ORCID Profile
0000-0003-3924-9375
Current Organisations
Brigham Young University
,
Deakin University
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Publisher: Springer Science and Business Media LLC
Date: 17-09-2022
DOI: 10.1007/S00586-022-07378-6
Abstract: Examine the effectiveness of interventions to approach guideline-adherent surgical referrals for low back pain assessed via systematic review and meta-analysis. Five databases (10 September 2021), Google Scholar, reference lists of relevant systematic reviews were searched and forward and backward citation tracking of included studies were implemented. Randomised controlled/clinical trials in adults with low back pain of interventions to optimise surgery rates or referrals to surgery or secondary referral were included. Bias was assessed using the Cochrane ROB2 tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random effects meta-analysis with a Paule Mandel estimator plus Hartung–Knapp–Sidik–Jonkman method was used to calculate the odds ratio and 95% confidence interval, respectively. Of 886 records, 6 studies were included ( N = 258,329) participants cluster sizes ranged from 4 to 54. Five studies were rated as low risk of bias and one as having some concerns. Two studies reporting spine surgery referral or rates could only be pooled via combination of p values and gave evidence for a reduction ( p = 0.021, Fisher’s method, risk of bias: low). This did not persist with sensitivity analysis ( p = 0.053). For secondary referral, meta-analysis revealed a non-significant odds ratio of 1.07 (95% CI [0.55, 2.06], I 2 = 73.0%, n = 4 studies, Grading of Recommendations Assessment, Development and Evaluation [GRADE] evidence certainty: very low). Few RCTs exist for interventions to improve guideline-adherent spine surgery rates or referral. Clinician education in isolation may not be effective. Future RCTs should consider organisational and/or policy level interventions. CRD42020215137.
Publisher: Center for Open Science
Date: 18-09-2018
Abstract: Introduction: Prostate cancer (PCa) is one of the most frequently diagnosed male cancers worldwide. One treatment, androgen deprivation therapy (ADT), is often accompanied with a myriad of adverse effects, including those that negatively impact muscle, fat and performance outcomes. Therefore, ADT-treated men may be living longer, but are at risk of both age- and treatment-related complications. The overall aim of this thesis was to quantify outcomes of muscle, fat and performance in men treated with ADT when compared to PCa (men diagnosed with PCa, not treated with ADT) and healthy controls (men not diagnosed with PCa), and assess the feasibility of implementing a multi-component exercise program combined with protein, calcium and vitamin D supplementation (Ex+ProCaD) compared to usual care in ADT-treated men. Methods: This thesis presents two studies that form part of a larger 52-week randomised controlled trial (RCT), which examined the efficacy of Ex+ProCaD compared to usual care in men treated with ADT for PCa. The first study presented was a nested cross-sectional study performed parallel to the baseline assessment of the RCT and examined differences in muscle, fat and performance outcomes between men treated with ADT when compared to PCa and healthy controls. The second study presented examined the feasibility of implementing the first 26 weeks of the RCT. Results: The cross-sectional study showed that height, weight, body mass index and diet were similar between the three groups, but ADT-treated men were four years older and tended to be less physically active (23-30% P=0.054). After adjusting for age and physical activity, total body fat mass was 3.3-5.0 kg (P & 0.05) greater in men treated with ADT compared to PCa controls, but there was no difference in total body and regional lean mass. When adiposity was considered, ADT-treated men had 10-12% (P & 0.05) lower appendicular lean mass adjusted for body mass index and 5.6-6.4% (P & 0.05) lower forearm percent muscle cross-sectional area compared to controls. Absolute muscle strength was similar between groups, but when expressed relative to body weight, men treated with ADT had 13-21% (P & 0.05) lower muscle strength compared to controls. Whilst only two ADT-treated men had sarcopenia, these men had a higher proportion (P & 0.001) of pre-sarcopenia when appendicular lean mass was adjusted for body mass index (42%) compared to PCa (15%) and healthy (7%) controls. Men treated with ADT had 15-36% (P & 0.05) greater storage of fat within subcutaneous depots when compared to controls, whereas visceral and intermuscular fat was similar. The majority of subcutaneous fat depots (excluding android region) were shown to be positively associated with ADT duration (P & 0.05). Forearm muscle density was shown to negatively correlate with ADT duration (P & 0.05). The RCT had a high participant retention rate (96%). Adherence was high for the supplement (mean, 92-93%) and modest for the exercise program (mean, 60%). A relatively high proportion (81%) of men in the intervention group reported an adverse event, although only 16% were confirmed to be related to the intervention and the vast majority (97%) were determined to be mild or moderate in terms of severity. Across the ten separate recruitment pathways considered, clinician referral (43%) and PCa support groups (29%) yielded the greatest proportion of enrolled participants. A total of 149 potential participants were screened, which resulted in 42 participants at the time of write up for this thesis. Among the first 28 participants to complete the 26-week intervention, 21-50% were unable to complete at least one measure of muscle strength due to pre-existing comorbidities. Data from the initial 28 participants tended to show that when compared to usual care, Ex+ProCaD led to net improvements in lean mass (0.2-1.4 kg), fat mass (-0.1 to -0.9 kg), muscle strength (8.0-19%), functional muscle power (8.6%) and functional capacity (12-14%). Conclusions: The following key themes emerged from this thesis and may be used to guide clinical practice guidelines and future research: 1) Men treated with ADT for PCa had greater amounts of fat when compared to non-ADT counterparts, 2) Current definitions of sarcopenia and sarcopenic obesity were limited in men treated with ADT for PCa, 3) The greater amounts of fat observed in men treated with ADT for PCa tended to be stored in subcutaneous depots and supersede age-related plateaus/losses, 4) The recruitment of men treated with ADT for PCa into a lifestyle intervention was challenging, and 5) Men treated with ADT for PCa tended to respond positively to a multi-modal exercise training combined with multi-nutrient supplementation.
Publisher: Wiley
Date: 08-2018
DOI: 10.1111/BJU.14473
Publisher: BMJ
Date: 09-2019
DOI: 10.1136/BMJSEM-2019-000556
Abstract: The transversus abdominis muscle (TrA) is active during running as a secondary respiratory muscle and acts, together with the multifidus, as trunk stabiliser. The purpose of this study was to determine size and symmetry of TrA and multifidus muscles at rest and with contraction in endurance runners without low back pain. Cross-sectional study. A medical imaging centre in Melbourne, Australia. Thirty middle-aged (43years±7) endurance-trained male (n=18) and female (n=12) runners without current or history of low back pain. MRI at rest and with the core engaged. The TrA and multifidus muscles were measured for thickness and length (TrA) and anteroposterior and mediolateral thickness (multifidus). Muscle activation was extrapolated from rest to contraction and compared with the same and contralateral side. Paired t-tests were performed to compare sides and contraction status. Left and right TrA and multifidus demonstrated similar parameters at rest (p .05). However, with contraction, the right TrA and multifidus (in mediolateral direction) were 9.2% (p=0.038) and 42% (p .001) thicker, respectively, than their counterparts on the left. There was no TrA thickness side difference with contraction in left-handed participants (p=0.985). When stratified by sex, the contracted TrA on the right side remained 8.4% thicker, but it was no longer statistically significant (p=0.134). The side difference with contraction of the TrA became less with increasing training age. Right-handed long-term runners without low back pain exhibit a greater right side core muscle activation when performing an isometric contraction. This activation preference diminishes with increasing training age.
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJSEM-2022-001343
Abstract: Muscle function may be impaired in people with generalised hypermobility, yet prior studies have primarily focused on muscles within the extremities. We aimed to examine changes in lateral abdominal muscle (transversus abdominis (TrA) and the external (EO) and internal abdominal obliques (IO)) thickness and length during contraction between participants with and without hypermobility. This cross-sectional study examined 12 participants with hypermobility and 12 age-matched, sex-matched, height-matched and weight-matched participants without hypermobility. The Beighton and Belavy-Owen-Mitchell score assessed systemic hypermobility. Muscle thickness and length were measured via panoramic ultrasound scans at rest and during contraction. When compared with rest across all lumbar levels (L1–L5), contraction produced a lesser increase in TrA thickness (β=0.03, p=0.034) for participants with hypermobility compared with control. No group-by-condition interaction was observed for TrA length across all lumbar levels (L1–L5 p=0.269). Contraction produced a greater decrease in EO thickness (β=0.08, p=0.002) at L3 only for participants with hypermobility compared with control. No group-by-condition interactions were observed for IO thickness. Participants with hypermobility had partially impaired lateral abdominal muscle function given a lesser ability to increase TrA muscle thickness during contraction compared with controls.
Publisher: MDPI AG
Date: 12-06-2020
DOI: 10.3390/JCM9061841
Abstract: (1) Background: Assessments of intervertebral disc (IVD) changes, and IVD tissue adaptations due to physical activity, for ex le, remains challenging. Newer magnetic resonance imaging techniques can quantify detailed features of the IVD, where T2-mapping and T2-weighted (T2w) and Dixon imaging are potential candidates. Yet, their relative utility has not been examined. The performances of these techniques were investigated to characterize IVD differences in asymptomatic in iduals with distinct physical activity histories. (2) Methods: In total, 101 participants (54 women) aged 25–35 years with distinct physical activity histories but without histories of spinal disease were included. T11/12 to L5/S1 IVDs were examined with sagittal T2-mapping, T2w and Dixon imaging. (3) Results: T2-mapping differentiated Pfirrmann grade-1 from all other grades (p 0.001). Most importantly, T2-mapping was able to characterize IVD differences in in iduals with different training histories (p 0.005). Dixon displayed weak correlations with the Pfirrmann scale, but presented significantly higher water content in the IVDs of the long-distance runners (p 0.005). (4) Conclusions: Findings suggested that T2-mapping best reflects IVD differences in asymptomatic in iduals with distinct physical activity histories changes. Dixon characterized new aspects of IVD, probably associated with IVD hypertrophy. This complementary information may help us to better understand the biological function of the disc.
Publisher: MDPI AG
Date: 03-06-2020
DOI: 10.3390/JCM9061726
Abstract: Exercise and spinal manipulative therapy are commonly used for the treatment of chronic low back pain (CLBP) in Australia. Reduction in pain intensity is a common outcome however, it is only one measure of intervention efficacy in clinical practice. Therefore, we evaluated the effectiveness of two common clinical interventions on physical and self-report measures in CLBP. Participants were randomized to a 6-month intervention of general strength and conditioning (GSC n = 20 up to 52 sessions) or motor control exercise plus manual therapy (MCMT n = 20 up to 12 sessions). Pain intensity was measured at baseline and fortnightly throughout the intervention. Trunk extension and flexion endurance, leg muscle strength and endurance, paraspinal muscle volume, cardio-respiratory fitness and self-report measures of kinesiophobia, disability and quality of life were assessed at baseline and 3- and 6-month follow-up. Pain intensity differed favoring MCMT between-groups at week 14 and 16 of treatment (both, p = 0.003), but not at 6-month follow-up. Both GSC (mean change (95%CI): −10.7 (−18.7, −2.8) mm p = 0.008) and MCMT (−19.2 (−28.1, −10.3) mm p 0.001) had within-group reductions in pain intensity at six months, but did not achieve clinically meaningful thresholds (20mm) within- or between-group. At 6-month follow-up, GSC increased trunk extension (mean difference (95% CI): 81.8 (34.8, 128.8) s p = 0.004) and flexion endurance (51.5 (20.5, 82.6) s p = 0.004), as well as leg muscle strength (24.7 (3.4, 46.0) kg p = 0.001) and endurance (9.1 (1.7, 16.4) reps p = 0.015) compared to MCMT. GSC reduced disability (−5.7 (−11.2, −0.2) pts p = 0.041) and kinesiophobia (−6.6 (−9.9, −3.2) pts p 0.001) compared to MCMT at 6-month follow-up. Multifidus volume increased within-group for GSC (p = 0.003), but not MCMT or between-groups. No other between-group changes were observed at six months. Overall, GSC improved trunk endurance, leg muscle strength and endurance, self-report disability and kinesiophobia compared to MCMT at six months. These results show that GSC may provide a more erse range of treatment effects compared to MCMT.
Publisher: American Society of Neuroradiology (ASNR)
Date: 08-10-2020
DOI: 10.3174/AJNR.A6791
Publisher: Public Library of Science (PLoS)
Date: 21-02-2020
Publisher: Springer Science and Business Media LLC
Date: 09-07-2020
DOI: 10.1038/S41746-020-0303-X
Abstract: Artificial intelligence and machine learning (AI/ML) could enhance the ability to detect patterns of clinical characteristics in low-back pain (LBP) and guide treatment. We conducted three systematic reviews to address the following aims: (a) review the status of AI/ML research in LBP, (b) compare its status to that of two established LBP classification systems (STarT Back, McKenzie). AI/ML in LBP is in its infancy: 45 of 48 studies assessed s le sizes people, 19 of 48 studies used ≤5 parameters in models, 13 of 48 studies applied multiple models and attained high accuracy, 25 of 48 studies assessed the binary classification of LBP versus no-LBP only. Beyond the 48 studies using AI/ML for LBP classification, no studies examined use of AI/ML in prognosis prediction of specific sub-groups, and AI/ML techniques are yet to be implemented in guiding LBP treatment. In contrast, the STarT Back tool has been assessed for internal consistency, test−retest reliability, validity, pain and disability prognosis, and influence on pain and disability treatment outcomes. McKenzie has been assessed for inter- and intra-tester reliability, prognosis, and impact on pain and disability outcomes relative to other treatments. For AI/ML methods to contribute to the refinement of LBP (sub-)classification and guide treatment allocation, large data sets containing known and exploratory clinical features should be examined. There is also a need to establish reliability, validity, and prognostic capacity of AI/ML techniques in LBP as well as its ability to inform treatment allocation for improved patient outcomes and/or reduced healthcare costs.
Publisher: Springer Science and Business Media LLC
Date: 14-07-2020
DOI: 10.1038/S41598-020-67509-1
Abstract: Astronauts are at increased risk of spine injury. With a view to developing training approaches for the muscles of the spine in microgravity, this study examined the effects of axial loading and postural cues on the contraction of transversus abdominis and lumbar multifidus in supine lying using a novel exercise device (GravityFit). Thirty (18 males and 12 females) endurance-trained runners without a history of spinal pain aged 33–55 years were recruited. Magnetic resonance imaging (MRI) was performed under one rest and five exercise conditions, which involved variations in axial loading and postural cues. Whole volume of the abdominal and lumbar paraspinal muscles was imaged and transversus abdominis thickness and length and multifidus anteroposterior and mediolateral thickness measured. Transversus abdominis contraction was greatest in the ‘stretch tall plus arm extension’ (length, − 15%, P 0.001 thickness, + 19%, P 0.001) and ‘stretch tall plus arm extension and thoracic cue’ (length, − 16%, P 0.001 thickness, + 18%, P 0.001) conditions. The contraction of multifidus was the greatest in the ‘arm extension and thoracic cue’ (anteroposterior, + 3.0%, P = 0.001 mediolateral, − 4.2%, P 0.001) and ‘stretch tall plus arm extension and thoracic cue’ (anteroposterior, + 6.0%, P 0.001 mediolateral, − 2.1%, P = 0.022) conditions. This study provides proof-of-principle for an exercise approach that may be used to facilitate the automatically contraction of the transversus abdominis and multifidus muscles. Axial loading of the body, with or without arm loading, most consistently led to contraction of the transversus abdominis and lumbar multifidus muscles, and regional differences existed in the contraction within the muscles.
Publisher: Hindawi Limited
Date: 16-09-2021
DOI: 10.1111/IJCP.14600
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-03-2020
DOI: 10.1519/JSC.0000000000003563
Abstract: Pearson, J, Spathis, JG, van den Hoek, DJ, Owen, PJ, Weakley, J, and Latella, C. Effect of competition frequency on strength performance of powerlifting athletes. J Strength Cond Res 34(5): 1213–1219, 2020—Powerlifting (PL) requires athletes to achieve the highest possible “total” weight lifted across squat, bench press, and deadlift. Athletes compete multiple times per year however, it is not well understood how often PL athletes should compete to facilitate maximal strength performance. This study investigated the effect of competition frequency on strength (relative and absolute) in PL athletes over a 12-month period. Results across all male ( n = 563, mean ± SD age 28 ± 10 years, body mass 89.3 ± 19.3 kg) and female ( n = 437, age 31 ± 11 years, body mass 70.1 ± 15.8 kg) PL athletes were collated. Total competition scores were used to calculate absolute and relative strength for each competition. Linear mixed models with random effects, and effect sizes ± 95% confidence intervals compared competition frequency and total score for (a) all, (b) male, and (c) female competition entries, respectively. The association between total score at each competition was assessed with Pearson's correlation coefficient for the same independent variables. Results demonstrate greater absolute strength at competition 2 for all athletes (5.1%: p = 0.043: d = 0.16) and males (2.9%: p = 0.049: d = 0.15). For females, absolute strength was greater at competition 5 compared to 1 (12.0%: p = 0.001: d = 0.65) and 2 (9.6%: p = 0.007: d = 0.50). Weak positive correlations for relative strength and number of times competed for males were evident between competitions 1 to 4 ( r 2 = 0.070–0.085, p = 0.003–0.043). For females, 3 competitions weakly correlated with absolute strength ( r 2 = 0.106, p = 0.016). PL athletes who compete multiple times per year are more likely to achieve higher totals however, there is an upper limit to the number of competitions (4 per year) that seem to allow a performance increase.
Publisher: Springer Science and Business Media LLC
Date: 17-07-2019
DOI: 10.1007/S00223-019-00586-1
Abstract: Androgen deprivation therapy (ADT) for prostate cancer (PCa) can compromise muscle health. Hence, we aimed to quantify the prevalence of sarcopenia (i.e., compromised lean mass, muscle strength, and physical function) in ADT-treated (> 12 week) men (n = 70) compared to similarly aged non-ADT-treated PCa (n = 52) and healthy controls (n = 70). Lean and fat mass were quantified by dual-energy X-ray absorptiometry. Muscle strength and function were measured using handgrip dynamometry and gait speed, respectively. Sarcopenia was defined as low adjusted appendicular lean mass [ALM height-adjusted (ALMI), body mass index-adjusted (ALM
Publisher: American Physiological Society
Date: 06-2020
DOI: 10.1152/JAPPLPHYSIOL.00125.2020
Abstract: We examined the impact of adding protein supplementation to exercise (resistive vibration exercise) as a countermeasure against changes in the spine during spaceflight simulation. We found that adding the protein supplementation reduced spine muscle atrophy more than exercise alone. Neither countermeasure approach prevented changes in the disks in the spine or impacted back pain reports.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 02-2022
Abstract: To determine whether classification systems improve patient-reported outcomes for people with low back pain (LBP). Systematic review with meta-analysis. The MEDLINE, Embase, CINAHL, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials databases were searched from inception to June 21, 2021. Reference lists of prior systematic reviews and included trials were screened. We included randomized trials comparing a classification system (eg, the McKenzie method or the STarT Back Tool) to any comparator. Studies evaluating participants with specific spinal conditions (eg, fractures or tumors) were excluded. Outcomes were patient-reported LBP intensity, leg pain intensity, and disability. We used the revised Cochrane Collaboration Risk of Bias Tool to assess risk of bias, and the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence. We used random-effects meta-analysis, with the Hartung-Knapp-Sidik- Jonkman adjustment, to estimate the standardized mean difference (SMD Hedges' Twenty-four trials assessing classification systems and 34 assessing subclasses were included. There was low certainty of a small effect at the end of intervention for LBP intensity (SMD, -0.31 95% CI: -0.54, -0.07 For patient-reported pain intensity and disability, there is insufficient evidence supporting the use of classification systems over generalized interventions when managing LBP.
Publisher: The Royal Australian College of General Practitioners
Date: 03-2021
Publisher: BMJ
Date: 11-2021
DOI: 10.1136/BMJOPEN-2021-057112
Abstract: Chronic low back pain disorders (CLBDs) present a substantial societal burden however, optimal treatment remains debated. To date, pairwise and network meta-analyses have evaluated in idual treatment modes, yet a comparison of a wide range of common treatments is required to evaluate their relative effectiveness. Using network meta-analysis, we aim to evaluate the effectiveness of treatments (acupuncture, education or advice, electrophysical agents, exercise, manual therapies/manipulation, massage, the McKenzie method, pharmacotherapy, psychological therapies, surgery, epidural injections, percutaneous treatments, traction, physical therapy, multidisciplinary pain management, placebo, ‘usual care’ and/or no treatment) on pain intensity, disability and/or mental health in patients with CLBDs. Six electronic databases and reference lists of 285 prior systematic reviews were searched. Eligible studies will be randomised controlled/clinical trials (including cross-over and cluster designs) that examine in idual treatments or treatment combinations in adult patients with CLBDs. Studies must be published in English, German or Chinese as a full-journal publication in a peer-reviewed journal. A narrative approach will be used to synthesise and report qualitative and quantitative data, and, where feasible, network meta-analyses will be performed. Reporting of the review will be informed by Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance, including the network meta-analysis extension (PRISMA-NMA). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for network meta-analysis will be implemented for assessing the quality of the findings. Ethical approval is not required for this systematic review of the published data. Findings will be disseminated via peer-reviewed publication. PROSPERO registration number CRD42020182039.
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.BONE.2022.116338
Abstract: Animal and human cross-sectional data suggest that bone marrow adipose tissue (MAT) may respond to mechanical loads and exercise. We conducted the first randomised controlled trial of exercise on MAT modulations in humans. Forty patients with chronic non-specific low back pain (NSCLBP) were enrolled in a six-month single-blinded randomised controlled trial (ACTRN12615001270505). Twenty patients loaded their spines via progressive upright aerobic and resistance exercises targeting major muscle groups (Exercise). Twenty patients performed non-weightbearing motor control training and manual therapy (Control). Testing occurred at baseline, 3-months (3mo) and 6-months (6mo). Lumbar vertebral fat fraction (VFF) was measured using magnetic resonance imaging axial mDixon sequences. When compared to baseline (percent change), lumbar vertebral fat fraction (VFF measured using magnetic resonance imaging axial mDixon sequences) was lower in Exercise at 3mo at L2 (-3.7[6.8]%, p = 0.033) and L4 (-2.6[4.1]%, p = 0.015), but not in Control. There were no between-group effects. The effects of Exercise on VFF were sex-specific, with VFF lower in men at L2, L3, L4 at 3mo and at L1, L2, L3 and L4 at 6mo (p all ≤ 0.05), but not in women. Leg and trunk lean mass were increased at 3mo in Exercise. Changes in VFF correlated significantly with changes in total fat (ρ = 0.40) and lean (ρ = -0.41) masses, but not with lumbar BMD (ρ = -0.10) or visceral adipose tissue volume (ρ = 0.23). This trial provided first prospective evidence in humans that a moderate exercise intervention may modulate lumbar VFF as a surrogate measure of MAT at 3mo, yet not 6mo. The effect of exercise on MAT may be more prominent in males than females.
Publisher: Wiley
Date: 08-2017
DOI: 10.1111/BJU.13942
Publisher: Wiley
Date: 31-07-2020
DOI: 10.1002/JOR.24809
Publisher: Wiley
Date: 12-02-2016
DOI: 10.1002/CAM4.639
Publisher: Springer Science and Business Media LLC
Date: 24-03-2020
Publisher: Frontiers Media SA
Date: 11-09-2019
Publisher: American Astronomical Society
Date: 31-07-2023
Publisher: BMJ
Date: 27-03-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2020
Publisher: Springer Science and Business Media LLC
Date: 25-01-2023
DOI: 10.1186/S12889-023-15123-X
Abstract: There are growing concerns about the mental health of university students in Australia and internationally, with universities, governments and other stakeholders actively developing new policies and practices. Previous research suggests that many students experience poor mental health while at university, and that the risk may be heightened for international students. Mental health-related knowledge, attitudes and behaviours are modifiable determinants of mental health and thus suitable targets for intervention. This study assessed the mental health-related knowledge, stigmatising attitudes, helping behaviours, and self-reported experiences of mental health problems in the student population of a large multi-c us Australian university, and conducted a comparative assessment of international and domestic students. Participants were 883 international and 2,852 domestic students (overall response rate 7.1%) who completed an anonymous voluntary online survey that was sent to all enrolled students in July 2019 (n = ~ 52,341). Various measures of mental health-related knowledge, attitudes and helping behaviours were assessed. A comparative analysis of international and domestic students was conducted, including adjustment for age and sex. Overall, there was evidence of improvements in mental health-related knowledge, attitudes and behaviours relative to previous studies, including higher depression recognition, intentions to seek help, and reported help-seeking behaviour. Comparative analysis indicated that international students scored predominantly lower on a range of indicators (e.g., depression recognition, awareness of evidence-based forms of help) however, differences were narrower difference between the two groups compared to what has been reported previously. Finally, some indicators were more favourable among international students, such as higher help-seeking intentions, and lower prevalence of self-reported mental health problems compared to domestic students. Though there were some important differences between domestic and international students in this study, differences were narrower than observed in previous studies. Study findings are informing the on-going implementation and refinement of this university’s student mental health strategy, and may be used to inform evolving policy and practice in the university sector.
Publisher: Informa UK Limited
Date: 23-04-2020
DOI: 10.1080/17461391.2019.1606942
Abstract: This study assessed the deconditioning hypothesis of low back pain (LBP) by examining physical function in relation to LBP and self-reported physical activity in women. This cross-sectional study recruited a representative population-based s le of females aged greater than 60 years. In total, 1182 women were included in the study and completed questionnaires (physical activity and LBP intensity) and functional testing (countermovement jump, chair rise, gait speed and grip strength). In iduals were stratified into four groups based on physical activity and LBP status and analysed via a two-way ANOVA. Most participants (87%) reported current LBP and 25% were physically active. Countermovement jump height, chair rise and grip strength were lower in physically inactive women (
Publisher: Public Library of Science (PLoS)
Date: 14-04-2021
DOI: 10.1371/JOURNAL.PONE.0249855
Abstract: Methodologies for the quantitative assessment of the spine tissues, in particular the intervertebral disc (IVD), have not been well established in terms of long-term reliability. This is required for designing prospective studies. 1 H water T 2 in the IVD (“T 2 ”) has attained wider use in assessment of the lumbar intervertebral discs via magnetic resonance imaging. The reliability of IVD T 2 measurements are yet to be established. IVD T 2 was assessed nine times at regular intervals over 368 days on six anatomical slices centred at the lumbar spine using a spin-echo multi-echo sequence in 12 men. To assess repeatability, intra-class correlation co-efficients (ICCs), standard error of the measurement, minimal detectable difference and co-efficients of variation (CVs) were calculated along with their 95% confidence intervals. Bland-Altman analysis was also performed. ICCs were above 0.93, with the exception of nuclear T 2 at L5/S1, where the ICC was 0.88. CVs of the central-slice nucleus sub-region ranged from 4.3% (average of all levels) to 10.1% for L5/S1 and between 2.2% to 3.2% for whole IVD T 2 (1.8% for the average of all levels). Averaging between vertebral levels improved reliability. Reliability of measurements was least at L5/S1. ICCs of degenerated IVDs were lower. Test-retest reliability was excellent for whole IVD and good to excellent for IVD subregions. The findings help to establish the long-term repeatability of lumbar IVD T 2 for the implementation of prospective studies and determination of significant changes within in iduals.
Publisher: Elsevier BV
Date: 2023
Publisher: MDPI AG
Date: 14-02-2020
DOI: 10.3390/JCM9020522
Abstract: Aerobic exercise training has many known cardiovascular benefits that may promote healthy aging. It is not known if long-term aerobic exercise training is also associated with structural benefits (e.g., lower fat mass, higher areal bone mineral density (BMD) and greater muscle mass). We evaluated these parameters in middle-aged long-term endurance runners compared to sex-, age-, height-, and weight-matched non-running controls. Total and regional lean and fat mass and areal BMD were assessed by dual-energy X-ray absorptiometry. Sagittal magnetic resonance images captured the cross-sectional area and thickness of the lumbar multifidus. Runners (n = 10 all male) had a mean (standard deviation SD) age of 49 (4) years, height of 178.9 (4.9) cm, weight of 67.8 (5.8) kg, body mass index (BMI) of 21.4 (1.4) kg/m2 and had been running 82.6 (27.9) km/week for 23 (13) years. Controls (n = 9) had a mean (SD) age of 51 (5) years, height of 176.0 (5.1) cm, weight of 72.8 (7.1) kg, and BMI of 23.7 (2.1) kg/m2. BMI was greater in controls (p = 0.010). When compared to controls on average, runners had a 10 percentage-point greater total body lean mass than controls (p = 0.001) and 14% greater trunk lean mass (p = 0.010), as well as less total body (8.6 kg p 0.001), arm (58% p = 0.002), leg (52% p 0.001), trunk (73% p 0.001), android (91% p 0.001), and gynoid fat mass (64% p 0.001). No differences were observed between groups for BMD outcomes or multifidus size. These results underscore the benefits of endurance running to body composition that carry over to middle-age.
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.SMRV.2022.101658
Abstract: Unpaid caregivers often experience sleep impairments as an unintended consequence of providing care. This systematic review and meta-analysis investigated the efficacy of interventions to improve sleep in unpaid caregivers. Six databases were searched from journal inception to 7-Sep-2021 to identify randomised controlled trials. Random-effects meta-analyses estimated mean differences (MD) at end-of-intervention. Twenty-one studies were identified (15 eligible for meta-analysis). Compared to control, interventions improved sleep quality (Pittsburgh Sleep Quality Index 12 studies, 1153 participants, MD = -1.66, 95% CI [-2.91, -0.41], p = 0.009, I
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 05-2023
Publisher: Springer International Publishing
Date: 2020
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 05-2021
Publisher: Wiley
Date: 03-2017
DOI: 10.1111/AJAG.12395
Publisher: Springer Science and Business Media LLC
Date: 12-07-2019
DOI: 10.1007/S00586-019-06059-1
Abstract: To investigate whether quantitative T2-times depend on lumbar intervertebral disc (IVD) level. The lumbar spine (Th12/L1-L5/S1) of 101 participants (53.5% female, 30.0[± 3.6]years, 173.5[± 9.6]cm and 69.9[± 13.4]kg), without history of back pain, was examined on a 3T scanner with sagittal T2-mapping. All IVDs were stratified according to Pfirrmann grade and lumbar level, with mean T2-time determined for the entire IVD volume and in five subregions of interests. Significant level-dependent T2-time differences were detected, both for the entire IVD volume and its subregions. For the entire IVD volume, Pfirrmann grade 2 IVDs displayed 9-18% higher T2-times in Th12/L1 IVDs compared to L2/L3-L5/S1 IVDs (0.001 > p < 0.004) and significantly different T2-times in L1/L2-L2/L3 IVDs compared to most of the IVDs in the lower lumbar spine. In Pfirrmann grades 1, 3 and 4 IVDs, no significant level-dependent T2-time differences were observed for the entire IVD. More pronounced results were observed when comparing IVD subregions, with significant level-dependent differences also within Pfirrmann grade 1 and grade 3 IVDs. For ex le, in posterior IVD subregions mean T2-time was 80-82% higher in Th12/L1 compared to L3/L4-L4/L5 Pfirrmann grade 1 IVDs (p p < 0.001). Significant level-dependent T2-time differences within several Pfirrmann grades, both for the entire IVD volume and for multiple IVD subregions, were shown in this large cohort study. The T2-time differences between levels existed in both non-degenerated and degenerated IVDs. These findings show the importance of stratifying for lumbar level when quantitative IVD studies are performed using T2-mapping. These slides can be retrieved under Electronic Supplementary Material.
Publisher: Springer Science and Business Media LLC
Date: 24-01-2017
DOI: 10.1038/PCAN.2016.69
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
Publisher: Elsevier BV
Date: 2021
Publisher: Research Square Platform LLC
Date: 18-02-2021
DOI: 10.21203/RS.3.RS-200491/V1
Abstract: Background: Emerging evidence suggests that muscle function can be impaired in people with generalized hypermobility. The Beighton scale was developed to assess for the presence of hypermobility. This cross-sectional study assessed the activation of the lateral abdominal muscles in hypermobile (N=10 Beighton score 5) and matched non-hypermobile control (N=10) participants. Methods: Panoramic ultrasound scans of the transversus abdominis (TrA) and the external and internal abdominal obliques (EO and IO, respectively) were obtained at three lumbar levels (L1, L3, L5) at rest and during the hollowing maneuver. Results: Between-group differences in the TrA length, as well as TrA, EO and IO thickness changes between conditions (rest vs hollowing) and trunk strength and endurance were examined. Hypermobile participants exhibited less TrA shortening than controls (L1-L5: 5.1% difference, L3: 8.9% difference) and greater thickness changes at level L1 (12.7% difference). EO and IO thickness differed between groups for both conditions, where both of the muscles were 0.07cm - 0.18cm thicker at rest and 0.07cm - 0.19cm thicker with hollowing in the hypermobile participants compared to control (all: P .001). The ability to contract the EO was less in hypermobile participants compared to controls (P=0.002 -5.3% vs no change in thickness), while the ability to contract the IO was greater in hypermobile participants compared to in controls (P=0.038 +21.3% vs +17.6% thickness change). Hypermobile participants demonstrated over 30% greater average trunk flexion strength. Moreover, greater joint mobility was associated with less TrA muscle shortening, reduced EO thickness changes, greater isometric trunk muscle strength for both extension and flexion (all: P .001) and with reduced trunk muscle endurance for extension and flexion (P=0.006 and P=0.002, respectively). Conclusion: The results of this study indicate joint hypermobility is associated with reduced ability to contract TrA and EO, however, this did not appear to be associated with impaired function (e.g. muscle strength and endurance).
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-01-2022
DOI: 10.1249/MSS.0000000000002858
Abstract: Understanding strength changes with resistance training is important in human performance. It also enables better understanding into the expected magnitude of strength increase and factors that influence this change over time. Squat, bench press, and deadlift scores were collated from 407 powerlifting meets ( n = 1896 unique competitors: ~625 females, ~1270 males) between 2003 and 2018. Absolute (in kilograms) and relative starting strength (in kilograms per body weight) for each lift type was expressed for both sexes. Maximum and overall strength gain per day and per year (in kilograms) was calculated by comparing first and final, or maximum scores for each lift, respectively, and considered based on strength quartile classification. Paired and independent t -tests compared strength changes from baseline and between sexes. One-way ANOVAs compared strength changes between quartiles. Pearson correlations assessed relationships between strength changes over time, and baseline strength, number of competitions, and total days competing. Maximum strength adaptations were greater for squat (20.2–25.4 kg·yr −1 ) and deadlift (18.1–21.1 kg·yr −1 ) compared with bench press (10.5–12.8 kg·yr −1 , P ≤ 0.001). However, the change in absolute (all lifts: P = 0.247–0.379) and relative strength (all lifts: P = 0.641–0.821) did not differ between sexes. For females, maximum strength gain per day did not differ by quartile (all lifts: P = 0.091–0.746), nor did overall strength gain per day ( P = 0.151–0.575). Conversely, males in the fourth quartile generally displayed lower maximum and overall strength gain per day. These findings show differences in strength gain between upper- and lower-body lifts, but not sex differences in the change in strength. In line with previous research, the strongest males likely gain strength more slowly than weaker counterparts. Professionals should consider this information in the training, assessment, and long-term benchmarking of athletes whose sports require a focus on muscular strength.
Publisher: Elsevier BV
Date: 04-2023
Publisher: Springer Science and Business Media LLC
Date: 19-06-2022
DOI: 10.1186/S13102-022-00505-2
Abstract: The ability for athletes to gain a competitive advantage over their opponents is well recognised. At times, this advantage may be considered a marginal gain. However, in the context of competition, marginal advantages may be the difference between winning and losing. This investigation explores how competition factors influence the odds of competitive success (i.e. winning) in powerlifting (PL) to assist athletes and coaches in achieving a competitive advantage. A cross-sectional, retrospective analysis of competition data from raw/classic, Australian powerlifting competitions 2010–2019 was conducted. Data included 10,599 competition entries (males: n = 6567 [62%], females: n = 4032 [38%]). Independent t-tests were used to compare continuous data between sexes or winners and non-winners at an event. Cohen’s d and the 95% confidence interval (d [95% CI]) were calculated. Univariate odds of winning an event based on independent variables (age [irrespective of category], sex, body weight and weight of first lift attempt [regardless of success]), were assessed by separate simple logistic regression. When compared to males, the odds of winning for females were 50% greater (OR [95% CI] 1.500 [1.384, 1.625] P 0.001). Athletes who had larger first lift attempts (Squat: + 7.0 kg P 0.001, Bench Press: + 3.2 kg P 0.001, and Deadlift: + 6.1 kg P 0.001and competed for a longer period (winners: 401 vs non-winners: 304 days, P 0.001) had an increased likelihood winning. Age was associated with increased odds of success for males (OR [95% CI] 1.014 [1.009, 1.019], P 0.001) per additional year of age for males, but not females (P = 0.509). Multiple factors appear to contribute to the likelihood of winning a PL competition. These results may help coaches to develop competition and training strategies that optimise athletes’ likelihood of competitive success in PL.
Publisher: Springer Science and Business Media LLC
Date: 21-12-2021
Publisher: Springer Science and Business Media LLC
Date: 08-01-2023
DOI: 10.1186/S40798-022-00539-3
Abstract: The COVID-19 pandemic markedly changed how healthcare services are delivered and telehealth delivery has increased worldwide. Whether changes in healthcare delivery borne from the COVID-19 pandemic impact effectiveness is unknown. Therefore, we examined the effectiveness of exercise physiology services provided during the COVID-19 pandemic. This prospective cohort study included 138 clients who received exercise physiology services during the initial COVID-19 pandemic. Outcome measures of interest were EQ-5D-5L, EQ-VAS, patient-specific functional scale, numeric pain rating scale and goal attainment scaling. Most (59%, n = 82) clients received in-person delivery only, whereas 8% ( n = 11) received telehealth delivery only and 33% ( n = 45) received a combination of delivery modes. Mean (SD) treatment duration was 11 (7) weeks and included 12 (6) sessions lasting 48 (9) minutes. The majority (73%, n = 101) of clients completed 80% of exercise sessions. Exercise physiology improved mobility by 14% ( β = 0.23, P = 0.003), capacity to complete usual activities by 18% ( β = 0.29, P 0.001), capacity to complete important activities that the client was unable to do or having difficulty performing by 54% ( β = 2.46, P 0.001), current pain intensity by 16% ( β = − 0.55, P = 0.038) and goal attainment scaling t-scores by 50% ( β = 18.37, P 0.001). Effectiveness did not differ between delivery modes (all: P 0.087). Exercise physiology services provided during the COVID-19 pandemic improved a range of client-reported outcomes regardless of delivery mode. Further exploration of cost-effectiveness is warranted.
Publisher: BMJ
Date: 2023
DOI: 10.1136/BMJSEM-2022-001524
Abstract: Poor intervertebral disc (IVD) health is associated with low back pain (LBP). This 12-week parallel randomised controlled trial will evaluate the efficacy of a progressive interval running programme on IVD health and other clinical outcomes in adults with chronic LBP. Participants will be randomised to either a digitally delivered progressive interval running programme or waitlist control. Participants randomised to the running programme will receive three in idually tailored 30 min community-based sessions per week over 12 weeks. The waitlist control will undergo no formal intervention. All participants will be assessed at baseline, 6 and 12 weeks. Primary outcomes are IVD health (lumbar IVD T2 via MRI), average LBP intensity over the prior week (100-point visual analogue scale) and disability (Oswestry Disability Index). Secondary outcomes include a range of clinical measures. All outcomes will be analysed using linear mixed models. This study has received ethical approval from the Deakin University Human Research Ethics Committee (ID: 2022-162). All participants will provide informed written consent before participation. Regardless of the results, the findings of this study will be disseminated, and anonymised data will be shared via an online repository. This will be the first study to evaluate whether a progressive interval running programme can improve IVD health in adults with chronic LBP. Identifying conservative options to improve IVD health in this susceptible population group has the potential to markedly reduce the burden of disease. This study was registered via the Australian New Zealand Clinical Trials Registry on 29 September 2022 (ACTRN12622001276741).
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 04-2022
Abstract: To examine the effectiveness of implementing interventions to improve guideline-recommended imaging referrals in low back pain. Systematic review with meta-analysis. We searched MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials from inception to June 14, 2021, as well as Google Scholar and reference lists of relevant systematic reviews published in the last 10 years. We conducted forward and backward citation tracking. Randomized controlled or clinical trials in adults with low back pain to improve imaging referrals. Bias was assessed using the Cochrane Risk of Bias 2 tool. Data were synthesized using narrative synthesis and random-effects meta-analysis (Hartung-Knapp-Sidik-Jonkman method). We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. Of the 2719 identified records, 8 trials were included, with 6 studies eligible for meta-analysis (participants: N = 170 460). All trials incorporated clinician education 4 included audit and/or feedback components. Comparators were no-intervention control and passive dissemination of guidelines. Five trials were rated as low risk of bias, and 2 trials were rated as having some concerns. There was low-certainty evidence that implementing interventions to improve guideline-recommended imaging referrals had no effect (odds ratio [95% confidence interval]: 0.87 [0.72, 1.05] We found low-certainty evidence that interventions to reduce imaging referrals or use in low back pain had no effect. Education interventions are unlikely to be effective. Organizational- and policy-level interventions are more likely to be effective.
Publisher: Springer Science and Business Media LLC
Date: 03-10-2017
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 09-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-10-2021
DOI: 10.1097/J.PAIN.0000000000002524
Abstract: Brain structure, psychosocial, and physical factors underpin back pain conditions however, less is known about how these factors differ based on pain duration and location. We examined, cross-sectionally, 11,106 in iduals from the UK Biobank who (1) were pain-free (n = 5616), (2) had acute back pain (n = 1746), (3) had chronic localised back pain (CBP n = 1872), or (4) had chronic back pain and additional chronic pain sites (CWP n = 1872). We found differences in structural brain measures in the chronic pain groups alone. Both CBP and CWP groups had lower primary somatosensory cortex {CBP mean difference (MD) (95% confidence interval [CI]): −250 (−393, −107) mm 3 , P 0.001 CWP: −170 (−313, −27)mm 3 , P = 0.011} and higher caudate gray matter volumes (CBP: 127 [38,216]mm 3 , P = 0.001 CWP: 122 [33,210]mm 3 , P = 0.002) compared with pain-free controls. The CBP group also had a lower primary motor cortex volume (−215 [−382, −50]mm 3 , P = 0.005), whereas the CWP group had a lower amygdala gray matter volume (−27 [−52, −3]mm 3 , P = 0.021) compared with pain-free controls. Differences in gray matter volumes in some regions may be moderated by sex and body mass index. Psychosocial factors and body mass index differed between all groups and affected those with widespread pain the most (all, P 0.001), whereas grip strength was only compromised in in iduals with widespread pain (−1.0 [−1.4, −0.5] kg, P 0.001) compared with pain-free controls. Longitudinal research is necessary to confirm these interactions to determine the process of pain development in relation to assessed variables and covariates. However, our results suggest that categorised pain duration and the number of pain sites warrant consideration when assessing markers of brain structure, psychosocial, and physical health.
Publisher: Wiley
Date: 04-2018
DOI: 10.1111/AJAG.12508
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJSEM-2021-001289
Abstract: Report the injury epidemiology of law enforcement and firefighter recruits. A systematic epidemiological review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was completed. Five online databases were searched from database inception to 5 May 2021. Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by law enforcement or firefighter recruits were included. We reported on all components of injury where data were available. All injury incidence rates were calculated as per 1000 training days (Poisson 95% CI) to allow comparisons between studies. Study quality was assessed using the Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies. No studies reporting firefighter recruits were identified. Eight published studies that reported on injuries to law enforcement recruits were identified. The studies were all low quality, and the credibility of the evidence was assessed as very low. Seven studies reported medical attention injuries, and one study reported the number of medical withdrawals from a recruit training programme. The prevalence of law enforcement recruits with medical attention injuries ranged from 13.7% to 24.5%. The overall medical attention injury incidence rate for law enforcement recruits ranged from 1.67 injuries per 1000 training days (Poisson 95% CI 1.00 to 2.34 injuries per 1000 training days) to 4.24 injuries per 1000 training days (Poisson 95% CI 2.97 to 5.51 injuries per 1000 training days). This review reported the prevalence and incidence rates for musculoskeletal injuries in law enforcement officers. However, the credibility of the evidence is very low. CRD42021251084.
Publisher: Wiley
Date: 27-06-2023
Publisher: Wiley
Date: 08-05-2019
DOI: 10.1002/JCSM.12446
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 2022
Publisher: Springer Science and Business Media LLC
Date: 27-08-2021
DOI: 10.1007/S40279-021-01526-6
Abstract: Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effects such as natural history are not clear. The aim of this systematic review and meta-analysis was to determine the relative contribution of these factors to better understand the true effect of exercise training for reducing pain in chronic primary musculoskeletal pain conditions. Systematic review with meta-analysis DATA SOURCES: MEDLINE, CINAHL, SPORTDiscus, EMBASE and CENTRAL from inception to February 2021. Reference lists of prior systematic reviews. Randomised controlled trials of interventions that used exercise training compared to placebo, true control or usual care in adults with chronic primary musculoskeletal pain. The review was registered prospectively with PROSPERO (CRD42019141096). We identified 79 eligible trials for quantitative analysis. Pairwise meta-analysis showed very low-quality evidence (GRADE criteria) that exercise training was not more effective than placebo (g [95% CI]: 0.94 [- 0.17, 2.06], P = 0.098, I There is very low-quality evidence that exercise training is not more effective than non-exercise placebo treatments in chronic pain. Exercise training and the associated clinical encounter are more effective than true control or standard medical care for reductions in pain for adults with chronic musculoskeletal pain, with very low quality of evidence based on GRADE criteria.
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2021-060189
Abstract: The aim of this preplanned secondary analysis of a 12-month randomised controlled trial was to investigate the effects of a multicomponent exercise programme combined with daily whey protein, calcium and vitamin D supplementation on cognition in men with prostate cancer treated with androgen deprivation therapy (ADT). 12-month, two-arm, randomised controlled trial. University clinical exercise centre. 70 ADT-treated men were randomised to exercise-training plus supplementation (Ex+ Suppl, n=34) or usual care (control, n=36). Men allocated to Ex + Suppl undertook thrice weekly resistance training with weight-bearing exercise training plus daily whey protein (25 g), calcium (1200 mg) and vitamin D (2000 IU) supplementation. Cognition was assessed at baseline, 6 and 12 months via a computerised battery (CogState), Trail-making test, Rey auditory-verbal learning test and Digit span. Data were analysed with linear mixed models and an intention-to-treat and prespecified per-protocol approach (exercise-training: ≥66%, nutritional supplement: ≥80%). Sixty (86%) men completed the trial (Ex + Suppl, n=31 control, n=29). Five (7.1%) men were classified as having mild cognitive impairment at baseline. Median (IQR) adherence to the exercise and supplement was 56% (37%–82%) and 91% (66%–97%), respectively. Ex + Suppl had no effect on cognition at any time. A 12-month multicomponent exercise training and supplementation intervention had no significant effect on cognition in men treated with ADT for prostate cancer compared with usual care. Exercise training adherence below recommended guidelines does not support cognitive health in men treated with ADT for prostate cancer. Australian and New Zealand Clinical Trial Registry (ACTRN12614000317695, registered 25/03/2014) and acknowledged under the Therapeutic Goods Administration Clinical Trial Notification Scheme (CT-2015-CTN-03372-1 v1).
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/BMJOPEN-2022-062089
Abstract: The global prevalence of Parkinsonism continues to rise given ageing populations. In iduals with Parkinsonism who have moderate or severe symptoms typically require a high level of care, including assistance with activities of daily living. This care is often provided across the 24-hour period by a family member or friend. It is likely that providing care significantly impacts the sleep duration and quality of the caregiver given overnight caring responsibilities, in addition to worry and stress associated with the caregiving role. The aim of this systematic review and meta-analysis was to investigate whether providing care to an in idual with Parkinsonism was associated with disturbed caregiver sleep, and to identify associated factors that may contribute to disturbed sleep in this population. Five databases were electronically searched on 30 June 2021 including CINAHL, PubMed, PsycINFO, CENTRAL and EMBASE. Eligibility criteria included a population of caregivers whose care recipient has a form of Parkinsonism. To be included in this systematic review, outcome measures of caregiver sleep (eg, sleep duration, sleep quality) were required. Eighteen studies (n=1998) were included. Findings indicated that caregivers of in iduals with Parkinsonism typically experience poor sleep quality (mean (95% CI): 5.6 (4.8 to 6.4) points on the Pittsburgh Sleep Quality Index), increased sleep latency and poor sleep efficiency. The degree of poor sleep quality was clinically significant. However, further investigation of sleep outcomes is required using sleep measurement tools tailored for this population (eg, measures that capture overnight sleep disruption by care recipient/s). Additionally, there is a need for appropriate in idual and societal-level interventions to improve caregiver sleep. CRD42021274529.
Publisher: JMIR Publications Inc.
Date: 08-02-2023
DOI: 10.2196/46370
Publisher: BMJ
Date: 10-2022
Publisher: BMJ
Date: 10-06-2021
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-052644
Abstract: To explore a protection motivation theory screening tool for predicting rehabilitation adherence. Analysis of a randomised controlled trial. An exercise physiology and physiotherapist clinic. Patients with chronic low back pain (n=40). General strength and conditioning (GSC) compared with motor control and manual therapy. Primary and secondary outcome measures: predicting patient adherence to supervised sessions and dropout using the Sports Injury Rehabilitation Beliefs Scale, seven-item barriers checklist and Positive and Negative Affect Schedule and Sports Injury Rehabilitation Adherence Scale. Average attendance was 77% (motor control and manual therapy) and 60% (GSC) with eight dropouts. No Sports Injury Rehabilitation Adherence Scale values other than 5 across all three components were recorded. Treatment efficacy (p=0.019), self-efficacy (p=0.001), rehabilitation value (p=0.028) and injury severity (p=0.002) positively correlated with susceptibility (the extent of vulnerability to having health problems from not taking action). Rehabilitation value positively correlated with self-efficacy (p=0.005). Injury severity positively correlated with rehabilitation value (p=0.011). The final model for number of cancellations included rehabilitation value only and accounted for approximately 12% of variance (p=0.033). Perceived value of rehabilitation should be considered by clinicians in the rehabilitation setting to improve treatment adherence in patients with chronic low back pain. ACTRN12615001270505.
Publisher: Research Square Platform LLC
Date: 16-12-2022
DOI: 10.21203/RS.3.RS-2153635/V1
Abstract: Background: Injuries are a common occurrence in military recruit training, however due to differences in the capture of training exposure, injury incidence rates are rarely reported. Our aim was to determine the musculoskeletal injury epidemiology of military recruits, including a standardised injury incidence rate. Methods: Epidemiological systematic review following the PRISMA 2020 guidelines. Five online databases were searched from database inception to 5 th May 2021. Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by military recruits after the year 2000 were included. We reported on the frequency, prevalence and injury incidence rate. Incidence rate per 1000 training days (Exact 95% CI) was calculated using meta-analysis to allow comparisons between studies. Observed heterogeneity (e.g., training duration) precluded pooling of results across countries. The Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies assessed study quality. Results: This review identified 41 studies comprising 451,782 recruits. Most studies (n=26 63%) reported the number of injured recruits, and the majority of studies (n=27 66%) reported the number of injuries to recruits. The prevalence of recruits with medical attention injuries or time-loss injuries was 22.8% and 31.4%, respectively. Meta-analysis revealed the injury incidence rate for recruits with a medical attention injury may be as high as 19.52 injuries per 1000 training days and time-loss injury may be as high as 3.97 injuries per 1000 training days. Longer recruit training programs were associated with a reduced injury incidence rate (p=0.003). The overall certainty of the evidence was low per a modified GRADE approach. Conclusion: This systematic review with meta-analysis highlights a high musculoskeletal injury prevalence and injury incidence rate within military recruits undergoing basic training with minimal improvement observed over the past 20 years. Longer training program, which may decrease the degree of overload experienced by recruit, may reduce injury incidence rates. Unfortunately, reporting standards and reporting consistency remain a barrier to generalisability. Systematic Review Registration: PROSPERO (Registration number: CRD42021251080)
Publisher: Elsevier BV
Date: 2021
DOI: 10.1016/J.JOCD.2019.11.001
Abstract: Inter-/intramuscular fat can be assessed with peripheral Quantitative Computed Tomography (pQCT) and is of interest as an indicator of "muscle quality." Typical pQCT scan sites (forearm, lower leg) have a low amount of inter-/intramuscular fat, however distal diaphyseal femur scan sites with conspicuous inter-/intramuscular fat have been identified as potentially more prudent scan sites, even in healthy adolescents. However, current state of the art analysis methods require labor-intensive manual segmentation of the scan. The purpose of the present study was to evaluate the reliability of a novel open source automated enclosing convex polygon approach (source code jrantal QCT, commit cec9bce) to quantify inter-/intramuscular fat from femoral pQCT scans in healthy adults. The distal diaphyseal femur (25% of tibial length from the knee joint towards the hip) of 27 adults aged 18-50 yr were scanned twice, 1 wk apart, using pQCT. Subcutaneous fat, muscle, inter-/intramuscular fat, and marrow areas, and corresponding densities were evaluated using a method we have reported previously, as well as the novel enclosing convex polygon method. The session-to-session reliability of the assessments was fair to excellent using the previously reported method as indicated by intraclass correlation coefficient (ICC Distal diaphyseal femur appears to be a potentially informative and prudent scan site for inter-/intramuscular fat evaluation with pQCT.
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.JBIOMECH.2019.08.006
Abstract: Specific spinal postures and physical activities have been linked to low back pain (LBP) but previous reviews have produced contrasting outcomes. This umbrella review examined (1) what relationship, if any, is evident between specific spinal postures or physical activities and LBP (2) the quality of existing systematic reviews in this area and (3) the extent to which previous systematic reviews demonstrate causality. Five electronic databases and reference lists of relevant articles were searched from January 1990 to June 2018. Systematic reviews and meta-analyses on spine posture or physical exposure and LBP symptoms (self-report) or outcomes (e.g. work absence, medical consultation) were included. The AMSTAR and the Bradford Hill Criteria were utilised to critically appraise the quality of included systematic reviews and to determine the extent to which these reviews demonstrated causality. Two independent reviewers screened 4285 publications with 41 reviews included in the final review. Both positive and null associations between spine posture, prolonged standing, sitting, bending and twisting, awkward postures, whole body vibration, and components of heavy physical work were reported. Results from meta-analyses were more consistently in favour of an association, whereas systematic reviews that included only prospective studies were less able to provide consistent conclusions. Evidence that these factors precede first time LBP or have a dose response relationship with LBP outcomes was mixed. Despite the availability of many reviews, there is no consensus regarding causality of physical exposure to LBP. Association has been documented but does not provide a causal explanation for LBP.
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-058478
Abstract: We investigated whether there were differences in associations between cognition with muscle strength, fitness and function in men with prostate cancer (PCa) treated with, and without androgen deprivation therapy (ADT) and non-PCa controls. A secondary aim was to compare differences in the prevalence of cognitive impairment. This cross-sectional study compared 70 ADT-treated men with PCa aged 50–85 years to non-ADT-treated men (n=52) and non-PCa controls (n=70). University clinical exercise laboratory. Nil. Standardised assessments were conducted for cognition (learning, memory, attention, processing speed and executive function), muscle strength (grip strength and leg press), fitness (400 m walk), gait speed (4 m walk) and dual-tasking mobility (timed-up-and-go with a cognitive task). ADT-treated men showed stronger associations between fitness and executive function and task switching relative to controls (both: p≤0.03). For both PCa groups (independent of ADT use), poorer dual-task mobility was more strongly associated with decreased psychomotor attention (both: p≤0.027) and global cognitive function (both: p≤0.031) compared with non-PCa controls. The overall prevalence of cognitive impairment was low (4%–13%) and did not differ between the groups. The presence of PCa, with or without ADT treatment, did not increase the risk of cognitive impairment relative to non-PCa controls, yet did alter the associations between physical fitness and some measures of functional performance with certain cognitive domains. This highlights the importance of men with PCa maintaining fitness and functional capacity to optimise cognitive health. This study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12614000317695).
Publisher: Wiley
Date: 11-11-2019
DOI: 10.1111/PAPR.12846
Abstract: Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the in idual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear-avoidance, pain catastrophizing, pain self-efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health-related quality-of-life measures, depending on what is deemed relevant for each in idual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered "real" in an in idual patient. This information can guide treatment selection when working with an in idual with CLBP.
Publisher: Informa UK Limited
Date: 02-2023
DOI: 10.2147/JPR.S386440
Publisher: Springer Science and Business Media LLC
Date: 11-07-2023
Publisher: Springer Science and Business Media LLC
Date: 28-10-2023
Publisher: American Medical Association (AMA)
Date: 26-02-2021
Publisher: Springer Science and Business Media LLC
Date: 19-10-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-04-2021
DOI: 10.1249/MSS.0000000000002682
Abstract: Androgen deprivation therapy (ADT) for prostate cancer has multiple adverse effects on musculoskeletal health. This 12-month randomized controlled trial aimed to assess the effects of multicomponent exercise training combined with whey protein, calcium and vitamin D supplementation on bone mineral density (BMD), structure and strength, body composition, muscle strength, and physical function in ADT-treated men. Seventy ADT-treated men were randomized to exercise plus supplementation (Ex + Suppl n = 34) or usual care (control n = 36). Ex + Suppl involved thrice weekly progressive resistance training plus weight-bearing impact exercise with daily multinutrient supplementation. Primary outcomes were DXA hip and spine areal BMD. Secondary outcomes included the following: tibia and radius pQCT volumetric BMD, bone structure and strength, DXA body composition, pQCT muscle and fat cross-sectional area and muscle density, and muscle strength and physical function. Sixty men (86%) completed the study. Mean exercise and supplement adherence were 56% and 77%, respectively. There were no effects of the intervention on bone or body composition outcomes. Ex + Suppl improved leg muscle strength (net difference, (95% confidence interval, or CI), 14.5% (−0.2 to 29.2) P = 0.007) and dynamic mobility (four-square-step test time, −9.3% (−17.3 to −1.3), P = 0.014) relative to controls. Per-protocol analysis of adherent participants (≥66% exercise, ≥80% supplement) showed Ex + Suppl preserved femoral neck aBMD (1.9% (0.1 to 3.8), P = 0.026) and improved total body lean mass (1.0 kg (−0.23 to 2.22), P = 0.044) relative to controls. Exercise training combined with multinutrient supplementation had a limited effect on ameliorating the adverse musculoskeletal consequences of ADT, likely related to the modest intervention adherence.
Publisher: BMJ
Date: 03-2022
DOI: 10.1136/BMJSEM-2021-001292
Abstract: To assess the validity and reliability of ultrasound-derived interbony landmark distances as a proxy for MRI-derived intervertebral disc (IVD) height. This is a cross-sectional criterion validity study. Twelve college-aged participants without current low back pain completed both MRI and ultrasound imaging of the lumbar spine in a prone position. Single-segment and multisegment distances between the spinous and mammillary processes at the lumbar segments (L2/L3, L3/L4, L4/L5) were measured twice using ultrasound and analysed digitally. Sagittal slices of the lumbar spine were taken via T1-weighted MRI and IVD height, and the overall distance between IVDs L2/L3 and L4/L5 was imaged once and measured twice. There was moderate correlation between multilevel-based measurements (overall distance between L2 and L5, r=0.677, p=0.016) and the average across three levels (r=0.596, p=0.041) when using the spinous processes as bony landmarks. Single-segment measures were not significantly correlated (all: p .092). Accuracy and precision were better for the overall MRI-derived distance between the three IVDs from L2 and L5 MRI and the distance measured between the spinous processes L2–L5. There was excellent reliability within multiple measurements at each location, with intraclass correlation coefficient, ICC (3,1) , ranging from 0.93 to 0.99 (95% CI 0.82 to 0.99) for ultrasound and from 0.98 to 0.99 (95% CI 0.92 to 0.99) for MRI. Findings do not support the use of ultrasound imaging for estimating single-segment IVD height, yet it may be used to measure the change in distance over time with a certain degree of precision based on its excellent reliability.
Publisher: BMJ
Date: 06-2021
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.BONE.2019.06.005
Abstract: Androgen deprivation therapy (ADT) improves survival in men with advanced prostate cancer (PCa), but has been associated with compromised skeletal health and increased fracture risk. However, limited previous research has investigated determinants of bone strength beyond DXA-derived areal bone mineral density (aBMD) in this population group. The aim of this cross-sectional study was to investigate the effects of ADT in men with PCa on BMD, bone structure, estimates of whole bone strength and cortical bone distribution. A total of 70 ADT-treated men, 52 PCa controls and 70 healthy controls had DXA lumbar spine and proximal femur aBMD and pQCT distal (4%) and proximal (66%) tibia and radius cortical and trabecular volumetric BMD (vBMD), bone structure, strength and cortical bone distribution assessed. Analyses included BMI and/or tibia/radius length as covariates. On average, ADT-treated men had a higher BMI than PCa (P < 0.05) but not healthy controls. ADT-treated men had 7.2-7.8% lower lumbar spine aBMD than PCa (P = 0.037) and healthy controls (P = 0.010), with a trend for a lower total hip aBMD in the ADT-treated men (P = 0.07). At the distal tibia, total bone area was 6.2-7.3% greater in ADT-treated men than both controls (P < 0.01), but total vBMD was 8.4-8.7% lower in ADT-treated men than both controls (P < 0.01). Moreover, bone strength index (BSI) was 10.8% lower relative to healthy controls only (P < 0.05). At the distal radius, ADT-treated men had lower total and trabecular vBMD (10.7-14.8%, P < 0.05) and BSI (23.6-27.5%, P < 0.001) compared to both controls. There were no other differences in bone outcomes at the proximal tibia or radius. In conclusion, ADT treatment for PCa was associated with lower BMD and estimated compressive bone strength, particularly at trabecular skeletal sites (lumbar spine, and distal tibia and radius), compared to controls, but there were no consistent differences in cortical bone structure, distribution or bending strength.
Publisher: Elsevier BV
Date: 2022
Publisher: Springer Science and Business Media LLC
Date: 07-09-2022
DOI: 10.1038/S41598-022-19542-5
Abstract: Chronic back pain (CBP) is heterogenous and identifying sub-groups could improve clinical decision making. Machine learning can build upon prior sub-grouping approaches by using a data-driven approach to overcome clinician subjectivity, however, only binary classification of pain versus no-pain has been attempted to date. In our cross-sectional study, age- and sex-matched participants with CBP (n = 4156) and pain-free controls (n = 14,927) from the UkBioBank were included. We included variables of body mass index, depression, loneliness/social isolation, grip strength, brain grey matter volumes and functional connectivity. We used fuzzy c-means clustering to derive CBP sub-groups and Support Vector Machine (SVM), Naïve Bayes, k-Nearest Neighbour (kNN) and Random Forest classifiers to determine classification accuracy. We showed that two variables (loneliness/social isolation and depression) and five clusters were optimal for creating sub-groups of CBP in iduals. Classification accuracy was greater than 95% for when CBP sub-groups were assessed only, while misclassification in CBP sub-groups increased to 35–53% across classifiers when pain-free controls were added. We showed that in iduals with CBP could sub-grouped and accurately classified. Future research should optimise variables by including specific spinal, psychosocial and nervous system measures associated with CBP to create more robust sub-groups that are discernible from pain-free controls.
Publisher: Public Library of Science (PLoS)
Date: 21-08-2023
DOI: 10.1371/JOURNAL.PONE.0282346
Abstract: In patients presenting with low back pain (LBP), once specific causes are excluded (fracture, infection, inflammatory arthritis, cancer, cauda equina and radiculopathy) many clinicians pose a diagnosis of non-specific LBP. Accordingly, current management of non-specific LBP is generic. There is a need for a classification of non-specific LBP that is both data- and evidence-based assessing multi-dimensional pain-related factors in a large s le size. The “PRedictive Evidence Driven Intelligent Classification Tool for Low Back Pain” (PREDICT-LBP) project is a prospective cross-sectional study which will compare 300 women and men with non-specific LBP (aged 18–55 years) with 100 matched referents without a history of LBP. Participants will be recruited from the general public and local medical facilities. Data will be collected on spinal tissue (intervertebral disc composition and morphology, vertebral fat fraction and paraspinal muscle size and composition via magnetic resonance imaging [MRI]), central nervous system adaptation (pain thresholds, temporal summation of pain, brain resting state functional connectivity, structural connectivity and regional volumes via MRI), psychosocial factors (e.g. depression, anxiety) and other musculoskeletal pain symptoms. Dimensionality reduction, cluster validation and fuzzy c-means clustering methods, classification models, and relevant sensitivity analyses, will classify non-specific LBP patients into sub-groups. This project represents a first personalised diagnostic approach to non-specific LBP, with potential for widespread uptake in clinical practice. This project will provide evidence to support clinical trials assessing specific treatments approaches for potential subgroups of patients with non-specific LBP. The classification tool may lead to better patient outcomes and reduction in economic costs.
Publisher: Springer Science and Business Media LLC
Date: 12-08-2023
DOI: 10.1038/S41598-023-40245-Y
Abstract: The classification of non-specific chronic low back pain (CLBP) according to multidimensional data could guide clinical management yet recent systematic reviews show this has not been attempted. This was a prospective cross-sectional study of participants with CLBP (n = 21) and age-, sex- and height-matched pain-free controls (n = 21). Nervous system, lumbar spinal tissue and psychosocial factors were collected. Dimensionality reduction was followed by fuzzy c-means clustering to determine sub-groups. Machine learning models (Support Vector Machine, k-Nearest Neighbour, Naïve Bayes and Random Forest) were used to determine the accuracy of classification to sub-groups. The primary analysis showed that four factors (cognitive function, depressive symptoms, general self-efficacy and anxiety symptoms) and two clusters (normal versus impaired psychosocial profiles) optimally classified participants. The error rates in classification models ranged from 4.2 to 14.2% when only CLBP patients were considered and increased to 24.2 to 37.5% when pain-free controls were added. This data-driven pilot study classified participants with CLBP into sub-groups, primarily based on psychosocial factors. This contributes to the literature as it was the first study to evaluate data-driven machine learning CLBP classification based on nervous system, lumbar spinal tissue and psychosocial factors. Future studies with larger s le sizes should validate these findings.
Publisher: BMJ
Date: 16-06-2020
Publisher: Cold Spring Harbor Laboratory
Date: 21-12-2022
DOI: 10.1101/2022.12.20.22283756
Abstract: Cell-free microRNAs (cf-miRNAs) are secreted from cells and transported via the blood to exert their effect on target tissues. Numerous pathophysiological adaptations, including exercise, alter cf-miRNA levels. The aim of the systematic review was to investigate the cf-miRNA response to an acute bout of exercise and to interpret it using a robust correlated and hierarchical effects (CHE) meta-analysis. The systematic review was registered in PROSPERO (CRD42021256303). A CHE meta-analysis was used to compare the changes in cf-miRNA levels and the influence of exercise modality. An exploratory machine-learning-based approach was used to capture influential moderators. Primary studies were retrieved from PubMed and SPORTDiscus (09.03.2022). Relative changes in cf-miRNA expression in response to exercise were computed for each study. The ROBINS-I, GRADE and AMSTAR2 tools were used to assess evidence certainty and risk of bias. Thirty-six studies including an acute exercise intervention in N=880 healthy males and females aged 18-45yrs met the eligibility criteria. Muscle enriched cf-miR-1 (N=320), cf-miR-133a (N=195) and cf-miR-133b (N=132) levels increased 1-2hr (cf-miR1: FC = 2.72, 95% CI= 1.5-4.0 cf-miR133a: FC = 2.10, 95% CI = 1.6-2.6 cf-miR-133b: FC = 2.39, 95% CI = 1.2-3.6) and 24 hr post-exercise (cf-miR1: FC = 2.25, 95% CI= 1.3-3.2 cf-miR133a: FC = 1.81, 95% CI = 1.4-2.2 cf-miR-133b: FC = 1.99, 95% CI = 1.2-2.8). Acute exercise triggers temporal and modality specific responses in cf-miRNAs. levels. Influential moderators included s le size, collection time point, exercise modality, age and the use of various technical quality controls. Exercise acutely alters cell-free miRNA (cf-miRNA) levels in human serum and plasma, but research is poorly reproducible Muscle-enriched cf-miRNA levels robustly increase following an acute bout of exercise, with temporal and modality specific responses The implementation of a CHE model, a novel statistical approach within the miRNA field, allowed to identify key methodological factors moderating cf-miRNA levels. Strict implementation of these factors is warranted to improve rigour and reproducibility in this field.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-08-2020
DOI: 10.1519/JSC.0000000000003752
Abstract: Mitchell, UH, Owen, PJ, Rantalainen, T, and Belavý, DL. Increased joint mobility is associated with impaired transversus abdominis contraction. J Strength Cond Res 36(9): 2472–2478, 2022—Increased joint mobility is a risk factor for joint injury, but muscle function may be able to compensate for it. Current evidence suggests reduced force production capacity in people with hypermobility. However, little is known about the lumbar spine. The purpose of this cross-sectional study was to assess whether there was a link between joint mobility and transverse abdominis and multifidus muscles contraction, muscles ascribed a core-stability role. Using a modified quantitative version of the Beighton scale (BOM score), we measured joint mobility of 30 middle-aged in iduals without low back pain. These scores were correlated with magnetic resonance imaging–derived measures of transverse abdominis and multifidus muscle contraction during a spinal loading maneuver. The level of significance was set for p ≤ 0.05. The results showed greater joint mobility (a higher BOM score) correlated ( r = 0.468 p = 0.009) with reduced transversus abdominis (TrA) shortening during contraction (i.e., less muscle shortening in people with greater joint mobility). The trunk subdomain score exhibited a correlation of 0.354 with TrA length change, but this did not reach statistical significance ( p = 0.055). The subdomains of the BOM score did not correlate significantly with each other ( p ≥ 0.097). No association was seen between multifidus contraction and joint mobility. The results suggest that greater general joint mobility is associated with impaired contraction of the TrA muscle. This should be considered when coaching athletes or treating patients with (functional) spinal instability. The quantitative approach we developed to measure joint mobility could be used in the future studies of global flexibility.
Publisher: BMJ
Date: 08-2022
Publisher: BMJ
Date: 30-10-2020
DOI: 10.1136/BJSPORTS-2019-100886
Abstract: Examine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP). Network meta-analysis (NMA). MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL. Exercise training randomised controlled/clinical trials in adults with NSCLBP. Among 9543 records, 89 studies (patients=5578) were eligible for qualitative synthesis and 70 (pain), 63 (physical function), 16 (mental health) and 4 (trunk muscle strength) for NMA. The NMA consistency model revealed that the following exercise training modalities had the highest probability (surface under the cumulative ranking (SUCRA)) of being best when compared with true control: Pilates for pain (SUCRA=100% pooled standardised mean difference (95% CI): −1.86 (–2.54 to –1.19)), resistance (SUCRA=80% −1.14 (–1.71 to –0.56)) and stabilisation/motor control (SUCRA=80% −1.13 (–1.53 to –0.74)) for physical function and resistance (SUCRA=80% −1.26 (–2.10 to –0.41)) and aerobic (SUCRA=80% −1.18 (–2.20 to –0.15)) for mental health. True control was most likely (SUCRA≤10%) to be the worst treatment for all outcomes, followed by therapist hands-off control for pain (SUCRA=10% 0.09 (–0.71 to 0.89)) and physical function (SUCRA=20% −0.31 (–0.94 to 0.32)) and therapist hands-on control for mental health (SUCRA=20% −0.31 (–1.31 to 0.70)). Stretching and McKenzie exercise effect sizes did not differ to true control for pain or function (p .095 SUCRA %). NMA was not possible for trunk muscle endurance or analgesic medication. The quality of the synthesised evidence was low according to Grading of Recommendations Assessment, Development and Evaluation criteria. There is low quality evidence that Pilates, stabilisation/motor control, resistance training and aerobic exercise training are the most effective treatments, pending outcome of interest, for adults with NSCLBP. Exercise training may also be more effective than therapist hands-on treatment. Heterogeneity among studies and the fact that there are few studies with low risk of bias are both limitations.
Publisher: Wiley
Date: 14-11-2022
DOI: 10.1002/EJP.1883
Abstract: Nervous system, psychosocial and spinal tissue biomarkers are associated with non‐specific low back pain (nsLBP), though relative contributions are unclear. MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus were searched up to 25 March 2020. Related reviews and reference lists were also screened. Observational studies examining structural and functional nervous system biomarkers (e.g. quantitative sensory tests, structural and functional brain measures), psychosocial factors (e.g. mental health, catastrophizing) and structural spinal imaging biomarkers (e.g. intervertebral disc degeneration, paraspinal muscle size) between nsLBP and pain‐free controls were included. For multivariate meta‐analysis, two of three domains were required in each study. Random‐effects pairwise and multivariate meta‐analyses were performed. GRADE approach assessed evidence certainty. Newcastle‐Ottawa scale assessed risk of bias. Main outcomes were the effect size difference of domains between nsLBP and pain‐free controls. Of 4519 unique records identified, 33 studies (LBP = 1552, referents = 1322) were meta‐analysed. Psychosocial state (Hedges’ g [95%CI]: 0.90 [0.69–1.10], p 0.001) in nsLBP showed larger effect sizes than nervous system (0.31 [0.13–0.49], p 0.001 difference: 0.61 [0.36–0.86], p 0.001) and spine imaging biomarkers (0.55 [0.37–0.73], p 0.001 difference: 0.36 [0.04–0.67], p = 0.027). The relationship between domains changes depending on if pain duration is acute or chronic. Psychosocial effect sizes in nsLBP are greater than those for spinal imaging and nervous system biomarkers. Limitations include cross‐sectional design of studies included and inference of causality. Future research should investigate the clinical relevance of these effect size differences in relation to pain intensity and disability. PROSPERO‐CRD42020159188. Spinal structural lesions (e.g. intervertebral disc degeneration), psychosocial (e.g. depression) and nervous system factors (detected by e.g. quantitative sensory tests, structural and functional measures) contribute to non‐specific low back pain. However, psychosocial factors may be more compromised than nervous system and spinal imaging biomarkers. This relationship depends on if the pain is acute or chronic. These findings underscore that the ‘non‐specific’ label in back pain should be reconsidered, and more specific multidimensional categories evaluated to guide patient management.
Publisher: Public Library of Science (PLoS)
Date: 05-08-2020
Publisher: Springer Science and Business Media LLC
Date: 22-07-2022
DOI: 10.1186/S40798-022-00483-2
Abstract: The COVID-19 pandemic has led to a shift in healthcare towards telehealth delivery, which presents challenges for exercise physiology services. We aimed to examine the impact of the COVID-19 pandemic on the reach, efficacy, adoption and implementation of telehealth delivery for exercise physiology services by comparing Australian practises before (prior to 25 January 2020) and during the COVID-19 pandemic (after 25 January 2020). This retrospective audit included 80 accredited exercise physiology clinicians. We examined relevant dimensions of the RE-AIM framework (reach, effectiveness, adoption and implementation) from the clinician perspective. During the COVID-19 pandemic, 91% ( n = 73/80) of surveyed clinicians offered telehealth delivery service, compared to 25% ( n = 20/80) prior. Mean (SD) telehealth delivery per week doubled from 5 (7) to 10 (8) hours. In-person delivery decreased from 23 (11) to 15 (11) hours per week. Typical reasons for not offering telehealth delivery were client physical/cognitive incapacity ( n = 33/80, 41%) and safety ( n = 24/80, 30%). Clinician-reported reasons for typical clients not adopting telehealth delivery were personal preference ( n = 57/71, 80%), physical capacity ( n = 35/71, 49%) and access to reliable delivery platforms ( n = 27/71, 38%). Zoom ( n = 54/71, 76%) and telephone ( n = 53/71, 75%) were the most commonly used platforms. Of the reasons contributing to incomplete treatment, lack of confidence in delivery mode was sevenfold higher for telehealth compared to in-person delivery. No serious treatment-related adverse events were reported. During the COVID-19 pandemic, telehealth delivery of exercise physiology services increased and in-person delivery decreased, which suggests the profession was adaptable and agile. However, further research determining comparative efficacy and cost-effectiveness is warranted.
Publisher: Springer Science and Business Media LLC
Date: 20-04-2016
Publisher: BMJ
Date: 29-08-2022
DOI: 10.1136/BJSPORTS-2021-105359
Abstract: Compare the effectiveness of primarily surgical versus primarily rehabilitative management for anterior cruciate ligament (ACL) rupture. Living systematic review and meta-analysis. Six databases, six trial registries and prior systematic reviews. Forward and backward citation tracking was employed. Randomised controlled trials that compared primary reconstructive surgery and primary rehabilitative treatment with or without optional reconstructive surgery. Bayesian random effects meta-analysis with empirical priors for the OR and standardised mean difference and 95% credible intervals (CrI), Cochrane RoB2, and the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence. Of 9514 records, 9 reports of three studies (320 participants in total) were included. No clinically important differences were observed at any follow-up for self-reported knee function (low to very low certainty of evidence). For radiological knee osteoarthritis, we found no effect at very low certainty of evidence in the long term (OR (95% CrI): 1.45 (0.30 to 5.17), two studies). Meniscal damage showed no effect at low certainty of evidence (OR: 0.85 (95% CI 0.45 to 1.62) one study) in the long term. No differences were observed between treatments for any other secondary outcome. Three ongoing randomised controlled trials were identified. There is low to very low certainty of evidence that primary rehabilitation with optional surgical reconstruction results in similar outcome measures as early surgical reconstruction for ACL rupture. The findings challenge a historical paradigm that anatomic instability should be addressed with primary surgical stabilisation to provide optimal outcomes. CRD42021256537.
Publisher: Wiley
Date: 04-09-2023
DOI: 10.1002/JBMR.4899
Abstract: Moderate‐ to high‐impact exercise improves bone mineral density (BMD) across the lifespan, but its effects on bone structure, which predicts fracture independent of areal BMD, are unclear. This systematic review and meta‐analysis investigated effects of impact exercise on volumetric BMD (vBMD) and bone structure. Four databases (PubMed, Embase, SPORTDiscus, Web of Science) were searched up to March 2022 for randomised controlled trials (RCTs) investigating the effects of impact exercise, with ground reaction forces equal to, or greater than, running, compared with sham or habitual activity, on bone vBMD and structure. Bone variables were measured by quantitative computed tomography or magnetic resonance imaging at the tibia, radius, lumbar spine and femur. Percentage changes in bone variables were compared between groups using mean differences (MD) and 95% CI calculated via random effects meta‐analyses. Subgroup analyses were performed in children/adolescents ( years), adults (18–50 years), postmenopausal women, and older men. Twenty‐eight RCTs (n = 2,985) were included. Across all studies, impact exercise improved trabecular vBMD at the distal tibia (MD = 0.54% [95%CI = 0.17, 0.90%]), total vBMD at the proximal femur (3.11% [1.07, 5.14%]), and cortical thickness at the mid roximal radius (1.78% [0.21, 3.36%]). There was no effect on vBMD and bone structure at the distal radius, femoral shaft or lumbar spine across all studies or in any subgroup. In adults, impact exercise decreased mid roximal tibia cortical vBMD (−0.20% [−0.24, −0.15%]). In postmenopausal women, impact exercise improved distal tibia trabecular vBMD (0.79% [0.32, 1.25%). There was no effect on bone parameters in children/adolescents in overall analyses, and there were insufficient studies in older men to perform meta‐analyses. Impact exercise may have beneficial effects on bone structure and vBMD at various skeletal sites but additional high‐quality RCTs in different age and sex subgroups are needed to identify optimal exercise protocols for improving bone health across the lifespan. This article is protected by copyright. All rights reserved.
Publisher: BMJ
Date: 03-2023
No related grants have been discovered for Patrick Owen.