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Papagoras H, Pizzari T, Coburn P, Sleigh K, Briggs AM. Supporting return to work through appropriate certification: a systematic approach for Australian primary care. AUST HEALTH REV 2019; 42:164-167. [PMID: 28263703 DOI: 10.1071/ah16247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/12/2017] [Indexed: 11/23/2022]
Abstract
Primary care practitioners play a critical role in supporting return to work (RTW) and minimising the detrimental physical and psychosocial sequelae of unnecessary and prolonged work absence in injured and ill workers. Accurate and consistent certification of capacity is an essential component of this role that has been scrutinised recently given the identified variation in certification practices between and within professions. This Perspective outlines the importance of correct certification of capacity for injured workers and provides a RTW flowchart to support systematised and appropriate certification. The flowchart is aimed at primary care practitioners (e.g. general practitioners or physiotherapists). The flowchart was developed at the Transport Accident Commission and WorkSafe Victoria as a guide for Australian primary care practitioners when certifying capacity. A more systematised approach to certification coupled with professional education and support may reduce variations and inaccuracies in certification, improve RTW rates and reduce the increasing burden of disease related to workplace injuries.
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Green B, Lin M, McClelland J, Semciw A, Schache A, Rotstein A, Cook J, Pizzari T. Which factors are predictive of return to play and re-injury following calf muscle strain injury? J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Perrott M, Pizzari T, Cook J. Does a lumbopelvic stability program improve hopping and landing measures compared to an active control? – a randomised trial. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Heerey J, Srinivasan R, Smith A, Kemp J, King M, Lawrenson P, Scholes M, Pizzari T, Souza R, Majumdar S, Crossley K. MRI defined intra-articular hip findings are seen in semi-elite football players with and without hip-related pain. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Heerey J, Agricola R, Smith A, Kemp J, King M, Lawrenson P, Scholes M, Pizzari T, Crossley K. Hip-related pain is not associated with bony hip morphology in male and female semi-elite football players. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Perrott MA, Pizzari T, Opar MS, Cook J. Athletes with a clinical rating of good and poor lumbopelvic stability have different kinematic variables during single leg squat and dip test. Physiother Theory Pract 2019; 37:906-915. [PMID: 31438758 DOI: 10.1080/09593985.2019.1655823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To examine the kinematics of athletes with good and poor lumbopelvic stability (LPS) based on clinical rating criteria of single leg squat (SLS) and dip test (DT) The aim was to establish if good and poor LPS categorization is supported by differences in kinematic variables. METHODS Sixty-two recreational athletes had their LPS categorized using clinical rating criteria for SLS and DT as good, poor or neither good nor poor. Kinematic measures were examined in those with good (N = 8) or poor (N = 14) LPS and results compared to the rating criteria. RESULTS Multiple clinical rating criteria for good and poor LPS groups were distinguished by kinematic measures. Smoothness of motion for both SLS and DT distinguished good and poor LPS. Minimal (good) or discernible movement (poor) out of the starting plane was confirmed with kinematic measures. For SLS these movements were: weight-bearing hip adduction, non-weightbearing hip abduction, pelvic rotation, and trunk sideflexion, and for DT: weightbearing hip adduction, non-weightbearing hip abduction and pelvic obliquity. Additionally, hip dissociation (SLS) distinguished good and poor LPS. CONCLUSION Athletes with good and poor LPS have different kinematic measures in single leg squat and dip test. Multiple clinical rating criteria of LPS that distinguish good and poor stability were confirmed by kinematic measures.
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Green R, Pizzari T, McClelland J, Zacharias A, Huynh P, Weerakkody N, Semciw A. Between session reliability of intramuscular electromyography for segments of gluteus medius and minimus during gait and stepping tasks. J Electromyogr Kinesiol 2019; 47:96-104. [DOI: 10.1016/j.jelekin.2019.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/19/2019] [Accepted: 05/22/2019] [Indexed: 11/17/2022] Open
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Ford JJ, Hahne AJ, Surkitt LD, Chan AYP, Richards MC, Slater SL, Pizzari T, Davidson M, Taylor NF. STOPS trial versus Costa et al: a more accurate analysis. Br J Sports Med 2019; 53:914-916. [DOI: 10.1136/bjsports-2017-098821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 11/03/2022]
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Hope D, French J, Pizzari T, Hoy G, Barwood S. Patients Undergoing Shoulder Stabilization Procedures Do Not Accurately Recall Their Preoperative Symptoms at Short- to Midterm Follow-up. Orthop J Sports Med 2019; 7:2325967119851084. [PMID: 31218238 PMCID: PMC6563408 DOI: 10.1177/2325967119851084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: A patient’s ability to recall symptoms is poor in some elderly populations, but we considered that the recall of younger patients may be more accurate. The accuracy of recall in younger patients after surgery has not been reported to date. Purpose: To assess younger patients’ abilities to recall their preoperative symptoms after having undergone shoulder stabilization surgery. We used 2 disease-specific, patient-reported outcome measures (PROMs)—the Western Ontario Shoulder Instability Index (WOSI) and the Melbourne Instability Shoulder Score (MISS)—at a period of up to 2 years postoperatively. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Participants (N = 119) were stratified into 2 groups: early recall (at 6-8 months postoperatively; n = 58) and late recall (at 9-24 months postoperatively; n = 61). All patients completed the PROMs with instructions to recall preoperative function. The mean and absolute differences between the preoperative scores and recalled scores for each PROM were compared using paired t tests. Correlations between the actual and recalled scores of the subsections for each PROM were calculated using an intraclass correlation coefficient (ICC). The number of individuals who recalled within the minimal detectable change (MDC) of each PROM was calculated. Results: Comparison between the means of the actual and recalled preoperative scores for both groups did not demonstrate significant differences (early recall differences, MISS 1.05 and WOSI –38.64; late recall differences, MISS –0.25 and WOSI –24.02). Evaluation of the absolute difference, however, revealed a significant difference between actual and recalled scores for both the late and early groups (early recall absolute differences, MISS 12.26 and WOSI 216.71; late recall absolute differences, MISS 12.84 and WOSI 290.08). Average absolute differences were above the MDC scores of both PROMs at both time points. Subsections of each PROM demonstrated weak to moderate correlations between actual and recalled scores (ICC range, 0.17-0.61). Total scores for the PROMs reached moderate agreement between actual and recalled scores. Conclusion: Individual recall after shoulder instability surgery was not accurate. However, the mean recalled PROM scores of each group were not significantly different from the actual scores collected preoperatively, and recall did not deteriorate significantly over 2 years. This suggests that recall of the individual, even in this younger group, cannot be considered accurate for research purposes.
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Briggs AM, Hinman RS, Darlow B, Bennell KL, Leech M, Pizzari T, Greig AM, MacKay C, Bendrups A, Larmer PJ, Francis-Cracknell A, Houlding E, Desmond LA, Jordan JE, Minaee N, Slater H. Confidence and Attitudes Toward Osteoarthritis Care Among the Current and Emerging Health Workforce: A Multinational Interprofessional Study. ACR Open Rheumatol 2019; 1:219-235. [PMID: 31777798 PMCID: PMC6857979 DOI: 10.1002/acr2.1032] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To measure confidence and attitudes of the current and emerging interprofessional workforce concerning osteoarthritis (OA) care. Methods Study design is a multinational (Australia, New Zealand, Canada) cross-sectional survey of clinicians (general practitioners [GPs], GP registrars, primary care nurses, and physiotherapists) and final-year medical and physiotherapy students. GPs and GP registrars were only sampled in Australia/New Zealand and Australia, respectively. The study outcomes are as follows: confidence in OA knowledge and skills (customized instrument), biomedical attitudes to care (Pain Attitudes Beliefs Scale [PABS]), attitudes toward high- and low-value care (customized items), attitudes toward exercise/physical activity (free-text responses). Results A total of 1886 clinicians and 1161 students responded. Although a number of interprofessional differences were identified, confidence in OA knowledge and skills was consistently greatest among physiotherapists and lowest among nurses (eg, the mean difference [95% confidence interval (CI)] for physiotherapist-nurse analyses were 9.3 [7.7-10.9] for knowledge [scale: 11-55] and 14.6 [12.3-17.0] for skills [scale: 16-80]). Similarly, biomedical attitudes were stronger in nurses compared with physiotherapists (6.9 [5.3-8.4]; scale 10-60) and in medical students compared with physiotherapy students (2.0 [1.3-2.7]). Some clinicians and students agreed that people with OA will ultimately require total joint replacement (7%-19% and 19%-22%, respectively), that arthroscopy is an appropriate intervention for knee OA (18%-36% and 35%-44%), and that magnetic resonance imaging is informative for diagnosis and clinical management of hip/knee OA (8%-61% and 21%-52%). Most agreed (90%-98% and 92%-97%) that exercise is indicated and strongly supported by qualitative data. Conclusion Workforce capacity building that de-emphasizes biomedical management and promotes high-value first-line care options is needed. Knowledge and skills among physiotherapists support leadership roles in OA care for this discipline.
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Heerey JJ, Kemp JL, Mosler AB, Jones DM, Pizzari T, Scholes MJ, Agricola R, Crossley KM. Correction to: What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis. Sports Med 2019; 49:1139-1141. [PMID: 31020547 DOI: 10.1007/s40279-019-01108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The original article can be found online.
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Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL. Current trends in tendinopathy management. Best Pract Res Clin Rheumatol 2019; 33:122-140. [DOI: 10.1016/j.berh.2019.02.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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63
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Zacharias A, Pizzari T, Semciw AI, English DJ, Kapakoulakis T, Green RA. Comparison of gluteus medius and minimus activity during gait in people with hip osteoarthritis and matched controls. Scand J Med Sci Sports 2019; 29:696-705. [DOI: 10.1111/sms.13379] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/12/2018] [Accepted: 01/03/2019] [Indexed: 12/17/2022]
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64
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Kemp JL, King MG, Barton C, Schache AG, Thorborg K, Roos EM, Scholes M, Grimaldi A, Semciw AI, Freke M, Risberg MA, Reiman MP, Mayes S, Pizzari T, Heerey JJ, Lawrenson PR, Ingelsrud LHH, Crossley KM. Is exercise therapy for femoroacetabular impingement in or out of FASHIoN? We need to talk about current best practice for the non-surgical management of FAI syndrome. Br J Sports Med 2019; 53:1204-1205. [PMID: 30626598 DOI: 10.1136/bjsports-2018-100173] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 11/04/2022]
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65
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Nunes GS, de Oliveira Silva D, Pizzari T, Serrão FV, Crossley KM, Barton CJ. Clinically measured hip muscle capacity deficits in people with patellofemoral pain. Phys Ther Sport 2019; 35:69-74. [DOI: 10.1016/j.ptsp.2018.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/21/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
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Barwood SA, French JA, Watson LA, Balster SM, Hoy GA, Pizzari T. The Specific AC Score (SACS): a new and validated method of assessment of isolated acromioclavicular joint pathology. J Shoulder Elbow Surg 2018; 27:2214-2223. [PMID: 30001828 DOI: 10.1016/j.jse.2018.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acromioclavicular (AC) joint (ACJ) pathology is a common cause of shoulder dysfunction, and treatment recommendations vary. When the efficacy of treatment is evaluated, the ability to measure outcomes specific to the population is essential. The aim of the current research was to develop and validate a specific ACJ questionnaire. METHODS Items for the "Specific AC Score" (SACS) were generated through the use of an expert panel, existing questionnaires, and patient feedback. Preliminary data analysis identified redundancy of items resulting in the questionnaire being refined. The final SACS was evaluated in 125 patients requiring surgical intervention of the ACJ. Internal consistency (the Cronbach α and corrected item-total correlation), content validity, criterion validity, responsiveness, and test-retest reliability (intraclass correlation coefficient) were examined and compared with the Shoulder Pain and Disability Index, Oxford Shoulder Score, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. The minimum detectable change score was calculated. RESULTS The Cronbach α for the total scale preoperatively and postoperatively was high (preoperatively = 0.91, postoperatively = 0.93). All 3 domains (Pain, Function, Quality of Life) demonstrated acceptable internal consistency (α > 0.70), and the correlation between items in each domain was satisfactory. The responsiveness was excellent (effect size, -2.32; standard response mean, -1.85) and was higher than the other general shoulder questionnaires. There were no relevant floor or ceiling effects. Reliability was high (intraclass correlation coefficient, 0.89) and the minimum detectable change was 6.5 points. DISCUSSION This new ACJ-specific questionnaire has been robustly developed, has good measurement properties, and has excellent responsiveness. The SACS is recommended for measuring outcomes in ACJ patients.
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O'Brien M, Bourne M, Heerey J, Timmins RG, Pizzari T. A novel device to assess hip strength: Concurrent validity and normative values in male athletes. Phys Ther Sport 2018; 35:63-68. [PMID: 30471548 DOI: 10.1016/j.ptsp.2018.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/09/2018] [Accepted: 11/10/2018] [Indexed: 11/18/2022]
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68
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Donnan L, Pizzari T, O’Dwyer N, Edwards S. Variations in lumbar spine joint moments in Australian Rules Football players with a history of hamstring injury. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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69
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Green B, McClelland J, Semciw A, Pizzari T. Calf strain injuries in elite Australian rules football: Epidemiological features, muscles injured and return to play. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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70
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Dooley K, Drew M, Schultz A, Snodgrass S, Pizzari T, McGann T, Donnan L, Rio E, Edwards S. High prevalence of groin pain identified in elite basketball U20s athletes and its impact on function and quality of life. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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71
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Perrott M, Cook J, Ellis M, Pizzari T. Movement variability improved more with stability exercise than stretching: A randomised controlled trial. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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72
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Wollin M, Thorborg K, Welvaert M, Pizzari T. In-season monitoring of hip and groin strength, health and function in elite youth soccer: Implementing an early detection and management strategy over two consecutive seasons. J Sci Med Sport 2018; 21:988-993. [DOI: 10.1016/j.jsams.2018.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/15/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
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Semciw AI, Pizzari T, Woodley S, Zacharias A, Kingsley M, Green RA. Targeted gluteal exercise versus sham exercise on self-reported physical function for people with hip osteoarthritis (the GHOst trial - Gluteal exercise for Hip Osteoarthritis): a protocol for a randomised clinical trial. Trials 2018; 19:511. [PMID: 30236151 PMCID: PMC6149073 DOI: 10.1186/s13063-018-2873-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/23/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Clinical practice guidelines recommend exercise as the first line of management for hip osteoarthritis, yet high-quality evidence from Cochrane reviews suggest only slight benefits for pain and physical function; and no benefit on quality of life (low-quality evidence). However, the scope of physical impairments identified in people with hip osteoarthritis may not have been adequately addressed with targeted rehabilitation options in previous randomised controlled trials (RCTs). Potential targeted options include gait retraining to address spatio-temporal impairments in walking; motor control training to address deep gluteal (gluteus minimus) dysfunction; and progressive, high-intensity resistance exercises to address atrophy of the gluteal muscles. The aim of this study is to investigate the effect of a targeted gluteal rehabilitation programme that incorporates gait retraining, motor control and progressive, high-intensity resistance-strength training, to address physical activity levels and self-reported physical function in people with mild to moderate disability from hip osteoarthritis. METHODS Ninety people diagnosed with mild to moderately disabling hip osteoarthritis will be recruited and randomised to receive one of two exercise programmes (sham or GHOst programme). Interventions will be 12 weeks in duration, with weekly, supervised physiotherapy sessions, and daily home exercises. Both groups will receive standardised education. Outcomes will be assessed at baseline, 7 weeks, 13 weeks (primary time-point) and 25 weeks. The primary outcome will be self-reported physical function measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes include physical activity measured with a tri-axial accelerometer, physical function tests, self-reported physical activity, isometric hip-muscle strength tests, hip-related patient-reported outcome measures, pain thoughts and depressive symptoms, quality of life, global rating of change, gluteal-muscle activity (electromyography (EMG)) and gluteal-muscle size and adiposity (magnetic resonance imaging (MRI)). DISCUSSION This will be the first study to compare a targeted gluteal rehabilitation programme to a sham exercise programme. The targeted GHOst programme includes exercises designed to address gait impairments as well as gluteal-muscle atrophy and dysfunction. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347 . Registered retrospectively on 5 July 2017. Protocol version 3.0.
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Checklin M, Pizzari T. Impaired Tongue Function as an Indicator of Laryngeal Aspiration in Adults with Acquired Oropharyngeal Dysphagia: A Systematic Review. Dysphagia 2018; 33:778-788. [DOI: 10.1007/s00455-018-9902-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/19/2018] [Indexed: 01/03/2023]
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75
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Watson L, Balster S, Warby SA, Sadi J, Hoy G, Pizzari T. A comprehensive rehabilitation program for posterior instability of the shoulder. J Hand Ther 2018. [PMID: 28641736 DOI: 10.1016/j.jht.2017.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Posterior shoulder instability is recognised as being less prevalent than anterior instability, however the diagnosis of this pathology is easily overlooked or missed and this may contribute to an underestimation of prevalence. Recently, there has been increasing recognition of this condition and consequently a greater requirement for knowledge of diagnostic procedures and treatment directions. Currently there is limited research into the conservative management of posterior instability, although it is recommended as first-line treatment prior to surgical review, particularly in those with an atraumatic instability mechanism. The aim of this paper is to outline a comprehensive rehabilitation program for the conservative management of posterior instability with a focus on scapular and humeral head control. The information provided includes extensive written information, flowcharts, figures and a table of management parameters that will provide therapists with adequate detail to replicate the program in the clinical setting.
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