Electroencephalography in hepatic encephalopathy: diagnostic and prognostic applications across the disease spectrum.

Musculoskeletal (MSK) disorders are a leading cause of disability in Canada and globally, accounting for a large burden of disease, reduced quality of life, and high health care utilization. Conditions such as osteoarthritis, low back pain, and neck and shoulder dysfunction are among the most commonly reported issues in primary care. Despite the high prevalence of these conditions, access to timely and effective MSK care in the Canadian health care system remains fragmented. System-level challenges, including long wait times, shortage of family physicians, siloed services, and inadequate funding for allied health professionals, have been consistently reported across multiple Canadian jurisdictions. These issues are particularly prominent for MSK patients, who often navigate a complex web of generalist and specialist providers, diagnostic delays, and restrictive referral pathways. There is an increasing emphasis in health services research to better understand the patient experience as a means to improving care quality and advancing a patient centered approach in the delivery of health care services from physicians (family physicians, sports medicine physicians, orthopedic surgeons), rehabilitation professionals, (physiotherapy, athletic therapy, chiropractors, massage therapists, etc.). Previous studies have explored dissatisfaction of MSK patients with access, provider communication, and service coordination. Importantly, the process of navigating the health care system itself influences not only patient perceptions of care quality but also their health outcomes. While many MSK conditions are chronic and may deteriorate regardless of intervention, delays in care, inconsistent treatment recommendations, and repeated episodes of ineffective management may not only preclude recovery but also compound physical dysfunction, chronic pain, or emotional distress. However, the holistic health impacts of navigating the health care system remain poorly understood. Holistic health offers a broader understanding of health, taking into consideration the interconnection between physical, mental, emotional, social, and financial well-being. Within the context of MSK care, this perspective is particularly relevant as it emphasizes that health extends beyond the physical disease and its management alone. A holistic health lens draws attention to the fact that MSK conditions, which are primarily physical, impact other dimensions of health, which may also require intervention. Understanding the holistic health impacts of system navigation, therefore, provides important insight into how system structures and processes compound the burden of MSK conditions and more accurately reflect the full patient journey through the MSK system.