Steven Milanese

School furniture and the user population: an anthropometric perspective

The purpose of this study was to determine the relationship between reported spinal symptoms in an adolescent student population, and the match between their individual anthropometric dimensions and their school furniture. The hypothesis was that students who were too large or too small for their school furniture, i.e. with anthropometric measurements furthest from the group whose anthropometry was the ‘best fit’ with the furniture, would have a higher frequency of reported symptoms. From data collected from 1269 schoolchildren, reported spinal symptoms and anthropometric measures were examined. Stature measures were divided into quartiles. A standard government issue school chair and desk was measured and the anthropometric quartile of the population having the ‘best fit’ with the furniture was identified using standard ergonomics recommendations. Odds ratios were calculated for spinal symptoms reported within each quartile group. The first quartile group (the smallest students) was identified as having the ‘best fit’ with the school furniture. An overall higher odds of reporting low back pain was noted in students with anthropometric dimensions in the fourth quartile (the tallest students). While it is acknowledged that there is a multifactorial nature of causality of adolescent spinal symptoms, it is contended that the degree of mis-match between child anthropometry and school furniture set-up should be further examined as a strong and plausible associate of adolescent low back pain.

Repeated Measures of Recent Headache, Neck and Upper Back Pain in Australian Adolescents:

The epidemiological and clinical literature identifies strong associations between adult headache, cervical and thoracic spine dysfunction and spinal posture. This paper reports on the prevalence and incidence of headache, neck and upper back pain which occurred in the previous week, in urban Australians aged 13–17 years. Commencing in 1999, we followed a cohort of South Australian students through 5 years of secondary schooling. Of our commencing cohort of students, 132 (30±) provided data on bodily pain every year. For both girls and boys, there was a significantly decreasing prevalence of headache over the study period, while neck pain and upper back pain increased. There was a significantly increasing trend over time for boys with upper back pain. Twenty percent of girls and boys consistently reported headache, neck pain or upper back pain over 5 years. The progression of early adolescent headaches to mid-adolescent neck and upper back pain potentially reflects the adolescents’ biomechanical responses to intrinsic and extrinsic imposts. This requires further investigation to understand the causes of adolescent headache, neck and upper thoracic pain.

What is adolescent low back pain? Current definitions used to define the adolescent with low back pain.

Adolescent low back pain (ALBP) is a common form of adolescent morbidity which remains poorly understood. When attempting a meta-analysis of observational studies into ALBP, in an effort to better understand associated risk factors, it is important that the studies involved are homogenic, particularly in terms of the dependent and independent variables. Our preliminary reading highlighted the potential for lack of homogeneity in descriptors used for ALBP. This review identified 39 studies of ALBP prevalence which fulfilled the inclusion criteria, ie, English language, involving adolescents (aged 10 to 19 years), pain localized to lumbar region, and not involving specific subgroups such as athletes and dancers. Descriptions for ALBP used in the literature were categorized into three categories: general ALBP, chronic/recurrent ALBP, and severe/disabling ALBP. Whilst the comparison of period prevalence rates for each category suggest that the three represent different forms of ALBP, it remains unclear whether they represented different stages on a continuum, or represent separate entities. The optimal period prevalence for ALBP recollection depends on the category of ALBP. For general ALBP the optimal period prevalence appears to be up to 12 months, with average lifetime prevalence rates similar to 1-year prevalence rates, suggesting an influence of memory decay on pain recall.

The Anatomy of the Forearm Extensor Muscles and the Fascia in the Lateral Aspect of the Elbow Joint Complex

Aim: This study aimed to address the lack of detailed information on the fascia, and the potentially diverse attachments of the Extensor Carpi Radialis Brevis and Extensor Digitroum Communis on the lateral epicondyle. Methodology: Twenty cadavers were dissected by layers consisting of the skin, subcutaneous fat, superficial fascia, deep fascia, and muscles. Results/Conclusion: The separable attachment of the Extensor Capri Radialis Brevis and Extensor Digitorum Communis on the lateral epicondyle is best described as the Common Extensor Origin. This Common Extensor Origin is formed by the Extensor Digitorum Communis at its superficial portion (approximately 65-75% of the Common Extensor Origin thickness) and by the Extensor Carpi Radialis Brevis at its deepest quarter (approximately 25-35% of the Common Extensor Origin thickness). Distal to the radiocapitellar joint, the proximal bellies of the Extensor Carpi Radialis Brevis and Extensor Digitorum Communis appear tightly attached to the deep fascia. The attachments of lateral intermuscular septum and superficial fascia in the lateral elbow appear to be tight. Clinical relevance: Cadaveric findings on the location of the Extensor Carpi Radialis Brevis and Extensor Digitorum Communis at the lateral elbow may potentially guide the sonologists during diagnostic scan and surgeons during operation in localizing pathological changes within the Common Extensor Origin in the elbow.

The Australian 75+ Health Assessment: could it detect early functional decline better?

OBJECTIVE The aim of the present study was to identify opportunities to improve the reach and impact of the Australian Medicare 75+ Health Assessment (75+HA) to detect early functional decline (FD). METHODS A comparison of two published review articles produced two outputs: (1) assessments identified in the systematic review that underpinned the 75+HA items were ranked for evidence of effectiveness and compared with the volume of research into assessment areas identified by a recent review on indicators of early FD; and (2) items in the 75+HA were compared with those in the recent review. RESULTS The review underpinning the 75+HA found 19 assessment areas, with strongest evidence of effectiveness for vision/hearing, teeth/oral, balance/gait, cognitive and service use. The more recent review reported on six domains (eight subdomains) of FD assessment: physical and cognitive elements of the performance capacity domain were the least well assessed, whereas the most comprehensively assessed domains were health service use, performance capacity (mental subdomain), participation (motivation/volition subdomain) and demographics. The 75+HA addresses only some items related to early FD as identified by the recent literature. CONCLUSION Reassessment of the 75+HA with a view to including current evidence-based assessments for early FD is recommended. Updating the 75+HA items with ways to detect FD earlier may increase its relevance to Australias ageing population.

Extracorporeal shock wave therapy as a treatment for heterotopic ossification

Abstract Background: Extracorporeal shock wave therapy (ESWT) is an intervention treatment in musculoskeletal conditions. Heterotopic ossification (HO) is a painful osseous condition of various origins, with the potential to cause significant incapacity. Objectives: To summarize the published data and assess the effectiveness of ESWT as a therapeutic intervention for patients with HO. Methods: A systematic search of the literature using Medline via Ovid, Scopus, CINAHL, and Web of Science databases. Reference lists of all articles found were also hand-searched. Articles were assessed using the Oxford Centre for Evidence Based Medicine (OCEBM) hierarchy of evidence and were critically appraised using the McMaster Critical Review Form for Quantitative Studies. A meta-analysis of data from four independent case studies totaling 52 HO patients treated with ESWT was performed. Outcome was assessed by pain and range of motion (ROM) of hip and knee flexion, since this was the only recorded movement data in the studies. Data were analyzed with a fixed effects model. Results: Only four articles met the inclusion criteria. Hierarchical evidence scores were low, but the articles scored well on the critical appraisal tool. ESWT led to an improvement in knee flexion by approximately 82% [95% confidence interval (CI): 66·58–96·87; P<0·001] and hip flexion of ∼10% (95% CI: 1·36–20·44; P = 0·086). Approximately 25% of relative improvement in ROM can be attributed to alleviation of pain after ESWT (r2 = 0·25; P = 0·496). Conclusion: ESWT may be associated with clinically significant improvement of ROM of lower extremities in patients with HO although larger studies are needed to confirm these findings.

Radial nerve measurements in nonsymptomatic upper extremities of Filipinos: A cross-sectional study.

Introduction: Despite reports on the association of radial nerve (RN) size and lateral epicondylalgia (LE), Filipino normative values on RN size in healthy elbows are not established. An association with upper extremity anthropometric measurements is likewise not reported. Methods: Musculoskeletal ultrasound measurements of the RN at the level of the lateral epicondyle (RN‐LE), posterior interosseous nerve at the level of the radial head and supinator (PIN‐RH and PIN‐sup), and superficial RN (SRN) in the elbows of healthy Filipinos were made in Manila from January–September 2011. Results: A total of 198 elbows of 99 healthy participants aged 43 years (range, 33–48 years) [median(IQR)] were investigated. Men have larger PIN‐RH, PIN‐sup, and SRN compared with women. Arm length was associated with PIN‐RH, PIN‐sup, and SRN (P < 0.05). Activities and elbow circumference measurements (at 2 levels) were associated with PIN‐RH. Conclusions: RN reference values can now be used for comparison in elbows with LE. Muscle Nerve 52: 568–575, 2015

Association between Lateral Epicondylalgia and Upper Extremity Anthropometric Measurements: A Case Control Study

Objectives: Directional asymmetry is a measure of departure from bilateral symmetry. In the upper extremities, directional asymmetry can be determined by comparing the anthropometric measurements of arm length, elbow circumference and elbow breadth of individuals with and without Lateral epicondylalgia. This study aimed to detect the presence of significant directional asymmetry in the upper extremities of individuals with Lateral epicondylalgia. Methods: Potential case and control participants were recruited from January 2011 to September 2011 in Manila, Philippines. To qualify as a case with Lateral epicondylalgia in the study, participants must have lateral elbow pain on at least one elbow, which was replicated by at least one of the provocation tests (Cozen, Mill or Maudsley test). A single case was ideally matched with two control participants based on gender, age, and occupation. Bilateral arm length, elbow circumference (at the level of the elbow joint, at 5cm above and 5cm below the elbow joint) were measured by the senior physiotherapist. The odds ratio using the using a General Linear Model Univariate Analysis approach was applied to examine the relationship between the differences in the upper extremity anthropometric measurements, diagnosis of LE (case or control) and hand dominance (right or left). Results: 52 individuals with 48 unilateral elbow pain and 4 bilateral elbow pain were eligible for the study. The cases were matched with 99 control participants with 198 non-symptomatic elbows. Hand dominance was found to be significantly associated with elbow circumferential measurements taken at the level of the lateral epicondyle, 5cm above the lateral epicondyle and 5cm below the lateral epicondyle (p 0.05) Conclusion: Arm length, elbow circumference, and elbow breadth were not associated with Lateral epicondylalgia in our sample.

Practices and risks associated with operation of tie-down lashings in the vehicle transport industry

Abstract Load restraint systems in automobile transport utilise tie-down lashings placed over the car’s tyres, which are tensioned manually by the operator using a ratchet assembly. This process has been identified as a significant manual handling injury risk. The aim of this study was to gain insight on the current practices associated with tie-down lashings operation, and identify the gaps between current and optimal practice. We approached this with qualitative and quantitative assessments and one numerical simulation to establish: (i) insight into the factors involved in ratcheting; (ii) the required tension to hold the car on the trailer; and (iii) the tension achieved by drivers in practice and associated joint loads. We identified that the method recommended to the drivers was not used in practice. Drivers instead tensioned the straps to the maximum of their capability, leading to over-tensioning and mechanical overload at the shoulder and elbow. We identified the postures and strategies that resulted in the lowest loads on the upper body during ratcheting (using both hands and performing the task with their full body). This research marks the first step towards the development of a training programme aiming at changing practice to reduce injury risks associated with the operation of tie-down lashings in the automobile transport industry. Practitioner Summary: The study investigated current practice associated with the operation of tie-down lashings through qualitative (interviews) and quantitative (biomechanical analysis) methods. Operators tended to systematically over-tension the lashings and consequently overexert, increasing injury risks.

Evidence‐based practice in sonography – making sense of diagnostic accuracy studies

The first paper in this series explored the general philosophy of evidence‐based practice for sonographers.