Karen Grimmer

Gender-age environmental associates of adolescent low back pain

This paper describes adolescent low back pain and tests its associations with environmental features of backpack load, time spent carrying loads, time sitting, and time playing sport, using data from 1269 adolescents in twelve volunteer high schools in Adelaide, South Australia. Backpacks were the preferred method of load carrying, two-thirds of wearers preferring to carry the load over two shoulders. The average load weighed 5.3 kg (approximating 10% of body weight). The youngest students carried approximately the same amount as the oldest students. Girls were more likely than boys to report recent low back pain, and there were gender- and age-specific associations between recent low back pain, the amount of time spent sitting, the backpack load and time spent carrying it, and time playing sport. Body mass was not a confounder of any association. These findings support ongoing concerns regarding environmental contributions to adolescent low back pain.

Virtual reality as a pediatric pain modulation technique: a case study.

Post-surgical pain has been consistently reported in pediatrics as being difficult to manage and limiting to surgical outcomes. Pain management of children is not ideal, and some children unable to tolerate traditional pharmacological agents. Virtual reality (VR) is a new and promising form of non-pharmacologic analgesia. This case study explored the use of VR analgesia with a 16-year-old patient with cerebral palsy participating in a twice-daily physiotherapy program following Single Event Multi-Level Surgery. Over 6 days, the patient spent half of his physiotherapy sessions using VR and the other half without (order randomized). Traditional pharmacological pain management was administered throughout the trial. Using a subjective pain scale (five faces denoting levels of pain), the patients overall pain ratings whilst in the VR (experimental) condition were 41.2% less than those in the no-VR (control) condition. This case report provides the first evidence that VR may serve as a powerful non-pharmacologic analgesic for children following surgery.

Measuring the endurance capacity of the cervical short flexor muscle group

The role of the cervical short flexor muscles in maintaining head posture has been recognised recently. While a computerised device is available for measuring isometric performance of this muscle group, no clinical method is available. This paper reports on an inexpensive and time-efficient method of measuring the endurance capacity of the cervical short flexor muscle group in a clinical setting. The measurement is adapted from an exercise described and illustrated by Trott (1988). The measurements of cervical short-flexor endurance were reproducible over a one month interval. There was a systematic improvement in mean endurance capacity for both women and men and the possible causes of this are discussed.

Prevalence of Adolescent Injury From Recreational Exercise: An Australian Perspective

PURPOSE To report the prevalence of recent adolescent recreational and sporting activities and associated injury. METHODS Data were collected during three school terms in 1997 using a validated questionnaire administered once only to 3538 girls and boys aged 11-12 years and 15-16 years. These students comprised 97.5% of the students in these age ranges in randomly selected state and private schools in the Adelaide metropolitan area (South Australia). Participants identified up to three recreational and/or sporting activities in which they had participated in the previous week. Data were collected on the nature and extent of participation, and on associated injuries. Participation and injury reports were summarized descriptively in gender strata in the two adolescent age groups and stratum specific odds ratios were used to explore injury risk. RESULTS Subjects reported participating in 8997 sporting and/or recreational activities in the preceding week (an average of 2.5 participations per student). Over 140 sports and recreational pursuits were represented, incorporating organized and nonorganized activities undertaken in teams, social groups, or alone. Approximately 25% of adolescents reported at least one recreational injury. Injuries were mostly minor, reflecting soft tissue trauma and skin abrasions. Organized group sport incurred the highest risk of injury. There were marked gender and year level differences in injury risk in a number of common activities. CONCLUSIONS These findings support the need for ongoing education regarding injury prevention and management.

A controlled double blind study comparing the effects of strong Burst Mode TENS and High Rate TENS on painful osteoarthritic knees.

This double blind, controlled study compared the changes in pain, stiffness, circumference and range of movement, produced by one 30 minute application of High Rate TENS, or strong Burst Mode TENS on chronic osteoarthritic knees. Both TENS applications were applied at strong, tolerable intensities for 30 minutes, over four acupuncture points around the knee. Pain, stiffness, circumference, and range of movement measurements were recorded immediately before and after the TENS applications. Length of continuation of pain relief and alteration in stiffness was reported by subjects. The study aimed to establish whether strong Burst Mode TENS produced significantly greater and longer lasting changes than those produced by High Rate TENS. The only significant change produced by strong Burst Mode when compared with High Rate TENS was on knee circumference.

Evaluation of three input mechanisms for wearable computers

This paper reports on an experiment investigating the functionality and usability of novel input devices on a wearable computer for text entry tasks. Over a 3-week period, 12 subjects used three different input devices to create and save short textual messages. The virtual keyboard, forearm keyboard, and Kordic keypad input devices were assessed for their efficiency and usability in simple text-entry tasks. Results collected included the textual data created by the subjects, the duration of activities, the survey data and observations made by supervisors. The results indicated that the forearm keyboard is the best performer for accurate and efficient text entry while other devices may benefit from more work on designing specialist graphical user interfaces (GUIs) for the wearable computer.

Discharge planning quality from the carer perspective

Discharge planning endeavours to assist the transition of patients from the acute hospital setting into the community. We examined the quality of discharge planning from the perspective of the carer. Spouses were the most common carers for the elderly patients in our study. Many carers were also elderly, with their own health problems. Using a new instrument (entitled PREPARED) (K. Grimmer and J. Moss, Int J Qual Health Care (in press)), carers rated the quality of planning for discharge much lower than did the patient, indicating that their needs were often not met when discharge was being planned. In free text responses, carers expressed their dissatisfaction over communication about how the family would cope once the patient went home. Carers generally had lower summary mental quality of life scores than the Australian norms (as measured by the SF-36 health survey (J. Ware and R. Sherbourne, Med Care 1992; 30: 473–483)), suggesting that the caring role may have impacted upon their emotional wellbeing. The rate of use of community services in the first week post-discharge was low, suggesting that carers and patients carried the majority of the burden immediately after discharge. We suggest that planning for hospital discharge requires more consideration of the carer.

Barriers to, and facilitators for, referral to pulmonary rehabilitation in COPD patients from the perspective of Australian general practitioners: a qualitative study

Background: Pulmonary rehabilitation (PR) is recommended in the management of people with chronic obstructive pulmonary disease (COPD), but referral to this service is low. Aims: To identify barriers to, and facilitators for, referral to PR programmes from the perspective of Australian general practitioners. Methods: Semi-structured interviews were conducted with general practitioners involved in the care of people with COPD. Interview questions were informed by a validated behavioural framework and asked about participants’ experience of referring people with COPD for PR, and barriers to, or facilitators of, this behaviour. Interviews were audiotaped, transcribed verbatim, and analysed using content analysis. Results: Twelve general practitioners participated in this study, 10 of whom had never referred a patient to a PR programme. Four major categories relating to barriers to referral were identified: low knowledge of PR for COPD; low knowledge of how to refer; actual or anticipated access difficulties for patients; and questioning the need to do more to promote exercise behaviour change. Awareness of benefit was the only current facilitator. Three major categories of potential facilitators were identified: making PR part of standard COPD care through financial incentive; improving information flow with regard to referrals and services; and informing patients and public. Conclusions: Significant barriers to referral exist, but opportunities to change the organisation of practice and information management were identified. Behaviour change strategies which directly target these barriers and incorporate facilitators should make up the key components of interventions to improve referral to PR by general practitioners who care for people with COPD.

Waking cervical pain and stiffness, headache, scapular or arm pain: Gender and age effects

A random population-based study using a structured telephone questionnaire was undertaken to determine the frequency, duration and prevalence of waking cervical spine pain and stiffness, headache, and aching between the scapulae or in the arm and their relationship to age and gender. Seventy-six per cent of households contacted completed the questionnaire, yielding a total of 812 questionnaires. Subjects most commonly reported waking with scapular or arm pain (27%) followed by headache (19%), cervical pain (18%) and cervical stiffness (17%). The majority of subjects reported that symptoms lasted for more than an hour on one or two occasions during the week. Subjects who reported the presence of one type of waking symptom were significantly more likely to report other waking symptoms. Females were significantly more likely to wake with a headache than males (OR 2.5, 95% CI 1.6 to 4.0), while all subjects aged over 60 years were significantly less likely to wake with a headache than subjects in other age groups (OR 0.6, 95% CI 0.4 to 1.0). Females exhibited a decline in waking cervical pain, stiffness and headache with increasing age. In contrast, males exhibited a peak prevalence of waking cervical pain, stiffness and headache in the 40 to 59 year age group. The prevalence of waking with aching between the scapulae or in the arm behaved differently from the other symptom groups in both genders.

An investigation of poor cervical resting posture

In an attempt to measure cervical resting posture, a device was developed to quantify the excursion of anatomical points on the upper and lower cervical spine. Measurements were taken from 427 randomly chosen subjects who had never sustained an injury to the neck or back. Excursion measurements were in good agreement over a month interval. Poor cervical resting posture was described by dividing the excursion angle data at each anatomical point into quintiles, and designating the first and fifth quintiles as extreme. Subjects whose upper and lower aspects of the cervical spine excursed by extremely small angles, and subjects whose upper and lower aspects of the cervical spine excursed by extremely large angles, were considered to have poor posture. These postures were markedly different. The study highlighted the need for further research into influences on habitual cervical resting posture.