Steve Milanese

Epidemiology of adolescent spinal pain : A systematic overview of the research literature

Study Design. Systematic literature review. Objective. To explore the available research literature, and provide an up-to-date synthesis of the epidemiology of idiopathic adolescent spinal pain (IASP). Summary of Background Data. IASP and its potential causes have been a concern to researchers for over 2 decades. Because it has been suggested that IASP is related to the incidence of adult spinal pain, it appears important to synthesize what is currently known about IASP. Method. A systematic meta-synthesis approach was used to identify secondary review articles and primary epidemiological studies regarding any type of IASP (neck, upper back, or low back). Results. A total of 56 primary epidemiological (cross-sectional or longitudinal) studies were identified. Spinal or back pain was the most commonly reported measure, with the lifetime prevalence figures ranging from 4.7% to 74.4%. The lifetime prevalence of low back pain had a similar range, 7% to 72%. The prevalence of pain in other areas of the spine (i.e., thoracic spine and neck) was variably reported, as were incidence rates for all areas of the adolescent spine. IASP is thus a significant problem, and the prevalence figures approach those of adults. There is some evidence that IASP is a risk factor for spinal pain in adulthood. However, there was considerable variation in how back pain was defined, the areas of the spine that were reported on, the manner in which data were collected and reported, thus preventing any significant comparisons of prevalence or incidence rates across studies. Conclusion. Although there is wide discrepancy in the manner in which adolescent spinal pain is reported, it is evident that lifetime prevalence rates increase steadily with age and approximate adult levels by around the age of 18 years. There is an opportunity for further longitudinal research, with standardized methodology, to be undertaken that builds on the findings from this large group of studies.

Extended scope physiotherapy roles for orthopedic outpatients: an update systematic review of the literature

Purpose This systematic review updates one conducted in 2008 into extended scope practice (ESP) in physiotherapy in orthopedics. Methods A comprehensive open-ended search was conducted using electronic library data-bases and Google Scholar to identify any primary study design reporting on physiotherapists working in ESP roles within orthopedic settings. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, although only studies in levels I, II, or III_1 were critically appraised using a purpose-built critical appraisal tool. Information was extracted on the country of origin, ESP tasks, relevant training, patient types, health, process, and cost measures. Results 1071 studies were identified, and twelve were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from II to IV, from which only two diagnostic studies met the criteria for critical appraisal. ESP tasks included injection therapy, removing k-wires, and requesting investigations. The education of ESP physiotherapists varied widely, and included formal and informal training. The positive outcomes of ESP initiatives were reported, in diagnostic ability, reduced costs and waiting times, and improved health outcomes. Conclusion Despite the positive results, the generally low level of evidence and the range of outcome measures reported, constrained clear conclusions regarding the health, process, and cost implications of ESP physiotherapy roles in orthopedic settings. The need for formalized, widely recognized training was highlighted, to give ESP physiotherapy roles credibility.

Measurement of Cervical Posture in the Sagittal Plane

BACKGROUND This article provides a historical perspective and an overview of different ways of measuring sagittal plane cervical posture in clinical and research settings. SPECIAL FEATURES Measures of cervical posture are considered, in terms of their purpose, their reliability and validity, and their capacity to provide knowledge about cervical posture. SUMMARY Despite technological advances in measurement techniques, there is still much to learn about cervical posture in terms of understanding how the neck balances the head against the force of gravity. The individual spinal segments of the neck assume different relative positions, depending on the individuals genetics; anatomical construction; occupational demands; muscle strength and endurance; as well as mental state, personality, and culture. Valid measures which can capture this objectively and reliably continue to challenge clinicians and researchers.

Where Does the Mouse Go? An Investigation into the Placement of a Body-Attached TouchPad Mouse for Wearable Computers

Abstract: We investigated the effects of placement of a TouchPad input device on a user’s body for the control of a wearable computer. This study involved 25 subjects performing selection tasks with a TouchPad mouse while wearing a wearable computer on their back and using a head-mounted display. Each subject performed the tasks in 27 different combinations of four postures (sitting, kneeling, standing and prone) and seven different placements of the TouchPad mouse on the subject’s body (forearm, thigh by 2, torso by 2, and upper arm by 2). We measured the time and error rate to complete the selection of a circular target. The results for the effects due to posture showed that there were similar time effects for sitting, standing and kneeling. When examining the effects resulting from mouse position, the front of the thigh was shown to be the best position of the mouse. When the posturing and mouse position conditions were combined, the results indicated that the thigh front mouse position would be most appropriate for sitting, kneeling and standing postures, and the forearm mouse position would be best for the prone position.

Efficient clinical evaluation of guideline quality: development and testing of a new tool

BackgroundEvaluating the methodological quality of clinical practice guidelines is essential before deciding which ones which could best inform policy or practice. One current method of evaluating clinical guideline quality is the research-focused AGREE II instrument. This uses 23 questions scored 1–7, arranged in six domains, which requires at least two independent testers, and uses a formulaic weighted domain scoring system. Following feedback from time-poor clinicians, policy-makers and managers that this instrument did not suit clinical need, we developed and tested a simpler, shorter, binary scored instrument (the iCAHE Guideline Quality Checklist) designed for single users.MethodsContent and construct validity, inter-tester reliability and clinical utility were tested by comparing the new iCAHE Guideline Quality Checklist with the AGREE II instrument. Firstly the questions and domains in both instruments were compared. Six randomly-selected guidelines on a similar theme were then assessed by three independent testers with different experience in guideline quality assessment, using both instruments. Per guideline, weighted domain and total AGREE II scores were calculated, using the scoring rubric for three testers. Total iCAHE scores were calculated per guideline, per tester. The linear relationship between iCAHE and AGREE II scores was assessed using Pearson r correlation coefficients. Score differences between testers were assessed for the iCAHE Guideline Quality Checklist.ResultsThere were congruent questions in each instrument in four domains (Scope & Purpose, Stakeholder involvement, Underlying evidence/Rigour, Clarity). The iCAHE and AGREE II scores were moderate to strongly correlated for the six guidelines. There was generally good agreement between testers for iCAHE scores, irrespective of their experience. The iCAHE instrument was preferred by all testers, and took significantly less time to administer than the AGREE II instrument. However, the use of only three testers and six guidelines compromised study power, rendering this research as pilot investigations of the psychometric properties of the iCAHE instrument.ConclusionThe iCAHE Guideline Quality Checklist has promising psychometric properties and clinical utility.

Number and frequency of physiotherapy services for motor vehicle-induced whiplash: interrogating motor accident insurance data 2006-2009.

OBJECTIVE Whilst prognostic factors for recovery from whiplash associated disorders have been documented, factors related to high physiotherapy use are not well recognized. This study profiles predictors for high use of physiotherapy services from a large dataset from an Australian state insurer for motor vehicle accidents. METHOD A dataset of Motor Accident Commission claims in South Australia for whiplash associated disorders (2006-2009) was interrogated. RESULTS The median number of physiotherapy services per claimant was 15 (range: 1-194). The typical high user of physiotherapy was female, aged 25-59 years, living in a high socio-economic area, with legal representation, who delayed obtaining physiotherapy for at least 28 days after the accident. The largest mean number of days between treatments (5.4 days) in the first 5 treatments related to the lowest subsequent use of physiotherapy services. CONCLUSION This represents the first review of physio-therapy service use based on an insurance dataset. A range of factors were related to high use of physiotherapy services. It is hoped that identifying the mean number and spread of physiotherapy interventions for whiplash associated disorders, and the profile of high users of physiotherapy will help gauge the success of strategies to maximize the efficacy of physiotherapy management of whiplash associated disorders.

Is a blended learning approach effective for learning in allied health clinicians

Abstract Background: An increase in demand for professional development activities amongst the allied health workforce has seen the emergence of new technology-based training delivery methods. Blended learning, involving a combination of the traditional face-to-face teaching with the use of e-learning, is one emerging approach to the provision of professional development activities in allied health. Objectives: This systematic review investigated the questions: ‘What is the effect on learning of a blended learning model of training delivery method for allied health clinicians?’ and, ‘From the perspective of stakeholders, what are the advantages, disadvantages and recommendations for successful implementation of a blended learning model of training delivery method for allied health clinicians?’ Methods: Eighteen databases were searched from inception. Only English language publications describing quantitative research (systematic reviews or primary quantitative studies) were included. All studies were appraised using the CASP critical appraisal tool (CAT) for Systematic Reviews and the McMaster CAT for Quantitative studies. Results: Four Systematic Reviews and 14 primary studies describing quantitative data were included. The literature indicates that there was weak evidence regarding improved outcomes from blended learning interventions, compared with other educational models. Conclusions: Whilst blended learning has advantages in terms of flexibility of learning, and economies of scale, there is no ‘one size fits all’ approach to optimizing the learning outcomes, no matter what the teaching and learning environment. A range of strategies for the effective provision of blended learning activities from the literature is provided.

University woodwind students’ experiences with playing-related injuries and their management: a pilot study

Background This study aimed to determine the experiences of university classical woodwind students with playing-related injuries (PRIs), the impact of these PRIs, the management selected by students with PRIs, and the perceived effectiveness of this management. Materials and methods All classical woodwind students enrolled in vocational education training or undergraduate courses at a university were sent an email with a link to an online survey. Only those aged 18 years and older were eligible. The survey obtained data regarding demographic information, details of PRI experienced (location, if they lasted for more than 3 months, and if they were current), and the impact of these, as well as the types of management strategies tried and their perceived effectiveness. Data were analyzed using descriptive statistics, and comments were reported descriptively. Results Fourteen students returned the survey; however, one of these only completed the questions regarding demographics, and was therefore excluded. A total of 62% of participants reported having experienced a PRI. Common locations for PRI were the wrist/hand/fingers, lower back, and neck. Reducing practice time by half and missing playing commitments were the most commonly reported consequences of PRIs. Playing-related management strategies were most frequently trialed, with these and passive nonplaying-related strategies perceived to be the most effective. Conclusion PRIs are common in this population, with a range of consequences reported. While it is encouraging that students had tried and found effective playing-related management strategies, active nonplaying-related strategies should be encouraged, particularly in preference to passive nonplaying-related strategies. This was a small-scale study, and the results are only applicable to the institution investigated; therefore, similar larger-scale studies are recommended to determine the generalizability of these findings.

Effectiveness of Stretching on Posterior Shoulder Tightness and Glenohumeral Internal Rotation Deficit: A Systematic Review of Randomised Controlled Trials

CONTEXT Posterior shoulder tightness (PST) and glenohumeral internal-rotation deficit (GIRD) can contribute to shoulder pain suffered by athletes engaged in overhead sporting activities. Stretching is a common intervention to resolve PST and GIRD, but it has weak evidence of effectiveness to date. OBJECTIVE This systematic review aimed to collect and synthesize effectiveness data from English- and Japanese-language randomized controlled trials (RCTs) investigating stretching interventions for PST and GIRD. EVIDENCE ACQUISITION 7 English databases and 3 Japanese databases were searched from inception until December 5, 2015. Only English- and Japanese-language RCTs were considered. Risk of bias in the included studies was assessed using the Physiotherapy Evidence Database scale. Data were synthesized qualitatively. EVIDENCE SYNTHESIS Eight English-language and 2 Japanese-language papers of low to high quality were included. There was moderate evidence for positive immediate and short-term effects of cross-body stretch on PST and GIRD in asymptomatic young subjects. Moderate evidence was found to suggest that active sleeper stretch might not be more effective than no intervention to improve PST and GIRD in the short term. CONCLUSIONS Cross-body stretch can be effective to improve PST and GIRD in asymptomatic young subjects immediately or in the short term. Further study with methodological rigor is necessary to investigate the long-term effectiveness of stretching interventions on PST and GIRD in symptomatic patients.

The prevalence and incidence of musculoskeletal symptoms experienced by flautists

BACKGROUND Musculoskeletal symptoms are reportedly common among musicians. Flautists may be at high risk of symptoms, due to their asymmetrical playing posture. AIMS To determine the prevalence and incidence of musculoskeletal symptoms among flautists. METHODS A systematic search of four databases, with reference and citation lists of included studies, screened for additional studies. Included studies were assigned to the Oxford Centre for Evidence-based Medicine levels of evidence and critical appraisal was performed using a previously published tool. Data extracted included the country, sample size, data collection methods, response rates, sample demographics and data pertaining to the prevalence or incidence of musculoskeletal symptoms among flautists. RESULTS Seven studies (evidence levels 1 and 3) were included. These were at moderate to high risk of bias. There was wide variation in the populations and the types of musculoskeletal symptoms investigated. Lifetime prevalence of any musculoskeletal symptoms of any duration varied from 15 to 95% depending on the populations and symptoms investigated. In schoolchildren, this was as high as 79%, and 95% in university students. The upper extremities were most commonly affected, with minimal differences in the prevalence of symptoms between right and left sides. Due to the differences in the types of data collected, different groups of flautists could not be directly compared. CONCLUSIONS The lack of studies with high evidence levels and low risk of bias in this area precludes a clear understanding of the prevalence and location of musculoskeletal symptoms in flautists, although current evidence suggests that the prevalence is high.