Michael Swain

Incidence and severity of neck injury in Rugby Union: a systematic review.

Objectives. To collate and appraise incidence and severity data for neck injury in Rugby Union. To report risk factors for neck injury in Rugby Union that are supported by incidence and severity data. Design. Systematic review. Methods. Original journal articles were retrieved from electronic searches of AusportMed, AUSPORT, Scopus, Medline (Ovid), CINAHL, Mantis, and Pubmed databases and relevant bibliographic hand searches. Selection criteria were restricted to: (a) prospective study designs including cohort, case-control, and intervention methodologies; (b) populations of Rugby Union players, either male or female of any age; (c) studies must report on neck injury incidence and/or severity specifically; (d) articles with republished neck injury data were excluded. The STROBE Statement was adapted for the quality assessment of included studies and categorised as either poor, moderate or good. Results. Thirty-three original articles met the selection criteria. Wide variation of injury and exposure definitions and population sampling was identified in the included articles. Neck injury incidence ranged between 0.26 (CI: 0.08, 0.93) and 9.17 (CI: 1.89, 26.81) per 1000 player hours for mixed populations that adopted an all inclusive sports injury definition. There is a paucity of severity data and analytical data which evaluates causal roles of risk factors for neck injury in Rugby Union. Conclusions. Meaningful understanding of neck injury incidence and severity in Rugby Union is restricted to a few studies which adopt comparable methodological construct. This paper provides an index for future neck injury studies in Rugby Union.

Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review

BackgroundNumerous clinical tests are used in the diagnosis of anterior cruciate ligament (ACL) injury but their accuracy is unclear. The purpose of this study is to evaluate the diagnostic accuracy of clinical tests for the diagnosis of ACL injury.MethodsStudy Design: Systematic review. The review protocol was registered through PROSPERO (CRD42012002069).Electronic databases (PubMed, MEDLINE, EMBASE, CINAHL) were searched up to 19th of June 2013 to identify diagnostic studies comparing the accuracy of clinical tests for ACL injury to an acceptable reference standard (arthroscopy, arthrotomy, or MRI). Risk of bias was appraised using the QUADAS-2 checklist. Index test accuracy was evaluated using a descriptive analysis of paired likelihood ratios and displayed as forest plots.ResultsA total of 285 full-text articles were assessed for eligibility, from which 14 studies were included in this review. Included studies were deemed to be clinically and statistically heterogeneous, so a meta-analysis was not performed. Nine clinical tests from the history (popping sound at time of injury, giving way, effusion, pain, ability to continue activity) and four from physical examination (anterior draw test, Lachman’s test, prone Lachman’s test and pivot shift test) were investigated for diagnostic accuracy. Inspection of positive and negative likelihood ratios indicated that none of the individual tests provide useful diagnostic information in a clinical setting. Most studies were at risk of bias and reported imprecise estimates of diagnostic accuracy.ConclusionDespite being widely used and accepted in clinical practice, the results of individual history items or physical tests do not meaningfully change the probability of ACL injury. In contrast combinations of tests have higher diagnostic accuracy; however the most accurate combination of clinical tests remains an area for future research.Clinical relevanceClinicians should be aware of the limitations associated with the use of clinical tests for diagnosis of ACL injury.

Does high level youth sports participation increase the risk of femoroacetabular impingement? A review of the current literature

Sports participation can be an integral part of adolescent development with numerous positive short and long-term effects. Despite these potential benefits very high levels of physical activity, during skeletal maturation, have been proposed as a possible cause of cam-type femoroacetabular impingement (FAI). The influence of physical activity on the developing physis has been previously described both in animal studies and epidemiological studies of adolescent athletes. It is therefore important to determine whether the development of FAI is secondary to excessive physical activity or a combination of a vulnerable physis and a set level of physical activity. A review of the current literature suggests that adolescent males participating in ice-hockey, basketball and soccer, training at least three times a week, are at greater risk than their non-athletic counterparts of developing the femoral head-neck deformity associated with femoroacetabular impingement.

Pain and moderate to vigorous physical activity in adolescence: An international population-based survey

OBJECTIVE To evaluate whether individual types of pain (headache, stomach-ache, and backache) or multiple pains affect the odds of young people achieving the recommended 60 minutes of moderate to vigorous physical activity (MVPA) per day in a large representative sample. DESIGN Multicenter cross-sectional survey. SETTING Twenty-eight countries across Europe and North America. SUBJECTS Adolescents (N = 242,103). METHODS An analysis of data collected in two waves (2001/02 and 2005/06) of the health behavior in school-aged children (HBSC) study was performed. Survey questions included the HBSC symptoms checklist and the amount of regular physical activity. Multilevel logistic regression was used to account for clustering effect of MVPA within countries. Models investigated the relationship between pain and physical activity, adjusted for the HBSC study year. Six models were conducted separately for gender and age-group (11, 13, and 15 years) strata. RESULTS In general, the presence of pain was associated with reduced physical activity. Headache alone was associated with reduced physical activity in all six strata (odd ratios 0.77-0.84), stomach-ache alone in five strata (0.77-0.92), and backache alone in four strata (0.86-0.96). In 11- and 13-year-old girls, headache, stomach-ache, and backache, individually and in combination, were associated with decreased odds of being physically active (odds ratios ranging from 0.73 to 0.91). Within the other four age and gender strata, the relationship was less consistent. CONCLUSION Pain is associated with reduced physical activity in adolescents but this association varies according to gender, age, and the type of pain experienced.

Short-term Clinical Course of Knee Pain in Children and Adolescents: A Feasibility Study Using Electronic Methods of Data Collection

BACKGROUND AND PURPOSE Musculoskeletal disorders, such as knee pain, are common in children and adolescents, but there is a lack of high quality research that evaluates the clinical course of these conditions. The objective of this study was to evaluate the feasibility of conducting a prospective study of children and adolescents with knee pain using electronic methods of data collection. METHODS Children and adolescents with knee pain that presented to primary care physiotherapy clinics were enrolled and followed-up on a weekly basis via short messaging service (SMS) until their knee pain had recovered (i.e. two consecutive weeks of no pain). Feasibility was assessed in terms of recruitment, retention and response rates to SMS and an online questionnaire. Baseline and 6-month follow-up measures included pain, disability, physical function, physical activity and health related quality of life. Kaplan-Meier survival analysis was used to estimate the median time to knee pain recovery. RESULTS Thirty participants (mean age 13.0 ± 2.2 years, 53% boys) were recruited over 26 months. The overall response rate to weekly SMS follow-up was 71.3% (809 received/1135 sent). One third of participants stopped responding to SMS prior to recovery, and these participants typically had a much lower response rate during the time they remained in the study. At 6-month follow-up, 80% of the cohort completed the final online questionnaire, and 29% of participants still reported current knee pain (≥1/10 VAS). The median time for knee pain recovery was 8 weeks (95%CI: 5, 10). CONCLUSION Electronic data collection alone seems insufficient to track pain recovery in young people and may need to be supplemented with more traditional data collection methods. Researchers should consider further measures to address slow recruitment rates and high attrition when designing large prospective studies of children and adolescents in the future. Copyright

Leadership and capacity building in international chiropractic research: introducing the chiropractic academy for research leadership (CARL)

In an evidence-based health care environment, healthcare professions require a sustainable research culture to remain relevant. At present however, there is not a mature research culture across the chiropractic profession largely due to deficiencies in research capacity and leadership, which may be caused by a lack of chiropractic teaching programs in major universities. As a response to this challenge the Chiropractic Academy for Research Leadership, CARL, was created with the aim of develop a global network of successful early-career chiropractic researchers under the mentorship of three successful senior academics from Australia, Canada, and Denmark. The program centres upon an annual week-long program residential that rotates continental locations over the first three-year cycle and between residentials the CARL fellows work on self-initiated research and leadership initiatives. Through a competivite application process, the first cohort was selected and consists of 13 early career researchers from five professions in seven countries who represent diverse areas of interests of high relevance for chiropractic. The first residential was held in Odense, Denmark, with the second being planned in April 2018 in Edmonton, Canada, and the final residential to be held in Sydney, Australia in 2019.

Prevalence and profile of Australian chiropractors treating athletes or sports people: a cross-sectional study

OBJECTIVES A range of health-care professionals including chiropractors provide treatment for sports-related health problems. This study reports analyses from the first national workforce survey to determine practitioner and practice-related factors associated with the frequent treatment of athletes or sports people by Australian chiropractors. DESIGN AND SETTING A 21-item questionnaire collecting information pertaining to practitioner and practice-related characteristics was distributed to all Australian registered chiropractors, as part of the Australian Chiropractic Research Network (ACORN) project and attracted a response rate of 43% (n = 2005). Statistical analyses compared the frequency of treating athletes or sports people against a wide range of relevant practitioner and practice characteristics. RESULTS Of the respondents, 49.5% (n = 936) reported frequently treating athletes or sports people, and these chiropractors were more likely to be male as well as report more patient care hours and patient visits per week than those chiropractors who did not frequently treat athletes or sports people. Chiropractors who frequently treat athletes or sports people were also more likely to perform multi-modal management, have multi-disciplinary practitioner relations, use diagnostic equipment and discuss nutrition and medication use as part of their patient care than those chiropractors who did not frequently treat athletes or sports people. CONCLUSIONS Nearly half of participating Australian chiropractors treat athletes or sports people frequently. The current and potential role of chiropractors in sports medicine appears significant. Further research is needed to examine the role, practices and outcomes of such chiropractic care helping to, provide treatment and policy development in this area of clinical management.

Relationship between growth, maturation and musculoskeletal conditions in adolescents: a systematic review

Objective To determine whether there is a relationship between physical growth and development, as determined by markers of biological maturation, and musculoskeletal conditions in adolescents. Design Systematic review. Data sources Electronic databases (PubMed, EMBASE and the Cumulative Index to Nursing and Allied Health Literature) were searched up to 6 September 2017. Eligibility criteria for selecting studies Studies that evaluated the association between biological maturation or growth and musculoskeletal conditions in adolescents (chronological age 10–19 years). Results From 20 361 titles identified by the searches, 511 full-text articles were retrieved and assessed for eligibility; 56 studies, all at high risk of bias, evaluating the relationship between maturation and/or growth and musculoskeletal conditions were included. A total of 208 estimates of association were identified across the included studies, which generally indicated no association or an unclear association between maturation, growth and musculoskeletal conditions. Summary/Conclusions While the relationship between maturation, growth and musculoskeletal conditions remains plausible, the available evidence is not supportive. The current body of knowledge is at high risk of bias, which impedes our ability to establish whether biological maturity and growth are independent risk factors for musculoskeletal conditions.

Therapeutic ultrasound is not clinically beneficial for acute ankle sprains

▶ van den Bekerom MP, van der Windt DA, Ter Riet G, et al. Therapeutic ultrasound for acute ankle sprains. Cochrane Database Syst Rev 2011;6:CD001250. Ankle sprains are the most common sports injury, and therapeutic ultrasound is often used in the first phase of treatment.1 Rationale for its use is based on physiological effects demonstrated in laboratory research.2 This review is an update of a Cochrane review first published in 1999 and previously updated in 2004. One randomised clinical trial has been published since then and added to the review.3 To determine the effect of ultrasound therapy compared with placebo, no treatment or other interventions in the clinical management of acute ankle sprain. This methodology followed those recommended by the Cochrane Collaboration. Electronic databases (the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register …