Kay Cooper

The long-term functional and radiological outcome after open reconstruction of the anterior cruciate ligament

We identified a series of 128 patients who had unilateral open reconstruction of the anterior cruciate ligament (ACL) by a single surgeon between 1993 and 2000. In all, 79 patients were reviewed clinically and radiologically eight to 15 years after surgery. Assessment included measurement of the Lysholm and Tegner scores, the ACL quality-of-life score and the Short Form-12 score, as well as the International Knee Documentation Committee clinical assessment, measurement of laxity by the KT-1000 arthrometer, a single-leg hop test and standardised radiography of both knees using the uninjured knee as a control. Of the injured knees, 46 (57%) had definite radiological evidence of osteoarthritis (Kellgren-Lawrence grade 2 or 3), with a mean difference between the injured and non-injured knees of 1.2 grades. The median ACL quality-of-life score was 80 (interquartile range (IQR) 60 to 90), the Lysholm score 84 (IQR 74 to 95), the Short Form-12 physical component score 54 (IQR 49 to 56) and the mean Hop Index 0.94 (0.52 to 1.52). In total 58 patients were graded as normal, 20 as nearly normal and one as abnormal on the KT-1000 assessment and pivot-shift testing. Taking the worst-case scenario of assuming all non-attenders (n = 48), two septic failures and one identified unstable knee found at review to be failures, the failure rate was 40%. Only two of the patients reviewed stated that they would not have similar surgery again. Open reconstruction of the ACL gives good, durable functional results, but with a high rate of radiologically evident osteoarthritis.

An exploration of physical activity and wellbeing in university employees

Aims: The aim was to explore levels of physical activity (PA) and mental wellbeing in university employees, as well as barriers to and incentives for workplace PA. Methods: An electronic survey was distributed to all staff at one UK university. The survey consisted of a PA stages of change questionnaire, an international PA questionnaire (short-form), the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), questions on perceived barriers to and incentives for workplace PA, questions on methods of enhancing employee wellbeing and demographics. A self-selected sample participated in two focus groups to explore key themes arising from the survey. Descriptive statistics were reported for survey data; associations between PA and wellbeing were tested for using Kruskal–Wallis with post hoc Mann–Whitney. Descriptive, thematic analysis was performed on focus group transcripts. Results: A total of 502 surveys were completed (34% response rate); 13 staff participated in focus groups. In all, 42% of the sample reported PA below the recommended guideline amount. Females were less active than males (p < 0.005). The mean WEMWBS was 49.2 (95% confidence interval (CI): 48.3–49.9). Low PA levels were related to lower WEMWBS scores, with statistically significant differences in WEMWBS demonstrated between low and moderate PA (p = 0.05) and low and high PA (p = 0.001). Lack of time and perceived expense of facilities were common barriers to workplace PA. The main focus group finding was the impact of university culture on workplace PA and wellbeing. Conclusion: University staff demonstrate PA levels and a relationship between PA and wellbeing similar to the general population. Carefully designed strategies aimed at enhancing PA and wellbeing in university staff are required. The specific cultural and other barriers to workplace PA that exist in this setting should be considered. These results are being used to inform PA and wellbeing interventions whose effectiveness will be evaluated in future research.

kNN Sampling for Personalised Human Activity Recognition

The need to adhere to recommended physical activity guidelines for a variety of chronic disorders calls for high precision Human Activity Recognition (HAR) systems. In the SelfBACK system, HAR is used to monitor activity types and intensities to enable self-management of low back pain (LBP). HAR is typically modelled as a classification task where sensor data associated with activity labels are used to train a classifier to predict future occurrences of those activities. An important consideration in HAR is whether to use training data from a general population (subject-independent), or personalised training data from the target user (subject-dependent). Previous evaluations have shown that using personalised data results in more accurate predictions. However, from a practical perspective, collecting sufficient training data from the end user may not be feasible. This has made using subject-independent data by far the more common approach in commercial HAR systems. In this paper, we introduce a novel approach which uses nearest neighbour similarity to identify examples from a subject-independent training set that are most similar to sample data obtained from the target user and uses these examples to generate a personalised model for the user. This nearest neighbour sampling approach enables us to avoid much of the practical limitations associated with training a classifier exclusively with user data, while still achieving the benefit of personalisation. Evaluations show our approach to significantly out perform a general subject-independent model by up to 5%.

The use of pMRI to validate the identification of palpated bony landmarks

Accurate palpation of lumbar spinous processes (SPs) is a key component of spinal assessment. It is also vital for the accurate measurement of spinal motion when using external skin marker-based measurement systems, which are being increasingly used to understand low back disorders and their management. The aim was to assess the accuracy of lumbar spinous process (SP) palpation using positional magnetic resonance imagery (MRI) (pMRI). Two experienced manual therapists palpated the L4 SP of nine pain-free participants in standing and prone lying. For each position, an MRI marker was attached over the SP and pMRI scanning was conducted. The position of the marker in relation to L4 on the MRI images was visually inspected, and measurements (mm) of the vertical distance from the superior/inferior aspect of the marker to the superior/inferior aspect of the L4 SP were used to determine palpation accuracy. 71% of Markers were correctly placed over the L4 SP. The magnitude of error for incorrectly placed markers was small, with the largest median distance of 2.7 mm (interquartile range (IQR) 0-3.6) recorded for one of the therapists palpating in prone lying. 100% of markers were correctly placed either on L4 or within one SP in height. pMRI is useful for investigating the accuracy of SP palpation in positions relevant to clinical and research practice.

The effectiveness of peer support interventions for community-dwelling adults with chronic non-cancer pain: a systematic review protocol

Background Chronic non‐cancer pain is a common condition that by its nature requires ongoing self management. Peer support is a method of facilitating self‐management of chronic conditions that has been shown to be effective. Peer support may be useful in overcoming some of the common barriers to chronic pain self‐management, and if successful could reduce the health service burden of this common chronic condition. Objectives To identify the effectiveness of peer support interventions on physical and emotional function, pain, quality of life, self‐efficacy and health service utilization in community dwelling adults with chronic non‐cancer pain, compared to those receiving usual care or other self‐management interventions. Inclusion criteria Types of participants Community‐dwelling adults with chronic (12 weeks or longer) non‐cancer pain. Types of intervention Any peer support intervention, or any intervention that included a defined element of peer support, delivered to groups or individuals in any format, including face‐to‐face, telephone and internet‐based interventions. Types of studies Randomized controlled trials or, in their absence, other quantitative research designs such as non‐randomized controlled trials and before and after studies. Types of outcomes Physical and emotional function, pain, quality of life, self‐efficacy and health service utilization. Due to the lack of standardization of chronic pain outcome measures, any relevant measure of these five domains was considered. Search strategy This review aimed to find both published and unpublished studies using the following three‐step search strategy: (i) An initial limited search of MEDLINE and CINAHL was undertaken using four initial keywords. (ii) All keywords identified from the initial search were utilized in a search of several databases. (iii) The reference lists of all identified reports and articles were searched for additional studies. Data collection and synthesis Two independent reviewers assessed 4078 studies for potential applicability to the review objectives based on the information provided in the title, abstract and subject headings. Thirty‐six full‐text articles were obtained and were likewise appraised for applicability to the review objectives. Twelve studies underwent critical appraisal by the two independent reviewers for methodological validity using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI‐MAStARI). Five studies were included in the review. Data were extracted from the five studies using the standardized data extraction tool from JBI‐MAStARI. There was a high degree of heterogeneity in terms of populations, interventions, outcome measures and comparators, rendering meta‐analysis inappropriate; results were therefore presented in narrative form. Results There is some evidence that peer support may have a beneficial effect on emotional function, pain, quality of life and self‐efficacy in specific subgroups of chronic pain patients; no evidence was found on the effect of peer support on health service utilization. Conclusions There is some evidence that peer support interventions may be more effective than usual care for some groups of patients with chronic non‐cancer pain. However, it is not possible to make specific recommendations for practice until further high‐quality research is conducted.

Weight-loss interventions for overweight/obese adults with chronic musculoskeletal pain: a mixed methods systematic review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this mixed methods review is to develop an aggregated synthesis of qualitative and quantitative data on weight-loss interventions for overweight/obese adults with chronic musculoskeletal pain in an attempt to derive conclusions and recommendations useful for clinical practice and policy decision making.The objective of the quantitative component of this review is to quantify the effectiveness of weight-loss interventions on weight, pain and physical and/or psychosocial function in overweight/obese adults with chronic musculoskeletal pain.The objectives of the qualitative component of this review are to explore the perceptions and experiences of overweight/obese adults with chronic musculoskeletal pain of the link between their weight and pain, and the effectiveness and appropriateness of weight-loss interventions and sustainability of weight-loss efforts.

SELFBACK—Activity Recognition for Self-management of Low Back Pain

Low back pain (LBP) is the most significant contributor to years lived with disability in Europe and results in significant financial cost to European economies. Guidelines for the management of LBP have self-management at their cornerstone, where patients are advised against bed rest, and to remain active. In this paper, we introduce SELFBACK, a decision support system used by the patients themselves to improve and reinforce self-management of LBP. SELFBACK uses activity recognition from wearable sensors in order to automatically determine the type and level of activity of a user. This is used by the system to automatically determine how well users adhere to prescribed physical activity guidelines. Important parameters of an activity recognition system include windowing, feature extraction and classification. The choices of these parameters for the SELFBACK system are supported by empirical comparative analyses which are presented in this paper. In addition, two approaches are presented for detecting step counts for ambulation activities (e.g. walking and running) which help to determine activity intensity. Evaluation shows the SELFBACK system is able to distinguish between five common daily activities with 0.9 macro-averaged F1 and detect step counts with 6.4 and 5.6 root mean squared error for walking and running respectively.

Exploring peer-mentoring for community dwelling older adults with chronic low back pain: a qualitative study

Objectives To explore the perceptions of patients, physiotherapists, and potential peer mentors on the topic of peer-mentoring for self-management of chronic low back pain following discharge from physiotherapy. Design Exploratory, qualitative study. Participants Twelve patients, 11 potential peer mentors and 13 physiotherapists recruited from physiotherapy departments and community locations in one health board area of the UK. Interventions Semi-structured interviews and focus groups. Main outcome measures Participants’ perceptions of the usefulness and appropriateness of peer-mentoring following discharge from physiotherapy. Data were processed and analysed using the framework method. Results Four key themes were identified: (i) self-management strategies, (ii) barriers to self-management and peer-mentoring, (iii) vision of peer-mentoring, and (iv) the voice of experience. Peer-mentoring may be beneficial for some older adults with chronic low back pain. Barriers to peer-mentoring were identified, and many solutions for overcoming them. No single format was identified as superior; participants emphasised the need for any intervention to be flexible and individualised. Important aspects to consider in developing a peer-mentoring intervention are recruitment and training of peer mentors and monitoring the mentor–mentee relationship. Conclusions This study has generated important knowledge that is being used to design and test a peer-mentoring intervention on a group of older people with chronic low back pain and volunteer peer mentors. If successful, peer-mentoring could provide a cost effective method of facilitating longer-term self-management of a significant health condition in older people.

The physiological effect of a 'climb assist' device on vertical ladder climbing.

Abstract ‘Climb assist’ claims to reduce strain when climbing ladders; however, no research has yet substantiated this. The purpose of this study was to assess the physiological and psychophysical effects of climb assist on 30 m ladder climbing at a minimum acceptable speed. Eight participants (six male and two female) climbed a 30 m ladder at 24 rungs per minute with and without climb assist, and were monitored for heart rate (HR), O2 and rate of perceived exertion (RPE). All three variables decreased significantly (p < 0.05) with climb assist with O2 decreasing by 22.5%, HR by 14.8% and RPE decreasing by a mean of 2.3 units on the 10-point Borg scale. When descending the ladder O2 decreased by a mean of 42% compared to that ascending. At the minimal acceptable climbing speed climb assist decreases the physiological strain on climbers, as demonstrated by reduced O2, HR and perceived exertion. Practitioner Summary: ‘Climb assist’ systems claim to reduce strain when climbing, however; no research has yet been published to substantiate this. A crossover study compared O2, HR and RPE at a minimal acceptable climbing speed with and without climb assist. Climb assist significantly reduced all variables confirming it reduces strain when climbing.

The effect of pitched and vertical ladder ergometer climbing on cardiorespiratory and psychophysical variables

This study aimed to assess whether modifying the pitch of a 75° ladder ergometer to vertical had a cardiorespiratory or psychophysical effect on climbing. Nine male participants climbed a ladder ergometer at 75° and subsequently at 90°, adjusted for an equivalent vertical climb rate, completing three climbing bouts at different vertical speeds. One participant dropped out being unable to complete the climb under the 90° condition. Each was monitored for heart rate (HR), V˙O2 and rating of perceived exertion (RPE). Results showed vertical climbing induced higher V˙O2 (mean increase 17.3%), higher HR (mean increase 15.8%), and higher RPE at all speeds and that moving from 75°to vertical exacerbates the effect of speed on the cardiorespiratory response to climbing. This may be explained by increased force production required to maintain balance in a vertical climbing position when the bodys centre of mass is not above the feet.