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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] [What about the content of this article? (0)] [Affiliation(s)] [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, Suffield C, Greeves JP, Comfort P, Hughes J, Cassidy RP, Bennett AN, Coppack RJ. How 'STRONG' is the British Army? BMJ Mil Health 2023:e002508. [PMID: 37487657 DOI: 10.1136/military-2023-002508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Allan R, Cassidy RP, Coppack RJ, Papadopoulou T, Bennett AN. Biomechanical and clinical outcomes in response to inpatient multidisciplinary hip and groin rehabilitation in UK military personnel. BMJ Mil Health 2021; 168:266-272. [PMID: 33619232 DOI: 10.1136/bmjmilitary-2020-001588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hip and groin related pain is a common complaint among the military population across UK Defence Rehabilitation and addressing associated biomechanical dysfunction is a key treatment goal. Personnel are exposed to complex occupational loads, therefore assessing movement during demanding tasks may expose biomechanical deficits. Observing biomechanical and clinical outcomes in response to treatment is therefore an important consideration. The aims were to examine clinical and biomechanical outcomes prior to (T1) and 12 weeks post (T2) inpatient rehabilitation and explore the influence of pathological subgroup. METHODS Prospective cohort study as part of a clinical service evaluation of 25 patients undergoing treatment for hip and groin related pain. Three-dimensional motion capture (3DM) during a single-leg squat, hip strength and patient-reported outcome measures were collected at T1 and T2. RESULTS Increased abductor and external rotator strength with reductions in contralateral pelvic drop (1.9°; p=0.041) at T2 on the injured side. Pain reduced by 9.6 mm (p=0.017) but no differences were found for Non-Arthritic Hip Score (NAHS). No statistically significant differences were found between pathological subgroups. Kinematic profiles display variation between diagnostic subgroups and response to treatment. CONCLUSION Strength and pain improved with treatment in this service evaluation although biomechanical adaptation and NAHS remain inconclusive. Small and uneven sample size prevents a firm conclusion regarding the effect of pathological subgroupings, however, the data can be considered hypothesis generating for future, larger studies to integrate 3DM for monitoring response to rehabilitation in pathological subgroups to support clinical decision making.
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Affiliation(s)
- Richard Allan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK
| | - T Papadopoulou
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,British Association of Sport and Exercise Medicine, Doncaster, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Ladlow P, Conway D, Hayhurst D, Suffield C, Cassidy RP, Coppack RJ. Integration of strength training into UK Defence Rehabilitation practice: current trends and future challenges. BMJ Mil Health 2020; 168:314-319. [PMID: 33087537 PMCID: PMC9340023 DOI: 10.1136/bmjmilitary-2020-001590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 11/19/2022]
Abstract
The use of strength and conditioning (S&C) in musculoskeletal rehabilitation has gained wide acceptance among the rehabilitation community. However, there is an absence of evidence demonstrating how to best integrate the principles of S&C into rehabilitation practice. This article discusses four broad themes: (1) an overview of the UK Defence Rehabilitation care pathway, (2) the historical and current approaches to physical training to support operational readiness of the British Armed Forces, (3) the current and future challenges of integrating S&C into Defence Rehabilitation practice and (4) research priorities relating to the use of S&C in Defence Rehabilitation. We detail the importance of strength/power-based physical attributes within our military population. We recommend that consideration be given to the benefits of an alternative education/coaching-based model to be used during the current 3-week residential care pathway, which aims to ensure effective implementation of therapeutic S&C over a longer period of care.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
- Department for Health, University of Bath, Bath, UK
| | - D Conway
- Complex Trauma Department, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - D Hayhurst
- Primary Care Rehabilitation Facility (PCRF) Credenhill, Credinhill, UK
| | - C Suffield
- Physical and Recreational Training Centre, Army Training Centre Pirbright, Pirbright, 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
| | - 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
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Coppack RJ, Bilzon JL, Wills AK, Papadopoulou T, Cassidy RP, Nicol AM, Bennett AN. The test-retest reliability of the Military Physical Loading Questionnaire (MPLQ). BMJ Mil Health 2020; 168:273-278. [PMID: 32234729 DOI: 10.1136/bmjmilitary-2020-001404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/25/2020] [Accepted: 03/01/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite the high prevalence of musculoskeletal injuries, there is a shortage of data quantifying the risk factors attributable to cumulative occupational demands among UK Military personnel. We developed a new comprehensive questionnaire that examines occupational and operational physical loading during military service. The aim of this study was to examine the test-retest reliability of the Military Physical Loading Questionnaire (MPLQ). METHODS Intraclass correlation coefficients (ICC) were used to evaluate the test-retest reliability (4-week interval) of the MPLQ on 18 occupational and 18 operational items in 50 male (mean age: 36 years; SD ±7.9) UK military personnel. A stratified analysis based on duration of Service (0-10 years, 11-20 years and ≥21 years) was conducted to assess whether stability of task items was dependent on participant length of recall. Internal consistency was assessed by Cronbach's alpha (α) coefficients. RESULTS Reliability of individual operational items ranged from fair to almost perfect agreement (ICC range: 0.37-0.89; α range: 0.53-0.94) with most items demonstrating moderate to substantial reliability. Overall scores related to occupational items showed substantial to almost perfect agreement between administrations (ICC range: 0.73-0.94; α range: 0.84-0.96). Stratifying by duration of Service showed similar within group reliability to the entire sample and no pattern of decreasing or increasing reliability with length of recall period was observed. CONCLUSIONS It is essential that data used in planning UK military policy and health services are as accurate as possible. This study provides preliminary support for the MPLQ as a reliable self-report instrument for assessing the cumulative lifelong effects of occupational loading in UK military personnel. Further validation studies using larger and more demographically diverse military populations will support its interpretation in future epidemiological research.
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Affiliation(s)
- Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK .,Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Bath, Bath, UK
| | - J L Bilzon
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Bath, Bath, UK.,Department for Health, University of Bath, Bath, UK
| | - A K Wills
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - T Papadopoulou
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK.,Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - A M Nicol
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Puffenberger EG, Jinks RN, Sougnez C, Cibulskis K, Willert RA, Achilly NP, Cassidy RP, Fiorentini CJ, Heiken KF, Lawrence JJ, Mahoney MH, Miller CJ, Nair DT, Politi KA, Worcester KN, Setton RA, Dipiazza R, Sherman EA, Eastman JT, Francklyn C, Robey-Bond S, Rider NL, Gabriel S, Morton DH, Strauss KA. Genetic mapping and exome sequencing identify variants associated with five novel diseases. PLoS One 2012; 7:e28936. [PMID: 22279524 PMCID: PMC3260153 DOI: 10.1371/journal.pone.0028936] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 11/17/2011] [Indexed: 01/12/2023] Open
Abstract
The Clinic for Special Children (CSC) has integrated biochemical and molecular methods into a rural pediatric practice serving Old Order Amish and Mennonite (Plain) children. Among the Plain people, we have used single nucleotide polymorphism (SNP) microarrays to genetically map recessive disorders to large autozygous haplotype blocks (mean = 4.4 Mb) that contain many genes (mean = 79). For some, uninformative mapping or large gene lists preclude disease-gene identification by Sanger sequencing. Seven such conditions were selected for exome sequencing at the Broad Institute; all had been previously mapped at the CSC using low density SNP microarrays coupled with autozygosity and linkage analyses. Using between 1 and 5 patient samples per disorder, we identified sequence variants in the known disease-causing genes SLC6A3 and FLVCR1, and present evidence to strongly support the pathogenicity of variants identified in TUBGCP6, BRAT1, SNIP1, CRADD, and HARS. Our results reveal the power of coupling new genotyping technologies to population-specific genetic knowledge and robust clinical data.
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Affiliation(s)
- Erik G Puffenberger
- Clinic for Special Children, Strasburg, Pennsylvania, United States of America.
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