Nicola Relph

Macrolide antibiotics for non-cystic fibrosis bronchiectasis

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the impact of macrolide antibiotics in the treatment of adults and children with non-cystic fibrosis bronchiectasis.

Criterion-Related Validity of Knee Joint-Position-Sense Measurement Using Image Capture and Isokinetic Dynamometry

CONTEXT Clinicians require portable, valid, and cost-effective methods to monitor knee joint-position-sense (JPS) ability. OBJECTIVE To examine the criterion-related validity of image-capture JPS measures against an isokinetic-dynamometer (IKD) procedure. DESIGN Random crossover design providing a comparison of knee JPS measures from image capture and IKD procedures. PARTICIPANTS 10 healthy participants, 5 female, age 28.0 ± 13.29 y, mass 60.3 ± 9.02 kg, height 1.65 ± 0.07 m, and 5 male, 29.6 ± 10.74 y, mass 73.6 ± 5.86 kg, height 1.75 ± 0.07 m. MAIN OUTCOME MEASURES The dependent variables were absolute error scores (AES) provided by 2 knee directions (flexion and extension). The independent variables were the method (image capture and IKD). RESULTS There was no significant difference between clinical and IKD AES into knee-flexion data (P = .263, r = 0.55). There was a significant difference between clinical and IKD AES into knee-extension data (P = .016, r = .70). CONCLUSIONS Analysis of photographic images to assess JPS measurements using knee flexion is valid against an IKD positioning method, but JPS measurements using knee extension may not be valid against IKD techniques. However, photo-analysis measurements provided a lower error score using knee-extension data and thus may provide an optimal environment to produce maximal knee JPS acuity. Therefore, clinicians do not need expensive equipment to collect representative JPS ability.

The effects of knee direction, physical activity and age on knee joint position sense.

BACKGROUND Previous research has suggested a decline in knee proprioception with age. Furthermore, regular participation in physical activity may improve proprioceptive ability. However, there is no large scale data on uninjured populations to confirm these theories. The aim of this study was to provide normative knee joint position data (JPS) from healthy participants aged 18-82years to evaluate the effects of age, physical activity and knee direction. METHODS A sample of 116 participants across five age groups was used. The main outcome measures were knee JPS absolute error scores into flexion and extension, Tegner activity levels and General Practitioner Physical Activity Questionnaire results. RESULTS Absolute error scores in to knee flexion were 3.6°, 3.9°, 3.5°, 3.7° and 3.1° and knee extension were 2.7°, 2.5°, 2.9°, 3.4° and 3.9° for ages 15-29, 30-44, 45-59, 60-74 and 75 years old respectively. Knee extension and flexion absolute error scores were significantly different when age group data were pooled. There was a significant effect of age and activity level on joint position sense into knee extension. Age and lower Tegner scores were also negatively correlated to joint position sense into knee extension. CONCLUSIONS The results provide some evidence for a decline in knee joint position sense with age. Further, active populations may have heightened static proprioception compared to inactive groups. Normative knee joint position sense data is provided and may be used by practitioners to identify patients with reduced proprioceptive ability.

Interexaminer, Intraexaminer, and Test–Retest Reliability of Clinical Knee Joint-Position-Sense Measurements Using an Image-Capture Technique

CONTEXT Knee joint-position sense (JPS) plays a critical role in controlled and stable joint movement. Poor ability to sense position of the knee can therefore increase risk of injury. There is no agreed consensus on JPS measurement techniques and a lack of reliability statistics on methods. OBJECTIVE To identify the most reliable knee JPS measurement technique using image capture. DESIGN Interexaminer, intraexaminer, and test-retest reliability of knee JPS measurements. SETTING Biomechanics laboratory. PARTICIPANTS 10 asymptomatic participants. INTERVENTIONS None. MAIN OUTCOME MEASURES Relative and absolute error scores of knee JPS in 3 conditions (sitting, prone, active) through 3 ranges of movement (10-30°, 30-60°, 60-90°), into 2 directions (flexion and extension) using both legs (dominant and nondominant) collected during 15 trials and repeated 7 d after the first data collection. RESULTS Statistical analysis by intraclass correlations revealed excellent interexaminer reliability between researchers (.98) and intraexaminer reliability within 1 researcher (.96). Test-retest reliability was highest in the sitting condition from a starting angle of 0°, target angle through 60-90° of flexion, using the dominant leg and absolute-error-score variables (ICC = .92). However, it was noted smallest detectable differences were a high percentage of mean values for all measures. CONCLUSIONS The most reliable JPS measurement for asymptomatic participants has been identified. Practitioners should use this protocol when collecting JPS data during prescreening sessions. However, generalizability of findings to a class/group of clients exhibiting knee pathologies should be done with caution.

Knee joint position sense ability in elite athletes who have returned to international level play following ACL reconstruction: A cross-sectional study.

BACKGROUND Following an ACL injury, reconstruction (ACL-R) and rehabilitation, athletes may return to play with a proprioceptive deficit. However, literature is lacking to support this hypothesis in elite athletic groups who have returned to international levels of performance. It is possible the potentially heightened proprioceptive ability evidenced in athletes may negate a deficit following injury. The purpose of this study was to consider the effects of ACL injury, reconstruction and rehabilitation on knee joint position sense (JPS) on a group of elite athletes who had returned to international performance. METHODS Using a cross-sectional design ten elite athletes with ACL-R and ten controls were evaluated. JPS was tested into knee extension and flexion using absolute error scores. Average data with 95% confidence intervals between the reconstructed, contralateral and uninjured control knees were analyzed using t-tests and effect sizes. RESULTS The reconstructed knee of the injured group demonstrated significantly greater angle of error scores when compared to the contralateral and uninjured control into knee flexion (p=0.0001, r=0.98) and knee extension (p=0.0001, r=0.91). There were no significant differences between the contralateral uninjured knee of the injured group and the uninjured control group. CONCLUSIONS Elite athletes who have had an ACL injury, reconstruction, rehabilitation and returned to international play demonstrate lower JPS ability compared to control groups. It is unclear if this deficiency affects long-term performance or secondary injury and re-injury problems. In the future physical therapists should monitor athletes longitudinally when they return to play.

Screening Tools as a Predictor of Injury in Dance: Systematic Literature Review and Meta-analysis

BackgroundDance involves movements of complexity and physical intensity which result in stress on the body. As a consequence, dancers are at risk of injury which can impact on their well-being. Screening tools are used for injury prevention to identify those dancers at risk of injury. The aim of this study was to investigate which screening tools can predict injury in dancers, encompassing all dance genres, levels and ages.MethodsAn electronic search of seven databases from their inception to December 2017 was conducted. The databases were the Allied and Complementary Medicine Database (AMED), CINAHL, eBOOK Collection (EBSCOhost), MEDLINE, Cochrane Database of Systematic Reviews, SPORTDiscus and PEDro: the Physiotherapy Evidence Base. The following search terms were used: (i) Dance AND injury AND Screening, (ii) Screening AND dance and (iii) Musculoskeletal AND Screening AND Dance. Studies were assessed using a 20-point scoring tool, and eligible studies were included in a meta-analysis.ResultsThe mean methodological quality score was 12.2 points. Injured dancers had a significantly higher compensated turnout range of motion than non-injured dancers: pooled mean difference of compensated turnout (23.29°; 95% CI 14.85–31.73; P < 0.00001; I2 = 0%). Injured dancers had significantly greater functional turnout range of motion when compared to non-injured dancers: pooled mean difference of functional turnout (14.08°; 95% CI 7.09–21.07; P < 0.0001; I2 = 0%). There also some evidence for use of hip range of motion as a predictor of dance injury.ConclusionsSome evidence exists for the potential use of dance-specific positions as a predictor of injury. A number of studies were limited by a lack of prospective injury design, injury definition and self-reporting of injury.

The efficacy of lower limb screening tests in predicting PlayerLoad within a professional soccer academy

CONTEXT Training exposure has been associated with injury epidemiology in elite youth soccer, where lower-limb musculoskeletal screening is commonly used to highlight injury risk. However, there has been little consideration of the relationship between lower-limb screening and the loading response to soccer activities. OBJECTIVE To quantify the efficacy of using screening tests to predict the loading elicited in soccer-specific activities and to develop a hierarchical ordering of musculoskeletal screening tests to identify test redundancy and inform practice. DESIGN Correlational. SETTING Professional soccer club academy. PARTICIPANTS A total of 21 elite male soccer players aged 15.7 (0.9) years. INTERVENTION Players completed a battery of 5 screening tests (knee to wall, hip internal rotation, adductor squeeze, single-leg hop, and anterior reach) and a 25-minute standardized soccer session with a Global Positioning System unit placed at C7 to collect multiplanar PlayerLoad data. MAIN OUTCOME MEASURES Baseline data on each screening test, along with uniaxial PlayerLoad in the mediolateral, anteroposterior, and vertical planes. RESULTS Stepwise hierarchical modeling of the screening tests revealed that dominant leg knee-to-wall distance was the most prevalent and powerful predictor of multiplanar PlayerLoad, accounting for up to 42% of variation in uniaxial loading. The adductor squeeze test was the least powerful predictor of PlayerLoad. Of note, one player who incurred a knee injury within 3 weeks of testing had shown a 20% reduction in knee-to-wall distance compared with peers, and elicited 23% greater PlayerLoad, supporting the hierarchical model. CONCLUSIONS There was some evidence of redundancy in the screening battery, with implications for clinical choice. Hierarchical ordering and a concurrent case study highlight dominant leg knee-to-wall distance as the primary predictor of multiaxial loading in soccer. This has implications for the design and interpretation of screening data in elite youth soccer.

Musculoskeletal injury rates in multiday marathon runners performing ten consecutive marathons on a repeat course

Since 2015 I started reading Greek Philosophy and I visited many times the museum of Acropolis, Athens. I found really amazing the Myth of Greek God Hephaestus. His mother Hera when was infant, decided to throw it in the sea because he was ugly. This little kid raised by two other women. Hephaestus was married with the Goodness of beauty, Aphrodite but his marriage was a disaster, because he was violent to his wife.

The effect of running nine marathons in nine days on proprioception and balance

Background Multi-day running events are becoming increasingly popular with nonprofessional athletes. However, it is unknown how and when this type of event affects injury risk factors such as proprioception and balance. Objective To evaluate the effect of running one, five consecutive and nine consecutive marathons on joint position sense (JPS) and dynamic balance. Design Cross-sectional, observational study. Setting Sports-injury clinic. Participants 21 athletes completing the event (age 44.8±8.09 yrs, mass 74.4±13.14 kg, years running 10.4±7.39 yrs, average weekly mileage 44.8±12.09 miles) entered the study. Ten athletes completed the JPS testing and five athletes completed the dynamic balance testing. Assessment of Risk Factors Risk factors were assessed the day before the event (day zero) and then following completion of one (day one), five (day five) and nine (day nine) consecutive marathons. The independent variable was time. Main Outcome Measurements JPS error into flexion and extension, star-excursion balance test (SEBT) and number of injuries per runner. Results Friedmans ANOVAs indicated no effects of time on JPS into extension (p=0.94), dominant-leg anterior (p=0.52) or posterior-lateral (p=0.65) SEBT reach. JPS flexion error significantly decreased by 1.3° from day one to five (p=0.032). Non-dominant leg anterior, posterior-medial and posterior-lateral SEBT reaches significantly decreased from day zero to nine by 0.09% (p=0.043), 0.13% (p=0.043) and 0.17% (p=0.043) of leg length respectively. Dominant leg posterior-medial SEBT reach also significantly decreased by 0.12% of leg length (p=0.043) from day zero to nine. There were 4.2 injuries per runner. Conclusions The results suggest multi-day running events can cause over four lower limb injuries per runner and reduce dynamic balance ability. Nonprofessional athletes completing these events should be aware of this high injury occurrence and prepare appropriately. Injury prevention programmes incorporating dynamic balance may be recommended. However future studies with additional risk factors and larger sample sizes are needed to substantiate these findings.

AN ASSESSMENT OF CLINICAL JOINT AND LIMB MEASURES IN PROFESSIONAL FEMALE SOCCER PLAYERS: SCREENING TOOLS FOR INJURY PREVENTION?

Background Female soccer has only recently become a professional sport within the UK. The need for accurate and reliable screening and profiling of professional female soccer players could assist in the design of injury prevention programmes. Objective To evaluate the clinical joint and limb measures during a preseason screening process in professional female soccer players. Design Cross-sectional, descriptive study. Setting Sports Therapy clinic. Participants 32 professional UK-based female soccer players (aged 23±3.60, mass 62.41±6.37 kg, height 167±6.65 cm) participated in the study. Assessment of Risk Factors Risk factors were assessed during the English Womens Super League preseason, January 2016. The independent variable was leg dominance. Main Outcome Measurements The outcome measures were leg length, knee to wall distance, knee flexion and extension, hip flexion and extension, hip internal and external rotation ranges of motion (ROM), straight leg raise hip flexion angle from both dominant and non-dominant legs. A qualified and experienced Sports Therapist subjectively assessed and recorded joint ligament laxity at the knee and ankle. Results Paired T-Tests revealed significantly reduced ROM in the dominant side compared to the non-dominant side for both hip flexion (p=0.005) and hip internal rotation (p=0.021). However, all other ROM measurements demonstrated limb symmetry. The most notable findings from the subjective laxity measures was that 35.9% of players had ankle talar inversion laxity. Conclusions Reduced hip ROM in the dominant side of players may increase the risk of lower limb injury. It may be important to include hip flexibility training into pre-season injury prevention programmes for female soccer players to ensure lower limb symmetry. Furthermore, ankle strengthening, proprioception and single leg change of direction exercises may be included in training programmes due to the high prevalence of ankle laxity in this sample. Future studies should monitor these measurements across a season and correlate them with injury incidence.