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Ladlow P, Suffield C, Greeves JP, Comfort P, Hughes J, Cassidy RP, Bennett AN, Coppack RJ. How 'STRONG' is the British Army? BMJ Mil Health 2024; 170:283-286. [PMID: 37487657 PMCID: PMC11287571 DOI: 10.1136/military-2023-002508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - C Suffield
- Physical Development Branch, Royal Army Physical Training Corps, Tidworth, UK
| | - J P Greeves
- Department of Army Health and Physical Performance Research, United Kingdom Ministry of Defence, Andover, UK
| | - P Comfort
- School of Health and Society, University of Salford, Salford, UK
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - J Hughes
- Headquarters, Royal Army Physical Training Corps, Aldershot, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
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Coppack RJ, Ladlow P, Cassidy RP, Egginton N, Barker-Davies R, Houston A, Lunt KM, O'Sullivan O, Bennett AN. Academic Department of Military Rehabilitation (ADMR): avoiding the pitfalls of ' the Walker Dip'. BMJ Mil Health 2024; 170:4-8. [PMID: 37495378 DOI: 10.1136/military-2023-002469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
A key research theme identified during the 2021 Strategic Delivery Plan (SDP) for Defence Medical Services (DMS) Research was preventing and treating musculoskeletal injury (MSKI). MSKI is a significant burden to military populations globally, reducing both operational strength and force readiness. It is therefore essential that research is conducted to gain a greater understanding of the epidemiology, aetiology and risk factors associated with MSKI to develop targeted prevention strategies and rehabilitation interventions. The Academic Department of Military Rehabilitation (ADMR) and the recently established MSKI research-theme working group must use a combination of balance and flexibility when coordinating research priorities to ensure they align and reflect both higher level DMS and UK Defence Rehabilitation practitioner-driven priorities. This article describes the response ADMR have taken to meet and align with the requirements of the 2021 SDP.
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Affiliation(s)
- Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - N Egginton
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - K M Lunt
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - O O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
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Ladlow P, Barker-Davies R, Hill O, Conway D, O'Sullivan O. Use of symptom-guided physical activity and exercise rehabilitation for COVID-19 and other postviral conditions. BMJ Mil Health 2023:military-2023-002399. [PMID: 37137489 DOI: 10.1136/military-2023-002399] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023]
Abstract
There are many similarities in symptoms between postviral conditions, including clinical features such as fatigue, reduced daily activity and postexertional symptom exacerbation. Unfavourable responses to exercise have influenced the wider debate on how to reintegrate physical activity (PA) and exercise while simultaneously managing symptoms during recovery from post-COVID-19 syndrome (or Long COVID). This has resulted in inconsistent advice from the scientific and clinical rehabilitation community on how and when to resume PA and exercise following COVID-19 illness. This article provides commentary on the following topics: (1) controversies surrounding graded exercise therapy as a treatment modality for post-COVID-19 rehabilitation; (2) evidence supporting PA promotion, resistance exercise and cardiorespiratory fitness for population health, and the consequences of physical inactivity in patients with complex rehabilitation needs; (3) population-based challenges for UK Defence Rehabilitation practitioners for the management of postviral conditions; and (4) 'symptom guided PA and exercise rehabilitation' as an appropriate treatment option for managing individuals with multifaceted medical needs.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Department for Health, University of Bath, Bath, UK
| | - R Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - O Hill
- Specialist Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - D Conway
- Department of Cancer and Surgery, Imperial College London, London, UK
- Pulmonary and COVID-19 Rehabilitation, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - O O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
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4
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Ladlow P, Holdsworth DA, O'Sullivan O, Barker-Davies RM, Houston A, Chamley R, Rogers-Smith K, Kinkaid V, Kedzierski A, Naylor J, Mulae J, Cranley M, Nicol ED, Bennett AN. Exercise tolerance, fatigue, mental health, and employment status at 5 and 12 months following COVID-19 illness in a physically trained population. J Appl Physiol (1985) 2023; 134:622-637. [PMID: 36759161 PMCID: PMC10010915 DOI: 10.1152/japplphysiol.00370.2022] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Failure to recover following severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may have a profound impact on individuals who participate in high-intensity/volume exercise as part of their occupation/recreation. The aim of this study was to describe the longitudinal cardiopulmonary exercise function, fatigue, and mental health status of military-trained individuals (up to 12-mo postinfection) who feel recovered, and those with persistent symptoms from two acute disease severity groups (hospitalized and community-managed), compared with an age-, sex-, and job role-matched control. Eighty-eight participants underwent cardiopulmonary functional tests at baseline (5 mo following acute illness) and 12 mo; 25 hospitalized with persistent symptoms (hospitalized-symptomatic), 6 hospitalized and recovered (hospitalized-recovered); 28 community-managed with persistent symptoms (community-symptomatic); 12 community-managed, now recovered (community-recovered), and 17 controls. Cardiopulmonary exercise function and mental health status were comparable between the 5 and 12-mo follow-up. At 12 mo, symptoms of fatigue (48% and 46%) and shortness of breath (SoB; 52% and 43%) remain high in hospitalized-symptomatic and community-symptomatic groups, respectively. At 12 mo, COVID-19-exposed participants had a reduced capacity for work at anaerobic threshold and at peak exercise levels of deconditioning persist, with many individuals struggling to return to strenuous activity. The prevalence considered "fully fit" at 12 mo was lowest in symptomatic groups (hospitalized-symptomatic, 4%; hospitalized-recovered, 50%; community-symptomatic, 18%; community-recovered, 82%; control, 82%) and 49% of COVID-19-exposed participants remained medically nondeployable within the British Armed Forces. For hospitalized and symptomatic individuals, cardiopulmonary exercise profiles are consistent with impaired metabolic efficiency and deconditioning at 12 mo postacute illness. The long-term deployability status of COVID-19-exposed military personnel is uncertain.NEW & NOTEWORTHY Subjective exercise limiting symptoms such as fatigue and shortness of breath reduce but remain prevalent in symptomatic groups. At 12 mo, COVID-19-exposed individuals still have a reduced capacity for work at the anaerobic threshold (which best predicts sustainable intensity), despite oxygen uptake comparable to controls. The prevalence of COVID-19-exposed individuals considered "medically non-deployable" remains high at 47%.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom.,Department for Health, University of Bath, Bath, United Kingdom
| | - David A Holdsworth
- Academic Department of Military Medicine, Birmingham, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Oliver O'Sullivan
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom.,Headquarters Army Medical Directorate (HQ AMD), Camberley, United Kingdom
| | - Robert M Barker-Davies
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Andrew Houston
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom
| | - Rebecca Chamley
- Academic Department of Military Medicine, Birmingham, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Kasha Rogers-Smith
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom
| | - Victoria Kinkaid
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom
| | - Adam Kedzierski
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom
| | - Jon Naylor
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Joseph Mulae
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Mark Cranley
- Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom
| | - Edward D Nicol
- Academic Department of Military Medicine, Birmingham, United Kingdom.,Royal Brompton Hospital, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
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5
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O'Sullivan O, Ladlow P, Coppack RJ, Bennett AN. The BMJ Military Health Military Rehabilitation special issue. BMJ Mil Health 2022; 168:253-255. [PMID: 35868832 DOI: 10.1136/bmjmilitary-2022-002145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Oliver O'Sullivan
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, UK
- Headquarters Army Medical Services (HQ AMS), Camberley, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, UK
- Department of Health, University of Bath, Bath, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, UK
- Department of Health, University of Bath, Bath, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Ladlow P, O'Sullivan O, Bennett AN, Barker-Davies R, Houston A, Chamley R, May S, Mills D, Dewson D, Rogers-Smith K, Ward C, Taylor J, Mulae J, Naylor J, Nicol ED, Holdsworth DA. The effect of medium-term recovery status after COVID-19 illness on cardiopulmonary exercise capacity in a physically active adult population. J Appl Physiol (1985) 2022; 132:1525-1535. [PMID: 35608204 PMCID: PMC9190734 DOI: 10.1152/japplphysiol.00138.2022] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A failure to fully recover following coronavirus disease 2019 (COVID-19) may have a profound impact on high-functioning populations ranging from frontline emergency services to professional or amateur/recreational athletes. The aim of the study is to describe the medium-term cardiopulmonary exercise profiles of individuals with “persistent symptoms” and individuals who feel “recovered” after hospitalization or mild-moderate community infection following COVID-19 to an age, sex, and job-role matched control group. A total of 113 participants underwent cardiopulmonary functional tests at a mean of 159 ± 7 days (∼5 mo) following acute illness; 27 hospitalized with persistent symptoms (hospitalized-symptomatic), 8 hospitalized and now recovered (hospitalized-recovered); 34 community managed with persistent symptoms (community-symptomatic); 18 community managed and now recovered (community-recovered); and 26 controls. Hospitalized groups had the least favorable body composition (body mass, body mass index, and waist circumference) compared with controls. Hospitalized-symptomatic and community-symptomatic individuals had a lower oxygen uptake (V̇o2) at peak exercise (hospitalized-symptomatic, 29.9 ± 5.0 mL/kg/min; community-symptomatic, 34.4 ± 7.2 mL/kg/min; vs. control 43.9 ± 3.1 mL/kg/min, both P < 0.001). Hospitalized-symptomatic individuals had a steeper V̇e/V̇co2 slope (lower ventilatory efficiency) (30.5 ± 5.3 vs. 25.5 ± 2.6, P = 0.003) versus. controls. Hospitalized-recovered had a significantly lower oxygen uptake at peak (32.6 ± 6.6 mL/kg/min vs. 43.9 ± 13.1 mL/kg/min, P = 0.015) compared with controls. No significant differences were reported between community-recovered individuals and controls in any cardiopulmonary parameter. In conclusion, medium-term findings suggest that community-recovered individuals did not differ in cardiopulmonary fitness from physically active healthy controls. This suggests their readiness to return to higher levels of physical activity. However, the hospitalized-recovered group and both groups with persistent symptoms had enduring functional limitations, warranting further monitoring, rehabilitation, and recovery. NEW & NOTEWORTHY At 5 mo postinfection, community-treated individuals who feel recovered have comparable cardiopulmonary exercise profiles to the physically trained and active controls, suggesting a readiness to return to higher intensity/volumes of exercise. However, both symptomatic groups and the hospital-recovered group have persistent functional limitations when compared with active controls, supporting the requirement for ongoing monitoring, rehabilitation, and recovery.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Oliver O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- Headquarters Army Medical Directorate, Robertson House, Camberley, United Kingdom
| | - Alexander N. Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Robert Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Andrew Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Rebecca Chamley
- Academic Department of Military Medicine, Birmingham, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Samantha May
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Daniel Mills
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Dominic Dewson
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Kasha Rogers-Smith
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Christopher Ward
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - John Taylor
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, United Kingdom
| | - Joseph Mulae
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Jon Naylor
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Edward D. Nicol
- Royal Brompton Hospital, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - David A. Holdsworth
- Academic Department of Military Medicine, Birmingham, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Burton I. Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes. Front Physiol 2021; 12:704306. [PMID: 34421641 PMCID: PMC8375597 DOI: 10.3389/fphys.2021.704306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023] Open
Abstract
Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.
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Affiliation(s)
- Ian Burton
- National Health Service (NHS) Grampian, Aberdeen, United Kingdom
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8
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Walters V, Coppack RJ, Cassidy RP, Suffield C, Papadopoulou T, Bilzon J, Ladlow P. Use of an isometric mid-thigh pull test during musculoskeletal rehabilitation: can the criterion values from the updated British Army physical employment standards be used to inform UK Defence Rehabilitation practice? BMJ Mil Health 2021; 168:279-285. [PMID: 34417340 DOI: 10.1136/bmjmilitary-2021-001950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/08/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Objective outcome measures that can quantify the force generating capacity of the lower limb are required to allow clinicians to accurately measure functional status and treatment adaptations over time. The aim of this prospective observational cohort study is to: (1) evaluate the acceptability of the isometric mid-thigh pull (IMTP) test as a measure of functional strength with military personnel undergoing residential hip pain rehabilitation; (2) compare the peak force values recorded against the updated Army physical employment standards (PES) assessment criteria and (3) assess if the minimum PES required of military personnel has the potential to inform clinical decision making and return to duty criteria within UK Defence Rehabilitation. METHODS Acceptability was assessed against patient's adherence to the testing procedures and test burden. Clinician acceptability was assessed against ease of administration and safety of test procedure. Hip pain was recorded before, immediately following and 1 hour after testing. Net peak force was recorded using portable force plates. RESULTS Full patient and clinician acceptability to IMTP testing procedures were demonstrated. Minimal changes in visual analogue scale (VAS) pain scores were demonstrated between baseline values at rest and follow-up. Despite being medically downgraded and functionally compromised due to chronic hip pain, 100% of patients met the PES expected on entry to the British Army and 79% met the PES expected at the end of basic training. CONCLUSION The IMTP provides rehabilitation clinicians with an objective quantifiable measure of maximum muscle strength that can be used early in the rehabilitation care pathway. Based on our finding, it is unclear if the current British Army PES can be used as a criterion standard in Defence Rehabilitation. Therefore, further research focused on generating clinically relevant patient-specific IMTP score criteria, with a larger sample of diverse diagnostic sub-groups is required.
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Affiliation(s)
- Vanessa Walters
- Department for Health, University of Bath, Bath, UK.,Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - C Suffield
- Headquarters, Royal Army Physical Training Corps, Aldershot, UK
| | - T Papadopoulou
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,British Association of Sport and Exercise Medicine, Doncaster, UK
| | - J Bilzon
- Department for Health, University of Bath, Bath, UK.,Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
| | - P Ladlow
- Department for Health, University of Bath, Bath, UK .,Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
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9
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Hayhurst D, Coppack RJ, Ingram C, Conway D, Cassidy RP, Ladlow P. Integrating blood flow restriction with low-load resistance exercise in a UK specialist military primary care rehabilitation facility. BMJ Mil Health 2021; 168:329-330. [PMID: 34131061 DOI: 10.1136/bmjmilitary-2021-001897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/29/2021] [Indexed: 11/03/2022]
Affiliation(s)
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK.,Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Bath, Bath, UK
| | - C Ingram
- Regents Park Barracks, London, UK
| | - D Conway
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK .,Department for Health, University of Bath, Bath, UK
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Conway D, Bliss A, Patterson SD. The influence of pain, kinesiophobia and psychological comorbidities on the accuracy of rating of perceived exertion in UK military spinal rehabilitation. BMJ Mil Health 2021; 168:292-298. [PMID: 34131066 DOI: 10.1136/bmjmilitary-2021-001797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/29/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Chronic low back pain (CLBP) is a leading cause of disability in the UK Military. Pain and psychological comorbidities have been reported to influence the rating of perceived exertion (RPE). Exercise rehabilitation can be monitored using RPE; however, the accuracy of RPE in inpatient CLBP rehabilitation is unknown. METHODS A prospective cohort correlation study of 40 UK Military inpatients with CLBP was completed. Disability (ODI), kinesiophobia (TSK), anxiety (GAD-7) and depression (PHQ-9) were subjectively reported at the beginning and end of a 3 week intervention. Pain (VAS) and HR were recorded in the first aerobic exercise (AE) session (T1) and the final aerobic exercise session (T2). RPE was reported for each AE session. RESULTS At T1, a positive correlation was observed between RPE accuracy (-7.2±20.9), and pre-exercise pain (2.7 mm ±1.6 mm) (p>0.001) and ODI (31.0±16.9) (p>0.05), and a negative relationship between RPE accuracy and average HR (135 bpm ±22 bpm) (p>0.001) was observed. At T2, there was no significant correlation between RPE accuracy (-4.4±22.6) and pre-exercise pain (2.8 mm ±1.6 mm) or ODI (34.0±16.5) (p>0.05). The strong negative relationship between RPE accuracy and average HR (137 bpm ±20 bpm) remained at T2. Improved RPE accuracy over the 3-week rehabilitation programme was correlated to the change in average HR (r=-0.314, p<0.05). CONCLUSIONS Comorbidities may negatively affect RPE accuracy in CLBP, but the magnitude of the influence reduces over intensive rehabilitation.
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Affiliation(s)
- Dean Conway
- Complex Trauma Department, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A Bliss
- The Faculty of Sport, Allied Health and Performance Science, St Mary's University Twickenham, Twickenham, London, UK
| | - S D Patterson
- The Faculty of Sport, Allied Health and Performance Science, St Mary's University Twickenham, Twickenham, London, UK
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11
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Coppack RJ, Ladlow P, Bennett AN. Developing UK Defence Rehabilitation research priorities: a 2020 clinical practitioner engagement exercise. BMJ Mil Health 2020; 168:256-259. [PMID: 33243765 DOI: 10.1136/bmjmilitary-2020-001676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Establishing research priorities help to address knowledge gaps and exploit emerging opportunities to develop a clinical evidence base. The previous clinical engagement exercise to determine UK Defence Rehabilitation practitioner-based research priorities was conducted in 2014. The aim of this article is to (1) describe how research priorities are established for UK Defence Rehabilitation; (2) review, reassess and rate the priorities highlighted and set by rehabilitation practitioners following the 2014 survey and (3) identify new rehabilitation research themes and topics reflecting 2020 priorities. METHODS Stage 1: delegates (n=72) at the October 2019 Defence Medical Services Rehabilitation Conference participated in a series of focus group workshops. Stage 2: an online survey circulated through the military chain of command to all Defence Primary Health Care clinical rehabilitation staff. Stage 3: a thematic analysis of all survey submissions yielding a ranked order of priority by topic. RESULTS 165 clinical rehabilitation staff completed an online survey. 'Rehabilitation outcomes', 'Psychological factors in rehabilitation' and 'Residential/Inpatient treatment paradigm' emerged as three clear research priorities across all three tiers of UK Defence Rehabilitation. New research priorities emerging from the 2020 survey were 'lifestyle factors during rehabilitation', 'management of pain during rehabilitation' and 'anterior knee pain'. CONCLUSION It is essential that funding directed to musculoskeletal rehabilitation focuses on the highest research priorities in the field to ensure optimum health return on investment. The results of this survey will assist in guiding the clinical research being conducted within UK Defence Rehabilitation over the next five years.
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Affiliation(s)
- Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Department for Health, University of Bath, Bath, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,Department for Health, University of Bath, Bath, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK .,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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