Greening Family Medicine clinic operations and clinical care, where do we start? A scoping review of toolkits and aids.

BACKGROUND: There is a pressing need for healthcare to respond to the climate crisis. Family physicians, given their central role in community healthcare provision, are strategically placed to lead, support, and promote sustainable healthcare, yet guidance on how to do this is fragmented. OBJECTIVE: To identify and evaluate toolkits and aids on sustainable healthcare to act as a curated resource for family physicians and their care teams interested in delivering evidence-based sustainable healthcare in their clinical practices. METHODS: A scoping review was completed of the published and grey literature across 4 databases and 2 search engines to identify articles and aids/toolkits from 1990 to present. Toolkits were subsequently evaluated for purpose, evidence-base, implementation process, adaptability to family medicine, and outcome measures. RESULTS: The search identified 17,751 articles. Screening resulted in 20 published articles and 11 toolkits. Most articles presented simple checklists to support greening clinic initiatives, 3 studies focussed on partial carbon footprint analyses, and 4 on educational initiatives. Toolkits ranged in sustainability topics and degree of depth covered, and adaptability and outcome measures. None of the resources identified have been formally evaluated for effectiveness. CONCLUSIONS: A range of aids exist to support greening of clinic operations; however, there is a significant gap in the literature for greening clinical care. Two toolkits were found to be comprehensive, one requiring tracking and reporting of sustainability initiatives. This scoping review provides a starting point for motivated family doctors and community clinics to initiate change and support more sustainable healthcare.

Associations of inter-segmental coordination and treadmill walking economy in youth with cerebral palsy.

This study investigated associations of thigh-shank coordination deficit severity and metabolic demands of walking in youth with cerebral palsy (CP) and their typically developing (TD) peers. Youth (ages 8-18 years) with hemiplegic and diplegic CP [Gross Motor Classification System (GMFCS) I-III] and their age (within 12 months) and sex-matched peers performed a modified six-minute-walk-test on a treadmill. Kinematics (Motion Analysis, USA, 240 Hz) and mass-specific gross metabolic rate (GMR; COSMED, Italy) were analyzed for minute two of treadmill walking. Thigh-shank coordination was determined using continuous relative phase (CRP) analysis. GMR was normalized using participant specific Froude numbers (i.e. GMREq). Maximum and minimum CRP deficit angles (CRPMax,CRPMin) were analysed in SPSS (IBM, USA) using paired samples t-tests with Bonferroni correction (p = 0.0125). Associations of knee extension angle deficit (KEDMax) and coordination outcomes with GMREq (log) were assessed using multiple linear regression. Twenty-eight matched pairs were included, demonstrating significantly larger CRPMax for youth with CP [GMFCS I mean pair difference (98.75%CI) 8.2 (-0.1,16.5), P = 0.013; GMFCS II/III 26.1 (2.3,50.0), P = 0.008]. Joint kinematics and coordination outcomes were significantly associated with GMREq (P < 0.001), primarily due to CRPMax (P < 0.001), leading to a 1.7 (95%CI; 1.1, 2.4)% increase in GMREq for every degree increase in CRPMax. These findings indicate an association of thigh-shank coordination deficit severity and increasing metabolic demands of walking in youth with CP. CRP may be a clinically useful predictor of metabolic demands of walking in CP. Future work will evaluate the sensitivity of CRP to coordination and walking economy changes with surgical and non-surgical management.