 95% confidence interval (CI) 0.56 to 1.03; N = 1283; studies = 19; moderate-quality evidence; fatigue: MD 0.68, 95% CI 0.45 to 0.92; N = 1291; studies = 19; low-quality evidence; emotional function: MD 0.56, 95% CI 0.34 to 0.78; N = 1291; studies = 19; mastery: MD 0.71, 95% CI 0.47 to 0.95; N = 1212; studies = 19; low-quality evidence). Statistically significant improvements were noted in all domains of the St. George's Respiratory Questionnaire (SGRQ), and improvement in total score was better than 4 units (MD -6.89, 95% CI -9.26 to -4.52; N = 1146; studies = 19; low-quality evidence). Sensitivity analysis using the trials at lower risk of bias yielded a similar estimate of the treatment effect (MD -5.15, 95% CI -7.95 to -2.36; N = 572; studies = 7).Both functional exercise and maximal exercise showed statistically significant improvement. Researchers reported an increase in maximal exercise capacity (mean Wmax (W)) in participants allocated to pulmonary rehabilitation compared with usual care (MD 6.77, 95% CI 1.89 to 11.65; N = 779; studies = 16). The common effect size exceeded the MCID (4 watts) proposed by Puhan 2011(b). In relation to functional exercise capacity, the six-minute walk distance mean treatment effect was greater than the threshold of clinical significance (MD 43.93, 95% CI 32.64 to 55.21; participants = 1879; studies = 38).The subgroup analysis, which compared hospital-based programmes versus community-based programmes, provided evidence of a significant difference in treatment effect between subgroups for all domains of the CRQ, with higher mean values, on average, in the hospital-based pulmonary rehabilitation group than in the community-based group. The SGRQ did not reveal this difference. Subgroup analysis performed to look at the complexity of the pulmonary rehabilitation programme provided no evidence of a significant difference in treatment effect between subgroups that received exercise only and those that received exercise combined with more complex interventions. However, both subgroup analyses could be confounded and should be interpreted with caution. AUTHORS' CONCLUSIONS: Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition. These improvements are moderately large and clinically significant. Rehabilitation serves as an important component of the management of COPD and is beneficial in improving health-related quality of life and exercise capacity. It is our opinion that additional RCTs comparing pulmonary rehabilitation and conventional care in COPD are not warranted. Future research studies should focus on identifying which components of pulmonary rehabilitation are essential, its ideal length and location, the degree of supervision and intensity of training required and how long treatment effects persist. This endeavour is important in the light of the new subgroup analysis, which showed a difference in treatment effect on the CRQ between hospital-based and community-based programmes but no difference between exercise only and more complex pulmonary rehabilitation programmes.

BACKGROUND: Low back pain (LBP) is responsible for considerable personal suffering worldwide. Those with persistent disabling symptoms also contribute to substantial costs to society via healthcare expenditure and reduced work productivity. While there are many treatment options, none are universally endorsed. The idea that chronic LBP is a condition best understood with reference to an interaction of physical, psychological and social influences, the 'biopsychosocial model', has received increasing acceptance. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds. OBJECTIVES: To review the evidence on the effectiveness of MBR for patients with chronic LBP. The focus was on comparisons with usual care and with physical treatments measuring outcomes of pain, disability and work status, particularly in the long term. SEARCH METHODS: We searched the CENTRAL, MEDLINE, EMBASE, PsycINFO and CINAHL databases in January and March 2014 together with carrying out handsearches of the reference lists of included and related studies, forward citation tracking of included studies and screening of studies excluded in the previous version of this review. SELECTION CRITERIA: All studies identified in the searches were screened independently by two review authors; disagreements regarding inclusion were resolved by consensus. The inclusion criteria were published randomised controlled trials (RCTs) that included adults with non-specific LBP of longer than 12 weeks duration; the index intervention targeted at least two of physical, psychological and social or work-related factors; and the index intervention was delivered by clinicians from at least two different professional backgrounds. DATA COLLECTION AND ANALYSIS: Two review authors extracted and checked information to describe the included studies, assessed risk of bias and performed the analyses. We used the Cochrane risk of bias tool to describe the methodological quality. The primary outcomes were pain, disability and work status, divided into the short, medium and long term. Secondary outcomes were psychological functioning (for example depression, anxiety, catastrophising), healthcare service utilisation, quality of life and adverse events. We categorised the control interventions as usual care, physical treatment, surgery, or wait list for surgery in separate meta-analyses. The first two comparisons formed our primary focus. We performed meta-analyses using random-effects models and assessed the quality of evidence using the GRADE method. We performed sensitivity analyses to assess the influence of the methodological quality, and subgroup analyses to investigate the influence of baseline symptom severity and intervention intensity. MAIN RESULTS: From 6168 studies identified in the searches, 41 RCTs with a total of 6858 participants were included. Methodological quality ratings ranged from 1 to 9 out 12, and 13 of the 41 included studies were assessed as low risk of bias. Pooled estimates from 16 RCTs provided moderate to low quality evidence that MBR is more effective than usual care in reducing pain and disability, with standardised mean differences (SMDs) in the long term of 0.21 (95% CI 0.04 to 0.37) and 0.23 (95% CI 0.06 to 0.4) respectively. The range across all time points equated to approximately 0.5 to 1.4 units on a 0 to 10 numerical rating scale for pain and 1.4 to 2.5 points on the Roland Morris disability scale (0 to 24). There was moderate to low quality evidence of no difference on work outcomes (odds ratio (OR) at long term 1.04, 95% CI 0.73 to 1.47). Pooled estimates from 19 RCTs provided moderate to low quality evidence that MBR was more effective than physical treatment for pain and disability with SMDs in the long term of 0.51 (95% CI -0.01 to 1.04) and 0.68 (95% CI 0.16 to 1.19) respectively. Across all time points this translated to approximately 0.6 to 1.2 units on the pain scale and 1.2 to 4.0 points on the Roland Morris scale. There was moderate to low quality evidence of an effect on work outcomes (OR at long term 1.87, 95% CI 1.39 to 2.53). There was insufficient evidence to assess whether MBR interventions were associated with more adverse events than usual care or physical interventions.Sensitivity analyses did not suggest that the pooled estimates were unduly influenced by the results from low quality studies. Subgroup analyses were inconclusive regarding the influence of baseline symptom severity and intervention intensity. AUTHORS' CONCLUSIONS: Patients with chronic LBP receiving MBR are likely to experience less pain and disability than those receiving usual care or a physical treatment. MBR also has a positive influence on work status compared to physical treatment. Effects are of a modest magnitude and should be balanced against the time and resource requirements of MBR programs. More intensive interventions were not responsible for effects that were substantially different to those of less intensive interventions. While we were not able to determine if symptom intensity at presentation influenced the likelihood of success, it seems appropriate that only those people with indicators of significant psychosocial impact are referred to MBR.

BACKGROUND: The worldwide population is progressively ageing, with an expected increase in morbidity and demand for long-term care. Physical rehabilitation is beneficial in older people, but relatively little is known about effects on long-term care residents. This is an update of a Cochrane review first published in 2009. OBJECTIVES: To evaluate the benefits and harms of rehabilitation interventions directed at maintaining, or improving, physical function for older people in long-term care through the review of randomised and cluster randomised controlled trials. SEARCH METHODS: We searched the trials registers of the following Cochrane entities: the Stroke Group (May 2012), the Effective Practice and Organisation of Care Group (April 2012), and the Rehabilitation and Related Therapies Field (April 2012). In addition, we searched 20 relevant electronic databases, including the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2009, Issue 4), MEDLINE (1966 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), AMED (1985 to December 2009), and PsycINFO (1967 to December 2009). We also searched trials and research registers and conference proceedings; checked reference lists; and contacted authors, researchers, and other relevant Cochrane entities. We updated our searches of electronic databases in 2011 and listed relevant studies as awaiting assessment. SELECTION CRITERIA: Randomised studies comparing a rehabilitation intervention designed to maintain or improve physical function with either no intervention or an alternative intervention in older people (over 60 years) who have permanent long-term care residency. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information. The primary outcome was function in activities of daily living. Secondary outcomes included exercise tolerance, strength, flexibility, balance, perceived health status, mood, cognitive status, fear of falling, and economic analyses. We investigated adverse effects, including death, morbidity, and other events. We synthesised estimates of the primary outcome with the mean difference; mortality data, with the risk ratio; and secondary outcomes, using vote-counting. MAIN RESULTS: We included 67 trials, involving 6300 participants. Fifty-one trials reported the primary outcome, a measure of activities of daily living. The estimated effects of physical rehabilitation at the end of the intervention were an improvement in Barthel Index (0 to 100) scores of six points (95% confidence interval (CI) 2 to 11, P = 0.008, seven studies), Functional Independence Measure (0 to 126) scores of five points (95% CI -2 to 12, P = 0.1, four studies), Rivermead Mobility Index (0 to 15) scores of 0.7 points (95% CI 0.04 to 1.3, P = 0.04, three studies), Timed Up and Go test of five seconds (95% CI -9 to 0, P = 0.05, seven studies), and walking speed of 0.03 m/s (95% CI -0.01 to 0.07, P = 0.1, nine studies). Synthesis of secondary outcomes suggested there is a beneficial effect on strength, flexibility, and balance, and possibly on mood, although the size of any such effect is unknown. There was insufficient evidence of the effect on other secondary outcomes. Based on 25 studies (3721 participants), rehabilitation does not increase risk of mortality in this population (risk ratio 0.95, 95% CI 0.80 to 1.13). However, it is possible bias has resulted in overestimation of the positive effects of physical rehabilitation. AUTHORS' CONCLUSIONS: Physical rehabilitation for long-term care residents may be effective, reducing disability with few adverse events, but effects appear quite small and may not be applicable to all residents. There is insufficient evidence to reach conclusions about improvement sustainability, cost-effectiveness, or which interventions are most appropriate. Future large-scale trials are justified.

To facilitate the interaction between the health professional and the patient, a framework to guide the rehabilitation process is needed. This framework would encompass three interwoven aspects: the rehabilitation management plan, Individual Rehabilitation Project (IRP), and rehabilitation cycle(s). All three framework aspects focus on the patient and on the aim of rehabilitation, i.e. to optimize a person's functioning across the continuum of care. An IRP is a multi-element, person-centered rehabilitation management scheme, in which rehabilitation is generally provided by a multiprofessional team under the leadership of a physical and rehabilitation medicine (PRM) physician, working in an interdisciplinary manner and together with the patient (or proxy). A reference system for operationalizing functioning and standardizing the process is the International Classification of Functioning, Disability and Health (ICF) - for assessing functioning needs, defining rehabilitation goals and outcomes. The objective of this paper is to present the IRP as a framework for rehabilitation in Europe (EUR-IRP). The specific aims are: 1) to introduce the IRP; and 2) to describe the framework components, elements and variables of the IRP. Demonstration projects (case studies) using the EUR-IRP will be conducted. The present paper presents the efforts to date for developing the EUR-IRP, a key part of the action plan of the PRM Section and Board of the European Union of Medical Specialists to implement the ICF systemwide across the care continuum. This paper serves as another step to bring together practice, science and governance in calling for contribution from rehabilitation clinicians and researchers and professional societies in PRM and beyond.

BACKGROUND: Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015. OBJECTIVES: To compare the effect of home-based and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease. SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 21 September 2016. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA: We included randomised controlled trials, including parallel group, cross-over or quasi-randomised designs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all identified references for inclusion based on pre-defined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Quality of evidence was assessed using GRADE principles and a Summary of findings table was created. MAIN RESULTS: We included six new studies (624 participants) for this update, which now includes a total of 23 trials that randomised a total of 2890 participants undergoing cardiac rehabilitation. Participants had an acute myocardial infarction, revascularisation or heart failure. A number of studies provided insufficient detail to enable assessment of potential risk of bias, in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported.No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in clinical primary outcomes up to 12 months of follow up: total mortality (relative risk (RR) = 1.19, 95% CI 0.65 to 2.16; participants = 1505; studies = 11/comparisons = 13; very low quality evidence), exercise capacity (standardised mean difference (SMD) = -0.13, 95% CI -0.28 to 0.02; participants = 2255; studies = 22/comparisons = 26; low quality evidence), or health-related quality of life up to 24 months (not estimable). Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate quality evidence). However, there was evidence of marginally higher levels of programme completion (RR 1.04, 95% CI 1.00 to 1.08; participants = 2615; studies = 22/comparisons = 26; low quality evidence) by home-based participants. AUTHORS' CONCLUSIONS: This update supports previous conclusions that home- and centre-based forms of cardiac rehabilitation seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction or revascularisation, or with heart failure. This finding supports the continued expansion of evidence-based, home-based cardiac rehabilitation programmes. The choice of participating in a more traditional and supervised centre-based programme or a home-based programme may reflect local availability and consider the preference of the individual patient. Further data are needed to determine whether the effects of home- and centre-based cardiac rehabilitation reported in the included short-term trials can be confirmed in the longer term and need to consider adequately powered non-inferiority or equivalence study designs.

The improvement and expansion of higher education have been priorities of our national development in Kenya.Within a span of thirty five years since independence, we have witnessed the creation of five public universities.Several private universities have also been established.In our national universities, more professional programmes have been developed at both undergraduate and postgraduate levels and several departments now offer Ph.D programmes through research.As one of many African countries that have suffered from the effects of colonialism and marginalization, Kenya has made tremendous progress in the field of higher education that should be desired for the wider region, now defined by the Preferential Trade Area (PTA) and the Common Market of East and Southern Africa (COMESA).There has, however, been a constant lack of locally available textbooks for use at both the undergraduate and postgraduate levels.Many departments continue to use imported textbooks at a great price in foreign exchange.Worse still, the teaching staff have to relate material in these texts to our local situation and experiences.With the onset of the third millennium and the ever-growing quest for information, there is a desperate need for people to write books in various areas of specialization that are relevant to our needs.One of the objectives of any institution of higher learning is to conduct research.Research generates new knowledge and information; it extends the frontiers of understanding as we gain new insights into phenomena.There can be no improvement of higher education without sound research.The Kenya Government has encouraged and supported research in our public universities and has gone further to establish independent research institutes in several disciplines.This is testimony to the important role that research plays in the national development of any country.It is with these points in mind that we set about the task of writing a book on research methods.Research methods as a subject cuts across the boundaries of all disciplines.Whether in History, Engineering, Medicine, Education or Literature, a researcher needs the necessary tools to conduct a research study properly.We sincerely believe that Research Methods compliments arid strengthens the philosophy of our system of education by equipping the student or any aspiring researcher with the necessary tools and skills to identify a problem and look for practical solutions in a systematic way.Excellent research skills should also strengthen a person's ability to work, thirik and act independently.In writing this book, we felt a research methods book should be "skill" and "application" oriented.We have therefore tried to discuss thoroughly the necessary skills in research and how such skills should be applied when conducting a research study.This text is intended for people who will either conduct field research.Or who need to rely on literature research.It is therefore suitable for university students at both the undergraduate and graduate levels and for personnel in Government and Non-Governmental Organizations.University teaching staff should also find this book useful as a reference text for their research.The organization of the material in this text follows the format of the research process.Chapters 1 and 2 deal with the definition and purpose of research.Chapters 3-9 deal with the critical, elemen. of the research process.Chapters 10 and 12 deal with types of research while Chapter 11 discusses logistical and ethical issues in research.Finally, research and project proposal development is discussed in Chapter 13.This chapter should be particularly helpful to students who are doing higher degrees and practitioners who may want to develop project proposals.There are review assignments at the .end of each chapter to help in studying and revision.An example of a published journal paper is included in Appendix I.The journal article contains most of the components of a research report as discussed in Chapter 9.While the book lays great emphasis on quantitative research methods, it also gives an introduction to qualitative approaches in Chapter 12. Information on qualitative approaches is also given under various topics throughout the text.

BACKGROUND: Remote virtual rehabilitation aroused growing interest in the last decades, and its role has gained importance following the recent spread of COVID19 pandemic. The advantages of virtual reality (VR), augmented reality (AR), gamification, and telerehabilitation have been demonstrated in several medical fields. In this review, we searched the literature for studies using these technologies for orthopedic rehabilitation and analyzed studies' quality, type and field of rehabilitation, patients' characteristics, and outcomes to describe the state of the art of VR, AR, gamification, and telerehabilitation for orthopedic rehabilitation. METHODS: A comprehensive search on PubMed, Medline, Cochrane, CINAHL, and Embase databases was conducted. This review was performed according to PRISMA guidelines. Studies published between 2015 and 2020 about remote virtual rehabilitations for orthopedic patients were selected. The Methodological Index for Non-Randomized Studies (MINORS) and Cochrane Risk-of-Bias assessment tool were used for quality assessment. RESULTS: 24 studies (9 randomized controlled trials (RCTs) and 15 non-randomized studies) and 2472 patients were included. Studies mainly concern telerehabilitation (56%), and to a lesser extent VR (28%), AR (28%), and gamification (16%). Remote virtual technologies were used following knee and hip arthroplasty. The majority of included patients were between 40 and 60 years old and had a university degree. Remote virtual rehabilitation was not inferior to face-to-face therapy, and physical improvements were demonstrated by increased clinical scores. Orthopedic virtual remote rehabilitation decreased costs related to transports, hospitalizations, and readmissions. CONCLUSION: The heterogeneity of included studies prevented a meta-analysis of their results. Age and social context influence adaptability to technology, and this can modify compliance to treatment and outcomes. A good relationship between patient and physiotherapist is essential for treatment compliance and new technologies are useful to maintain clinical interactions remotely. Remote virtual technologies allow the delivery of high-quality care at reduced costs. This is a necessity given the growing demand for orthopedic rehabilitation and increasing costs related to it. Future studies need to develop specific and objective methods to evaluate the clinical quality of new technologies and definitively demonstrate advantages of VR, AR, gamification, and telerehabilitation compared to face-to face orthopedic rehabilitation.

Purpose: We examine physical activity levels of Polish and Turkish students to determine cross-cultural and gender differences in exercise habits. Methods: Our study assessed 50 students from Adnan Menderes University in Aydin, Turkey and 50 students from the University of Physical Education in Krakow, Poland. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ; short form). Results were expressed in MET-minutes/week (Metabolic Equivalent of Task). Results: More than half of the students (52%) engaged in moderate physical activity in the week prior to the survey, while a quarter of the students (37%) engaged in vigorous physical activity. Low levels of physical activity were reported by 11% of the students. Total physical activity per week, expressed in MET-minutes/week, was significantly higher for Polish students (5,953.51 MET) than for Turkish students (3,095.45 MET). Moderate physical activity was higher among Turkish students while vigorous physical activity was higher among Polish students. Physical activity contrasts were further exemplified between genders. Polish women engaged in significantly more (p < 0.05) total physical activity than Turkish women. Total physical activity, high-level physical activity, and moderate-level physical activity differences were not significant (p > 0.05) between Polish and Turkish men. Conclusion: Polish university students engage in more physical activity than students from Turkey. Men were more physically active in both countries. More than half of Turkish students do not meet minimum weekly physical activity the World Health Organization recommends for preserving health.

BACKGROUND: Human resources for rehabilitation are often a neglected component of health services strengthening and health workforce development. This may be partly related to weaknesses in the available research and evidence to inform advocacy and programmatic strategies. The objective of this study was to quantitatively describe the global situation in terms of supply of and need for human resources for health-related rehabilitation services, as a basis for strategy development of the workforce in physical and rehabilitation medicine. METHODS: Data for assessing supply of and need for rehabilitative personnel were extracted and analyzed from statistical databases maintained by the World Health Organization and other national and international health information sources. Standardized classifications were used to enhance cross-national comparability of findings. RESULTS: Large differences were found across countries and regions between assessed need for services requiring health workers associated to physical and rehabilitation medicine against estimated supply of health personnel skilled in rehabilitation services. Despite greater need, low- and middle-income countries tended to report less availability of skilled health personnel, although the strength of the supply-need relationship varied across geographical and economic country groupings. CONCLUSION: The evidence base on human resources for health-related rehabilitation services remains fragmented, the result of limited availability and use of quality, comparable data and information within and across countries. This assessment offered the first global baseline, intended to catalyze further research that can be translated into evidence to support human resources for rehabilitation policy and practice.

BACKGROUND: The purpose was to conduct systematic reviews of the relationship between physical activity of healthy community-dwelling older (>65 years) adults and outcomes of functional limitations, disability, or loss of independence. METHODS: Prospective cohort studies with an outcome related to functional independence or to cognitive function were searched, as well as exercise training interventions that reported a functional outcome. Electronic database search strategies were used to identify citations which were screened (title and abstract) for inclusion. Included articles were reviewed to complete standardized data extraction tables, and assess study quality. An established system of assessing the level and grade of evidence for recommendations was employed. RESULTS: Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence, and 34 were included with a cognitive function outcome. Greater physical activity of an aerobic nature (categorized by a variety of methods) was associated with higher functional status (expressed by a host of outcome measures) in older age. For functional independence, moderate (and high) levels of physical activity appeared effective in conferring a reduced risk (odds ratio ~0.5) of functional limitations or disability. Limitation in higher level performance outcomes was reduced (odds ratio ~0.5) with vigorous (or high) activity with an apparent dose-response of moderate through to high activity. Exercise training interventions (including aerobic and resistance) of older adults showed improvement in physiological and functional measures, and suggestion of longer-term reduction in incidence of mobility disability. A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia; however, there were mixed results of the effects of exercise interventions on cognitive function indices. CONCLUSIONS: There is a consistency of findings across studies and a range of outcome measures related to functional independence; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age. Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult, it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes.

OBJECTIVE: To use bibliometric analyses to determine whether Annals of Rehabilitation Medicine (hereafter also referred to as Annals) became an international journal after adopting an English-only policy in 2011. METHODS: Articles from the third issue of 2011 to the third issue of 2015 were analyzed according to the following parameters: whether the research was supported by funding, country of authorship, impact factor, total citations, the countries of researchers who cited Annals; the journals that cited Annals; and the Hirsch index. RESULTS: One hundred twenty-eight (34.2%) of the 374 original articles were supported by research funds. The main authors were from Korea (550/556, 98.9%), the USA (3), Iran (2), Japan (1), Turkey (1), and the United Kingdom (1). The manually calculated impact factors in 2013 and 2014 were 0.582 and 0.667, respectively. The total annual citations from years 2012 to 2015 were 15, 130, 252, and 189, respectively. The countries of residence of the main authors who cited Annals were the USA (146), Korea (89), and China (49). The journals that cited Annals most frequently were the Journal of Physical Therapy (34), Archives of Physical Medicine and Rehabilitation (15), and Frontiers in Human Neuroscience (13). The Hirsch index was 9. CONCLUSION: The above results demonstrate that the change of the language policy of Annals to English-only was successful in elevating the journal to the international level. The journal's aim of sharing up-to-date knowledge dedicated to advancing the care of the disabled and enhancing their everyday abilities and quality of life has been satisfactorily realized.

AIMS: To investigate physical activity levels of nursing and medicine students, examine predictors of physical activity level and examine the most influential benefits and barriers to exercise. BACKGROUND: Healthcare professionals have low levels of physical activity, which increases their health risk and may influence their health promotion practices with patients. DESIGN: We surveyed 361 nursing (n = 193) and medicine (n = 168) students studying at a UK medical school. METHODS: Questionnaire survey, active over 12 months in 2014-2015. Measures included physical activity level, benefits and barriers to exercise, social support, perceived stress and self-efficacy for exercise. RESULTS: Many nursing and medicine students did not achieve recommended levels of physical activity (nursing 48%; medicine 38%). Perceived benefits of exercise were health related, with medicine students identifying additional benefits for stress relief. Most notable barriers to exercise were as follows: lack of time, facilities having inconvenient schedules and exercise not fitting around study or placement schedules. Nursing students were less active than medicine students; they perceived fewer benefits and more barriers to exercise and reported lower social support for exercise. Physical activity of nursing and medicine students was best predicted by self-efficacy and social support, explaining 35% of the variance. CONCLUSION: Physical activity should be promoted in nursing and medicine students. Interventions should aim to build self-efficacy for exercise and increase social support. Interventions should be developed that are targeted specifically to shift-working frontline care staff, to reduce schedule-related barriers to exercise and to increase accessibility to workplace health and well-being initiatives.

OBJECTIVE: Interest in the use of musculoskeletal ultrasonography in the field of Physical Medicine and Rehabilitation has increased significantly over recent years. In order to determine to what extent this growing interest among Physical and Rehabilitation Medicine physicians is resulting in publications, we reviewed the trend in publications by physiatrists on musculoskeletal ultrasonography. METHODS: We searched retrospectively for all papers indexed in Science Citation Index-Expanded and Index Medicus in which "rehabilitation medicine" was addressed as at least one of the authors' affiliations (up to 2011). All papers were examined individually for the authors' affiliations, document types, publication years, countries, and journal categories. RESULTS: A total of 171 papers was included in the study. After 2004, there appears to be a significant amount of increase in the number of publications. USA, Turkey, Taiwan and South Korea were the leading countries in which physiatrists carry out research and publish papers on musculoskeletal ultrasonography. The top 5 journal categories in which these papers were published were: Rehabilitation (44.3%), Orthopaedics (14.1%), Radiology (10.7%), Neurology (8.1%) and Rheumatology (6.7%). CONCLUSION: The number of scientific publications by physiatrists about musculoskeletal ultrasonography is increasing in parallel with the interest regarding its routine use in Physical Medicine and Rehabilitation clinics.

Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: 1) support the conduct of primary studies and systematic reviews, and 2) identify relevant systematic reviews for knowledge translation purposes. We performed a multimodal study including seven preliminary research and discussion papers, four Consensus Meetings and three Delphi rounds with 80 rehabilitation stakeholders. The Delphi Study aimed to obtain agreement, refine and complete the items composing the definition and meanings of rehabilitation. These stakeholders covered 5 continents, representing 11 global and continental rehabilitation organizations, 11 scientific journals, 4 Cochrane Networks and 3 Cochrane Groups, and included invited experts, and representatives of low middle-income countries (LMICs) and consumers. We had a 70% to 82.5% response rate to the three Delphi rounds, during which participants responded to all items (100%) and provided relevant comments (range 5.5-50% per item). This participation led to several refinements to the rehabilitation definition through three preliminary versions, and the final items reached an agreement between 88.9% and 100%. We structured the definition using the PICO (Population, Intervention, Comparison, Outcome) framework. We concluded that "In a health care context," rehabilitation is defined as a "multimodal, person-centered, collaborative process" (Intervention-general), including interventions targeting a person's "capacity (by addressing body structures, functions, and activities/participation) and/or contextual factors related to performance" (Intervention-specific) with the goal of "optimizing" the "functioning" (Outcome) of "persons with health conditions currently experiencing disability or likely to experience disability, or persons with disability" (Population). Rehabilitation requires that all the items of the definition are satisfied. We defined a "rehabilitation intervention" as "any intervention provided within the rehabilitation process." We developed a rehabilitation definition for research purposes achieving a broad agreement with global stakeholders. This definition provides explicit criteria to define rehabilitation. Using the proposed definition will improve rehabilitation research by standardizing the description of interventions. Our definition may require revision in the future, as further research enhances understanding and communication of the essence and complexity of rehabilitation.

BACKGROUND: The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS). METHODS: All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting. RESULTS: The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D. CONCLUSION: These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.

INTRODUCTION: Loneliness is a common, emotionally distressing experience and is associated with adverse physical and mental health and an unhealthy lifestyle. Nevertheless, little is known about the prevalence of loneliness in different age groups in Switzerland. Furthermore, the existing evidence about age and gender as potential effect modifiers of the associations between loneliness, physical and mental health and lifestyle characteristics warrants further investigation. Thus, the aim of the study was to examine the prevalence of loneliness among adults in Switzerland and to assess the associations of loneliness with several physical and mental health and behavioral factors, as well as to assess the modifying effect of sex and age. METHODS: Data from 20,007 participants of the cross-sectional population-based Swiss Health Survey 2012 (SHS) were analyzed. Logistic regression analyses were used to assess associations of loneliness with physical and mental health or lifestyle characteristics (e.g. diabetes, depression, physical activity). Wald tests were used to test for interactions. RESULTS: Loneliness was distributed in a slight U-shaped form from 15 to 75+ year olds, with 64.1% of participants who had never felt lonely. Lonely individuals were more often affected by physical and mental health problems, such as self-reported chronic diseases (Odds ratio [OR] 1.41, 95% confidence interval [CI] 1.30-1.54), high cholesterol levels (OR 1.31, 95% CI 1.18-1.45), diabetes (OR 1.40, 95% CI 1.16-1.67), moderate and high psychological distress (OR 3.74, 95% CI 3.37-4.16), depression (OR 2.78, 95% CI 2.22-3.48) and impaired self-perceived health (OR 1.94, 95% CI 1.74-2.16). Loneliness was significantly associated with most lifestyle factors (e.g. smoking; OR 1.13, 95% 1.05-1.23). Age, but not sex, moderated loneliness' association with several variables. CONCLUSION: Loneliness is associated with poorer physical and mental health and unhealthy lifestyle, modified by age, but not by sex. Our findings illustrate the importance of considering loneliness for physical and mental health and lifestyle factors, not only in older and younger, but also in middle-aged adults. Longitudinal studies are needed in Switzerland to elucidate the causal relationships of these associations.

BACKGROUND: The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS). METHODS: Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature reviews reviewing the evidence on CTIS (assessment, bracing, physiotherapy, physiotherapeutic scoliosis-specific exercises (PSSE) and other CTIS) were conducted. Documents, recommendations and practical approach flow charts were developed using a Delphi procedure. The process was completed with the Consensus Session held during the first combined SOSORT/IRSSD Meeting held in Banff, Canada, in May 2016. RESULTS: = 14). According to the agreed strength and level of evidence rating scale, there were 2 recommendations on bracing and 1 recommendation on PSSE that reached level of recommendation "I" and level of evidence "II". Three recommendations reached strength of recommendation A based on the level of evidence I (2 for bracing and one for assessment); 39 recommendations reached strength of recommendation B (20 for bracing, 13 for PSSE, and 6 for assessment).The number of paper for each level of evidence for each treatment is shown in Table 8. CONCLUSION: The 2016 SOSORT guidelines were developed based on the current evidence on CTIS. Over the last 5 years, high-quality evidence has started to emerge, particularly in the areas of efficacy of bracing (one large multicentre trial) and PSSE (three single-centre randomized controlled trials). Several grade A recommendations were presented. Despite the growing high-quality evidence, the heterogeneity of the study protocols limits generalizability of the recommendations. There is a need for standardization of research methods of conservative treatment effectiveness, as recognized by SOSORT and the Scoliosis Research Society (SRS) non-operative management Committee.