Wayne Hing

International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy intervention

A consensus clinical reasoning framework for best practice for the examination of the cervical spine region has been developed through an iterative consultative process with experts and manual physical therapy organisations. The framework was approved by the 22 member countries of the International Federation of Orthopaedic Manipulative Physical Therapists (October 2012). The purpose of the framework is to provide guidance to clinicians for the assessment of the cervical region for potential of Cervical Arterial Dysfunction in advance of planned management (inclusive of manual therapy and exercise interventions). The best, most recent scientific evidence is combined with international expert opinion, and is presented with the intention to be informative, but not prescriptive; and therefore as an aid to the clinicians clinical reasoning. Important underlying principles of the framework are that 1] although presentations and adverse events of Cervical Arterial Dysfunction are rare, it is a potentially serious condition and needs to be considered in musculoskeletal assessment; 2] manual therapists cannot rely on the results of one clinical test to draw conclusions as to the presence or risk of Cervical Arterial Dysfunction; and 3] a clinically reasoned understanding of the patients presentation, including a risk:benefit analysis, following an informed, planned and individualised assessment, is essential for recognition of this condition and for safe manual therapy practice in the cervical region. Clinicians should also be cognisant of jurisdictionally specific requirements and obligations, particularly related to patient informed consent, when intending to use manual therapy in the cervical region.

Mulligan's Mobilization with Movement: A Systematic Review

Abstract Mulligans manual therapy technique at peripheral joints, namely mobilization with movement (MWM), has been well documented in research. The efficacy of MWM has been established in the treatment of joint dysfunction and various pathologies. The purpose of this systematic review was to critically evaluate the literature regarding MWM at peripheral joints and determine the overall efficacy related to MWM prescription. Electronic databases (Cinahl, Medline and Amed via Ovid, Pubmed and Medline via Ebsco Health Databases, Cochrane via Wiley and PEDro) were searched up to August 2008 with no date restriction to identify all studies pertaining to MWM at peripheral joints. The keywords used were mobilisation with movement* OR mobilization with movement* OR MWM*; manual therapy AND (mobilisation* OR mobilization); mulligan mobilisation* OR mulligan mobilization*. Two researchers independently reviewed all papers and crossexamined reference lists for further potential studies. Methodological quality was assessed using the Downs and Black checklist, and tables were compiled to determine study characteristics. Twenty-one studies, which have investigated MWM at peripheral joints, were included for analysis. This review highlights that there is an overall moderate level of methodological quality (mean = 15 (/28), SD ± 4.54, range = 4—23 /28). The efficacy of MWM at peripheral joints is well established for various joints and pathologies with 24 out of 25 studies (96%) demonstrating positive effects. It would be advisable that future research have more robust methodology and investigate and/or implement all necessary established parameters of MWM prescription.

Perceived Benefits, Motives, and Barriers to Aqua-based Exercise Among Older Adults With and Without Osteoarthritis

This study aimed to (a) identify factors that motivate older adults to participate in aqua-based exercise; (b) identify potential barriers; and (c) compare perceptions between older adults with and without osteoarthritis (OA). Fifteen adults above 60 years of age participated in one of three focus groups during which they discussed perceived benefits, motives, and barriers to aqua exercise. Pain reduction was considered a major benefit among those with OA, improved health and fitness was a principal benefit for those without OA. All participants felt that the instructor could act as both a motivator and barrier; the most significant barrier was cold changing facilities in winter. With the exception of pain reduction, perceived benefits, motivators, and barriers to aqua-based exercise are similar among older adults with and without OA. A greater understanding of these factors may help us to facilitate older adults with OA to initiate and adhere to aqua-based exercise.

Acute Injuries in Recreational and Competitive Surfers Incidence, Severity, Location, Type, and Mechanism

Background: There are an estimated 37 million surfers worldwide, with 2.5 million recreational surfers in Australia. The recreational activity and sport of surfing has grown dramatically since the 1960s, but scientific research has been poorly mirrored in comparison with most other mainstream sports. Purpose: To identify the incidence, severity, location, type, and mechanism of acute injuries in recreational and competitive surfers over a 12-month period. Study Design: Descriptive epidemiology study. Methods: An online survey using an open-source survey application was utilized. The survey consisted of 2 primary sections: Section 1 included demographic information and participation levels (age, height, weight, hours surfed, competitive level); section 2 incorporated injury type, mechanism, severity, and injury management. Results: A total of 1348 participants (91.3% males; 43.1% competitive surfers) were included in data analysis. A total of 512 acute injuries were classified as major, providing an incidence proportion of 0.38 (CI, 0.35-0.41) acute injuries per year. The incidence rate was calculated to be 1.79 (CI, 1.67-1.92) major injuries per 1000 hours of surfing. The shoulder, ankle, and head/face regions had the highest frequencies of acute injury, representing 16.4%, 14.6%, and 13.3%, respectively. Injuries were predominantly of muscular, joint, and skin origin, representing 30.3%, 27.7%, and 18.9%, respectively. Skin injuries were primarily a result of direct trauma, while joint and muscular injuries were mainly a result of maneuvers performed and repetitive actions. Key risk factors that increased the incidence of sustaining an acute injury included competitive status, hours surfed (>6.5 hours/week), and the ability to perform aerial maneuvers. The incidence proportion for surfers completing aerial maneuvers was calculated to be 0.48 (CI, 0.39-0.58) major injuries per year, this being the highest incidence proportion irrespective of competitive status. Conclusion: This is the largest surfing-specific survey that included both recreational and competitive surfers conducted in Australia to date. The shoulder, ankle, head, and face were identified as the key regions where acute injuries occur in surfers. This research may aid in reducing the occurrence of injury through musculoskeletal screening in these key injury-prone regions and through the use of sport-specific strength training and conditioning.

Interexaminer Reliability of Symptom-Provoking Active Sidebend, Rotation and Combined Movement Assessments of Patients with Low Back Pain

Abstract Symptom-provoking active movements can be useful assessments of patients with low back pain. They may give an early indication of the likelihood of chronicity and can also assist the clinician in selecting treatment interventions. Reliability data for such movements is incomplete. While symptom-provoking flexion and extension movements have consistently shown acceptable reliability and results for sidebend tests have suggested moderate reliability, results for symptom-provoking active rotation are variable and only one study has investigated the reliability of combined movements. The purpose of this study was to further investigate the interexaminer reliability of symptom-provoking active sidebend, rotation and combined movement assessments. Symptom-provoking movements were identified on the basis of aggravation or reproduction of the patients pain complaint, that is, the symptoms for which the patient was seeking treatment. Pairs of therapists from a pool of four therapists independently examined patients with low back pain during a routine clinic visit. Percent agreement and Kappa values (95% Confidence Interval) for the movement assessments were sidebend 81.4% and 0.60 (0.40; 0.79), rotation 70% and 0.17 (−0.08; 0.42), sidebend-rotation 64.3% and 0.29 (0.06; 0.51), flexion-sidebend-rotation 70% and 0.39 (0.18; 0.61), and extension-sidebend-rotation 67.1% and 0.29 (0.06; 0.52). The majority of schemes described for the physical examination of patients with low back pain include symptom-provoking active sidebend, and findings from this study support the ongoing clinical use of this assessment. While symptom-provoking active rotation and combined movements were found to be unreliable, these assessments have been shown to have potential diagnostic value. Further research is warranted to investigate procedural changes that may improve reliability and to further investigate their diagnostic accuracy.

Comparative effects of 2 aqua exercise programs on physical function, balance, and perceived quality of life in older adults with osteoarthritis

Background:Osteoarthritis (OA) is a degenerative joint disease, which affects a large number of older adults. Many older adults with OA are physically inactive, which can contribute to reduced functional capability, quality of life, and an increased risk of falls. Although hydrotherapy is often recommended for older adults with OA, less is known about aqua fitness (AF), a widely available form of aqua-based exercise. Purpose:To compare the effect of an AF program and a seated aqua-based exercise program on a range of functional measures and quality of life among older adults with OA. Methods:Thirty-five older adults with OA were allocated to an AF group or an active control group who performed seated exercises in warm water for 12 weeks. The primary outcome measure was the timed up-and-go (TUG) test; other measures included step test, sit-to-stand (STS) test, handgrip strength test, 400-m walk test, Arthritis Impact Measurement Scale-Short Form (AIMS2-SF), and Falls Efficacy Scale-International (FES-I). Results:FES-I scores improved significantly in the AF group compared with the control group (P = 0.04). Within-group analysis indicated both groups significantly improved their 400-m walk time (P = 0.04) and that the AF group significantly improved its step test right (P = 0.02) and left (P = 0.00) and the AIMS2-SF total score (P = 0.02). No significant change in TUG, STS, or handgrip strength was observed for either group. Conclusions:Aqua fitness may offer a number of positive functional and psychosocial benefits for older adults with OA, such as a reduced fear of falling and increased ability to perform everyday tasks.

High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: a systematic review and meta-analysis

Background Aerobic capacity has been shown to be inversely proportionate to cardiovascular mortality and morbidity and there is growing evidence that high-intensity interval training (HIIT) appears to be more effective than moderate-intensity continuous training (MICT) in improving cardiorespiratory fitness within the cardiac population. Previously published systematic reviews in cardiovascular disease have neither investigated the effect that the number of weeks of intervention has on cardiorespiratory fitness changes, nor have adverse events been collated. Objective We aimed to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) within the cardiac population that investigated cardiorespiratory fitness changes resulting from HIIT versus MICT and to collate adverse events. Methods A critical narrative synthesis and meta-analysis was conducted after systematically searching relevant databases up to July 2017. We searched for RCTs that compared cardiorespiratory fitness changes resulting from HIIT versus MICT interventions within the cardiac population. Results Seventeen studies, involving 953 participants (465 for HIIT and 488 for MICT) were included in the analysis. HIIT was significantly superior to MICT in improving cardiorespiratory fitness overall (SMD 0.34 mL/kg/min; 95% confidence interval [CI; 0.2–0.48]; p<0.00001; I2=28%). There were no deaths or cardiac events requiring hospitalization reported in any study during training. Overall, there were more adverse events reported as a result of the MICT (n=14) intervention than the HIIT intervention (n=9). However, some adverse events (n=5) were not classified by intervention group. Conclusion HIIT is superior to MICT in improving cardiorespiratory fitness in participants of cardiac rehabilitation (CR). Improvements in cardiorespiratory fitness are significant for CR programs of >6-week duration. Programs of 7–12 weeks’ duration resulted in the largest improvements in cardiorespiratory fitness for patients with coronary artery disease. HIIT appears to be as safe as MICT for CR participants.

Profiling the sport of stand-up paddle boarding

Abstract Stand-up paddle boarding (SUP) is a rapidly growing activity where only anecdotal evidence exists for its proposed health and fitness benefits. The purpose of this study was to profile elite and recreational SUP with respect to anthropometric, physiological and musculoskeletal measurements. A total of 30 SUP participants (15 recreational, 15 elite) and 15 sedentary controls participated in this study. Elite and recreational (rec) SUP participants had significantly lower body fat than sedentary (sed) individuals, elite had significantly higher HDL and significantly lower triglycerides than other groups during lipid profiling (P > 0.05). There were significant differences (P > 0.05) between all groups in maximal oxygen uptake (elite 43.7, s = 5.89 ml · kg–1 · min–1 vs. rec 31.9, s = 7.7 ml · kg–1 · min–1 vs. sed 20.4, s = 3.7 ml · kg–1 · min–1) and anaerobic power outputs (35.7, s = 11.1 W vs. 25.0, s = 11.7 W vs. 13.5, s = 7.1 W). The elite group displayed significantly longer endurance than the recreational and sedentary group in the prone bridge (elite 253.4, s = 67.6 s vs. rec 165.6, s = 42.2 s vs. sed 69.7, s = 31.2 s), right-sided bridge (elite 107.9, s = 34.0 s vs. recreational 68.2, s = 24.1 s vs. sed 34.6, s = 15.5 s), left-sided bridge (elite 99.8, s = 24.9 s vs. rec 68.2, s = 27.2 s vs. sed 32.5, s = 15.2 s) and Biering Sorensen test (elite 148.8, s = 35.4 s vs. rec 127.2, s = 43.2 s vs. sed 71.1, s = 32.9 s). Elite SUP had significantly better static and dynamic postural control when compared to the other groups. This study demonstrates the anthropometric, physiological and musculoskeletal values representative of elite and recreational SUP. SUP appears to be associated with increased levels of aerobic and anaerobic fitness, increased static and dynamic balance and a high level of isometric trunk endurance.

Assessment of shoulder active range of motion in prone versus supine: a reliability and concurrent validity study

Abstract Background: As swimming and surfing are prone dominant sports, it would be more sport specific to assess shoulder active range of motion in this position. Objectives: To determine the reliability of the inclinometer and HALO© for assessing shoulder active range of motion in supine and prone and the concurrent validity of the HALO©. Concurrent validity is based on the comparison of the HALO© and inclinometer. To determine if active range of motion (AROM) differences exists between prone and supine when assessing shoulder internal (IR) and external rotation (ER). Design: The design included clinical measurement, reliability and validity. Methods: Thirty shoulders (mean age = 26.8 years) without pathology were evaluated. Measurements were taken in supine and prone with both an inclinometer and HALO© device. Results: Active ER ROM in prone was significantly higher than in supine when using both devices. Intra-rater reliability (within and between session) intraclass correlation coefficient (ICC) values ranged between 0.82–0.99 for both devices in supine and prone. An ICC test revealed a significant (p < 0.01) correlation for both devices in IR and ER movements (ICC3,1 = 0.87 and ICC3,1 = 0.72), respectively. Conclusion: This study has shown prone assessment of active ER and IR ROM to be a reliable and appropriate method for prone dominant athletes (swimmers and surfers). In this study greater ER ROM was achieved in prone compared to supine. This finding highlights the importance of standardizing the test position for initial and follow up assessments. Furthermore the HALO© and inclinometer have been shown to be reliable tools that show good concurrent validity.

Do coursework summative assessments predict clinical performance? A systematic review

BackgroundTwo goals of summative assessment in health profession education programs are to ensure the robustness of high stakes decisions such as progression and licensing, and predict future performance. This systematic and critical review aims to investigate the ability of specific modes of summative assessment to predict the clinical performance of health profession education students.MethodsPubMed, CINAHL, SPORTDiscus, ERIC and EMBASE databases were searched using key terms with articles collected subjected to dedicated inclusion criteria. Rigorous exclusion criteria were applied to ensure a consistent interpretation of ‘summative assessment’ and ‘clinical performance’. Data were extracted using a pre-determined format and papers were critically appraised by two independent reviewers using a modified Downs and Black checklist with level of agreement between reviewers determined through a Kappa analysis.ResultsOf the 4783 studies retrieved from the search strategy, 18 studies were included in the final review. Twelve were from the medical profession and there was one from each of physiotherapy, pharmacy, dietetics, speech pathology, dentistry and dental hygiene. Objective Structured Clinical Examinations featured in 15 papers, written assessments in four and problem based learning evaluations, case based learning evaluations and student portfolios each featured in one paper. Sixteen different measures of clinical performance were used. Two papers were identified as ‘poor’ quality and the remainder categorised as ‘fair’ with an almost perfect (k = 0.852) level of agreement between raters. Objective Structured Clinical Examination scores accounted for 1.4–39.7% of the variance in student performance; multiple choice/extended matching questions and short answer written examinations accounted for 3.2–29.2%; problem based or case based learning evaluations accounted for 4.4–16.6%; and student portfolios accounted for 12.1%.ConclusionsObjective structured clinical examinations and written examinations consisting of multiple choice/extended matching questions and short answer questions do have significant relationships with the clinical performance of health professional students. However, caution should be applied if using these assessments as predictive measures for clinical performance due to a small body of evidence and large variations in the predictive strength of the relationships identified. Based on the current evidence, the Objective Structured Clinical Examination may be the most appropriate summative assessment for educators to use to identify students that may be at risk of poor performance in a clinical workplace environment. Further research on this topic is needed to improve the strength of the predictive relationship.