ORCID Profile
0000-0003-4030-9697
Current Organisations
University of Queensland
,
Royal Brisbane and Women's Hospital
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Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.JELEKIN.2006.10.011
Abstract: Studies of lumbar intradiscal pressure (IDP) in standing and upright sitting have mostly reported higher pressures in sitting. It was assumed clinically that flexion of the lumbar spine in sitting relative to standing, caused higher IDP, disc degeneration or rupture, and low back pain. IDP indicates axial compressive load upon a non-degenerate disc, but provides little or no indication of shear, axial rotation or bending. This review is presented in two main parts. First, in vivo IDP data in standing and upright sitting for non-degenerate discs are comprehensively reviewed. As methodology, results and interpretations varied between IDP studies, in vivo studies measuring spinal shrinkage and spinal internal-fixator loads to infer axial compressive load to the discs are also reviewed. When data are considered together, it is clear that IDP is often similar in standing and sitting. Secondly, clinical assumptions related to IDP in sitting are considered in light of basic and epidemiologic studies. Current studies indicate that IDP in sitting is unlikely to pose a threat to non-degenerate discs, and sitting is no worse than standing for disc degeneration or low back pain incidence. If sitting is a greater threat for development of low back pain than standing, the mechanism is unlikely to be raised IDP.
Publisher: Informa UK Limited
Date: 28-02-2022
DOI: 10.1080/09638288.2021.1887374
Abstract: Evaluate the validity of the Clinical Test of Sensory Integration of Balance (CTSIB) scored using Kids-Balance Evaluation Systems Test (Kids-BESTest) criteria compared to laboratory measures of postural control. Participants were 58 children, 7-18 years, 17 with ambulant cerebral palsy (CP) (GMFCS I-II), and 41 typically developing (TD). Postural control in standing was assessed using CTSIB items firm and foam surfaces, eyes open (EO) then closed (EC). Face validity was evaluated comparing clinical Kids-BESTest scores between groups. Correlating force plate centre-of-pressure (CoP) data and clinical scores allowed evaluation of concurrent and content validity. Face validity: TD children scored higher for all CTSIB conditions when compared to children with CP. Concurrent validity: the agreement between clinical and CoP derived scores was poor to excellent (Firm-EO = 76%, Firm-EC = 76%, Foam-EO = 59%, Foam-EC = 94%). Clinical scores of "2- Face validity of Kids-BESTest CTSIB criteria was supported. Content and concurrent validity were partially supported. Improved Kids-BESTest scoring terms were recommended to describe postural characteristics of "2
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 11-2013
Abstract: Cross-sectional controlled laboratory study. To investigate potential changes in the function of discrete regions of the psoas major (PM) and quadratus lumborum (QL) with changes in spinal curvatures and hip positions in sitting, in people with recurrent low back pain (LBP). Although the PM and QL contribute to control of spinal curvature in sitting, whether activity of these muscles is changed in in iduals with LBP is unknown. Ten volunteers with recurrent LBP (pain free at the time of testing) and 9 pain-free in iduals in a comparison group participated. Participants with LBP were grouped into those with high and low erector spinae (ES) electromyographic (EMG) signal litude, recorded when sitting with a lumbar lordosis. Data were recorded as participants assumed 3 sitting postures. Fine-wire electrodes were inserted with ultrasound guidance into fascicles of the PM arising from the transverse process and vertebral body, and the anterior and posterior layers of the QL. When data from those with recurrent LBP were analyzed as 1 group, PM and QL EMG signal litudes did not differ between groups in any of the sitting postures. However, when subgrouped, those with low ES EMG had greater EMG signal litude of the PM vertebral body and QL posterior layer in flat posture and greater EMG signal litude of the QL posterior layer in short lordotic posture, compared to those in the pain-free group. For the group with high ES EMG, the PM transverse process and PM vertebral body EMG was less than that of the other LBP group in short lordotic posture. The findings suggest a redistribution of activity between muscles that have a potential extensor moment in in iduals with LBP. The modification of EMG of discrete fascicles of the PM and QL was related to changes in ES EMG signal litude recorded in sitting.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.APMR.2018.12.021
Abstract: To evaluate the reproducibility, including reliability and agreement, of the Kids Balance Evaluation Systems Test (Kids-BESTest) and the short form of Kids-BESTest (Kids-Mini-BESTest) for measuring postural control in school-aged children with cerebral palsy. Psychometric study of intrarater, interrater, and test-retest reliability and agreement. Clinical laboratory and home. Convenience s le of children (N=18) aged 8 to 17 years with ambulant cerebral palsy (CP) (Gross Motor Function Classification System I-II) with spastic or ataxic motor type. Not applicable. Postural control was assessed using the Kids-BESTest and the Kids-Mini-BESTest. An experienced physiotherapist assessed all children in real time and the testing session was videotaped. The same physiotherapist viewed and scored the video twice, at least 2 weeks apart, to assess intrarater reproducibility. Another experienced physiotherapist scored the same video to determine interrater reproducibility. Thirteen children returned for a repeat assessment with the first physiotherapist within 6 weeks and their test-retest performance was rated in real time and with video. Excellent reliability was observed for both the Kids-BESTest (intraclass correlation coefficient [ICC] 0.96-0.99) and Kids-Mini-BESTest (ICC 0.79-0.98). The smallest detectable change was good to excellent for all Kids-BESTest agreement analyses (5%-9%), but poor to good for Kids-Mini-BESTest analyses (9%-16%). The Kids-BESTest shows an excellent ability to discriminate postural control abilities of school-aged children with CP and it has a low smallest detectable change, suitable for use as a preintervention and postintervention outcome measure. Although the Kids-Mini-BESTest is 5 to 10 minutes shorter to administer, it has poorer reproducibility and focuses only on falls-related balance, which excludes 2 domains of postural control.
Publisher: Proceedings of the National Academy of Sciences
Date: 12-09-2022
Abstract: Outer membrane porins in Gram-negative bacteria facilitate antibiotic influx. In Klebsiella pneumoniae , modifications in the porin OmpK36 are implicated in increasing resistance to carbapenems. An analysis of large K. pneumoniae genome collections, encompassing major healthcare-associated clones, revealed the recurrent emergence of a synonymous cytosine-to-thymine transition at position 25 (25c t) in ompK36. We show that the 25c t transition increases carbapenem resistance through depletion of OmpK36 from the outer membrane. The mutation attenuates K. pneumoniae in a murine pneumonia model, which accounts for its limited clonal expansion observed by phylogenetic analysis. However, in the context of carbapenem treatment, the 25c t transition tips the balance toward treatment failure, thus accounting for its recurrent emergence. Mechanistically, the 25c t transition mediates an intramolecular messenger RNA (mRNA) interaction between a uracil encoded by 25t and the first adenine within the Shine–Dalgarno sequence. This specific interaction leads to the formation of an RNA stem structure, which obscures the ribosomal binding site thus disrupting translation. While mutations reducing OmpK36 expression via transcriptional silencing are known, we uniquely demonstrate the repeated selection of a synonymous ompK36 mutation mediating translational suppression in response to antibiotic pressure.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
Publisher: JMIR Publications Inc.
Date: 06-10-2023
DOI: 10.2196/47267
Publisher: MDPI AG
Date: 29-01-2022
Abstract: Poor communication is an important factor contributing to health disparity. This study sought to investigate clinicians’ perspectives about communicating with Aboriginal and Torres Strait Islander patients with pain. This multi-site and mixed-methods study involved clinicians from three pain management services in Queensland, Australia. Clinicians completed a survey and participated in focus groups. Clinicians rated the importance of communication training, their knowledge, ability, and confidence in communicating with Aboriginal and Torres Strait Islander patients using a 5-point Likert scale. Rating scores were combined into low (scores 1–2) moderate (score 3) and high (scores 4–5). Informed by an interpretive description methodology, thematic analysis of focus group data was used to identify the communication needs and training preferences of clinicians. Overall (N = 64), 88% of clinicians rated the importance of communication training when supporting Aboriginal and Torres Strait Islander patients as “high”. In contrast, far fewer clinicians rated as “high” their knowledge (28%), ability (25%) and confidence (28%) in effectively communicating with Aboriginal and Torres Strait Islander patients. Thematic analysis identified three areas of need: knowledge of Aboriginal and Torres Strait Islander cultures, health beliefs, and understanding cross-cultural cues. Communication skills can be learned and training, in the form of a tailored intervention to support quality engagement with Aboriginal and Torres Strait Islander patients, should combine cultural and communication aspects with biomedical knowledge.
Publisher: Elsevier BV
Date: 03-2022
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.APERGO.2015.09.006
Abstract: Few studies quantify spinal posture behaviour at both the thoracolumbar and lumbar spinal regions. This study compared spontaneous spinal posture in 50 asymptomatic participants (21 males) during three conditions: 10-min computer task in sitting (participants naïve to the measure), during their perceived 'correct' sitting posture, and standing. Three-dimensional optical tracking quantified surface spinal angles at the thoracolumbar and lumbar regions, and spinal orientation with respect to the vertical. Despite popular belief that lordotic lumbar angles are 'correct' for sitting, this was rarely adopted for 10-min sitting. In 10-min sitting, spinal angles flexed 24(7-9)deg at lumbar and 12(6-8)deg at thoracolumbar regions relative to standing (P < 0.001). When participants 'corrected' their sitting posture, their thoracolumbar angle -2(7)deg was similar to the angle in standing -1(6)deg (P = 1.00). Males were flexed at the lumbar angle relative to females for 10-min sitting, 'correct' sitting and standing, but showed no difference at the thoracolumbar region.
Publisher: Cold Spring Harbor Laboratory
Date: 07-02-2022
DOI: 10.1101/2022.02.07.479342
Abstract: Mutations in outer membrane porins act in synergy with carbapenemase enzymes to increase carbapenem resistance in the important nosocomial pathogen, Klebsiella pneumoniae (KP). A key ex le is a di-amino acid insertion, Glycine-Aspartate (GD), in the extracellular loop 3 (L3) region of OmpK36 which constricts the pore and restricts entry of carbapenems into the bacterial cell. Here we combined genomic and experimental approaches to characterise the ersity, spread and impact of different L3 insertion types in OmpK36. We identified L3 insertions in 3588 (24.1%) of 14,888 KP genomes with an intact ompK36 gene from a global collection. GD insertions were most common, with a high concentration in the ST258/512 clone that has spread widely in Europe and the Americas. Aspartate (D) and Threonine-Aspartate (TD) insertions were prevalent in genomes from Asia, due in part to acquisitions by ST16 and ST231 and subsequent clonal expansions. By solving the crystal structures of novel OmpK36 variants, we found that the TD insertion causes a pore constriction of 41%, significantly greater than that achieved by GD (10%) or D (8%), resulting in the highest levels of resistance to selected antibiotics. In a murine pneumonia model, KP mutants harbouring L3 insertions have a competitive disadvantage relative to a strain expressing wild-type OmpK36 in the absence of antibiotics. This explains the reversion of GD and TD insertions observed at low frequency among KP genomes. Finally, we demonstrate that strains expressing L3 insertions remain susceptible to drugs targeting carbapenemase-producing KP, including novel beta lactam-beta lactamase inhibitor combinations. This study provides a contemporary global view of OmpK36-mediated resistance mechanisms in KP, integrating surveillance and experimental data to guide treatment and drug development strategies. Rapidly rising rates of antibiotic resistance among Klebsiella pneumoniae (KP) necessitate a comprehensive understanding of the ersity, spread and clinical impact of resistance mutations. In KP, mutations in outer membrane porins play an important role in mediating resistance to carbapenems, a key class of antibiotics. Here we show that resistance mutations in the extracellular loop 3 (L3) region of the OmpK36 porin are found at high prevalence among clinical genomes and we characterise their ersity and impact on resistance and virulence. They include amino acid insertions of Aspartate (D), Glycine-Aspartate (GD) and Threonine-Aspartate (TD), which act by decreasing the pore size and restricting entry of carbapenems into the bacterial cell. We show that these L3 insertions are associated with large clonal expansions of resistant lineages and impose only a low fitness cost. Critically, strains harbouring L3 insertions remain susceptible to novel drugs, including beta lactam-beta lactamase inhibitor combinations. This study highlights the importance of monitoring the emergence and spread of strains with OmpK36 L3 insertions for the control of resistant KP infections and provides crucial data for drug development and treatment strategies.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-07-2023
DOI: 10.1097/BRS.0000000000004715
Abstract: This is a case-control study of prospectively collected data. To quantify paraspinal muscle size asymmetry in adolescent idiopathic scoliosis (AIS) and determine if this asymmetry is i) greater than observed in adolescent controls with symmetrical spines and ii) positively associated with skeletal maturity using Risser grade, scoliosis severity using the Cobb angle, and chronological age in years. AIS is a three-dimensional deformity of the spine which occurs in 2.5-3.7% of the Australian population. There is some evidence of asymmetry in paraspinal-muscle activation and morphology in AIS. Asymmetrical paraspinal muscle forces may facilitate asymmetrical vertebral growth during adolescence. An asymmetry index [Ln(concave/convex volume)] of i) deep and ii) superficial paraspinal-muscle volumes, at the level of the i) major curve apex (Thoracic 8-9 th vertebral level) and ii) lower-end vertebrae ( LEV , Thoracic 10-12 th vertebral level), was determined from 3D Magnetic Resonance Imaging (MRI) of 25 adolescents with AIS (all right thoracic curves), and 22 healthy controls (convex=left) all female, 10-16 years. Asymmetry index of deep paraspinal-muscle volumes was greater in AIS (0.16±0.20) than healthy spine controls (-0.06±0.13) at the level of the apex ( P .01, linear mixed-effects analysis), but not LEV ( P .05). Asymmetry index was positively correlated with Risser grade (r=0.50, P .05) and scoliosis Cobb angle (r=0.45, P .05), but not age (r=0.34, P .05). There was no difference in the asymmetry index of superficial paraspinal muscle volumes between AIS and controls ( P .05). The asymmetry of deep apical paraspinal-muscle volume in AIS at the scoliosis apex is greater than that observed at equivalent vertebral levels in controls and may play a role in the pathogenesis of AIS.
Publisher: Elsevier BV
Date: 12-2015
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.GAITPOST.2017.04.010
Abstract: This study evaluated the intra-rater, inter-rater and test-retest reproducibility of the Full-BESTest and Mini-BESTest when assessing postural control in children. Thirty-four children aged 7-17 years participated in intra-rater and inter-rater evaluation, and 22 children repeated assessment six weeks later for evaluation of test-retest reliability. Postural control was assessed using the Full Balance Evaluation Systems Test (Full-BESTest) and the short-form Mini-BESTest. Intra-rater, inter-rater and test-retest reproducibility were examined using video assessment. Test-retest reproducibility was also assessed in real-time. Reproducibility was examined by agreement and reliability statistics. Agreement was calculated using percentage of agreement, Limits of Agreement and Smallest Detectable Change. Reliability was calculated using Intra-class Correlation Coefficients. Results showed that the reliability of Total Scores was excellent for the Full-BESTest for all conditions (all ICCs>0.82), whereas the Mini-BESTest ranged from fair to excellent (ICC=0.56-0.86). Percentage of Domain Scores with good-excellent reliability (ICCs>0.60) was slightly higher for the Full-BESTest (66%) compared to the Mini-BESTest (59%). Smallest Detectable Change scores were good to excellent for the Full-BESTest (2%-6%) and for the Mini-BESTest (5%-10%) relative to total test scores. Both the Full-BESTest and Mini-BESTest can discriminate postural control abilities within and between days in school-aged children. The Full-BESTest has slightly better reproducibility and a broader range of items, which could be the most useful version for treatment planning. We propose minor modifications to improve reproducibility for children, and indicate the modified version by the title Kids-BESTest. Future psychometric research is recommended for specific paediatric clinical populations.
Publisher: BMJ
Date: 26-03-2020
DOI: 10.1136/BJSPORTS-2019-100935
Abstract: To test (i) if greater foot pronation (measured as midfoot width mobility) is associated with better outcomes with foot orthoses treatment, compared with hip exercises and (ii) if hip exercises are superior to foot orthoses, irrespective of midfoot width mobility. A two-arm parallel, randomised superiority clinical trial was conducted in Australia and Denmark. Participants (18–40 years) were included who reported an insidious onset of knee pain (≥6 weeks duration) ≥3/10 numerical pain rating, that was aggravated by activities (eg, stairs, squatting, running). Participants were stratified by midfoot width mobility ( high ≥11 mm change in midfoot width) and site, randomised to foot orthoses or hip exercises and blinded to objectives and stratification. Success was defined a priori as much better or better on a patient-perceived 7-point scale at 12 weeks. Of 218 stratified and randomised participants, 192 completed 12-week follow-up. This study found no difference in success rates between foot orthoses versus hip exercises in those with high (6/21 vs 9/20 29% vs 45%, respectively) or low (42/79 vs 37/72 53% vs 51%) midfoot width mobility. There was no association between midfoot width mobility and treatment outcome (Interaction effect p=0.19). This study found no difference in success rate between foot orthoses versus hip exercises (48/100 vs 46/92 48% vs 50%). Midfoot width mobility should not be used to help clinicians decide which patient with patellofemoral pain might benefit most from foot orthoses. Clinicians and patients may consider either foot orthoses or hip exercises in managing patellofemoral pain. ACTRN12614000260628.
Publisher: JMIR Publications Inc.
Date: 14-03-2023
Abstract: he delivery of education about pain neuroscience and the evidence for different treatment approaches has become a key component of contemporary persistent pain management. Chatbots, or more formally conversation agents, are increasingly being used in health care settings due to their versatility to provide interactive and in idualized approaches to both capture and deliver information. Research focused on the acceptability of erse chatbot formats can assist in developing a better understanding of the education needs of target populations and maximize the impact of these software applications within the health field. his study aimed to 1) detail the development and initial pilot testing of a multi-modality pain education chatbot (Dolores) that can be utilized across different age groups, and 2) investigate if acceptability and feedback was comparable across age groups following pilot testing. ollowing an initial design phase involving software engineers (n=2) and expert clinicians (n=6), 60 in iduals with chronic pain who attended an outpatient clinic at one of two pain centers in Australia were recruited for pilot testing. Twenty adolescents (10-18 years), 20 young adults (19-35 years), and 20 adults (over 35 years of age) with persistent pain were recruited. Participations were given an iPad with the Dolores app installed and spent 20-30 minutes completing interactive chatbot activities to: i) gather a pain history and ii) provide education about pain and pain treatments. After the chatbot activities, participants completed a custom-made feedback questionnaire measuring acceptability constructs pertaining to health education chatbots. To determine the effect of age group on acceptability ratings and feedback provided, a series of binomial logistic regression models and cumulative odds ordinal logistic regression models with proportional odds were then generated. verall, acceptability was high for the following constructs: engagement, perceived value, usability, accuracy, responsiveness, adoption intention, aesthetics and overall quality. The effect of age group on all acceptability ratings was small and not statistically significant. Analysis of open-ended question responses revealed that major frustrations with the app were related to Dolores’ speech which was explored further through a comparative analysis. For providing negative feedback about Dolores’ speech, a logistic regression model showed that the effect of age group was statistically significant (χ2(2) = 11.68, P = .003) and explained 27.1% of the variance (Nagelkerke R2). Adults and young adults were less likely to comment on Dolores’ speech compared to adolescent participants (OR=0.20, 95% CI [0.05, 0.84] OR=0.05, 95% CI [0.01, 0.43] respectively). Comments related to both speech rate (too slow) and quality (unpleasant and robotic). his study provided support for the acceptability of pain history and education chatbots across different age groups. Chatbot acceptability for adolescent cohorts may be improved by enabling self-selection of speech characteristics such as rate and personable tone.
Publisher: Springer Science and Business Media LLC
Date: 13-03-2023
DOI: 10.1007/S00223-023-01075-2
Abstract: Dual-energy X-ray absorptiometry (DEXA) scan is an emerging screening method for identifying likely adolescent idiopathic scoliosis (AIS). Using DEXA in an unbiased population s le (the Raine Study), we aimed to report the inter-rater reliability and minimal detectable change (MDC 95 ) for scoliosis curve angle measurement, identify likely AIS prevalence, and the concordance between reported AIS diagnosis and DEXA-identified likely AIS. Scoliosis curve angles were measured using the modified Ferguson method on DEXA scans ( n = 1238) at age 20 years. For curve angle inter-rater reliability, two examiners measured angles (6–40°) on 41 scans. Likely, AIS was determined with quantitative and qualitative criteria (modified Ferguson angles ≥ 10° and expert review of spinal curves).The inter-rater reliability for scoliosis curve angle measurement was good–excellent (ICC: 0.82 95% CI: 0.71–0.89 p 0.001), and MDC 95 was 6.2°. The prevalence of likely AIS was 2.1% (26/1238). Diagnosis of AIS was reported despite little or no scoliosis curve ( 3.8°) for 20 participants (1.6%), and diagnosis of AIS was not reported despite scoliosis curve ≥ 10° for 11 participants (0.9%). Results support the use of modified Ferguson method to measure scoliosis curve angles on DEXA. There is potential utility for using a combination of quantitative measurement and qualitative criteria to evaluate DEXA images, to identify likely AIS for reporting prevalence. Without formal school screening, the analysis of DEXA in this population s le suggested that relying on current health professional diagnosis alone could result in 2.5% of this cohort being at risk of false positive diagnosis or delay in necessary management due to non-diagnosis of AIS.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Springer Science and Business Media LLC
Date: 15-07-2016
DOI: 10.1007/S10067-015-3000-4
Abstract: Neck pain is associated with changes in neuromuscular control of cervical muscles. Violin and viola playing requires good function of the flexor muscles to stabilize the instrument. This study investigated the flexor muscle behaviour in violin/viola players with and without neck pain using the craniocervical flexion test (CCFT). In total, 12 violin/viola players with neck pain, 21 violin/viola players without neck pain in the preceding 12 weeks and 21 pain-free non-musicians were included. Activity of the sternocleidomastoid muscles (SCM) was measured with surface electromyography (EMG) during the CCFT. Violin/viola players with neck pain displayed greater normalised SCM EMG litudes during CCFT than the pain-free musicians and non-musicians (P < 0.05). Playing-related neck pain in violinists/violists is associated with altered behaviour of the superficial neck flexor muscles consistent with neck pain, despite the specific use of the deep and superficial neck flexors during violin playing.
Publisher: Research Square Platform LLC
Date: 21-06-2022
DOI: 10.21203/RS.3.RS-1740247/V1
Abstract: Background: Providing cultural education to health professionals is essential in improving the quality of care and the outcomes for Aboriginal and Torres Strait Islander patients. This study reports the evaluation of a novel training workshop used as an intervention to improve communication with Aboriginal and Torres Strait Islander patients at persistent pain services. Methods : In this single-arm intervention study, health professionals undertook a one-day workshop, which included cultural capability and communication skills training based on a clinical yarning framework. The workshop was delivered across three adult persistent pain clinics in Queensland. At the end of the training, participants completed a retrospective pre ost evaluation questionnaire (5 points Likert scale , 1=very low to 5=very high) , to rate their perceived importance of communication training, their knowledge, ability, and confidence to communicate effectively. Participants also rated their satisfaction with the training and suggested improvements for future interventions. Results: Fifty-seven health professionals were trained (N= 57/111 51% participation rate), 51 completed an evaluation questionnaire (n=51/57 90% response rate). Significant improvements in the perceived importance of communication training, knowledge, ability and confidence to effectively communicate with Aboriginal and Torres Strait Islander patients were identified ( p .001 ). The greatest increase was in the perceived confidence pre-training mean of 2.96 (SE=0.11) to the post-training mean of 4.02 (SE=0.09). Conclusion: This patient-centred communication training, delivered through a novel model that combines cultural capability and the clinical yarning framework applied to the pain management setting, was highly acceptable and significantly improved participants’ perceived competence. This method is transferrable to other health system sectors seeking to train their clinical workforce with culturally sensitive communication skills.
Publisher: Wiley
Date: 05-09-2022
DOI: 10.1002/MSC.1687
Abstract: The six‐minute walk test (6MWT) is a commonly used measure of functional capacity. This study is the first to investigate the test‐retest reliability, minimal detectable difference (MDD) and the minimal clinically important difference (MCID) for people attending a persistent pain service. Relationships between change in 6MWT performance and change in self‐reported physical, functional and psychological outcome measures were also explored. A cross‐sectional repeated measures design was used with people having months of pain attending an 8‐week outpatient persistent pain programme. For reliability and MDD, 27 people were recruited, for MCID calculations, 32 people were recruited. The MCID was examined by dichotomising people into “improvers”, or “non‐improvers” based upon the Global Rating of Change (GRC) in physical abilities score. The mean (SD) 6MWT distance was 389.4 (93.6) m at programme start, and 427.8 (83.0) m at week eight completion. The test‐retest reliability was good (intraclass correlation coefficient = 0.89) and the MDD = 86.1 m. As there was no relationship between change in 6MWT distance and GRC physical abilities at week eight ( r = 0.132, p = 0.472) the MCID could not be calculated. Furthermore, no relationships were found between change in 6MWT distance and other self‐reported measures. Changes in GRC physical abilities and 6MWT were frequently discordant, with increased 6MWT for 7/11 “GRC non‐improvers” and decreased 6MWT for 7/21 “GRC improvers”. Amongst this cohort, change in physical ability may or may not be reflected by self‐reported change. Objective tests of physical ability are recommended for people attending pain services, and validated tests should align with intervention aims.
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.JELEKIN.2022.102640
Abstract: Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity occurring between ages of 10-18 years. We aimed to present a reasoned synthesis of the published evidence for and against asymmetrical paraspinal muscle activation in AIS. PubMed and Embase databases were searched using terms: adolescent idiopathic scoliosis AND electromyogra* (EMG). Identified studies (n = 94) were screened for eligibility. We identified 16 studies, from which 136 EMG outcome measures contributed to the review. For EMG onset, one of two studies provided evidence of earlier muscle activation on the convex compared to concave side of the spine, particularly in those with progressive AIS. For EMG litude, 43 outcome measures provided evidence of convex > concave activation, 85 outcomes supported no difference between sides, and 8 outcomes supported concave > convex activation. Greater activity on the convex than concave side was more commonly demonstrated at the scoliosis curve apex level, in people with single right thoracic [progressive] curves, during postural tasks. Further research is needed to determine the relationships between muscle activity asymmetry and spinal curve parameters in a variety of motor tasks. Recommendations are provided to improve methodological quality for future studies of spinal neuromuscular function in AIS, as well as more comprehensive and transparent reporting of methods and results.
Publisher: Springer Science and Business Media LLC
Date: 18-04-2021
Publisher: BMJ
Date: 13-12-2016
DOI: 10.1136/BJSPORTS-2016-096545
Abstract: Patellofemoral pain (PFP) is a multifactorial and often persistent knee condition. One strategy to enhance patient outcomes is using clinically assessable patient characteristics to predict the outcome and match a specific treatment to an in idual. A systematic review was conducted to determine which baseline patient characteristics were (1) associated with patient outcome (prognosis) or (2) modified patient outcome from a specific treatment (treatment effect modifiers). 6 electronic databases were searched (July 2016) for studies evaluating the association between those with PFP, their characteristics and outcome. All studies were appraised using the Epidemiological Appraisal Instrument. Studies that aimed to identify treatment effect modifiers underwent a checklist for methodological quality. The 24 included studies evaluated 180 participant characteristics. 12 studies investigated prognosis, and 12 studies investigated potential treatment effect modifiers. Important methodological limitations were identified. Some prognostic studies used a retrospective design. Studies aiming to identify treatment effect modifiers often analysed too many variables for the limiting s le size and typically failed to use a control or comparator treatment group. 16 factors were reported to be associated with a poor outcome, with longer duration of symptoms the most reported (>4 months). Preliminary evidence suggests increased midfoot mobility may predict those who have a successful outcome to foot orthoses. Current evidence can identify those with increased risk of a poor outcome, but methodological limitations make it difficult to predict the outcome after one specific treatment compared with another. Adequately designed randomised trials are needed to identify treatment effect modifiers.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.CLINBIOMECH.2018.01.003
Abstract: Previous research explored muscle activity in four distinct sitting postures with fine-wire electromyography, and found that lumbar multifidus muscle activity increased incrementally between sitting with flat thoracolumbar and lumbar regions, long thoracolumbar lordosis, or short lordosis confined to the lumbar region. This study used similar methods to explore whether people with a history of low back pain provoked by prolonged sitting used different patterns of trunk muscle activity in specific postures. Fine-wire electromyography electrodes were inserted into the right lumbar multifidus (deep and superficial), iliocostalis (lateral and medial), longissimus thoracis and transversus abdominis muscles. Superficial abdominal muscle activity was recorded with surface or fine-wire electrodes. Electromyography litude was compared between postures for the back pain group and observations were contrasted with the changes previously reported for pain-free controls. For comparison between groups normalised and non-normalised electromyography litudes were compared. In iduals with a history of back pain demonstrated greater activity of the longissimus thoracis muscle in the long lordosis compared with the flat posture [mean difference (95% CI): 46.6 (17.5-75.7)%, normalised to sitting posture peak activity], but pain-free participants did not [mean difference: 7.7 (minus 12-27.6)%]. Pain-free participants modulated lumbar multifidus activity with changes in lumbar curve, but people with a history of pain in prolonged sitting did not change multifidus activity between the long and short lordotic postures. In clinical ergonomic interventions that modify spinal curves and sagittal balance in sitting, the muscle activity used in those postures may differ between people with and without a history of back pain.
Publisher: BMJ
Date: 07-10-2021
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1016/J.MATH.2008.06.001
Abstract: There is a lack of quantitative evidence for spinal postures that are advocated as 'ideal' in clinical ergonomics for sitting. This study quantified surface spinal curves and examined whether subjects could imitate clinically 'ideal' directions of spinal curve at thoraco-lumbar and lumbar regions: (i) flat - at both regions (ii) long lordosis - lordotic at both regions (iii) short lordosis - thoracic kyphosis and lumbar lordosis. Ten healthy male subjects had 3-D motion sensors adhered to the skin so that sagittal spinal curves were represented by angles at thoracic (lines between T1-T5 and T5-T10), thoraco-lumbar (T5-T10 and T10-L3) and lumbar regions (T10-L3 and L3-S2). Subjects attempted to imitate pictures of spinal curves for the flat, long lordosis, short lordosis and a slumped posture, and were then given feedback/manual facilitation to achieve the postures. Repeated measures analysis of variance was used to compare spinal angles between posture and facilitation conditions. Results show that although subjects imitated postures with the same curve direction at thoraco-lumbar and lumbar regions (slumped, flat or long lordosis), they required feedback/manual facilitation to differentiate the regional curves for the short lordosis posture. Further study is needed to determine whether the clinically proposed 'ideal' postures provide clinical advantages.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 02-2013
Abstract: Cross-sectional controlled laboratory study. To investigate the function of discrete regions of psoas major (PM) and quadratus lumborum (QL) with changes in spinal curvature and hip position. Anatomically discrete regions of PM and QL may have differential function on the lumbar spine, based on anatomical and biomechanical differences in their moment arms between fascicles within each muscle. Fine-wire electrodes were inserted with ultrasound guidance into PM fascicles arising from the transverse process (PM-t) and vertebral body (PM-v) and anterior (QL-a) and posterior (QL-p) layers of QL. Recordings were made on 9 healthy participants, who performed 7 tasks with maximal voluntary efforts and adopted 3 sitting postures that involved different spinal curvatures and hip angles. Activity of PM-t was greater during trunk extension than flexion, whereas activity of PM-v was greater during hip flexion than trunk efforts. Activity of QL-p was greater during trunk extension and lateral flexion, whereas QL-a showed greater activity during lateral flexion. During sitting tasks, PM-t was more active when sitting with a short lordosis than a flat (less extended) lumbar spine posture, whereas PM-v was similarly active in both sitting postures. Activity of PM-t was more affected by changes in position of the lumbar spine than the hip, whereas PM-v was more actively involved in the movement of the hip rather than that of the lumbar spine. Moreover, from its anatomy, PM-t has a combined potential to extend/lordose the lumbar spine and flex the hip, at least in a flexed-hip position.
Publisher: Frontiers Media SA
Date: 06-12-2022
DOI: 10.3389/FPAIN.2022.1041968
Abstract: Pain management requires a multidisciplinary approach and a collaborative relationship between patient-provider in which communication is crucial. This study examines the communication experiences of Aboriginal and Torres Strait Islander patients and Aboriginal and Torres Strait Islander Hospital Liaison Officers (ATSIHLOs), to improve understanding of how pain is managed in and through patient-health professional communication. This qualitative study involved a purposive s le of patients attending three persistent pain clinics and ATSIHLOs working in two hospitals in Queensland, Australia. Focus groups and in-depth interviews explored the communication experiences of patients managing pain and ATSIHLOs supporting patients with pain. This study adopted a descriptive phenomenological methodology, as described by Colaizzi (1978). Relevant statements (patient and ATSIHLOs quotes) about the phenomenon were extracted from the transcripts to formulate meanings. The formulated meanings were subsequently sorted into thematic clusters and then integrated into themes. The themes were then incorporated into a concise description of the phenomenon of communication within pain management. Findings were validated by participants. A total of 21 Aboriginal and Torres Strait Islander participants were involved in this study. Exploration of the communication experiences of patients and ATSIHLOs revealed overlapping themes of important barriers to and enablers of communication that affected access to care while managing pain. Acknowledging historical and cultural factors were particularly important to build trust between patients and health professionals. Some patients reported feeling stigmatized for identifying as Aboriginal and Torres Strait Islander, while others were reluctant to disclose their background for fear of not having the same opportunity for treatment. Differences in the expression of pain and the difficulty to use standard pain measurement scales were identified. Communication was described as more than the content delivered, it is visual and emotional expressed through body language, voice intonation, language and the speed of the conversation. Communication can significantly affect access to pain management services. Aboriginal and Torres Strait Islander patients highlighted the burden of emotional pain caused by historical factors, negative stereotypes and the fear of discrimination. Pain management services and their health professionals need to acknowledge how these factors impact patients trust and care.
Publisher: SAGE Publications
Date: 02-07-2020
Abstract: The popularity of the Internet as a source of health-related information for low back pain (LBP) is growing. Although research has evaluated information quality in health-related websites, few studies have considered whether content and presentation match consumer preferences. The aim of this study was to evaluate whether LBP website content and presentation matched preferences of consumers with LBP, whether matching preference of consumers changed over 8 years as recognition of people-centred healthcare has developed and whether this differs between countries of Internet searching. The most prominent and top 20 LBP websites were identified using common search engines in 2010, 2015 and 2018. Websites identified in the top 20 in 2010 were followed up if not identified in 2015 and 2018. Two reviewers independently evaluated websites with a 16-item checklist developed from research of consumer preferences. In 2015, websites were identified using searches conducted using IP addresses from Australia, the United States of America (USA), the United Kingdom and Canada. After removal of duplicates, 55 websites were evaluated in 2010. In 2015 and 2018, 33 and 28 new sites, respectively, were identified, and 37 previous websites were re-evaluated. In 2010 and 2015, websites predominantly originated from USA and were sponsored by “for-profit” organisations. In 2018, most websites originated from Australian “not-for-profit” organisations. None of the websites provided information on all content areas. At least 55% of websites were rated as poor or fair. No site rated as excellent overall. There was some worsening over time. Country of search did not affect results. Websites retrieved using typical searches did not meet information and presentation preferences of people with LBP.
Publisher: JMIR Publications Inc.
Date: 27-02-2023
Abstract: he 6-minute walk test (6MWT) is a common method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic or when the person is geographically remote. his study aimed to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT, in a persistent pain population. eople with persistent pain (n=36) were recruited to complete: 1) a conventional 6MWT and 2) 6MWT measured by a smartphone app using the global positioning system (GPS). Tests were performed in random order, separated by a 15-minute rest. The 95% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100m. he mean 6MWD measured by the GPS-based smartphone app was 13.2m higher (SD 46, 95%CI [−2.7, 29.1]) than the 6MWD assessed in the conventional manner. The 95% limits of agreement were 103.9m (95%CI [87.4, 134.1]) and −77.6m (95%CI [−107.7, −61.0]), which exceeded the maximum allowable difference. n in iduals with persistent pain, the two methods of assessing 6MWT may not be interchangeable due to limited validity. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow in iduals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment.
Publisher: Informa UK Limited
Date: 24-10-2015
DOI: 10.1080/00140139.2014.970586
Abstract: This study examined the perceived effort, success rates and kinematics for three push strategies in a simulated lateral patient transfer (horizontal slide). Thirteen healthy subjects (four males) completed three repetition pushing loads of 6, 10 and 14 kg in random order with a spontaneous push strategy, then with a straight-back bent-knees (squat) strategy and the preparatory pelvic movement ('rockback') strategy in random order. Perceived effort and kinematic parameters measured at the onset of movement and at maximum push excursion were compared between strategies and between loads with repeated measures ANOVA. The spontaneous and 'rockback' strategies achieved the pushing task with less perceived effort across all loads than the squat push (P < 0.001). Only 3/13 participants were successful on all attempts at pushing the 14 kg load using a squat strategy, which contrasted with 12/13 participants when the spontaneous strategy or the 'rockback' strategy was used. Forward movement of the pelvis and forward trunk inclination may be positively associated with lower perceived effort in the push task. Practitioner Summary: In a manual-handling task that simulated a lateral patient transfer (horizontal slide), perceived effort and success rates of three push strategies were compared. A straight-back bent-knees push (squat) strategy demonstrated greater perceived effort and lower success rates than a spontaneous push strategy, or a push strategy with preparatory 'rockback' pelvic movement.
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.MATH.2013.11.007
Abstract: Cuboid syndrome describes lateral midfoot pain localised to the cuboid bone. Previously reported case studies promoted joint mobilisation or manipulation interventions. The assumed mechanism was correction of a subtle disruption to the calcaneocuboid joint position. There is an absence of evidence for correction of joint position, but there is evidence of neurophysiological mechanisms for pain modulation. This case study reports on a patient who suffered two occurrences of cuboid syndrome on opposite feet, three years apart. With both occurrences, joint mobilisation achieved rapid and lasting resolution of severe pain and functional limitations. This occurred despite the presence of an active bone pathology at the symptomatic cuboid (demonstrated with nuclear imaging), which could represent a stress reaction, transient osteoporosis, ischaemic necrosis, infection or neoplasm. This case contributes three considerations for clinical reasoning and manual therapy research. 1. Active local bone pathology could exist in other patients with pain at the cuboid, and other conditions where symptoms resolve with joint mobilisation. 2. Rapid and lasting symptom resolution fits with a hypothesis that joint mobilisation acted to reverse neurological sensitisation. 3. Lasting symptom resolution may be clinically associated with manual therapy, but mechanisms extending beyond temporary analgesia are yet to be identified.
No related grants have been discovered for Andrew Claus.