Fibromyalgia is characterized by widespread musculoskeletal pain accompanied by fatigue, cognitive dysfunction, and sleep disturbances affecting an estimated 4% to 7% of the population globally. The enigmatic nature of fibromyalgia lies in its complex symptomatology including chronic pain that becomes exacerbated by movement, posing substantial hurdles to patients’ engagement in physical activity and hence compromising functionality. Traditional approaches predominantly emphasize pharmacologic treatments, yet fatigue remains a largely unaddressed symptom, leaving patients with limited options for comprehensive symptom relief.

TENS involves the application of mild electrical pulses via electrodes adhered to the skin, which modulate nociceptive input and are thought to engage endogenous pain inhibitory pathways in the central nervous system. Prior laboratory-based randomized controlled trials have evidenced the potential of TENS to reduce pain under controlled conditions, but these do not always translate effectively to heterogenous clinical populations. Addressing this knowledge gap, the FM-TENS study conducted across 28 outpatient physical therapy clinics within multiple Midwest healthcare systems enrolled 384 participants of diverse demographic backgrounds, inclusive of rural communities, thereby enhancing external validity.

Participants were randomized at the clinic level to either receive standard physical therapy alone or physical therapy augmented with daily TENS usage for a minimum of two hours, which could be distributed flexibly throughout the day. Electrode placement targeted the upper and lower back, delivering mixed-frequency stimulation at intensities approaching the threshold of patient tolerance. The longitudinal design extended over six months, allowing assessment of both immediate and sustained effects on pain and fatigue.

Data analyses revealed that the cohort receiving PT plus TENS exhibited significant reductions in movement-evoked pain after 60 days, coupled with notable decreases in both resting pain and fatigue measures at rest and during physical activity. Contrastingly, the group undergoing physical therapy without TENS did not report meaningful changes in movement-associated pain. These analgesic effects of TENS were dose-dependent, with adherence levels directly correlating with clinical improvements, underscoring the importance of consistent, patient-directed use.

Remarkably, the analgesic efficacy of TENS persisted over time without evidence of tolerance development, an advantage over many pharmacological pain relievers whose therapeutic benefits often diminish with continued use. Furthermore, when participants initially assigned to the PT-only group were subsequently provided with TENS devices following the primary endpoint, they experienced analogous improvements, affirming TENS’s robust effect in various treatment timelines.

Beyond pain attenuation, TENS also mitigated the fatigue that severely restricts functional capacity in fibromyalgia patients. Fatigue management remains an unfulfilled need in clinical practice, and the ability of TENS to exert measurable effects here represents a pivotal advance. This dual-action of targeting both pain and fatigue uniquely positions TENS as a valuable adjunct within multimodal fibromyalgia treatment regimens.

Expert commentary from Dana Dailey, PT, PhD, highlights that TENS should not be misconstrued as a standalone remedy but rather as a complementary intervention synergizing with physical therapy and traditional pharmacologic therapies. Indeed, the study population concurrently utilized pain medications and physical therapy, yet TENS contributed incremental symptom relief, emphasizing its role as a vital component of an integrative pain management strategy.

This real-world implementation trial further substantiates the translational success of TENS protocols optimized through decades of rigorous mechanistic research that elucidated stimulation parameters and neurophysiological underpinnings. The study overcomes the typical challenges associated with moving interventions from controlled experimental settings into routine clinical practice, demonstrating scalability, patient acceptability, and sustained adherence.

Given the multifactorial pathophysiology of fibromyalgia, encompassing central sensitization, dysregulated pain processing, and autonomic dysfunction, treatment paradigms necessitate multifaceted approaches. TENS offers patients an empowering self-management tool with minimal side effects and ease of use, facilitating enhanced participation in therapeutic exercise and daily activities, thereby potentially ameliorating functional impairment.

The implications of this landmark study are profound, suggesting that TENS could redefine standard of care for fibromyalgia, offering a non-pharmacologic option that is accessible, tolerable, and effective in addressing the disabling symptoms that traditional treatments struggle to control. As the healthcare community continues to confront the opioid epidemic and seeks safer alternatives for chronic pain, TENS emerges as a promising candidate deserving further integration into clinical guidelines.

The research consortium comprised interdisciplinary collaborators from the University of Iowa Health Care, the University of Iowa College of Public Health, University of Illinois Chicago, and several specialized physical therapy centers, exemplifying a model for cooperative research bridging academia, clinical practice, and community engagement. Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases under the NIH’s HEAL Initiative, this study augurs future exploration of neuromodulatory therapies in complex pain syndromes.

In summary, this pioneering investigation not only confirms TENS as an efficacious adjunct to physical therapy for movement-related pain and fatigue in fibromyalgia but also emphasizes its sustained usability and potential to improve long-term patient outcomes. This enhanced understanding heralds a new era of integrative modalities in chronic pain management, empowering patients and clinicians alike to better navigate the challenges posed by fibromyalgia.

New findings from a systematic review and meta-analysis conducted by Safavi-Abbasi and colleagues have provided compelling evidence for the effectiveness of mindfulness meditation. This comprehensive study has synthesized data from multiple trials, revealing a noteworthy impact of mindfulness-based interventions on pain intensity, mobility, physical function, and overall quality of life in patients grappling with chronic low back pain. Given the increasing interest in holistic health approaches, these findings are timely and significant.

The concept of mindfulness meditation is rooted in ancient Buddhist practices, which emphasize mental awareness and presence. It is defined as the practice of maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment. This practice has gradually permeated Western healthcare paradigms, leading to the development of structured programs designed for various health conditions. Among these, its application in managing chronic pain has garnered particular attention.

Chronic low back pain is a prevalent condition affecting millions worldwide, often leading to physical limitations, emotional distress, and social isolation. Conventional treatments, including medications and surgeries, may not always provide satisfactory relief and can sometimes exacerbate the situation by introducing unwanted side effects. As a result, mindfulness meditation presents a viable adjunct or alternative therapy that warrants further exploration.

The systematic review led by Safavi-Abbasi investigated a substantial body of literature surrounding mindfulness meditation’s role in chronic pain management. Researchers included randomized controlled trials that specifically examined mindfulness interventions in adult populations suffering from low back pain. Selection criteria were rigorously applied to ensure the validity and reliability of the included studies, accounting for variables such as intervention duration, follow-up period, and measurement tools used to assess pain and functional outcomes.

The meta-analysis revealed statistically significant reductions in pain intensity among participants who engaged in mindfulness meditation compared to control groups. Additionally, improvements in mobility and overall physical function were noted, suggesting that mindfulness practices may encourage a greater range of motion and an increased ability to engage in daily activities. The implications of these findings are far-reaching, indicating that mindfulness not only alleviates pain but also enhances the overall quality of life for those affected.

Moreover, the researchers highlighted that the effects of mindfulness meditation extended beyond mere physical pain relief. Participants in mindfulness interventions experienced improvements in psychological well-being, including reduced anxiety and depression, which are often comorbid with chronic pain conditions. This dual benefit underscores the holistic nature of mindfulness meditation, addressing both the mind and body.

The neurobiological mechanisms underpinning the effects of mindfulness meditation are still being elucidated, but existing research suggests that practicing mindfulness may facilitate changes in brain regions associated with pain perception and emotional regulation. Specifically, regular mindfulness practice can lead to alterations in the thalamus, anterior cingulate cortex, and prefrontal cortex—areas integral to processing pain and emotional responses. Such changes may provide biological explanations for the observed improvements in pain management and emotional health reported by participants.

Implementing mindfulness meditation as part of chronic pain management strategies also poses logistical benefits. Mindfulness practices can be conducted individually or in group settings, making them accessible in various environments, including hospitals, community centers, and even at home. This adaptability promotes wider adoption among individuals who may benefit from interventions but have limited access to traditional healthcare options.

Despite the promising outcomes depicted in this meta-analysis, it is essential to approach mindfulness meditation as a complementary therapy rather than a standalone cure. Patients are encouraged to incorporate mindfulness into a comprehensive pain management plan that may include physical therapy, dietary management, and other lifestyle modifications. Collaboration with healthcare providers is crucial to tailor mindfulness practices to individual needs and conditions.

Further research is needed to explore long-term outcomes associated with mindfulness meditation in chronic low back pain populations. Studies with larger sample sizes, diverse demographics, and varied mindfulness interventions could contribute to a more thorough understanding of this practice’s efficacy and optimal implementation protocols. Future research may also consider comparing the effectiveness of mindfulness against other non-pharmacological interventions, as well as its role in pain management across different populations and pain types.

As healthcare continues to evolve, integrating complimentary therapies like mindfulness meditation could revolutionize the management of chronic conditions. Safavi-Abbasi and colleagues’ analysis not only sheds light on the tangible benefits of mindfulness for individuals suffering from chronic low back pain but also encourages a broader dialogue around the importance of mental health and holistic practice in contemporary medicine. As the body of evidence grows, so does the promise of mindfulness meditation as a pillar of chronic pain management.

In conclusion, the systematic review conducted by Safavi-Abbasi et al. provides a powerful endorsement for the use of mindfulness meditation among adults with chronic low back pain. Its multifaceted benefits—not just limited to pain relief—position mindfulness as a significant player in enhancing life quality, mobility, and emotional well-being. As awareness around mental health and mindfulness continues to rise, practitioners and patients alike should embrace these insights as part of a more integrated approach to healthcare for chronic pain.

Subject of Research: Effectiveness of mindfulness meditation on chronic low back pain

Article Title: Effectiveness of mindfulness meditation on the quality of life, pain intensity, mobility and physical function in adults with chronic low back pain: a systematic review and meta-analysis

Article References:

Safavi-Abbasi, S., Venezia, E., Sughrue, M. et al. Effectiveness of mindfulness meditation on the quality of life, pain intensity, mobility and physical function in adults with chronic low back pain: a systematic review and meta-analysis.
Discov Psychol 5, 183 (2025). https://doi.org/10.1007/s44202-025-00525-2

Image Credits: AI Generated

DOI: https://doi.org/10.1007/s44202-025-00525-2

Keywords: Mindfulness meditation, chronic low back pain, quality of life, pain intensity, mobility, physical function.

Myofascial pain syndrome is a complex condition characterized by localized muscle pain and tenderness, often attributed to the presence of trigger points. These hyperirritable spots within taut bands of muscle can lead to significant discomfort and limitations in daily activities. Traditionally, treatment modalities for MPS have included physical therapy, medication, and, in some cases, invasive procedures. However, these methods can sometimes fall short in providing long-lasting relief.

The advent of ultrasound-guided hydrodissection marks a paradigm shift in how practitioners approach myofascial pain. This technique allows for precise targeting of fascial planes, minimizing damage to surrounding tissues, and enhancing the effectiveness of the treatment. Utilizing ultrasound technology not only increases the accuracy of fluid administration but also enables real-time monitoring of the procedure, which is crucial for minimizing patient discomfort and optimizing outcomes.

A recent retrospective study conducted by Chen et al. sheds light on the benefits of this innovative approach. The researchers aimed to evaluate the effectiveness of ultrasound-guided myofascial hydrodissection in providing pain relief and improving functional mobility in patients diagnosed with MPS. Preliminary observations suggest that this technique can significantly reduce pain intensity, allowing individuals to reclaim their quality of life.

The study involved a cohort of patients who underwent the hydrodissection procedure, implemented under the careful guidance of ultrasound imaging. The procedure involved injecting a sterile saline solution into the affected fascial layers, effectively hydrating the tissue and promoting separation of the fascial planes. This process is thought to reduce pressure on sensitive nerve endings within the fascia, thereby alleviating pain.

Results from the study indicate that patients experienced substantial reductions in pain scores following hydrodissection. The use of validated pain assessment tools allowed the researchers to quantify these improvements effectively. Moreover, participants reported enhanced functional mobility, which is a critical component of rehabilitation from myofascial pain syndrome. Patients noted an increased ability to engage in daily activities without the debilitating discomfort they previously faced.

One of the striking aspects of the study was the rapid onset of relief experienced by patients post-procedure. For many individuals grappling with chronic pain, immediate results can be a transformative experience, often reigniting hope for recovery. The findings suggest that ultrasound-guided hydrodissection not only provides immediate benefits but may also foster long-term advantages regarding pain management and functional enhancement.

Furthermore, the significance of employing ultrasound guidance during the procedure cannot be understated. This imaging technique ensures accurate localization of treatment areas, reducing the likelihood of complications associated with blind injection approaches. The study highlights the safety profile of hydrodissection, indicating a low incidence of adverse effects when performed correctly.

As more practitioners become aware of this technique, training and education will play a critical role in its implementation. Integrating ultrasound-guided hydrodissection into clinical practice requires familiarity with ultrasound imaging and an understanding of the anatomy involved in myofascial pain syndrome.

Future research is essential for validating these findings and exploring the potential mechanisms behind the observed pain relief. Understanding how hydrodissection interacts with myofascial tissue and the surrounding structures will be pivotal in refining treatment protocols and enhancing patient outcomes.

Consequently, the implications of ultrasound-guided myofascial hydrodissection extend beyond individual patient cases. By offering a minimally invasive alternative to traditional pain therapies, this technique could reshape the treatment landscape for myofascial pain management. It emphasizes the importance of innovation in the medical field, particularly in developing effective, patient-centered approaches to pain relief.

As the field of pain management continues to evolve, techniques like ultrasound-guided hydrodissection represent a beacon of hope for individuals battling chronic pain conditions. As healthcare professionals increasingly adopt this method, the ongoing commitment to research and advancement in treatment techniques remains vital. Ultimately, the journey towards comprehensive pain relief begins with innovative approaches that prioritize the well-being of patients and their quality of life.

In summary, ultrasound-guided myofascial hydrodissection offers a promising avenue for addressing the challenges associated with myofascial pain syndrome. By leveraging advanced imaging techniques, healthcare providers can effectively target and treat affected areas, providing patients with the relief they desperately seek. The findings of the recent study reinforce the necessity for continued exploration and refinement of techniques aimed at improving the lives of those coping with chronic pain conditions.

Subject of Research: Ultrasound-Guided Myofascial Hydrodissection

Article Title: Ultrasound-Guided Myofascial Hydrodissection for Myofascial Pain Syndrome: A Retrospective Study on Pain Relief and Functional Improvement

Article References:

Chen, Y., Sun, Y., Ai, S. et al. Ultrasound-Guided Myofascial Hydrodissection for Myofascial Pain Syndrome: A Retrospective Study on Pain Relief and Functional Improvement.
J. Med. Biol. Eng. (2025). https://doi.org/10.1007/s40846-025-00994-9

Image Credits: AI Generated

DOI: https://doi.org/10.1007/s40846-025-00994-9

Keywords: Myofascial Pain Syndrome, Ultrasound-Guided Hydrodissection, Pain Relief, Functional Improvement, Chronic Pain Management.

Chronic pain, particularly in the lower back and legs, typically associated with sciatica, can dramatically impair one’s quality of life. Individuals suffering from this condition often report persistent discomfort that limits their mobility and ability to engage in daily activities. Conventional treatments frequently involve medications, physical therapy, and in some cases, surgical intervention. However, the quest for a holistic and effective remedy has led many to explore complementary approaches, with acupuncture emerging as a popular option.

Acupuncture, a practice rooted in traditional Chinese medicine, involves the insertion of fine needles into specific points on the body to stimulate energy flow and promote healing. This ancient technique is thought to activate the body’s natural pain-relief mechanisms. The study in question meticulously investigates whether acupuncture can specifically alleviate the pain and functional disability experienced by patients with chronic sciatica.

The methodology adopted in this research was robust and well-structured. Participants were carefully selected based on specific criteria to ensure a representative sample of individuals suffering from chronic sciatica. They were then divided into groups receiving either acupuncture treatments or standard care. This randomized, controlled approach reinforces the findings and lends credence to the argument presented by the researchers.

Results from the study indicate that patients who underwent acupuncture reported significant reductions in pain levels compared to those receiving conventional treatment alone. The findings suggest that acupuncture may not only serve as a temporary relief for sciatica patients but could also instigate long-term benefits regarding pain management. Many participants in the acupuncture group indicated improved mobility and a better overall sense of well-being within a few sessions.

Interestingly, the study also highlights the psychological components of pain management. Chronic pain often leads to anxiety and depression, compounding the suffering experienced by afflicted individuals. The stress reduction associated with acupuncture treatments may, therefore, play a crucial role in its efficacy. By addressing both the physical and psychological aspects of chronic sciatica, acupuncture showcases the potential for holistic treatment strategies to emerge as viable alternatives.

As the research aligns with a growing body of evidence supporting alternative treatments, it raises intriguing questions about the role of acupuncture within healthcare settings. Healthcare practitioners are historically cautious regarding complementary approaches, particularly those lacking extensive scientific backing. However, the positive outcomes of this study could provide practitioners with the impetus to consider acupuncture as an adjunct therapy for their patients suffering from chronic sciatica.

Furthermore, the implications of this research extend beyond just sciatica relief. If acupuncture proves effective in managing pain and disability for one condition, could it serve similar roles for other chronic pain syndromes? The findings encourage a broader examination of acupuncture’s utility across diverse medical contexts. This could herald a paradigm shift in pain management strategies within contemporary medicine.

The increased interest in non-pharmacological therapies echoes broader societal shifts toward integrative healthcare. Patients are increasingly seeking alternatives to traditional medication, particularly amid growing concerns over opioid dependency and the side effects associated with long-term drug use. This transition towards more holistic modalities is exemplified by the enthusiastic reception of acupuncture and other complementary therapies among patients.

Moving forward, additional research will be essential to explore the optimal protocols for acupuncture treatment. Questions regarding the frequency of sessions, duration of effects, and the specific points best suited for sciatica remain critical avenues for investigation. Future studies could also delve into the synergetic effects of combining acupuncture with other treatment options, further enriching the mosaic of chronic pain management strategies.

In conclusion, the research led by Konon and Fuest offers a compelling narrative about the potential benefits of acupuncture for patients battling chronic sciatica. Their findings not only illuminate a promising alternative pain management option but also advocate for a deeper exploration into the integration of holistic practices within contemporary medical frameworks. As acupuncture gains recognition in the realm of evidence-based medicine, it has the potential to provide relief to countless individuals, potentially transforming the management of chronic pain.

In summary, this exploration of acupuncture highlights a pivotal moment in the evolution of pain management approaches. With growing interest among both patients and healthcare providers, acupuncture could lead the charge towards a more comprehensive and effective approach to treating conditions that have long resisted conventional cures. The harmony between traditional practices and modern medical standards may hold the key to brighter, pain-free futures for many.

Subject of Research: Acupuncture for Chronic Sciatica

Article Title: Patients interested in Acupuncture for Chronic Sciatica may find it Reduces Pain and Disability.

Article References:

Konon, E., Fuest, S. EBM BLS: Patients interested in Acupuncture for Chronic Sciatica may find it Reduces Pain and Disability.
J GEN INTERN MED (2025). https://doi.org/10.1007/s11606-025-09762-6

Image Credits: AI Generated

DOI: 10.1007/s11606-025-09762-6

Keywords: Acupuncture, Chronic Sciatica, Pain Relief, Disability, Alternative Medicine, Integrative Healthcare.

To tackle this pressing issue, the authors employed the Consolidated Framework for Implementation Research (CFIR), a comprehensive tool designed to systematically evaluate the barriers and facilitators associated with implementing evidence-based practices in healthcare settings. The framework emphasizes the importance of taking into account various contextual factors, including the perspectives of key stakeholders, to ensure successful adoption and integration of new treatment modalities. This research is expected to bridge the gap between theoretical evidence and clinical practice, a challenge that has plagued many medical fields.

The study commenced with an in-depth exploration of the existing literature surrounding frozen shoulder management. The authors meticulously reviewed previous findings, noting that while there is a wealth of evidence supporting various treatment approaches—such as physical therapy, corticosteroid injections, and surgical intervention—these interventions are not consistently applied in clinical practice. This inconsistency presents a formidable barrier to improving patient outcomes, as individuals are often left to navigate their treatment options without receiving optimal care.

Central to their research was the engagement of key stakeholders, including healthcare providers, patients, and policymakers, to gather insights on the facilitators and barriers to implementing evidence-based guidelines. By prioritizing collaboration with these groups, researchers were able to uncover first-hand perspectives on the challenges faced in treatment delivery. For instance, many practitioners highlighted a lack of training and resources as significant obstacles, noting that without proper knowledge and ongoing education, the likelihood of adopting new, evidence-based practices diminishes.

Furthermore, the authors recognized that patient involvement is crucial in this process. The study revealed that patients often face confusion regarding treatment options due to insufficient communication from healthcare providers. By actively engaging patients and incorporating their feedback into the treatment process, practitioners can better tailor interventions to meet individual needs, ultimately leading to improved adherence and outcomes. This patient-centered approach ensures that care aligns closely with patient preferences, a vital component of effective healthcare delivery.

The research also delved into the cultural and systemic barriers that may impede the adoption of evidence-based practices in the management of frozen shoulder. Identifying these challenges is essential for devising strategies to overcome them. For example, the study noted that variations in local healthcare policies can significantly affect the availability of resources and support necessary for implementing new care protocols. Addressing these issues necessitates a collaborative effort among healthcare systems to foster an environment conducive to adopting best practices across the board.

Another noteworthy aspect of the research involved evaluating the efficacy of existing tools and frameworks used in the current management of frozen shoulder. By critically assessing these resources, the authors were able to pinpoint areas requiring enhancement and development. Investing in training programs, guidelines, and materials tailored for providers can serve as a catalyst for change, driving the integration of evidence-based practices into everyday clinical routines.

As the study progressed, the authors conducted a series of stakeholder workshops aimed at generating discussion around barriers and facilitators. These workshops served not only as a platform for exchanging ideas but also as a catalyst for fostering a sense of community among participants. By working together in this collaborative environment, stakeholders were empowered to identify actionable steps toward overcoming existing challenges, demonstrating the importance of collective effort in improving healthcare delivery.

Importantly, the research emphasized the role of leadership in driving change within healthcare organizations. Strong support and commitment from healthcare leaders are essential for allocating resources, integrating new practices, and sustaining long-term improvements. By championing evidence-based approaches, leaders can inspire their teams and cultivate an organizational culture that prioritizes continuous learning and adaptation.

The findings from this article herald a new horizon in the management of frozen shoulder, advocating for a transformative shift towards embracing evidence-based practices in clinical settings. By actively engaging key stakeholders, clinicians can better navigate the complexities surrounding treatment delivery, ultimately improving patient outcomes. The use of the CFIR framework exemplifies a forward-thinking approach that has the potential to reshape how frozen shoulder is managed in the future.

This groundbreaking research contributes to the growing body of literature on evidence-based practice in healthcare and serves as a model for similar studies in other medical fields. As these insights are disseminated throughout the medical community, the hope is for a ripple effect, prompting widespread adoption of similar strategies to address various healthcare challenges. The commitment to elevating healthcare practices through stakeholder engagement reflects a progressive vision that can enhance patient care on a larger scale.

As the authors prepare to share their findings with a broader audience, there is a palpable sense of optimism surrounding the potential of this research to transform how frozen shoulder is managed. By equipping healthcare providers with the tools needed to implement evidence-based guidelines effectively, the authors aim to eradicate the barriers that have long hindered optimal patient care. In this regard, the article not only contributes to academic discourse but also serves as a call to action for the healthcare community.

The imperative to enact change is more urgent than ever, and this study stands as a pivotal step towards fostering an environment of collaboration, communication, and evidence-driven care in the realm of frozen shoulder management. As stakeholders unite to address the barriers and facilitators identified in this research, the potential for improved patient outcomes and enhanced quality of care becomes increasingly tangible.

In conclusion, this research marks a significant milestone in advancing the management of frozen shoulder, paving the way for a new era of healthcare where evidence-based practices are not just theoretical concepts but practical realities. It invites continued dialogue among stakeholders committed to enhancing the future of patient care and addresses the necessity for ongoing evaluation and adaptation of treatment approaches in a rapidly evolving healthcare landscape. By cultivating a deep understanding of the complexities surrounding frozen shoulder, the medical community can forge a path forward that minimizes patient distress and maximizes recovery.

Subject of Research: Implementation of evidence-based practices for frozen shoulder management.

Article Title: Implementing evidence into practice for the management of frozen shoulder: engaging with key stakeholders and evaluating barriers and facilitators using the Consolidated Framework for Implementation Research.

Article References:

Clark, N.L., Johnson, M., Kottam, L. et al. Implementing evidence into practice for the management of frozen shoulder: engaging with key stakeholders and evaluating barriers and facilitators using the Consolidated Framework for Implementation Research. Health Res Policy Sys 23, 73 (2025). https://doi.org/10.1186/s12961-025-01335-7

Image Credits: AI Generated

DOI: 10.1186/s12961-025-01335-7

Keywords: Frozen shoulder, Evidence-based practice, Implementation research, Healthcare stakeholders, Patient care.