Mark Boocock

Interventions for the prevention and management of neck/upper extremity musculoskeletal conditions: a systematic review

Considered from medical, social or economic perspectives, the cost of musculoskeletal injuries experienced in the workplace is substantial, and there is a need to identify the most efficacious interventions for their effective prevention, management and rehabilitation. Previous reviews have highlighted the limited number of studies that focus on upper extremity intervention programmes. The aim of this study was to evaluate the findings of primary, secondary and/or tertiary intervention studies for neck/upper extremity conditions undertaken between 1999 and 2004 and to compare these results with those of previous reviews. Relevant studies were retrieved through the use of a systematic approach to literature searching and evaluated using a standardised tool. Evidence was then classified according to a “pattern of evidence” approach. Studies were categorised into subgroups depending on the type of intervention: mechanical exposure interventions; production systems/organisational culture interventions and modifier interventions. 31 intervention studies met the inclusion criteria. The findings provided evidence to support the use of some mechanical and modifier interventions as approaches for preventing and managing neck/upper extremity musculoskeletal conditions and fibromyalgia. Evidence to support the benefits of production systems/organisational culture interventions was found to be lacking. This review identified no single-dimensional or multi-dimensional strategy for intervention that was considered effective across occupational settings. There is limited information to support the establishment of evidence-based guidelines applicable to a number of industrial sectors.

The short-term effects of running on the deformation of knee articular cartilage and its relationship to biomechanical loads at the knee

OBJECTIVE To investigate the short-term effects of recreational running on the deformation of knee articular cartilage and to examine the relationship between changes in knee cartilage volume and biomechanical modulators of knee joint load. METHOD Twenty healthy volunteers participated in a two phase cross-sectional study. Session 1 involved Magnetic Resonance Imaging (MRI) of femoral and tibial cartilage volumes prior to and following a 30 min period of relaxed sitting, which was directly followed by a recreational run of 5000 steps. Subsequently, all participants undertook a laboratory study of their running gait to compare biomechanical derived measures of knee joint loading with changes in cartilage volume. Estimates of knee joint load were determined using a rigid-link segment, dynamic biomechanical model of the lower limbs and a simplified muscle model. RESULTS Running resulted in significant deformation of the medial (5.3%, P<0.01) and lateral femoral cartilage (4.0%, P<0.05) and lateral aspect of the tibial cartilage (5.7%, P<0.01), with no significant differences between genders. Maximum compression stress was significantly correlated with percentage changes in lateral femoral cartilage volume (r(2)=0.456, P<0.05). No other biomechanical variables correlated with volume changes. CONCLUSION Limited evidence was found linking biomechanical measures of knee joint loading and observed short-term deformation of knee articular cartilage volume following running. Further enhancement of knee muscle modelling and analysis of stress distribution across cartilage are needed if we are to fully understand the contribution of biomechanical factors to knee joint loading and the pathogenesis of knee osteoarthritis (OA).

The effects of prior warning and lifting-induced fatigue on trunk muscle and postural responses to sudden loading during manual handling

This study investigated the effects of warning and lifting-induced fatigue on trunk muscle activity and postural responses to sudden loading. Thirty-one male subjects were subjected to sudden loading of a hand-held box with and without prior warning, before and after either lifting-induced fatigue or light callisthenic exercises. Results showed that warning did not alter the level of trunk muscle activity prior to sudden loading. Following warning, there was a reduction in all muscle and joint onset latencies and the magnitude of hip and knee flexion. Although fatigue did not influence muscle and joint initiation, it did negate the effects that warning had on reducing joint displacement. These findings indicate that warning prior to sudden loading may enhance postural responses, reduce ranges of joint motion and increase stability. However, the benefits of prior warning for reducing ranges of joint motion may not be present when a person is fatigued. Sudden unexpected loading and fatigue arising from manual handling practices in the workplace have been identified as contributing factors to the risk of low back injury. Findings from this study provide information that is important for the design of interventions intended to reduce the incidence of manual handling-related back injuries.

The effects of spinal posture and pelvic fixation on trunk rotation range of motion.

BACKGROUND Axial rotation of the trunk is important to many vocational tasks and activities of daily living, and may be associated with back injuries. The influence of spinal postures on trunk rotation appears conflicting. This study investigated the influence of forward trunk inclination, spinal posture and pelvic fixation on maximum trunk rotation. METHODS Twenty male participants were assessed using an optoelectronic motion-analysis system to track trunk movement during maximal trunk rotations in different spinal positions within the sagittal plane. A repeated-measures multivariate analysis of variance investigated the effects of forward trunk inclination, spinal posture and pelvic fixation on trunk and pelvic rotation. Test-retest reliability was determined using interclass correlation coefficients and standard error of measurement. FINDINGS Forward trunk inclination at 45° yielded a 19% (6.2°; P<0.001) increase in trunk rotation and a 40% (25.5°; P<0.001) decrease in pelvic rotation when compared to standing. When flexing and extending the spine at a forward trunk inclination of 45° there was a 5% (1.9°; P<0.01) and a 4% (1.6°; P<0.05) decrease in trunk rotation. Fixing the pelvis increased the trunk rotation by up to 9% (3.3°; P<0.001). INTERPRETATION Inclining the trunk forward and maintaining a neutral spine maximised trunk rotation range of motion (RoM). This has implications for educational programmes intended to maximise sporting performance. Within the clinical setting, unrestricted observation of trunk rotations is considered more appropriate as it may benefit the clinician in determining possible detrimental relative flexibilities that may exist within the body.

Advanced musculoskeletal simulation as an ergonomic design method

In recent years, the advent of new tools for musculoskeletal simulation has increased the potential for significantly improving the ergonomic design process and ergonomic assessment of design. In this paper we investigate the use of one such tool, ‘The AnyBody Modeling System’, applied to solve a one-parameter and yet, complex ergonomic design problem. The aim of this paper is to investigate the potential of computer-aided musculoskeletal modelling in the ergonomic design process, in the same way as CAE technology has been applied to engineering design.

During step descent, older adults exhibit decreased knee range of motion and increased vastus lateralis muscle activity.

PURPOSE There is substantial evidence indicating an increase in the incidence of lower limb joint osteoarthritis with increasing age. One factor that may contribute to this is an age related reduction in the ability to attenuate the impulse generated during gait and step descent. SCOPE The aim of this study was to investigate the differences between older and younger adults, in the strategies used to attenuate the force generated between initial contact (IC) and maximum vertical ground reaction force (vGRF) (impulse phase) when descending a step. METHODS Ten older participants aged 60-80 years (mean 65.3, SD ±5) and 10 younger participants aged 20-30 years (mean 22.8, SD ±2.5) took part in the study. Vertical ground reaction force (vGRF) and the time taken to reach maximum vGRF were measured. The maximum joint range of motion of the hip and knee during step descent was measured between IC and the maximum vGRF. Electromyography (EMG) was measured from four lower limb muscles and normalised to task for each individual. RESULTS There was a statistically significant difference between older and younger adults in the amount of knee flexion and vastus lateralis EMG activity in the leading leg during the impulse phase of step descent. Older adults had less knee flexion (F(1,18)=5.48; p=0.031) and more vastus lateralis EMG activity (F(1,18)=5.21; p=0.035) during step descent than younger adults. CONCLUSION Older and younger adults used different strategies during step descent. Older adults demonstrated two strategies that have the potential to increase the impulse of a step.

The assessment of lesions of the Achilles tendon by ultrasound imaging in inflammatory arthritis: A systematic review and meta-analysis ☆

OBJECTIVE Ultrasound (US) is a highly sensitive, reliable and non-invasive tool, which allows for the assessment of lesions of tendons and entheseal sites. The aim of this systematic review and meta-analysis is to identify differences in US lesions of the Achilles tendon (AT) between people with inflammatory arthritis (IA) and healthy controls. METHODS An electronic literature search was performed on Medline, CINAHL, SportDiscus and The Cochrane Library. Methodological quality was assessed using a modified Quality Index. Odds ratios with 95% confidence intervals (CI) were determined. Meta-analysis was conducted on those studies that were considered to be homogenous. RESULTS A total of 13 high-to-medium quality studies met the inclusion criteria. The majority of studies reported US lesions in spondyloarthropathy (SpA), with limited evidence for other forms of IA. US lesions were not consistently defined with regard to Outcome Measures in Rheumatology Clinical Trials (OMERACT) definitions, and numerous scoring systems were used across the majority of studies. The mean AT thickness at the enthesis in people with SpA was 0.54mm thicker (95% CI: 0.10-0.97mm) with more frequent erosions in people with SpA (odds ratio = 7.43, 95% CI: 1.99-27.77, P = 0.003) and rheumatoid arthritis (RA) (odds ratio = 9.60, 95% CI: 1.23-74.94, P = 0.03), compared to controls. There was no significant difference in the frequency of enthesophyte formation in people with SpA compared to the controls (odds ratio = 2.48, 95% CI: 0.64-9.70, P = 0.19). CONCLUSIONS The systematic review identified that a majority of studies reporting US lesions were in SpA, but limited evidence relating to other forms of IA. Consistent application of the OMERACT US definitions and scoring of US lesions is required in future studies of AT disease in IA. Further work is also required to distinguish between US lesions reflective of inflammation and structural damage.

A method for personalising the blade size for competitors in flatwater kayaking

The intent of this project was to explore the feasibility of personalising the paddle blade size for individual flatwater kayakers based on their power output profiles. Twelve elite male kayakers performed on a kayak ergometer at the same intensity and resistance that they would normally experience while paddling at race pace for 500 m on the water. The kayak ergometer was instrumented so that power profiles could be determined from the instantaneous force and velocity of the representative centre point of the paddle blade. From the power profile information, the researchers calculated a personalised blade size that was expected to improve performance for those kayakers differing more than 5% from the calculated ‘ideal’ size. For the elite kayakers studied, it was recommended that seven of the paddlers should increase their blade size by approximately 5–10%. For the remaining five paddlers, the results indicated that their current blade sizes were within the expected measurement error of their predicted ideal value and should be retained. It is anticipated that this research will provide the theoretical rationale for elite kayakers to see the need to personalise their blade size based on their own muscle power profiles.

Ultrasound Characteristics of the Achilles Tendon in Tophaceous Gout: A Comparison with Age- and Sex-matched Controls

Objective. To investigate the frequency and distribution of characteristics of the Achilles tendon (AT) in people with tophaceous gout using musculoskeletal ultrasound (US). Methods. Twenty-four participants with tophaceous gout and 24 age- and sex-matched controls without gout or other arthritis were recruited. All participants underwent a greyscale and power Doppler US examination. The AT was divided into 3 anatomical zones (insertion, pre-insertional, and proximal to the mid-section). The following US characteristics were assessed: tophus, tendon echogenicity, tendon vascularity, tendon morphology, entheseal characteristics, bursal morphology, and calcaneal bone profile. Results. The majority of the participants with tophaceous gout were middle-aged men (n = 22, 92%) predominately of European ethnicity (n = 14, 58%). Tophus deposition was observed in 73% (n = 35) of tendons in those with gout and in none of the controls (p < 0.01). Intratendinous hyperechoic spots (p < 0.01) and intratendinous power Doppler signal (p < 0.01) were more frequent in participants with gout compared to controls. High prevalence of entheseal calcifications, calcaneal bone cortex irregularities, and calcaneal enthesophytes were observed in both gout participants and controls, without differences between groups. Intratendinous structural damage was rare. Hyperechoic spots were significantly more common at the insertion compared to the zone proximal to the mid-section (p < 0.01), but between-zone differences were not observed for other features. Conclusion. US features of urate deposition, tophus, and vascularization are present throughout the AT in patients with tophaceous gout. Despite crystal deposition, intratendinous structural changes are infrequent. Many characteristics observed in the AT in people with tophaceous gout, particularly at the calcaneal enthesis, are not disease-specific.

Play-based interventions improve physical function for people with adult-acquired brain injury: a systematic review and meta-analysis of randomised controlled trials

Objective: To undertake a systematic review and meta-analysis of the effectiveness of play-based interventions compared to traditional therapy in rehabilitation of adults with adult-acquired brain injury. Data sources: The search was performed using Medline; Cinahl Plus; Health Source (Nursing/Academic Edition); Psychology and behavioural sciences collection; Biomedical reference collection (basic). Review methods: Studies included were randomised controlled trials that investigated the effect of play-based interventions on physical function of adults with adult acquired brain injury. Two independent reviewers identified eligible studies and assessed methodological quality using a modified Downs and Black. Meta-analysis compared standardised differences in means, to determine effect sizes for grouped functional outcome measures. The GRADE scoring system was used to determine the level of clinical evidence. Results: Thirty studies met the inclusion criteria, 13 were considered high quality and 17 moderate quality. Studies predominantly involved post-stroke participants, with only three studies including participants with traumatic brain injury. When compared to traditional therapy, dose-matched studies of play-based interventions showed a significant effect on independence (Effect size (ES) = 0.6) and physical performance (ES = 0.43), as measured using the Fugl –Meyer. For non-dose matched studies, play-based interventions showed a significant improvement for balance (ES = 0.76) compared with traditional therapy. In all studies that measured participant enjoyment, play-based therapy was rated as more enjoyable than traditional therapy. Conclusion: Play-based interventions for people with adult acquired brain injury are more effective in improving balance and independence, which may be due to them being more enjoyable than traditional therapy.