Cameron Gosling

Referencing and quotation accuracy in four manual therapy journals

The aim of the study was to investigate the reference and quotation accuracy in four peer-reviewed manual therapy journals. A stratified random sample of original research (n=7) was collected from each of the journals spanning the years January 2000 to December 2001. A further random selection of 80 references from each journal paper sampled was then reviewed (Total N=320) for citation and quotation accuracy. Numbers of citations with errors were determined, then classified as either major or minor and categorized by bibliographic headings (author, title, journal, year, volume, page and irretrievable). Each quotation was individually assessed for accuracy and judged to be either correct or incorrect. A quotation was deemed correct if it accurately substantiated and reported the original authors assertions. One hundred and fifteen citations across all journals contained errors (35.9%). Some citations exhibited multiple major and minor errors. Bibliographically classified errors for all journals showed 61 author, 51 title, 6 journal, 4 year, 12 volume and 25 page errors. JMPT showed the lowest referencing error rate (20%) while JBWMT recorded the highest (58.8%). The total number of quotation errors across all journals was 69 (12.3%). JMPT showed the lowest quotation error rate of 6 (4.7%), MT had 12 errors (7.3%), JOM produced 21 errors (13.3%), while JBWMT recorded the highest error rate with 32 (27.6%). Poor citation and quotation is a reflection on the scholarly work of the authors and the journal. The trend for errors in quotation is more worrying than citation errors as it reflects poor diligence on the part of the investigators.

Inter-examiner and intra-examiner agreement for assessing simulated leg length inequality using palpation and observation during a standing assessment

Abstract Osteopaths commonly assess leg length. Inequalities in leg length are associated with an increased incidence of low back pain, adaptive muscle shortening, ligamentous and capsular hypomobility and degenerative joint disease. Accurate detection of leg length inequality could allow early preventative intervention. Several clinical methods of assessing leg length are documented, yet few show convincing reliability. The aim of this study was to determine the inter-examiner and intra-examiner reliability of the standing assessment of leg length inequality using heel inserts to simulate leg length discrepancy. Twenty-seven subjects (mean age=23) were examined by eight examiners. Assessment of leg length was performed by palpation of iliac crests, posterior superior iliac spines, greater trochanters and gluteal folds with the subjects standing. Examiners indicated whether leg length was equal or if there was a longer leg on the left or right. Subjects were assessed with no heel insert and heel inserts of 0.5cm and 1 cm in their shoes. Each insert intervention was examined twice on each subject by each examiner. Zero, 0.5cm and 1cm interventions demonstrated inter-examiner percentage agreement of 52.5% ( K =0.27), 53.9% ( K =0.28) and 63.4% ( K =0.19) respectively. Zero, 0.5cm and 1cm interventions demonstrated intra-examiner percentage agreement of 58.4% ( K =0.35), 60.7% ( K =0.34) and 63.5% ( K =0.14) respectively. The results of this study indicate that examiners are unable to reliably detect simulated leg length discrepancies of 1cm or less by standing assessment.

Validity of outcome measures used to assess one and six month outcomes in orthopaedic trauma patients

INTRODUCTION To evaluate the validity of the 12-item Short Form Health Survey (SF-12), Sickness Impact Profile (SIP) and the Short Musculoskeletal Functional Assessment Questionnaire (SMFA) for use in an orthopaedic trauma population. MATERIALS AND METHODS A prospective validation trial was completed at a Level 1 adult trauma centre in Melbourne, Australia. One hundred and fifty four patients with orthopaedic trauma managed or followed-up by an orthopaedic unit were prospectively recruited. Patients with pathological fractures related to metastatic disease and/or an isolated orthopaedic injury, a documented history of mental illness or dementia or those for whom follow-up was likely to be difficult were excluded. The SF-12, SIP and SMFA were administered by a trained interviewer at one and six months. Each questionnaire was scored for the physical and mental components and then compared for content and construct validity at each time point. RESULTS Complete data were collected for 134 patients at one and six months. The one and six month component scores correlated strongly between the SF-12 physical, SIP physical (r=0.513-0.669) and SMFA dysfunction (r=0.529-0.778); the SF-12 mental, SIP mental (r=0.643-0.719) and SMFA bother (r=0.564-0.602) components. The strength of association was greater for the six month time point compared to the one month measure. The SF-12 demonstrated no ceiling or floor effects, and provided a lower time burden on participants and researchers when compared to the SIP and SMFA. CONCLUSIONS For large population-based surveillance research into orthopaedic injury the SF-12 provides a valid and versatile tool.

Assessing fitness-to-practice of overseas-trained health practitioners by Australian registration & accreditation bodies.

BackgroundAssessment of fitness-to-practice of health professionals trained overseas and who wish to practice in Australia is undertaken by a range of organisations. These organisations conduct assessments using a range of methods. However there is very little published about how these organisations conduct their assessments. The purpose of the current paper is to investigate the methods of assessment used by these organisations and the issues associated with conducting these assessments.MethodsA series of semi-structured interviews was undertaken with a variety of organisations who undertake assessments of overseas-trained health professionals who wish to practice in Australia. Content analysis of the interviews was used to identify themes and patterns.ResultsFour themes were generated from the content analysis of the interviews: (1) assessing; (2) process; (3) examiners; and (4) cost-efficiency. The themes were interconnected and each theme also had a number of sub-themes.ConclusionsThe organisations who participated in the present study used a range of assessment methods to assess overseas trained health professionals. These organisations also highlighted a number of issues, particularly related to examiners and process issues, pre- and post-assessment. Organisations demonstrated an appreciation for ongoing review of their assessment processes and incorporating evidence from the literature to inform their processes and assessment development.

The Perception of Injury Risk and Safety in Triathlon Competition: An Exploratory Focus Group Study

Objective:To explore stakeholder perceptions of triathlon competition safety and injury risk. Design:Qualitative focus group study. Setting:Triathlon stakeholders from Melbourne, Australia. Participants:Competition organizers, coaches, and competitors of various skill levels, age, gender, and experience (n = 18). Interventions:Focus groups were conducted, recorded, and transcribed for analysis. Main Outcome Measures:Key themes were identified using content analysis. Results:The perceived risk of serious injury was highest for cycling. Running was most commonly linked to minor injuries. Physical and environmental factors, including course turning points, funneling of competitors into narrow sections, and the weather, were perceived as contributing to injury. Experience, skill level, feelings of vulnerability, personal awareness, club culture, and gender issues were perceived as the competitor-related factors potentially contributing to injury. The cycling mount/dismount area, cycling, and swim legs were the race sections perceived as the riskiest for competitors. Competition organizers were considered to generally have the competitors’ best interest as a priority. Triathlons were acknowledged as risky activities and individual competitors accepted this risk. Conclusions:This study has highlighted the main risks and concerns perceived by triathlon competitors, coaches, and competition organizers, which will help identify potential, context-relevant intervention strategies to reduce injury risk.

Musculoskeletal injury profiles in professional Women’s Tennis Association players

Objective The physical demands of professional tennis combined with high training/match loads can contribute to musculoskeletal injury. The objectives of this study were to (1) describe the type, location and severity of injuries sustained during a 12-month tennis season in a cohort of professional female tennis players on the Women’s Tennis Association (WTA) tour and (2) prospectively investigate associations between training/match loads and injury. Methods 52 WTA players competing at the Australian Open (2015) consented to participate. Injuries reported to WTA medical staff were classified using tennis-specific guidelines. Individual match exposure data were collected for all matches played at international level in 2015 and expressed per 1000 hours of WTA competition matchplay (MP) and 1000 match exposures (MEs). Variables associated with the number of injuries in the season and loss of time from competition were identified with regression analysis. Results The injury incidence rate (IR) was 56.6 (95% CI: 49.5 to 64.6) per 1000 hours of MP or 62.7 (95% CI: 54.8 to 71.6) per 1000 MEs, although the IR of injuries resulting in loss of time from competition was lower (12.8 per 1000 hours of MP, 92 injuries/100 players). Lower limb (51%) and muscle/tendon (50%) injuries were the most common site and type of injury. Common specific injury site subcategories were the thigh, shoulder/clavicle, ankle and knee in order of frequency. Various measures of match load were significantly associated with injury. Conclusion This study prospectively analysed injury profiles, including severity across an entire season of professional tennis, and investigated the relationship between training/match loads and injury. These data may help medical professionals develop injury risk identification and prevention programmes.

Prevalence of non‐union and delayed union in proximal humeral fractures

Little is known about the prevalence of proximal humeral non‐union. There is disagreement on what constitutes union, delayed union and non‐union. Our aim was to determine the prevalence of these complications in proximal humeral fractures (PHFs) admitted to trauma hospitals.

Patient outcomes following traumatic fracture of the femoral shaft. Does surgical approach influence outcomes

Background and Aim Lower limb fractures are often associated with poorer patient outcomes. The aim was to describe the 12-month outcomes of bony union, complication rates, health related quality of life (HRQL) and pain following femoral shaft fractures in a trauma registry based cohort. Methods Data for all patients with an ICD-10 injury code for femur, below the level of neck, admitted between May 2005 and June 2009 were obtained from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) database. Data were collected at baseline (patient, injury, x-ray and hospital record details) and 12-months (bony union, complications, pain and HRQL—short form-12 (SF-12) summary scores for physical and mental component summary (PCS-12, MCS-12). Results 417 femoral shaft fractures (AO-32) were identified in 403 patients (70% male; average (SD) age=37.6(20.6) years). Transport crashes were the most common cause of injury (66%). Simple femoral fractures (51%) were the most common type. Most patients underwent fixation using an antegrade femoral nailing approach (62%). Fracture union was confirmed in 231 patients (average time: 196.5 days), although 45% and 12% demonstrated non-union at 6 and 12-months respectively. 23% of the reviewed cases underwent further femoral surgical intervention including implant exchange, dynamisation and/or bone grafting. There was no association between fixation approach and pain or bone union. The antegrade group had better 12-month physical function scores (PCS-12) (p<0.001). Significance The high rate of delayed union, and the requirement for further surgical intervention in this registry based cohort warrants further investigation in the real world environment.

TRAUMATIC SUBTROCHANTERIC FRACTURES. CLASSIFICATION, INTERVENTION, COMPLICATIONS AND PATIENT OUTCOMES

Background and Aim Femoral fracture outcomes studies have focused on fractures of the femoral neck, shaft and distal femur. The aim of this study was to describe subtrochanteric fractures collected consecutively in a trauma registry, and to report the treatment methods and patient outcomes at 12-months. Methods Data for all patients with an ICD-10 injury code for femur below the level of neck of femur admitted between May 2005 and June 2009 were obtained from the Victorian Orthopaedic Trauma Outcomes Registry database. Data were collected at baseline (patient, injury, x-ray and hospital details) and at 12-months (bony union, complications, health related quality of life—short form-12 summary scores for physical and mental component summary (PCS-12, MCS-12)). Results Subtrochanteric femoral fractures were identified in 124 patients from 884 fracture codes (54% female; average (SD) age=58.6(25.9) years). Low falls were the most common cause of injury (44%), with most (65%) of the cases recording isolated femoral fractures. Most patients underwent fixation using an intramedullary sliding hip screw (55%). Fracture union was confirmed in 69 patients (average union time: 223.7 days). Non-union was identified in 45% and 16% of the cases followed-up at 6 and 12-months respectively. Complications were identified in 38% of the reviewed cases. Physical function scores (PCS-12: 38.4(10.6)) were lower than population scores, while mental function scores were similar (MCS-12: 49.3(12.4)). Significance The long time to union outcomes and high complication rates in this registry based consecutive cohort study is not consistent with the reported literature.