Clare L Ardern

• BPhysio(Hons); Ph.D.
• Assistant Professor at University of British Columbia

Background Persisting symptoms after an attempt of nonoperative treatment represents one of the most common indications for surgery in many musculoskeletal conditions, such as tennis elbow. The rationale behind the practice of resorting to surgery in individuals with long-standing symptoms is that resolution of symptoms is believed to be unlikely w...

Background and objectives Peer review is ubiquitous in evaluating scientific research. While peer review of manuscripts submitted to journals has been widely studied, there has been relatively less attention paid to peer review of grant applications (despite how crucial peer review is to researchers having the means and capacity to conduct research...

Background. The specific roles and responsibilities expected of leaders of consensus-based decision committees, such as grant peer review panels and guideline development panels, are not well-defined, which makes it difficult to train people to lead well. We aimed to explore, describe and define the roles, responsibilities, and leadership character...

Objectives Most first-time biomedical research grant applications are not funded. In the challenging research funding climate, resubmitting a grant application is a necessary task for scientists. Identifying which factors influence their decision to resubmit and the success of resubmissions will inform funders and applicants. However, data on resub...

SYNOPSIS: In 2025, JOSPT will continue its mission to enhance research in the field of musculoskeletal rehabilitation. JOSPT aims to support authors who are working to advance the research methods applied to answer clinical questions in the musculoskeletal rehabilitation field. Using the most robust methods helps authors ensure their studies can ha...

Purpose : To explore how the change-point method can be used to analyze complex longitudinal data and detect when meaningful changes (change points) have occurred during rehabilitation. Method : This design is a prospective single-case observational study of a football player in a professional club who sustained an acute lower-limb muscle injury du...

Background Systematic reviews (SRs) are being published at an accelerated rate. Decision-makers may struggle with comparing and choosing between multiple SRs on the same topic. We aimed to understand how healthcare decision-makers (eg, practitioners, policymakers, researchers) use SRs to inform decision-making and to explore the potential role of a...

Making return-to-sport decisions can be complex and multi-faceted, as it requires an evaluation of an individual’s physical, psychological, and social well-being. Specifically, the timing of progression, regression, or return to sport can be difficult to determine due to the multitude of information that needs to be considered by clinicians. With t...

Background In this retrospective study, we investigated the outcomes (funded/not funded) and factors related to the funding of resubmitted applications to the Canadian Institutes of Health Research (CIHR) Open Operating Grants Competition and Project Grant Competition between 2000 and 2022. Method and Findings The primary outcome was the proportion...

Objective Clinicians treating patients with patellofemoral pain (PFP) rely on consensus statements to make the best practice recommendations in the absence of definitive evidence on how to manage PFP. However, the methods used to generate and assess agreement for these recommendations have not been examined. Our objective was to map the methods use...

Background Wheelchair tennis, a globally popular sport, features a professional tour spanning 40 countries and over 160 tournaments. Despite its widespread appeal, information about the physical demands of wheelchair tennis is scattered across various studies, necessitating a comprehensive systematic review to synthesise available data. Objective...

BACKGROUND: The Lancet Series of Low Back Pain (LBP) highlighted the lack of LBP data from low- and middle-income countries (LMICs). The study aimed to describe (1) what LBP care is currently delivered in LMICs and (2) how that care is delivered. METHODS: An online mixed-methods study. A Consortium for LBP in LMICs (n = 65) was developed with an ex...

Learning health systems (LHSs) embed social accountability into everyday workflows and can inform how governments build bridges across the digital health divide. They shape partnerships using rapid cycles of data-driven learning to respond to patients' calls to action for equity from digital health. Adopting the LHS approach involves re-distributin...

In this paper, we explore what is needed to generate quality research to guide evidence-informed digital health policy and call the Canadian community of patients, clinicians, policy (decision) makers and researchers to action in setting digital health research priorities for supporting underserved communities. Using specific examples, we describe...

People often use infographics (also called visual or graphical abstracts) as a substitute for reading the full text of an article. This is a concern because most infographics do not present sufficient information to interpret the research appropriately and guide wise health decisions. The Reporting Infographics and Visual Abstracts of Comparative s...

Background: Adherence to established reporting guidelines can improve clinical trial reporting standards, but attempts to improve adherence have produced mixed results. This exploratory study aimed to determine how accurately a Large Language Model generative AI system (AI-LLM) could measure reporting guideline compliance in a sample of sports medi...

Adherence to study registration and reporting best practices is vital to fostering evidence-based medicine. All registered clinical trials on ClinicalTrials.gov conducted in Canada as of 2009 and completed by 2019 were identified. A cross-sectional analysis of those trials assessed prospective registration, subsequent result reporting in the regist...

Background Eating frequency may affect body weight and cardiometabolic health. Intervention trials and observational studies have both indicated that high- and low-frequency eating can be associated with better health outcomes. There are currently no guidelines to inform how to advise healthy adults about how frequently to consume food or beverages...

Background Several open science-promoting initiatives have been proposed to improve the quality of biomedical research, including initiatives for assessing researchers’ open science behaviour as criteria for promotion or tenure. Yet there is limited evidence to judge whether the interventions are effective. This review aimed to summarise the litera...

The allocation of public funds for research has been predominantly based on peer review where reviewers are asked to rate an application on some form of ordinal scale from poor to excellent. Poor reliability and bias of peer review rating has led funding agencies to experiment with different approaches to assess applications. In this study, we comp...

Background Following anterior cruciate ligament reconstruction (ACLR), many athletes do not return to their sport, often driven by concerns about re-injury. Psychological support strategies might help, but are not routinely included in rehabilitation after ACLR. The BAck iN the Game (BANG) intervention is a 24-week eHealth program delivered via sma...

SYNOPSIS: The Journal of Orthopaedic & Sports Physical Therapy was first published in the summer of 1979 by the Orthopaedic and Sports Sections of the American Physical Therapy Association. The journal's mission was to publish scientifically rigorous content and promote its application to movement-related health. In 1979, we were focused solely on...

The Canadian Institutes of Health Research (CIHR) commenced a Quality Assurance Program in 2019 to monitor the quality of peer review in its Project Grant Competition Peer Review Committees. Our primary aim was to describe the performance of CIHR grant peer reviewers, based on the assessments made by CIHR peer review leaders during the first 3 year...

Background The Oxford Elbow Score (OES) and the short version of Disabilities of Arms, Shoulder and Hand (QuickDASH) are common patient-reported outcomes for people with elbow problems. Our primary objective was to define thresholds for the Minimal Important Difference (MID) and Patient-Acceptable Symptom State (PASS) for the OES and QuickDASH. The...

Objectives: Determine if improvements in pain and disability in patients with mid-portion Achilles tendinopathy relate to changes in muscle structure and function whilst completing exercise rehabilitation. Design: A systematic review exploring the relationship between changes in pain/disability and muscle structure/function over time, following...

Background: Tennis is a multidirectional high-intensity intermittent sport for male and female individuals played across multiple surfaces. Although several studies have attempted to characterise the physical demands of tennis, a meta-analysis is still lacking. Objective: We aimed to describe and synthesise the physical demands of tennis across...

SYNOPSIS: This editorial introduces JOSPT Open, a new gold open-access journal in the JOSPT stable. In 2023, JOSPT Open will publish its inaugural issue. The journal aims to cover all aspects of musculoskeletal rehabilitation and associated areas related to musculoskeletal health, including clinical biomechanics, diagnostic imaging, epidemiology, p...

The state of open science needs to be monitored to track changes over time and identify areas to create interventions to drive improvements. In order to monitor open science practices, they first need to be well defined and operationalized. To reach consensus on what open science practices to monitor at biomedical research institutions, we conducte...

Objectives We aimed to determine (1) the proportion of women authors overall, in first (lead) and last (senior) author positions, (2) the proportion of women research participants and (3) the association between women in first and/or last author positions and the proportion of women research participants in original research articles and editorials...

Introduction Primary cam morphology is highly prevalent in many athlete populations, causing debilitating hip osteoarthritis in some. Existing research is mired in confusion partly because stakeholders have not agreed on key primary cam morphology elements or a prioritised research agenda. We aimed to inform a more rigorous, inclusive and evidence-...

Introduction Primary cam morphology is a mostly benign bony prominence that develops at the femoral head-neck junction of the hip, but it is highly prevalent in many athlete populations. In the small proportion of athletes for whom it is not benign, the resulting hip osteoarthritis can be debilitating. Clinicians, athletes, patients and researchers...

Objective: This scoping review examines how different levels and types of partial foot amputation affect gait and explores how these findings may affect the minimal impairment criteria for wheelchair tennis. Methods: Four databases (PubMed, Embase, CINAHL and SPORTDiscus) were systematically searched in February 2021 for terms related to partial...

Return-to-sport (RTS) decisions are critical to clinical sports medicine and are often characterised by uncertainties, such as re-injury risk, time pressure induced by competition schedule and social stress from coaches, families and supporters. RTS decisions have implications not only for the health and performance of an athlete, but also the spor...

The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries; risk factors for post-t...

Background Two common ways of assessing the clinical relevance of treatment outcomes are the minimal important difference (MID) and the patient acceptable symptom state (PASS). The former represents the smallest change in the given outcome that makes people feel better, while the latter is the symptom level at which patients feel well. Methods We...

SYNOPSIS: JOSPT has published scientifically rigorous, clinically-relevant musculoskeletal rehabilitation- and sports-related content for over 40 years. The benefit of so many years of JOSPT is a rich back catalogue of quality musculoskeletal rehabilitation and sports content. To harness the back catalogue, the Journal is launching JOSPT Collection...

Background: Adherence to study registration and reporting best practices are vital to foster evidence-based medicine. Poor adherence to these standards in clinical trials conducted in Canada would be detrimental to patients, researchers, and the public alike. Methods: All registered clinical trials on ClinicalTrials.gov conducted in Canada as of 20...

Background After a serious knee injury, up to half of athletes do not return to competitive sport, despite recovering sufficient physical function. Athletes often desire psychological support for the return to sport, but rehabilitation clinicians feel ill-equipped to deliver adequate support. Objective We aimed to design and develop an internet-de...

Accurate and reliable evaluation of muscle strength in para-athletes is essential for monitoring the effectiveness of strength training and/or rehabilitation programmes, and sport classification. Our aim is to synthesise evidence related to assessing muscle strength in para-athletes. Four databases were searched from January 1990 to July 2021 for o...

Background Mandates and recommendations related to embedding open science practices within the research lifecycle are increasingly common. Few stakeholders, however, are monitoring compliance to their mandates or recommendations. It is necessary to monitor the current state of open science to track changes over time and to identify areas to create...

Background The limited research on prognosis after nonsurgical management of anterior cruciate ligament (ACL) injury has focused on physical factors. We aimed to assess relationships between key patient-reported outcomes, in line with a biopsychosocial approach, and returning to preinjury sport at 12 months after ACL injury treated without reconstr...

Consensus is an often neglected but important part of the scientific process. Consensus agreement allows researchers to agree on fundamentals such as terminology and taxonomy, to establish core outcome sets for reporting on medical conditions, and to set research priorities. Consensus methods are invoked by the scientific community to provide answe...

Background The Numerical Rating Scale (NRS) and Patient-rated wrist/hand evaluation (PRWHE) are patient-reported outcomes frequently used for evaluating pain and function of the wrist and hand. The aim of this study was to determine thresholds for minimal important difference (MID) and patient acceptable symptom state (PASS) for NRS pain and PRWHE...

Background: Two common ways of assessing the clinical relevance of treatment outcomes are the minimal important difference (MID) and the patient acceptable symptom state (PASS). The former represents the smallest change in the given outcome that makes people feel better, while the latter is the symptom level at which patients feel well. Methods: We...

Complex systems are open systems consisting of many components that can interact among themselves and the environment. New forms of behaviours and patterns often emerge as a result. There is a growing recognition that most sporting environments are complex adaptive systems. This acknowledgement extends to sports injury and is reflected in the indiv...

The REPORT guide is a 'How to' guide to help you report your clinical research in an effective and transparent way. It is intended to supplement established first choice reporting tools, such as Consolidated Standards of Reporting Trials (CONSORT), by adding tacit knowledge (ie, learnt, informal or implicit knowledge) about reporting topics that we...

This month, we welcome Dr Jackie Whittaker, PT, PhD, to the role of JOSPT Editor. Dr Whittaker joins Dr Joshua Cleland, Dr Bryan Heiderscheit, Dr Steven Kamper, Dr Christopher Hughes, and Dr Clare Ardern on the senior editorial team of JOSPT. J Orthop Sports Phys Ther 2022;52(1):1-2. doi:10.2519/jospt.2022.0101.

Synopsis: There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sp...

Background: Tennis elbow is a common painful enthesopathy of the lateral elbow that limits upper limb function and frequently results in lost time at work. Surgeons often recommend surgery if symptoms persist despite nonsurgical management, but operations for tennis elbow are inconsistent in their efficacy, and what we know about those operations...

Editor-in-Chief Clare Ardern and JOSPT's editors thank all of those who contributed to JOSPT in 2021. J Orthop Sports Phys Ther 2021;51(12):552–555. doi:10.2519/jospt.2021.0111

Altered biomechanics due to amputation can contribute to substantial limitations, influencing sporting activities. Individuals with lower extremity amputations or congenital lower limb deficiency are encouraged to participate in para-sports. However, to compete in Paralympic sports, the candidate must have an impairment that results in lower extrem...

Background Bayesian networks (BN) are directed acyclic graphs derived from empirical data that describe the dependency and probability structure. It may facilitate understanding of complex epidemiology by presenting the data in a multi-dimensional visual representation, and guiding inferences on the likelihood of the severity based on new informati...

Poor reporting of medical and healthcare systematic reviews is a problem from which the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields are not immune. Transparent, accurate and comprehensive systematic review reporting helps researchers replicate methods, readers understand what was done and why, and clinici...

Shared decision making for return to sport (RTS) is complex and typically influenced by advice from different stakeholders in the coaching, medical, and performance teams. Involving the player by listening to their needs is critical to RTS decision making, yet player narratives are rarely part of published research. In this editorial, we highlight...

The REPORT guide is a “How to” guide to help you achieve effective and transparent clinical trial reporting. It is intended to supplement “first choice” reporting tools, such as CONSORT, by adding tacit knowledge about reporting topics we have struggled with as authors or see others struggle with as journal reviewers or editors. Focus is the random...

Objectives To assess the implementation, limited efficacy, and acceptability of the BEAST (better and safer return to sport) tool – a rehabilitation and return-to-sport (RTS) decision tool after anterior cruciate ligament reconstruction (ACLR) in nonprofessional athletes. Design Prospective cohort. Participants 43 nonprofessional pivoting sport a...

Background Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging conce...

Objective: To assess the relationship of individual article citations in the Sport Sciences field to (i) journal impact factor; (ii) each article's open access status; and (iii) Altmetric score components. Design: Cross-sectional. Methods: We searched the ISI Web of Knowledge InCites Journal Citation Reports database "Sport Sciences" category...

We are excited to introduce JOSPT infographics as a way of helping clinicians and patients efficiently and effectively translate the information from a JOSPT article to your clinical context. Infographics do not replace a published article-they supplement the content. Our goal is to share a powerful visual representation of research results with re...

During the American Physical Therapy Association's virtual Combined Sections Meeting held throughout the month of February 2021, JOSPT recognized the authors of the most outstanding research manuscript published in the Journal in 2020. The JOSPT Guy G. Simoneau Excellence in Research Award was presented to Fábio Franciscatto Stieven, Giovanni Estev...

Background In the treatment of anterior cruciate ligament (ACL) injuries, there is little evidence of when and why a decision for ACL reconstruction (ACLR) or nonoperative treatment (non-ACLR) is made. Purpose To (1) describe the key characteristics of ACL injury treatment decisions and (2) compare patient-reported knee instability, function, and...

The revised clinical practice guideline (CPG) on ankle sprain, published in the April 2021 issue of the JOSPT, addresses issues related to both a first-time lateral ankle sprain and chronic ankle instability (CAI). Recommendations were made for preventing primary and recurrent injury. Evidence was also presented to support interventions for patient...

Purpose To synthesise evidence on low back pain (LBP) in adult rowers and to create a consensus statement to inform clinical practice. Methods There were four synthesis steps that informed the consensus statement. In step one, seven expert clinicians and researchers established the scope of the consensus statement and conducted a survey of experie...

Background The results of clinical trials should be assessed for both statistical significance and importance of observed effects to patients. Minimal important difference (MID) is a threshold denoting a difference that is important to patients. Patient acceptable symptom state (PASS) is a threshold above which patients feel well. Objective To det...

Background: After serious knee injury, up to half of athletes do not return to competitive sport, despite recovering sufficient physical function. Athletes often desire psychological support to return to sport, but rehabilitation clinicians feel ill-equipped to deliver adequate support. Objective: To design and develop an Internet-delivered psychol...

Objective Describe a consecutive cohort of people with a non-surgically treated ACL injury and evaluate correlations between functional performance and patient reported outcome measures (PROMs). Design Cross-sectional. Participants Sixty-eight individuals (38 males, 18–45 years old) 2–5 years after ACL injury. Main outcome measures Tegner Activi...

Objective To summarise the evidence for non-pharmacological management of low back pain (LBP) in athletes, a common problem in sport that can negatively impact performance and contribute to early retirement. Data sources Five databases (EMBASE, Medline, CINAHL, Web of Science, Scopus) were searched from inception to September 2020. The main outcom...

Editor-in-Chief Clare Ardern thanks all of those who contributed to JOSPT in 2020. J Orthop Sports Phys Ther 2020;50(12):653-656. doi:10.2519/jospt.2020.0110.

Despite advances in surgical techniques and the development of criterion-based postoperative rehabilitation protocols, outcomes following anterior cruciate ligament reconstruction (ACLR) are not optimal. Only 65% of athletes that undergo ACLR return to their previous level of sport [1]. Young individuals that do return to sport (RTS) are at high ri...

Anyone who works with athletes of any age and ability knows the best way for the athlete to avoid injury is to avoid playing sports. Anyone who works with athletes also knows that athletes want to play sports above almost all else. Understanding the relationship between how much sports activity an athlete participates in (ie, workload) and injury w...

The JOSPT editorial team details digital developments since the beginning of 2020: JOSPT's website redesign, the launches of the JOSPT Insights podcast and JOSPT blog, and the JOSPT Asks video series. J Orthop Sports Phys Ther 2020;50(9):471-472. doi:10.2519/jospt.2020.0107.

Background: Sustaining injury is a common consequence of playing sport. At least one in every three recreational athletes with anterior cruciate ligament (ACL) reconstruction do not return to their preinjury sport following treatment. Psychological factors including confidence and fear of new injury exert large effects on returning to sport. The p...

Background The long-term prevalence of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is unknown, especially in patients without a history of ACL surgery. Purpose To (1) describe the prevalence of radiographic OA, symptomatic OA, and knee replacement surgery 32 to 37 years after acute ACL injury and to (2) compare the preva...

Abstract Objective To provide a consistently updated overview of the comparative effectiveness of treatments for Achilles tendinopathy. Design Living systematic review and network meta-analysis. Data sources Multiple databases including grey literature sources were searched up to February 2019. Study eligibility criteria Randomised controlled trial...

High quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best practice methods—methods matter (greatly!). The 1st METHODS MATTER Meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research me...

If including patients as equal partners in health care research is increasingly regarded as "the right thing to do," then it is important that researchers and patients "do it right." The research community should be aware of, use, and share resources that support best practices in this domain. The first editorial in the series focused on why resear...

Synopsis: High-quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best-practice methods-methods matter (greatly!). The first METHODS MATTER meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise i...

Purpose Return-to-play (RTP) is an on-going challenge in professional football. Return-to-play related research is increasing. However, it is unknown to what extent the recommendations presented within research are being implemented by professional football teams, and where there are gaps between research and practice. The purposes of this study we...

The decision-making process about when an athlete may safely return to training and competition after an injury is a difficult decision. Safe return to training and competition is characterised by physical and psychological readiness to return to the sport. The objectives of this study are (1) to assess the measurement properties of the Psychologic...

Objective To investigate the risk of new meniscal tears after treatment for anterior cruciate ligament (ACL) injury, in children and adults with and without ACL reconstruction. Design Prognosis systematic review (PROSPERO registration number CRD42016036788). Methods We searched Embase, Ovid Medline, Cochrane, CINAHL, SPORTDiscus, PEDro and Google...

Using the Downs and Black checklist, the majority of included RCTs (8/11) were judged to be high-quality trials. Kosik et al interpreted study quality assessment findings to provide moderate-quality to high-quality evidence for therapeutic interventions improving patient-reported function in individuals with CAI. Using ROB2 on the same sample of RC...

In this editorial, we introduced risk of bias as the perceived risk that the results of a research study may underestimate or overestimate the truth. Systematic review authors should perform a domain-based risk of bias assessment that reflects risk of bias instead of assessing study quality. If a research study reports multiple outcome measures, se...

As 2019 draws to a close, it is the right time for the JOSPT editors to say thank you, and celebrate all who contributed to the Journal this year. It is your knowledge, willingness to share, and commitment to quality that allow JOSPT to publish high-quality content to help rehabilitation clinicians help patients and athletes. J Orthop Sports Phys T...