Paul Marchant

Arthroscopic treatment of labral tears in femoroacetabular impingement

Labral tears are commonly associated with femoroacetabular impingement. We reviewed 151 patients (156 hips) with femoroacetabular impingement and labral tears who had been treated arthroscopically. These were subdivided into those who had undergone a labral repair (group 1) and those who had undergone resection of the labrum (group 2). In order to ensure the groups were suitably matched for comparison of treatment effects, patients with advanced degenerative changes (Tönnis grade > 2, lateral sourcil height < 2 mm and Outerbridge grade 4 changes in the weight-bearing area of the femoral head) were excluded, leaving 96 patients (101 hips) in the study. At a mean follow-up of 2.44 years (2 to 4), the mean modified Harris hip score in the labral repair group (group 1, 69 hips) improved from 60.2 (24 to 85) pre-operatively to 93.6 (55 to 100), and in the labral resection group (group 2, 32 hips) from 62.8 (29 to 96) pre-operatively to 88.8 (35 to 100). The mean modified Harris hip score in the labral repair group was 7.3 points greater than in the resection group (p = 0.036, 95% confidence interval 0.51 to 14.09). Labral detachments were found more frequently in the labral repair group and labral flap tears in the resection group. No patient in our study group required a subsequent hip replacement during the period of follow-up. This study shows that patients without advanced degenerative changes in the hip can achieve significant improvement in their symptoms after arthroscopic treatment of femoroacetabular impingement. Where appropriate, labral repair provides a superior result to labral resection.

Evaluation of communication, life participation and psychological well‐being in chronic aphasia: The influence of group intervention

Background: The impact of change in communication, life participation, and psychological well‐being in aphasia is recognised but still not fully explored. Further, considerable scope exists to address these factors within the context of intervention. Innovative practices and group intervention are advocated for people with chronic aphasia but detail and evidence remains limited. We are grateful to Leeds Health Authority, the Leeds Speech and Language Therapy Service, Leeds Social Services, Leeds Metropolitan University and the Leeds Modernisation Team ‐ Disability for funding and other resources for the group and the research. Our thanks in particular are conveyed to the group participants. Additionally we thank the reviewers for their guidance. Aims: To explore the experience of aphasia within the context of communication, life participation and psychological well‐being and evaluate the outcomes of these phenomena in people with chronic aphasia following participation in a group intervention involving a social model approach. Methods & Procedures: A group of seven people with chronic moderate aphasia were assessed on communication measures, by means of the Conversational Analysis Profile for People with Aphasia (CAPPA), and aspects of psychological well‐being, by means of The Hospital Anxiety and Depression Scale (HADS) and The Visual Analogue Self‐esteem Scale (VASES) pre, post, and at 3‐month follow‐up of a group intervention. The group involved a social model approach and the use of Total Communication to support conversation. Speech and language therapy and social care personnel, including an equality disability trainer, contributed to the group. Outcomes & Results: Although variation in individual participants was demonstrated, results showed evidence of statistically significant beneficial change in conversation experiences (many of these related to life participation) and, to a lesser degree, beneficial change in conversation abilities. Additionally there were beneficial changes for some participants on psychological well‐being measures. Due to the small sample, participant variation, and (in the case of psychological well‐being measures) the lack of evidence of serious reduction in psychological well‐being at the outset, the results have to be evaluated with caution. Conclusions: Appropriately planned group intervention can produce benefits in conversation, life participation, and psychological well‐being in chronic aphasia.

Cross‐Sectional Comparisons of BMI and Waist Circumference in British Children: Mixed Public Health Messages

Research suggests that there has been a leveling off in obesity prevalence occurring in the child population. However, a concern with the evidence base is that all of the studies have relied upon the use of BMI. The purpose of this study was to compare waist circumference (WC), BMI, and waist‐to‐height ratio (WHtR) data in three different sample of children (total number: 14,697) typically aged 11–12 years. Obesity prevalence defined by BMI did not change significantly between measurement years (2005 boys 20.6%, girls 18.0%; 2006 boys 19.3%, girls 17.3%; 2007 boys 19.8%, girls 16.4%). Obesity prevalence defined by WC was considerably higher especially, in girls (2005 boys 26.3%, girls 35.6%; 2006 boys 20.3%, girls 28.2%; 2007 boys 22.1%, girls 30.1%). The prevalence of children defined as “at risk” according to WHtR (2005 boys 23.3%, girls 21.1%; 2006 boys 16.7%, girls 15.6%; 2007 boys 17.6%, girls 17.2%) was found to be between obesity prevalence, estimated using BMI and WC. This data are the most up to date collection that includes BMI and WC in three large samples of children and clearly demonstrates inconsistencies between different measurements based on current classification systems. There is a need to understand the relationship between BMI and WC, with growth and health risk to establish a consistent public health message that is easily understood by the public.

The effect of psychological skills training (PST) on self-regulation behavior, self-efficacy, and psychological skill use in military pilot-trainees

Set within B. J. Zimmerman’s (1989, A social cognitive view of self-regulated academic learning, Journal of Educational Psychology, Vol. 81, pp. 329–339; and B. J. Zimmerman, 2000, Attaining self-regulation: A social-cognitive perspective, in M. Boekaerts, P. Pintrich, & M. Seidner, Eds., Self-Regulation: Theory, Research, and Applications, pp. 13–39, Orlando, Florida, Academic Press) cyclical model of self-regulation and social–cognitive theory, this study tested the hypothesis that multi-modal psychological skills training (PST) would increase self-regulation behavior, self-efficacy, and psychological skill use in military pilot-trainees experiencing course-related learning difficulties. From pre- to post-intervention, findings showed that specific self-regulation behavior increased linearly. Likewise, significant increases in self-efficacy and psychological skill use occurred, along with concomitant reductions in anxiety and worry. Changes were generally retained at 2-month follow-up. PST highlights potential in modifying pilot-trainee cognitive and behavioral strategies to underpin learning, improve individual/cohort responsiveness, and importantly, cost effectiveness in training provision.

The effectiveness of walking stick use for neurogenic claudication: results from a randomized trial and the effects on walking tolerance and posture.

UNLABELLED Comer CM, Johnson MI, Marchant PR, Redmond AC, Bird HA, Conaghan PG. The effectiveness of walking stick use for neurogenic claudication: results from a randomized trial and the effects on walking tolerance and posture. OBJECTIVES To determine the immediate effects of using a stick on walking tolerance and on the potential explanatory variable of posture, and to provide a preliminary evaluation of the effects of daily walking stick use on symptoms and function for people with neurogenic claudication. DESIGN A 2-phase study of neurogenic claudication patients comprising a randomized trial of 2 weeks of home use of a walking stick and a crossover study comparing walking tolerance and posture with and without a walking stick. SETTING A primary care-based musculoskeletal service. PARTICIPANTS Patients aged 50 years or older with neurogenic claudication symptoms (N=46; 24 women, 22 men, mean age=71.26y) were recruited. INTERVENTION Walking stick. MAIN OUTCOME MEASURES Phase 1 of the trial used the Zurich Claudication Questionnaire symptom severity and physical function scores to measure outcome. The total walking distance during a shuttle walking test and the mean lumbar spinal posture (measured by using electronic goniometry) were used as the primary outcome measurements in the second phase. RESULTS Forty of the participants completed phase 1 of the trial, and 40 completed phase 2. No significant differences in symptom severity or physical function were shown in score improvements for walking stick users (stick user scores - control scores) in the 2-week trial (95% confidence interval [CI], -.24 to .28 and -.10 to .26, respectively). In the second phase of the trial, the ratio of the shuttle walking distance with a stick to without a stick showed no significance (95% CI, .959-1.096) between the groups. Furthermore, the use of a walking stick did not systematically promote spinal flexion; no significant difference was shown for mean lumbar spinal flexion for stick use versus no stick (95% CI, .351 degrees -.836 degrees ). CONCLUSIONS The prescription of a walking stick does not improve walking tolerance or systematically alter the postural mechanisms associated with symptoms in neurogenic claudication.

Area-level deprivation and adiposity in children: is the relationship linear?

Objective:It has been suggested that childhood obesity is inversely associated with deprivation, such that the prevalence is higher in more deprived groups. However, comparatively few studies actually use an area-level measure of deprivation, limiting the scope to assess trends in the association with obesity for this indicator. Furthermore, most assume a linear relationship. Therefore, the aim of this study was to investigate associations between area-level deprivation and three measures of adiposity in children: body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR).Design:This is a cross-sectional study in which data were collected on three occasions a year apart (2005–2007).Subjects:Data were available for 13 333 children, typically aged 11–12 years, from 37 schools and 542 lower super-output areas (LSOAs).Measures:Stature, mass and WC. Obesity was defined as a BMI and WC exceeding the 95th centile according to British reference data. WHtR exceeding 0.5 defined obesity. The Index of Multiple Deprivation affecting children (IDACI) was used to determine area-level deprivation.Results:Considerable differences in the prevalence of obesity exist between the three different measures. However, for all measures of adiposity the highest probability of being classified as obese is in the middle of the IDACI range. This relationship is more marked in girls, such that the probability of being obese for girls living in areas at the two extremes of deprivation is around half that at the peak, occurring in the middle.Conclusion:These data confirm the high prevalence of obesity in children and suggest that the relationship between obesity and residential area-level deprivation is not linear. This is contrary to the ‘deprivation theory’ and questions the current understanding and interpretation of the relationship between obesity and deprivation in children. These results could help make informed decisions at the local level.

Comparison of post-treatment effects of conventional and acupuncture-like transcutaneous electrical nerve stimulation (TENS): A randomised placebo-controlled study using cold-induced pain and healthy human participants

TENS can be administered in conventional (high frequency, low intensity) or acupuncture-like (AL-TENS: low frequency, high intensity) formats. It is claimed that AL-TENS produces stronger and longer-lasting hypoalgesia than conventional TENS, although evidence is lacking. This randomised controlled parallel group study compared the effects of 30 minutes of AL-TENS, conventional TENS, and placebo (no current) TENS, on cold-pressor pain threshold (CPT), in 43 healthy participants. Results showed a greater increase in mean loge cold-pressor pain threshold relative to baseline for both AL-TENS and conventional TENS vs. placebo TENS, and for AL-TENS vs. placebo 5 and 15 minutes after TENS was switched off. There were no statistically significant differences between conventional TENS vs. placebo or between AL-TENS vs. conventional TENS at 5 or 15 minutes after TENS was switched off. In conclusion, AL-TENS but not conventional TENS prolonged post-stimulation hypoalgesia compared to placebo TENS. However, no differences between AL-TENS and conventional TENS were detected in head-to-head comparisons.

Conventional versus acupuncture‐like transcutaneous electrical nerve stimulation on cold‐induced pain in healthy human participants: effects during stimulation

Objectives:  To compare the hypoalgesic effects of conventional transcutaneous electrical nerve stimulation (TENS) (high frequency, low intensity) and acupuncture‐like TENS (AL‐TENS, low frequency, high intensity) on cold‐induced pain.

Predictors of the Academic Performance of Teacher Education Students

England and the other in the Republic of Ireland. It seeks to account for the variation in the first-year academic performance on the teacher education course with reference to the students’ prior achievement and how they interpret and approach the demands of the course. It examines differences between the two groups. It is based on a detailed questionnaire survey of all the first-year students in the two colleges in March 1996 and also on information gathered in September–October 1996 to ascertain students’ academic achievement on entry to the course and on completion of the first year.

A Quantitative Comparison of Teacher Education: students’ experiences at two colleges in England and the Republic of Ireland

SUMMARY This paper examines and compares some aspects of the academic and social experiences of first-year teacher education students at two colleges, one in England and the other in the Republic of Ireland. It describes the transition from second level (and, for some, the transition from further education) to third level education and offers an account of the integration of first-year students into the academic and social system of their institution. In comparing the experiences of students in both colleges, we use inferential statistics, thus assuming the legitimacy of inferring differences in the populations from which the samples come. Although we have no reason to believe that the students and colleges in our study are untypical of teacher education students and their respective colleges more generally in England and Ireland, we acknowledge the need for tentativeness in making the leap to the broader population and for further research to explore the national and international comparisons using a wid...