Assessing injury risk in male and female Royal Navy recruits: does the Functional Movement Screen provide understanding to inform effective injury mitigation?

INTRODUCTION

Musculoskeletal injuries (MSKIs) are common during military and other occupational physical training programmes, and employers have a duty of care to mitigate this injury risk. MSKIs account for a high number of working days lost during initial military training, contribute to training attrition and impact training costs. Poorer movement quality may be associated with increased MSKI risk.

METHODS

The present study evaluated the relationship between the Functional Movement Screen (FMS) Score, as a measure of movement quality, and injury risk in Royal Navy (RN) recruits. A cohort of 957 recruits was assessed using the FMS prior to the 10-week phase I training programme. Injury occurrence, time, type and severity were recorded prospectively during the training period.

RESULTS

Total FMS Score was associated with injury risk (p≤0.001), where recruits scoring ≥13 were 2.6 times more likely to sustain an injury during training. However, FMS Score accounted for only 10% of the variance in injury risk (R2=0.1). Sex was the only additional variable to significantly affect the regression model. Mean FMS Scores for men (14.6±2.3) and women (14.4±2.4) were similar, but injury occurrence in women was 1.7 times greater than in men. Examining the influence of individual FMS movement tests on injury prediction did not improve the model, where those movements that significantly contributed to injury prediction only accounted for a small amount of the variance (R2=0.01).

CONCLUSION

There was a weak relationship between FMS and injury risk in RN recruits. Evidence is provided that FMS score alone would not be appropriate to use as an injury prediction tool in military recruits.

Clinical Utility of Ultrasound Imaging for Measuring Anterior Thigh Thickness after Anterior Cruciate Ligament Injury in an Individual Patient to Assess Postsurgery Outcome

The present study investigated the clinical utility of ultrasound imaging (USI) for assessing changes in an individual's quadriceps muscle and subcutaneous fat (SF) thickness of the anterior thigh and their relative proportions. A patient was studied prior to and after anterior cruciate ligament reconstruction (ACLR) surgery and during rehabilitation. This case study involved an 18-year-old female recreational athlete with a complete tear of the anterior cruciate ligament (ACL). Tissue thickness (SF and quadriceps muscle) was measured from transverse USI of the anterior thigh before surgery, at weekly intervals during 12 weeks of postsurgery, and then every 2 weeks for the following 12 weeks (total of 21 measurement sets). Statistically significant differences presurgery to postrehabilitation were found for muscle thickness (p = 0.04) and SF tissue thickness (p = 0.04) measurements. There was no difference in muscle to fat ratio (p = 0.08). Changes in measurements greater than the reported minimal detectable change (MDC) demonstrate the sensitivity of the USI technique as an objective tool to assess clinically useful changes in an individual's anterior thigh muscle thickness post-ACLR surgery and during rehabilitation.

Movement retraining programme in young soccer and rugby football players: A feasibility and proof of concept study

INTRODUCTION

Movement screening to identify abnormal movement patterns can inform development of effective interventions. The primary objective of this study was to evaluate the feasibility of using a movement screening tool in combination with a tailored movement control retraining programme in young soccer and rugby football players. A secondary objective was to investigate changes in movement control patterns post-intervention, to provide proof of concept (PoC) for movement retraining.

METHODS

52 male amateur players, including 34 soccer players (mean age 15 ± 2 years) and 18 rugby players (mean age 15 ± 1 years) participated. They were screened for movement control ability using a shortened version of the Hip and Lower Limb Movement Screening (Short-HLLMS) and completed an eight-week movement control retraining programme. Evaluation of feasibility included consent from players invited, adherence, attendance at the exercise sessions, drop-out and adverse events. Short-HLLMS total score and The Copenhagen Hip and Groin Outcome Score (HAGOS) were analysed to provide PoC for retraining movement control.

RESULTS

feasibility outcomes were favourable. Significant statistical changes occurred post-intervention in the Short-HLLMS total score (paired-samples t-test) and in three HAGOS subscales (symptoms, physical function in daily living and in sport and recreation) (Wilcoxon-Signed Rank Test) in both groups.

CONCLUSIONS

Feasibility of using the Short-HLLMS in combination with a movement control retraining programme in soccer and rugby players was promising. The data provided PoC for the potential application of a shortened version of the HLLMS to evaluate changes in movement control and to inform targeted motor control programmes.

Musculoskeletal injury in military specialists: a 2-year retrospective study

BACKGROUND

Military specialists are elite personnel who are trained to work across diverse operational environments where a high level of physical conditioning is a prerequisite for their role. Anecdotally, personnel are acknowledged to be at high risk of developing musculoskeletal injuries (MSKIs). However, there are presently no published data on this UK military population to support this view. This is the first (2-year) retrospective epidemiological study to identify the MSKI sustained by this military population.

METHODS

All MSKI reported over a 2-year period (January 2018-December 2019) were recorded to identify the incidence, frequency, nature, onset, cause, location and reporting times. Injuries were described using injury count and relative frequency (percentage). Time at risk for each personnel day was calculated as 365 days.

RESULTS

A total of 199 personnel reported 229 injuries over the reporting periods. The injury incidence rates were 26.8 personnel per 100 person years (2018) and 27.7 personnel per 100 person years (2019), respectively. Military training accounted for the highest number of injuries (32%), followed by 'other injuries' (28%), personal training (28%) and sport (12%). The leading activity associated with injury was weight training (15%), followed by running (11%) and military exercise (10%). Lower extremity injuries accounted for the highest number of injuries (40%), followed by trunk (36%) and upper extremity (24%) injuries.

CONCLUSION

This study identifies the MSKI profile of a military specialist population over a 2-year period. Areas where modifiable risk factors may be identified to reduce risk of injury are highlighted. Recommendations for further research include investigating injury burden and the impact of injury on operational readiness.

P04-04 Non-invasive biomarkers with high discriminant ability indicative of musculoskeletal health with ageing

Background

The use of large-scale pooled analyses and data sharing is a potential source to generate evidence to address complex scientific challenges and develop strategies to promote healthy ageing. However, the success of such analyses depends on robust measurements of musculoskeletal (MSK) health in ageing. Simple tests indicative of MSK health and suitable for use with older people are required. This study aims to assess the discriminatory ability of a combination of routine physical function tests and novel measures, notably muscle mechanical properties and ultrasound imaging of thigh composition (relative contribution of muscle and subcutaneous adipose tissue) to classify healthy individuals according to their age and gender.

Methods

This cross-sectional study included 138 community-dwelling, self-reported healthy males and females (65 young, mean age±SD = 25.7±4.8 years; 73 older, 74.9±5.9 years). Handgrip strength; quadriceps strength; respiratory peak flow; timed up and go; stair climbing; anterior thigh tissue thickness (using ultrasound imaging), muscle mechanical properties (stiffness, tone and elasticity; Myoton technology); and self-reported health related quality of life (SF36) were assessed. Stepwise linear discriminant analysis was used to classify cases based on criterion variable derived from the known effects of age on physical function.

Results

Combining conventional physical function tests with novel measures, revealed two discriminant functions which significantly (Wilks's λ = 0.05, 0.34; p>0.001) classified 89% of grouped cases with 11% error rate using leave-one-out cross-validation. Seven variables associated with grip strength, peak flow, timed up and go, anterior thigh thickness, and muscle mechanical properties demonstrated high discriminant ability (p>0.05 correlation with discriminant functions) to classify healthy people.

Conclusions

The present study provides reference data for comparison with clinical populations and a comprehensive battery of non-invasive dry biomarkers with high discriminant ability indicative of musculoskeletal health. The most sensitive novel biomarkers require no volition, highlighting potentially useful tests for screening and monitoring effects of interventions on MSK health for vulnerable older people with pain or cognitive impairment. Older misclassified cases who appeared younger than predicted support the need for studies of older people with different habitual activity levels, to provide relevant reference values for assessment, so rehabilitation goals are targeted appropriately.

P04-05 Testing muscle strength and dynamic balance in older recreational golfers and healthy sedentary non-golfers in community settings

Background

Regular physical activity is known to reduce premature mortality, and help prevent and manage chronic diseases. Despite this, older people are not sufficiently active. Playing golf is associated with better aerobic fitness and mental wellbeing but evidence of a relationship with strength and balance is lacking. If the physical demands of golf are sufficient to meet the World Health Organisation recommendations for strength and balance, golf may qualify for exercise on prescription/social prescribing for people with long-term conditions. The hypothesis of this ongoing study is that playing recreational golf will be associated with better strength and balance in older people. Data are presented for grip strength and dynamic balance in golfers and sedentary older adults, tested using simple techniques suitable in community settings.

Methods

Seventy nine healthy older participants (aged 65-79 years) have been studied: 62 golfers (n = 31 females, 31 males) and 17 sedentary non golfers (9 males, 8 females). Difficulties in recruiting sedentary participants and then the outbreak of Covid-19 explain the discrepancy between group sizes. Golfers played 18 holes at least once a week for minimum of two years. Grip strength was tested for the right hand using the MIE hand-grip dynamometer, with results normalized to body weight. Dynamic balance was assessed using the Y-balance test, with reaching distance normalized to lower-limb length. Non-parametric statistics were used due to unequal group sizes.

Results

Grip strength was significantly greater in golfers than non-golfers (median and interquartile range); males and females combined; golfers 4.3±1.2; non-golfers 3.3±1.9 (p=0.039*; Mann-Whitney). The Y-balance performance was also significantly better in golfers than non-golfers (p=0.002*: Mann-Whitney). Normalised composite reach distance data (3 directions) for the right side were greater in golfers (81.7±13.3) than non-golfers (74.2±17.2).

Conclusions

These preliminary data indicate that playing recreational golf at least once a week is associated with greater grip strength and better dynamic balance in older golfers compared to sedentary non-golfers. These findings support further data collection (when permitted) to produce reference data. This will allow parametric statistical analysis to determine whether conclusive evidence will support the hypothesis, forming the basis of a randomised controlled trial.

Protocol and reference values for minimal detectable change of MyotonPRO and ultrasound imaging measurements of muscle and subcutaneous tissue

The assessment of muscle health is of paramount importance, as the loss of muscle mass and strength can affect performance. Two non-invasive tools that have been found to be useful in this are the MyotonPRO and rehabilitative ultrasound imaging, both have shown to be reliable in previous studies many of which conducted by the research team. This study aims to determine the reliability of previously unassessed local body structures and to determine their minimal detectable changes (MDC) to support both researchers and clinicians. Twenty healthy participants were recruited to determine the reliability of seven skin positions out of a previously established protocol. Reliability was determined between three independent raters, and day to day reliability was assessed with one rater a week apart. Intraclass Correlation Coefficients (ICC) between raters and between days for tissue stiffness, tone and elasticity range from moderate to excellent (ICC 0.52–0.97), with most good or excellent. ICCs for subcutaneous thickness between days was good or excellent (ICC 0.86–0.91) and moderate to excellent between raters (ICC 0.72–0.96), in muscles it was moderate to excellent between raters and days (ICC 0.71–0.95). The protocol in this study is repeatable with overall good reliability, it also provides established MDC values for several measurement points.

A-07 Initial Symptoms, Pre-Existing Emotional Factors, and Symptoms of Stress During Recovery from Concussion

Purpose: Investigate the association of initial symptoms, mechanism of concussion, and emotional state with symptoms of stress reported during recovery from concussion in high school students. Methods: Concussed High School students (n = 183) aged 13–18 were evaluated within 30 days of injury at a North Texas Concussion Registry (ConTex) clinic with 71% (n = 130) sport-related. Subjects completed a medical history, the Sport Concussion Assessment Tool-5 Symptom Evaluation (PCSS), General Anxiety Disorder (GAD-7), and Patient Health Questionnaire-8 (PHQ-8) at initial visit. At three-month follow-up subjects completed the PTSD Checklist for DSM-5 (PCL-5). A linear regression was conducted predicting total scores on the follow up PCL-5. Predictors included initial Total PCSS Symptom Score, GAD-7, PHQ-8, sex, mechanism of injury (sport vs non-sport) and history of treatment for anxiety/depression. Results: A multiple regression model predicting participant’s total PCL-5 score at three month follow-up (R2 = 0.40, p < 0.001) included PHQ-8 (β = 0.34, p < 0.001), GAD-7 (β = 0.20, p = 0.016), history of treatment for depression (β = 0.17, p = 0.015), severity of initial symptoms (β = 0.15, p = 0.045) and mechanism of injury (β = −0.14, p = 0.018). There was no significant difference in PCL-5 scores between sport vs non-sport injury groups. Conclusions: Pre-existing depression and higher levels of self-reported anxiety and/or depression at time of injury may be associated with increased symptoms of stress during concussion recovery. Severity of initial symptoms and mechanism of injury may also be related to feelings of stress during recovery. Further investigations should include baseline measure of stress prior to injury.

P-326 Current real-world patterns of care for women diagnosed with uterine fibroids (UF) and heavy menstrual bleeding (HMB) in a predominantly African American (AA) population database

Study question

What are the clinical characteristics and patterns of care in African American women diagnosed with UF and HMB compared to White women?

Summary answer

The majority of the women were African American. Though similar in age, there were significant differences between the groups in multiple comorbidities and therapies.

What is known already

UF (leiomyomas) are common, benign uterine tumors affecting approximately 80% of African American and 70% of White women by age 50. In the United States, marked differences exist in disease presentation, severity, treatment, outcomes, and quality of life for African American women compared with White women. African American women typically develop uterine leiomyomas at a younger age, progress to clinically significant disease at an earlier age, have larger uteri at diagnosis and are more likely to be anemic. Limited data exist on the current clinical real-world characteristics and patterns of care for African American women with UF and HMB.

Study design, size, duration

This retrospective observational study identified women 18-55 years, with UF and HMB from IBM-Watson’s MarketScan® Multi-state Medicaid claims database between 2010-2019. The focus was on women with diagnoses of UF (index) and HMB, appearing on the same or different claims, continuously enrolled for > 12 months pre- and post-index (censored on claim for hysterectomy). A total of ≥ 24 months of observation was available for most patients.

Participants/materials, setting, methods

A total of 27,122 women met the inclusion criteria, 16,776 African Americans, 7,353 Whites, and 2,993 others or race unknown. The statistical analyses were carried out on the African American and White patients only. Descriptive analyses of baseline demographics, pre-index comorbidities and post-index treatment were performed. Chi-square tests analyses were applied to counts and t-tests analyses were applied to means. All tests used an alpha value of 0.05 for significance.

Main results and the role of chance

The majority of the analytical cohort of 24,129 women was African American (AA:69.5%; W:30.5 %). The mean (SD) follow-up time was 40.5 (24.7) months. The mean age was similar for both groups (AA:39.6 ± 7.11 years; W: 40.2 ± 7.23 years, p < 0.1). There were 48 pre-indexed comorbidities identified for analyses. The groups significantly differed on 14(29%) comorbidities. For 11 of the comorbidities, African American women were less likely to be diagnosed than White women (all Ps < 0.0001). Many of these diseases were related to bulk symptoms (e.g., pelvic pressure/pain), anxiety and depression. More African American women had diagnoses for diabetes (p = 0.0143), hypertension, and obesity (Ps < 0.0001). Though bulk symptoms were common in both groups, again fewer African American women were diagnosed than White (AA: 68.4%; W:77.0%, p < 0.0001).

Post-index, African American women were more likely treated with hormone-based therapy (42.4% vs. 38.5%, p < 0.0001). Contraceptives were the most frequent form of hormonal treatment prescribed (AA:39.9%; W:35.6%). African American were on contraceptives slightly longer than White women (AA: 377.3 (522.2 days); W: 323.1 (460.2 days) (p < 0.001). Fewer African American women had a hysterectomy (AA:32.0%; W:46.8%, p < 0.001).

Limitations, reasons for caution

This study was observational and descriptive in nature, which limits the ability to make conclusions regarding causality or identify women beyond the age and time constraints within the study. Additionally, claims data may be subject to reporting errors. This data is specific to Medicaid populations and may not be generalizable.

Wider implications of the findings

In this Medicaid population differences in clinical characteristics and UF treatment were evident between African American and White women. The breakdown of some comorbidities did not match national prevalence by race for these conditions (e.g., depression). Further analyses are needed to determine if these differences are clinically and socially meaningful.

Trial registration number

NA

Feasibility and reliability of measuring muscle stiffness in Parkinson's Disease using MyotonPRO device in a clinical setting in Ghana

OBJECTIVES

To examine the feasibility and within-session reliability of Myoton technology to measure muscle stiffness objectively in people with Parkinson's disease in an outpatient setting.

DESIGN

An exploratory quantitative study design was used.

SETTING

The study was conducted in the outpatient physiotherapy department of a Teaching Hospital in Ghana. Participants were recruited from three sites.

PARTICIPANTS

Thirty adults with Parkinson's disease over 18 years with increased tone (muscle stiffness) and at Hoehn and Yahr Stages I-III were studied. Persons with severe comorbidities were excluded.

INTERVENTION

There was no intervention before testing. The MyotonPRO device measured the mechanical properties of the biceps brachii, flexor carpi radialis and tibialis anterior muscles in a relaxed supine position. The probe applied mechanical impulses to the skin, eliciting tissue oscillations. The muscles' three parameters (stiffness, non-neural tone and elasticity) were recorded bilaterally. The reliability of two sets (of 5 impulses) of Myoton data on all three muscles was examined.

RESULTS

All 30 participants (66.3±8.9 years) were recruited and tested within eight weeks. Intraclass correlation coefficients (ICC 3,2) were above 0.92 for biceps brachii and tibialis anterior and above 0.86 for flexor carpi radialis.

CONCLUSION

The MyotonPRO was reliable for measuring two sets of data within the same session, indicating that only one set of measurements is needed. The technique is feasible and easy to use in a clinical setting in Ghana, with the potential to assess the effect of medical and physiotherapy interventions on muscles in people with Parkinson's disease.

FUNDING

M.S discloses a grant from the Science and Technology Facilities Council Impact Acceleration Account at the University of Southampton to support this collaborative research (no personal finance received). All other authors, M.W.A, P.E.M, C.O.Y, B.E.A.S, S.A.-B, and A.A have no financial disclosure.

Task selection for a sensor-based, wearable, upper limb training device for stroke survivors: a multi-stage approach

PURPOSE

Post-stroke survivors report that feedback helps to increase training motivation. A wearable system (M-MARK), comprising movement and muscle sensors and providing feedback when performing everyday tasks was developed. The objective reported here was to create an evidence-based set of upper-limb tasks for use with the system.

MATERIALS AND METHODS

Data from two focus groups with rehabilitation professionals, ten interviews with stroke survivors and a review of assessment tests were synthesized. In a two-stage process, suggested tasks were screened to exclude non-tasks and complex activities. Remaining tasks were screened for suitability and entered into a categorization matrix.

RESULTS

Of 83 suggestions, eight non-tasks, and 42 complex activities were rejected. Of the remaining 33 tasks, 15 were rejected: five required fine motor control; eight were too complex to standardize; one because the role of hemiplegic hand was not defined and one involved water. The review of clinical assessment tests found no additional tasks. Eleven were ultimately selected for testing with M-Mark.

CONCLUSIONS

Using a task categorization matrix, a set of training tasks was systematically identified. There was strong agreement between data from the professionals, survivors and literature. The matrix populated by tasks has potential for wider use in upper-limb stroke rehabilitation. IMPLICATIONS FOR REHABILITATIONRehabilitation technologies that provide feedback on quantity and quality of movements can support independent home-based upper limb rehabilitation.Rehabilitation technology systems require a library of upper limb tasks at different levels for people with stroke and therapists to choose from.A user-defined and evidence-based set of upper limb tasks for use within a wearable sensor device system have been developed.

Patient, clinician and manager experience of the accelerated implementation of virtual consultations following COVID-19: A qualitative study of preferences in a tertiary orthopaedic rehabilitation setting

AIM

To investigate the experiences of patients, clinicians and managers during the accelerated implementation of virtual consultations (VCs) due to COVID-19. To understand how patient preferences are constructed and organized.

METHODS

Semi-structured interviews with patients, clinicians and managerial staff at a single specialist orthopaedic centre in the United Kingdom. The interview schedule and coding frame were based on Normalisation Process Theory. Interviews were conducted over the telephone or by video call. Abductive analysis of interview transcripts extended knowledge from previous research to identify, characterize and explain how patient preferences for VC were formed and arranged.

RESULTS

Fifty-five participants were included (20 patients, 20 clinicians, 15 managers). Key mechanisms that contribute to the formation of patient preferences were identified. These were: (a) context for the consultation (normative expectations, relational expectations, congruence and potential); (b) the available alternatives and the implementation process (coherence, cognitive participation, collective action and reflexive monitoring). Patient preferences are mediated by the clinician and organisational preferences through the influence of the consultation context, available alternatives and the implementation process.

CONCLUSIONS

This study reports the cumulative analysis of five empirical studies investigating patient preferences for VC before and during the COVID-19 pandemic as VC transitioned from an experimental clinic to a compulsory form of service delivery. This study has identified mechanisms that explain how preferences for VC come about and how these relate to organisational and clinician preferences. Since clinical pathways are shaped by interactions between patient, clinicians and organisational preferences, future service design must strike a balance between patient preferences and the preferences of clinicians and organisations.

PATIENT AND PUBLIC CONTRIBUTION

The CONNECT Project Patient and Public Involvement (PPI) group provided guidance on the conduct and design of the research. This took place with remote meetings between the lead researcher and the chair of the PPI group during March and April 2020. Patient information documentation and the interview schedule were developed with the PPI group to ensure that these were accessible.

Digital tools to support the maintenance of physical activity in people with long-term conditions: A scoping review

Objective

This scoping review aimed to bring together and identify digital tools that support people with one or more long-term conditions to maintain physical activity and describe their components and theoretical underpinnings.

Methods

Searches were conducted in Cumulative Index to Nursing and Allied Health Literature, Medline, EMBASE, IEEE Xplore, PsycINFO, Scopus, Google Scholar and clinical trial databases, for studies published between 2009 and 2019, across a range of long-term conditions. Screening and data extraction was undertaken by two independent reviewers and the Preferred Reporting Items for Scoping Reviews guidelines informed the review's conduct and reporting.

Results

A total of 38 results were identified from 34 studies, with the majority randomised controlled trials or protocols, with cardiovascular disease, type 2 diabetes mellitus and obesity the most common long-term conditions. Comorbidities were reported in >50% of studies but did not clearly inform intervention development. Most digital tools were web-browser-based ± wearables/trackers, telerehabilitation tools or gaming devices/components. Mobile device applications and combination short message service/activity trackers/wearables were also identified. Most interventions were supported by a facilitator, often for goal setting/feedback and/or monitoring. Physical activity maintenance outcomes were mostly reported at 9 months or 3 months post-intervention, while theoretical underpinnings were commonly social cognitive theory, the transtheoretical model and the theory of planned behaviour.

Conclusions

This review mapped the literature on a wide range of digital tools and long-term conditions. It identified the increasing use of digital tools, in combination with human support, to help people with long-term conditions, to maintain physical activity, commonly for under a year post-intervention. Clear gaps were the lack of digital tools for multimorbid long-term conditions, longer-term follow-ups, understanding participant's experiences and informs future questions around effectiveness.

A qualitative investigation into the results of a discrete choice experiment and the impact of COVID-19 on patient preferences for virtual consultations

OBJECTIVES

To conduct a qualitative investigation on a subset of participants from a previously completed Discrete Choice Experiment (DCE) to understand why factors identified from the DCE are important, how they influenced preference for virtual consultations (VC) and how COVID-19 has influenced preference for VC.

METHODS

A quota sample was recruited from participants who participated in our DCE. We specifically targeted participants who were strongly in favour of face-to-face consultations (F2F - defined as choosing all or mostly F2F in the DCE) or strongly in favour of virtual consultations (VC - defined as choosing all or mostly VC consultations in the DCE) to elicit a range of views. Interviews were conducted via telephone or videoconference, audio recorded, transcribed verbatim and uploaded into NVIVO software. A directed content analysis of transcripts was undertaken in accordance with a coding framework based on the results of the DCE and the impact of COVID-19 on preference.

RESULTS

Eight F2F and 5 VC participants were included. Shorter appointments were less 'worth' travelling in for than a longer appointment and rush hour travel had an effect on whether travelling was acceptable, particularly when patients experienced pain as a result of extended journeys. Socioeconomic factors such as cost of travel, paid time off work, access to equipment and support in its use was important. Physical examinations were preferable in the clinic whereas talking therapies were acceptable over VC. Several participants commented on how VC interferes with the patient-clinician relationship. VC during COVID-19 has provided patients with the opportunity to access their care virtually without the need for travel. For some, this was extremely positive.

CONCLUSIONS

This study investigated the results of a previously completed DCE and the impact of COVID-19 on patient preferences for VC. Theoretically informative insights were gained to explain the results of the DCE. The use of VC during the COVID-19 pandemic provided opportunities to access care without the need for face-to-face social interactions. Many felt that VC would become more commonplace after the pandemic, whereas others were keen to return to F2F consultations as much as possible. This qualitative study provides additional context to the results of a previously completed DCE.

Patient preferences for use of virtual consultations in an orthopaedic rehabilitation setting: Results from a discrete choice experiment

Objective

Virtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting.

Methods

Previous research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models.

Results

Sixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks’ time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients’ access to resources, context for the consultation and the requirements of the consultation.

Conclusions

This conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.

Validity of load rate estimation using accelerometers during physical activity on an anti-gravity treadmill

Introduction

A simple tool to estimate loading on the lower limb joints outside a laboratory may be useful for people who suffer from degenerative joint disease. Here, the accelerometers on board of wearables (smartwatch, smartphone) were used to estimate the load rate on the lower limbs and were compared to data from a treadmill force plate. The aim was to assess the validity of wearables to estimate load rate transmitted through the joints.

Methods

Twelve healthy participants (female n = 4, male n = 8; aged 26 ± 3 years; height: 175 ± 15 cm; body mass: 71 ± 9 kg) carried wearables, while performing locomotive activities on an anti-gravity treadmill with an integrated force plate. Acceleration data from the wearables and force plate data were used to estimate the load rate. The treadmill enabled 7680 data points to be obtained, allowing a good estimate of uncertainty to be examined. A linear regression model and cross-validation with 1000 bootstrap resamples were used to assess the validation.

Results

Significant correlation was found between load rate from the force plate and wearables (smartphone: R 2 = 0.71 ; smartwatch: R 2 = 0.67 ).

Conclusion

Wearables' accelerometers can estimate load rate, and the good correlation with force plate data supports their use as a surrogate when assessing lower limb joint loading in field environments.

Non-Invasive Biomarkers of Musculoskeletal Health with High Discriminant Ability for Age and Gender

A novel approach to ageing studies assessed the discriminatory ability of a combination of routine physical function tests and novel measures, notably muscle mechanical properties and thigh composition (ultrasound imaging) to classify healthy individuals according to age and gender. The cross-sectional study included 138 community-dwelling, self-reported healthy males and females (65 young, mean age ± SD = 25.7 ± 4.8 years; 73 older, 74.9 ± 5.9 years). Handgrip strength; quadriceps strength; respiratory peak flow; timed up and go; stair climbing time; anterior thigh tissue thickness; muscle stiffness, tone, elasticity (Myoton technology), and self-reported health related quality of life (SF36) were assessed. Stepwise feature selection using cross-validation with linear discriminant analysis was used to classify cases based on criterion variable derived from known effects of age on physical function. A model was trained and features selected using 126 cases with 0.92 accuracy (95% CI = 0.86–0.96; Kappa = 0.89). The final model included five features (peak flow, timed up and go, biceps brachii elasticity, anterior thigh muscle thickness, and percentage thigh muscle) with high sensitivity (0.82–0.96) and specificity (0.94–0.99). The most sensitive novel biomarkers require no volition, highlighting potentially useful tests for screening and monitoring effects of interventions on musculoskeletal health for vulnerable older people with pain or cognitive impairment.

Factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting: a qualitative study

OBJECTIVES

To identify, characterise and explain factors that influence patient preferences, from the perspective of patients and clinicians, for virtual consultations in an orthopaedic rehabilitation setting.

DESIGN

Qualitative study using semi-structured interviews and abductive analysis.

SETTING

A physiotherapy and occupational therapy department situated within a tertiary orthopaedic centre in the UK.

PARTICIPANTS

Patients who were receiving orthopaedic rehabilitation for a musculoskeletal problem. Occupational therapists, physiotherapists or therapy technicians involved in the delivery of orthopaedic rehabilitation for patients with a musculoskeletal problem.

RESULTS

Twenty-two patients and 22 healthcare professionals were interviewed. The average interview length was 48 minutes. Four major factors were found to influence preference: the situation of care (the ways that patients understand and explain their clinical status, their treatment requirements and the care pathway), the expectations of care (influenced by a patients desire for contact, psychological status, previous care and perceived requirements), the demands on the patient (due to each patients respective social situation and the consequences of choice) and the capacity to allocate resources to care (these include financial, infrastructural, social and healthcare resources).

CONCLUSION

This study has identified key factors that appear to influence patient preference for virtual consultations in orthopaedic rehabilitation. A conceptual model of these factors, derived from empirical data, has been developed highlighting how they combine and compete. A series of questions, based on these factors, have been developed to support identification of preferences in a clinical setting.

Exploring the use of ultrasound imaging by physiotherapists: An international survey

BACKGROUND

National surveys in New Zealand, Australia and the United Kingdom suggest ultrasound imaging (USI) use by physiotherapists is increasing. However, concerns exist regarding clarity for scopes of practice, and availability and standardisation of training.

OBJECTIVES

To investigate physiotherapists' understanding of scopes of practice for the use of USI; clarify the professional contexts, clinical uses and levels of training; and identify barriers preventing physiotherapists' USI use.

DESIGN

A cross-sectional, observational survey.

METHODS

An Internet-based survey, offered in 20 different languages, was used including items covering five domains: (1) demographic and professional characteristics; (2) knowledge of scope of practice; (3) USI use; (4) USI training content and duration; and (5) perceived barriers to physiotherapists' use of USI.

RESULTS

1307 registered physiotherapists from 49 countries responded; 30% were unsure of the scope of practice for physiotherapists' USI use. 38% of participants were users of USI, reporting varied contexts and clinical uses, reflected in the broader categories of: (i) biofeedback; (ii) diagnosis; (iii) assessment; (iv) injection guidance; (v) research; (vi) and teaching. The training users received varied, with formal training more comprehensive. 62% were non-users, the most common barrier was lack of training (76%).

CONCLUSION

These findings suggest physiotherapists' USI use is increasing in various contexts; however, there is uncertainty regarding scopes of practice. There are discrepancies in training offered, with a lack of training the most common barrier to physiotherapists' use of USI. International guidelines, including a USI training framework, are needed to support the consistent and sustainable use of USI in physiotherapy.

Prevalence of probable sarcopenia in community-dwelling older Swiss people - a cross-sectional study

BACKGROUND

The European Working Group on Sarcopenia in Older People has recently defined new criteria for identifying "(probable) sarcopenia" (EWGSOP2). However, the prevalence of probable sarcopenia, defined by these guidelines, has not been determined extensively, especially in the oldest old. This study aims to determine the prevalence of probable sarcopenia in older, community-living people and its association with strength-related determinants.

METHODS

Handgrip strength and reported determinants (age, height, weight, osteoarthritis of hands, medications, fall history, physical activity, activities of daily living (ADL) and global cognitive function) were collected in a cross-sectional study of 219 community-living Swiss people (75 years and over). Probable sarcopenia was estimated based on cut-off values for handgrip strength as recommended by EWGSOP2. Spearman correlations, binary-regression analyses and contingency tables were used to explore relationships between variables.

RESULTS

The prevalence of probable sarcopenia in women (n = 137, age 84.1 ± 5.7 years) and men (n = 82, age 82.6 ± 5.2 years) was 26.3 and 28.0%, respectively. In women, probable sarcopenia correlated positively with age and falls (r_s range 0.332-0.195, p < .05), and negatively with weight, cognition, physical activity, using stairs regularly, participating in sports activities and ADL performance (r_s range = - 0.141 - -0.409, p < .05). The only significant predictor of probable sarcopenia at the multivariate level was ADL performance (Wald(1) = 5.51, p = .019). In men, probable sarcopenia was positively correlated with age (r_s = 0.33, p < .05) and negatively with physical activity, participation in sports and ADL performance (r_s range - 0.221 - - 0.353, p < .05). ADL performance and age (Wald(1) = 4.46, p = .035 and Wald(1) = 6.30, p = .012) were the only significant predictors at the multivariate level. Men and women with probable sarcopenia were 2.8 times more likely to be dependent in ADL than those without.

CONCLUSION

Probable sarcopenia affected one in every four community-living, oldest old people and was independently associated with impaired ADL performance in both sexes. This highlights the importance of detection of handgrip strength in this age group in clinical practice. Although prospective studies are required, independence in ADL might help to protect against probable sarcopenia.

A-32 Acute Concussive Symptom Profiles in Adolescents and Young Adults with History of Depression and Anxiety

Objective

The aims of this study are (1) to examine the clinical symptom profiles of individuals with depression and/or anxiety history following a concussion and (2) to compare profile differences across groups.

Method

Participants aged 12-25 (n=129, mean=15.6) with premorbid diagnoses of depression (n=24), anxiety (n=50), or depression+anxiety (n=55) were evaluated within 21 days after sustaining a concussion as part of the North Texas Concussion Registry (ConTex) using the Post-Concussion Symptom Scale (PCSS). Following the model described by Kontos and Collins (2014), symptom clusters were derived from the PCSS to create six domains (cognitive/fatigue, vestibular, ocular, posttraumatic migraine, anxiety/mood, cervical). ANOVAs with Tukey’s post-hoc tests were conducted to compare domain symptom severity and total symptom severity across groups.

Results

There were no demographic differences between groups. A single symptom profile was prominent across each group, with the primary, secondary, and tertiary symptomatic domains being posttraumatic migraine, ocular, and cognitive/fatigue, respectively. Across each domain the depression+anxiety group was most symptomatic, followed in order by the depression and anxiety groups. The depression+anxiety group reported significantly higher anxiety/mood (M=2.0 vs. M=1.3) and cognitive/fatigue (M=2.9 vs M=2.1) symptom severity compared to the anxiety group. Group differences on total symptom severity approached significance (F=2.83, p=.06).

Conclusions

The observed symptom profiles suggest that the acute-concussive response is similar in adolescents and young adults with history of depression and/or anxiety. Multiple premorbid conditions, such as depression and anxiety, appear to magnify overall symptom severity. Further research is warranted to understand the relationship between symptom burden and premorbid mental health factors.

Radial scars and complex sclerosing lesions on core needle biopsy of the breast: upgrade rates and long-term outcomes

PURPOSE

Radial scars and complex sclerosing lesions of the breast are part of a group of "indeterminate" breast lesions, which are excised due to risk of coexistent carcinoma. The aim of this study was to assess rate of upgrade of these lesions to invasive and in situ carcinoma and to quantify the risk of development of subsequent cancer in women diagnosed with these lesions.

METHODS

A retrospective review of a prospectively maintained breast screening database was performed. All patients with radial scar identified at either core biopsy or final excision biopsy between January 2006 and July 2012 were identified. Full pathological reports for both core biopsy and final excision biopsy were reviewed. Patient outcomes were followed for a mean of 117.1 months.

RESULTS

Of 451 B3 biopsies performed at our screening unit, 95 (22%) were found to have a radial scar or complex sclerosing lesion (CSL) on core needle biopsy. Within this group, 77 had no atypia on CNB, with 7 (9%) upgraded to invasive/in situ carcinoma on final excision. Of nine with definite atypia on CNB, 3 (33%) were upgraded. In those patients without atypia or malignancy on final excision, 7.5% developed cancer during 10-year follow-up.

CONCLUSION

Patients with radial scar with atypia have a higher risk of upgrade to malignancy. Further research is needed to identify which patients may safely avoid excision of radial scar. Patients with a diagnosis of radial scar on CNB are at increased subsequent risk of breast cancer and may benefit from additional screening.

Comorbidities and their link with individual health status: A cross-sectional analysis of 23,892 people with knee and hip osteoarthritis from primary care

Objectives:

Robust data on the impact of comorbidities on health in people with osteoarthritis (OA) are lacking, despite its potential importance for patient management. Objectives were to determine coexisting conditions in people with OA in primary care and whether more comorbidities were linked with individual health status.

Methods:

A retrospective analysis of 23,892 patients with knee and hip OA was conducted to determine comorbidities present (number/clusters) and how these linked with pain intensity (0–100), widespread pain (site numbers), medication usage (paracetamol, nonsteroidal anti-inflammatory drugs, opioids), quality of life EuroQol five dimension scale (EQ-5D), and physical function (walking speed) using independent t-tests or χ² test.

Results:

Sixty-two percent of people with OA treated in primary care had at least one comorbidity; hypertension (37%), heart disease (8%), and diabetes (7%) being most common. Outcome measures worsened with more comorbidities (0–4+ comorbidities); pain intensity [mean (SD)] 46(22)–57(21); number of painful sites 3.7(3.0)–6.3(5.4); quality of life 0.73(0.10)–0.63(0.15); walking speed 1.57 m/s (0.33)–1.24 m/s (0.31), while the proportion of people using pain medication increased from 0 to 2 comorbidities (58–69%; p < 0.001), with an increase in opioid use from 4.6% to 19.5% with more comorbidities (0–4+ comorbidities).

Conclusion:

Most people with knee or hip OA in primary care have at least one other long-term condition. A greater number of comorbidities is linked with worsening health, highlighting the importance of screening for comorbidities when treating patients with OA. It is important for clinicians to consider how OA treatments will interact and affect other common comorbidities.

New advances in mechanomyography sensor technology and signal processing: Validity and intrarater reliability of recordings from muscle

Introduction

The Mechanical Muscle Activity with Real-time Kinematics project aims to develop a device incorporating wearable sensors for arm rehabilitation following stroke. These will record kinematic activity using inertial measurement units and mechanical muscle activity. The gold standard for measuring muscle activity is electromyography; however, mechanomyography offers an appropriate alterative for our home-based rehabilitation device. We have patent filed a new laboratory-tested device that combines an inertial measurement unit with mechanomyography. We report on the validity and reliability of the mechanomyography against electromyography sensors.

Methods

In 18 healthy adults (27–82 years), mechanomyography and electromyography recordings were taken from the forearm flexor and extensor muscles during voluntary contractions. Isometric contractions were performed at different percentages of maximal force to examine the validity of mechanomyography. Root-mean-square of mechanomyography and electromyography was measured during 1 s epocs of isometric flexion and extension. Dynamic contractions were recorded during a tracking task on two days, one week apart, to examine reliability of muscle onset timing.

Results

Reliability of mechanomyography onset was high (intraclass correlation coefficient = 0.78) and was comparable with electromyography (intraclass correlation coefficient = 0.79). The correlation between force and mechanomyography was high (R² = 0.94).

Conclusion

The mechanomyography device records valid and reliable signals of mechanical muscle activity on different days.

P129 Adolescent knee pain and risk of knee osteoarthritis 50 years later

Background

Adolescent knee pain is a common complaint which may be due to patellar dislocation, meniscal tear, Osgood-Schlatter’s disease or patellofemoral maltracking. We studied the association of such pain with knee osteoarthritis (OA) 50 years later using a retrospective cohort design.

Methods

This study was based in the Hertfordshire Cohort Study, a cohort of men and women born in 1931 - 9. Participants completed a questionnaire detailing recall of adolescent knee pain, self-reported OA, demographics, lifestyle and The Western Ontario and McMaster Universities Arthritis Index (WOMAC). Clinical OA was defined based on the American College of Rheumatology (ACR) criteria and assessed at a clinical visit where knee radiographs were also taken and graded according to the methods of Kellgren and Lawrence.

Results

Completed data were available for 135 men and 139 women. The mean age was 78.8 (SD 2.6) years and the mean (SD) BMI was 26.3 (4.0). Two percent of men (n = 3) and 5% of women (n = 7) reported adolescent knee pain, of which 2 men and 3 women sought medical advice for their knee pain. 1 man and 2 women reported that their pain had been constant since teenage years while 2 men and 4 women reported that it was intermittent in nature. A report of adolescent knee pain was associated with an increased risk of clinical (odds ratio (OR) 5.45, p-value 0.015, 95% confidence interval (CI) 1.39 - 21.36); radiological (OR 2.33, p-value 0.228, 95% CI 0.60 - 9.24) and self-report (OR 2.71, p-value 0.134, 95% CI 0.74 - 10.0) of knee OA in later life. After adjustments for age, sex and BMI, adolescent knee pain was associated with an increased risk of clinical (OR 4.80, p-value 0.047, 95% CI 1.02 - 22.53); radiological (OR 1.85, p-value 0.404, 95% CI 0.44 - 7.78); self-report (OR 3.23, p-value 0.10, 95% CI 0.80 - 12.94) although relationships were only significant for clinical knee OA.

Conclusion

Recalled adolescent knee pain was associated with a clinical diagnosis of knee OA in later life. The lack of association with self-report of OA suggests that this is not simply a consequence of recall bias and exploration in other data sets is now indicated.

Disclosures

M.A. Clynes: None. F. Laskou: None. M.H. Edwards: None. C. Cooper: None. A. Taylor: None. M. Stokes: None. E.M. Dennison: None.

Protocol for the CONNECT project: a mixed methods study investigating patient preferences for communication technology use in orthopaedic rehabilitation consultations

INTRODUCTION

Technology has been placed at the centre of global health policy and has been cited as having the potential to increase efficiency and remove geographical boundaries for patients to access care. Communication technology may support patients with orthopaedic problems, which is one of the leading causes of disability worldwide. There are several examples of technology being used in clinical research, although uptake in practice remains low. An understanding of patient preferences will support the design of a communication technology supported treatment pathway for patients undergoing orthopaedic rehabilitation.

METHODS AND ANALYSIS

This mixed methods project will be conducted in four phases. In phase I, a systematic review of qualitative studies reporting communication technology use for orthopaedic rehabilitation will be conducted to devise a taxonomy of tasks patients' face when using these technologies to access their care. In phase II, qualitative interviews will investigate how the work of being a patient changes during face-to-face and communication technology consultations and how these changes influence preference. In phase III, a discrete choice experiment will investigate the factors that influence preferences for the use of communication technology for orthopaedic rehabilitation consultations. Phase IV will be a practical application of these results. We will design a 'minimally disruptive' communication technology supported pathway for patients undergoing orthopaedic rehabilitation.

ETHICS AND DISSEMINATION

The design of a pathway and underpinning patient preference will assist in understanding factors that might influence technology implementation for clinical care. This study requires ethical approval for phases II, III and IV. Approvals have been received for phase II (approval received on 4 December 2016 from the South Central-Oxford C Research Ethics Committee (IRAS ID: 255172, REC Reference 18/SC/0663)) and phase III (approval received on 18 October 2019 from the London-Hampstead Research Ethics Committee (IRAS ID: 248064, REC Reference 19/LO/1586)) and will be sought for phase IV. All participants will provide informed written consent prior to being enrolled onto the study.

PROSPERO REGISTRATION NUMBER

CRD42018100896.

P593Oxygen sensitive cardiac magnetic resonance in demonstrating myocardial ischaemia of the right ventricle in patients with pulmonary artery hypertension

Background

Progressive right ventricular (RV) dysfunction is a natural progression of pulmonary arterial hypertension (PAH) which is associated with adverse clinical outcomes. The main contributor to progressive RV dysfunction is RV ischemia. Oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) has been used to determine the in-vivo myocardial oxygenation of the left ventricle (LV).

Purpose

The aim of the present study was to (1) Determine the feasibility of RV targeted rest/stress OS-CMR imaging in PAH patients and normal volunteers; (2) To define the presence and extent of RV myocardial ischaemia in patients with known PAH.

Methods

We prospectively recruited 20 patients with right heart catheter proven PAH and 9 normal (NC), age matched controls with no heart disease. The CMR examination involved standard functional imaging and OS-CMR imaging. OS-CMR images were acquired using a T2* sequence at rest and adenosine-induced stress vasodilatation. The RV was divided into 3 segments - RV anterior, RV free-wall and RV inferior. An OS-CMR signal intensity (SI) index (stress/rest signal intensity) was acquired at RV anterior, RV free-wall and RV inferior segments.

Results

All the PAH patients tolerated and completed the adenosine induced stress OS-CMR without any complications or adverse effects. In NC, reliable OS signal intensity changes was only obtained from the RV inferior segment. As RV dysfunction in PAH is a global process, hence this segment was used in both patients and NC for further comparison. RV OS-CMR signal intensity change between rest and stress in the normal volunteers was 17±4% (mean ± SD). 9 out of twenty (45%) of the PAH patients had a mean BOLD signal intensity change of less than 9% (or 2SD different from the mean values in normal volunteers). Overall, RV OS SI index between the PAH patients and controls was 11±9% vs 17±5% (p-value = 0.045) in RV inferior segment.

Conclusion

Pharmacological induced OS-CMR is a feasible and safe technique to identify and study myocardial oxygenation in the RV of PAH patients.

PRACTICAL CONSIDERATIONS FOR STANDARDIZED RECORDING OF MUSCLE MECHANICAL PROPERTIES USING A MYOMETRIC DEVICE: RECORDING SITE, MUSCLE LENGTH, STATE OF CONTRACTION AND PRIOR ACTIVITY

Purpose: This study aimed to systematically examine the influence of various muscle and experimental conditions on Myoton recordings. Methods: A cross-sectional, observational design was used to examine muscle conditions and experimental factors (different recording sites, muscle length, level of contraction and prior physical activity) that may influence reproducibility of Myoton recordings for biceps brachii (BB) and rectus femoris (RF). Fifty-three healthy adults (26 young, 27 older) aged 18–90 years were studied. Muscle stiffness, tone and elasticity were measured using the MyotonPRO device. Results: Statistically significant differences in Myoton parameters were found for aspects of all four muscle and experimental conditions compared with the control condition ([Formula: see text]). However, clinically relevant differences in tone, stiffness and elasticity were only found for contracted compared to resting muscle, with changes being greater than the minimal detectable change. Elasticity was not affected by prior activity. Conclusions: The conditions studied significantly altered Myoton parameters of BB and RF in healthy adults, but only changes in parameters during muscle contraction were clinically relevant. These findings provide evidence to support the need to consider muscle condition and experimental factors for improving the robustness of test protocols for assessing muscle mechanical properties using the MyotonPRO device.

Exercise programs for the management of people with hand osteoarthritis: a scoping review protocol

REVIEW QUESTIONS

The review questions for this scoping review are.

Handgrip strength in old and oldest old Swiss adults - a cross-sectional study

Background

Handgrip strength is indicative of overall physical health and mobility in the elderly. A reduction in strength below a certain threshold severely increases the risk of mobility limitations and is predictive for adverse outcomes such as dependence in daily activities and mortality. An overview of age- and geography- specific handgrip strength values in older adults provide a reference for further investigations and measures in clinical practice to identify people at risk for clinically meaningful weakness. The aim of this study was to evaluate handgrip strength in the Swiss-German population aged 75 and over.

Methods

In a cross-sectional study, maximal isometric handgrip strength of the dominant hand was evaluated in 244 Swiss people aged 75 years and over (62.7% women), with mean age (SD) of 84.5 (5.6) years in men and 83.1 (5.9) years in women. Demographic data and information about comorbidities, medication, fall history, global cognitive function, self-reported physical activity and dependence in activities of daily living were collected, and correlated with grip strength measures. Age- and gender specific grip strength values are reported as means, standard deviations and standard error of mean.

Results

Sex-stratified handgrip strength was significantly lower with advancing age in men (p < .01), from 37.7 (6.5) kg to 25.6 (7.6) kg and in women (p < .01) from 22.2 (4.0) kg to 16.5 (4.7) kg. Handgrip strength in our sample was significantly higher than in Southern European countries. Handgrip strength was independently associated with age, height and ADL dependence in men and women. Overall, 44% of men and 53% of women had handgrip strength measures that were below the clinically relevant threshold for mobility limitations.

Conclusion

This study reports the age- and sex-stratified reference values for handgrip strength in a representative sample of the Swiss population, aged 75–99 years. Although grip strength decreased with advancing age in both sexes; the relative decline was greater in men than women. Nonetheless men had significantly higher grip strength in all age groups. While the Swiss population sampled had greater grip strength than that reported in other European countries, about 50% were still classified as at risk of mobility limitations.

Accuracy of movement quality screening to document effects of neuromuscular control retraining exercises in a young ex-footballer with hip and groin symptoms: A proof of concept case study

Hip and groin pain is common in footballers and altering movement patterns can reduce symptoms. Observational tests of movement control are thought to identify abnormal movement patterns, but their accuracy needs yet to be confirmed by comparison with an objective measure. To assess the accuracy, using 3D motion analysis, of observational movement control tests and their ability to detect changes, and document changes in symptoms following a neuromuscular control exercise programme in an ex-footballer with hip and groin pain. A 25-year-old male with chronic bilateral hip and groin pain had their movement control ability rated and kinematic data collected using 3D motion analysis while performing Small Knee Bend (SKB) and SKB with Rotation (SKB Rot) tests pre-and post-neuromuscular control exercise training. Movement control was rated as at fault if they were unable to control specific trunk and pelvic movements during the tests. The Copenhagen Hip and Groin Outcome Score (HAGOS) was used to assess symptoms. Following the intervention, observational rating during the SKB test improved from fault to no fault for anterior pelvic tilt, which decreased by 17° and 16° during right and left leg SKB tests respectively. The HAGOS symptoms subsection improved from 36% to 61%. Observational movement screening ratings were supported by 3-D motion analysis. These findings indicate that the screening tool was accurate for detecting improvements in trunk and pelvic movement control following an exercise programme in an ex-footballer who had presented with hip and groin pain.

Muscle strength, functional endurance, and health-related quality of life in active older female golfers

Background

Grip strength is a reliable predictor of whole body strength in older adults, but muscle characteristics of people with different activity levels have not been studied previously. The present study examined the relationship between grip strength (GS), quadriceps peak torque (QPT), functional endurance, and health-related quality of life (HRQoL) in older female golfers.

Methods

Twenty-nine healthy female golfers (mean age 69.1 years, SD 3.4) participated. The ISOCOM and JAMAR dynamometers were used to assess QPT and GS, respectively. Functional endurance tests included 1-min sit-to-stand test (1MSTS), 30-s wall press (30SWP), and 2-min stair climb (2MSC). HRQol was assessed using the SF-36 questionnaire.

Results

Mean GS and QPT were 27.5 ± 4 kg/f and 103.7 ± 25.1 N m, respectively. Mean scores for the 1MSTS, 30SWP, and 2MSC were 31 ± 7.7, 17.4 ± 3.5, and 237.5 ± 48.6 repetitions, respectively. GS was moderately correlated with QPT (r = 0.44), 1MSTS (r = 0.36), and 2MSC (r = 0.36), but had weak correlation with 30SWP (r = 0.003). Moderate correlation was observed between quadriceps peak torque and the 1MSTS (r = 0.50; p = 0.01), 2MSC (r = 0.44; p = 0.02) and 30SWP (r = 0.33). 30SWP and 2MSC had moderate correlations with PF r = 0.41 (p = 0.03) and r = 0.61 (p < 0.0005) and general physical well-being r = 0.47 (p = 0.01) and r = 0.39 (p = 0.04), respectively.

Conclusion

Quadriceps strength was more closely associated with functional endurance than grip strength. A single strength measure may not reflect overall muscle characteristics in active older females, and hence, assessment of both upper and lower limb strengths may be appropriate.

Thigh muscle and subcutaneous tissue thickness measured using ultrasound imaging in older females living in extended care: a preliminary study

BACKGROUND

Thigh tissue thickness has not been examined in older females living in extended care in UK as an indicator of musculoskeletal health. This study examined the feasibility of using ultrasound imaging to measure the thickness of superficial (fat) and deep layers (muscle) of the thigh in older females living in extended care.

METHODS

In ten older females in extended care (aged 80-98 years, mean 88 ± 6.8; body mass: 56.5 ± 12.6 kg) images of the anterior thigh (dominant) were taken in supine using B-mode ultrasound imaging. Superficial and deep layers were measured and percentage thickness was calculated. Independent t tests compared data from those in extended care to ten sedentary females living independently (aged 80-90 years, mean 84 ± 3.6; body mass: 61.6 ± 10.0 kg).

RESULTS

Thickness of the superficial layers was not significantly different between the two groups (CI -0.017 to 0.815, p = 0.059). However, those living in extended care had greater (p < 0.001) muscle thickness (mean 2.75 ± 0.48 cm) than those living independently (mean 1.83 ± 0.3 cm), which was similarly significant when normalised for body mass (extended care 0.51 ± 0.16; independent living 0.30 ± 0.06).

CONCLUSIONS

These novel findings showed it is feasible to use ultrasound to measure muscles in older females in extended care and that muscle thickness was larger than in those living independently. The reason for the difference seen between groups would need to be confirmed by a larger study that also examined factors related to risk of sarcopenia and frailty, such as nutrition and physical activity levels.

Effects of posture and anatomical location on inter-recti distance measured using ultrasound imaging in parous women

STUDY DESIGN

Cross-sectional repeated measures.

OBJECTIVES

To quantify the effects of posture and measurement site on the inter-recti distance (IRD) and investigate the reliability of IRD measurement using ultrasound imaging in different postures.

BACKGROUND

The linea alba connects the rectus abdominis muscles anteriorly and the width is known as the IRD. The IRD is usually measured in crook-lying and is the primary outcome measure to assess for a divarication of recti abdominis (DRA). The effects of posture and measurement site on the IRD have not been investigated.

METHODS

Ultrasound imaging was used to measure IRD in 41 women ≥8 weeks postpartum. The IRD was measured at three sites (superior-umbilicus, umbilicus and inferior-umbilicus), in three postures (crook-lying, sitting and standing), and repeated one-week later. The effects of posture and site were investigated using one-way ANOVAs. Reliability was analysed using Intraclass correlation coefficients (ICCs), Bland Altman analyses, standard error of measurement and minimal detectable change.

RESULTS

The IRD was wider when standing vs. lying at both the superior-umbilicus and umbilicus by 0.30 cm (95% CI 0.21 to 0.39) and 0.20 cm (0.11-0.30) respectively (p < 0.001). Measurements at the inferior-umbilicus were, on average, 1.6 and 2.1 cm narrower than superior-umbilicus and umbilicus sites, respectively (p < 0.001). There was high intra-rater reliability within-session (ICC_3.3) and between-session (ICC_3.1) at all sites measured.

CONCLUSION

The IRD can be measured reliably at all sites and postures. The IRD is wider at superior-umbilicus and umbilicus when upright compared with lying. There is a difference in IRD between all sites measured.

Exploring the clinical use of ultrasound imaging: A survey of physiotherapists in New Zealand

BACKGROUND

In New Zealand ultrasound imaging (USI) is being used increasingly by physiotherapists. To fully understand the extent to which physiotherapists in New Zealand are using USI, it is necessary to evaluate not only the context of its clinical use but also the barriers preventing its uptake.

OBJECTIVES

To examine the field and scope of use of USI, the type and content of training and the barriers restricting physiotherapists from using the technique.

DESIGN

Cross-sectional observational design utilising an Internet-based electronic survey.

METHOD

An electronic survey built on the design of previous research with guidance from an expert review panel. Participants were included if they were New Zealand registered physiotherapists.

RESULTS

Of the 465 participants who responded, 433 were eligible to complete the survey. There were 415 participants who completed the survey, 24% who said they used USI whilst 76% did not. For those using USI, the uses were varied including those within a rehabilitative paradigm (i.e. biofeedback; 52%) and also diagnostic (49%). USI training was also varied ranging from formal to informal. The main barriers preventing physiotherapists from using USI were lack of training, access to equipment, and equipment expense.

CONCLUSIONS

The participants reported a variety of clinical uses of USI and levels of training. A better understanding of the clinical uses and benefits of USI would enhance both training and clinical uptake. With the identification of barriers limiting physiotherapists' use of USI, ways to overcome these in New Zealand can now be explored further.