The validity of a single inertial sensor to assess cervical active range of motion.

Cervical active range of motion (AROM) is an important outcome measure for clinicians working with a range of patient populations, especially people with neck pain. Multi-sensor inertial measurement unit (IMU) devices demonstrate good validity in the research laboratory but are expensive and not easily accessible in clinical settings. The use of single-IMU devices has been proposed but their validity for measuring cervical AROM is unknown. A concurrent and content validity study was conducted, comparing accuracy of single-IMU NeckCare Pro™ with multi-IMU Xsens™ for measuring cervical AROM in healthy adults (8 males, 7 females, mean age 30.6 years [SD 10.4]). Cervical AROM was assessed for flexion, extension, rotation (right and left), and lateral flexion (right and left), whereby six repetitions were performed for each movement with the subjects strapped to a high-back chair. Regarding content validity, Xsens™ detected a small amount of thoracic movement that could not be detected by the NeckCare Pro™ during cervical AROM testing, with means ranging from 1.5° to 4.1°. However, this did not significantly impact concurrent validity, which was good for all movements (ICC 0.764 - 0.966). This paper found that single-IMU technology (NeckCare Pro™) had good validity for measuring cervical AROM in healthy adults when subjects were strapped to a chair to limit trunk movement.

A core musculoskeletal anatomy syllabus for undergraduate physical therapy student education.

Knowledge of musculoskeletal anatomy is fundamental to physical therapy education. Although detailed anatomy syllabi have been developed for medical and other health professional students, none are available for training physical therapists. Therefore, the aim of this project was to produce a core musculoskeletal anatomy syllabus specific to physical therapy students, utilizing a modified Delphi approach. An international Delphi panel (n = 53) composed of anatomists and clinicians involved in physical therapy education considered a total of 2193 anatomical items arranged in four categories (musculoskeletal concepts; vertebral column; pectoral girdle and upper limb; pelvic girdle and lower limb). Using specific criteria, items were rated on the basis of whether they were considered essential knowledge for a competent physical therapy student, and were categorized as core, recommended, not recommended or not core. Of the 2193 items, 1700 (77.5%) were rated as core or recommended. For musculoskeletal concepts, 70% (233/332) of items were categorized as core/recommended. Approximately 80% of items in the other three categories were considered core/recommended-vertebral column (355/440), pectoral girdle and upper limb (513/657), and pelvic girdle and lower limb (599/764). This project presents a detailed musculoskeletal anatomy syllabus which may be used within a physical therapy curriculum. A key difference compared to published musculoskeletal anatomy syllabi for medical students is that a greater number of items are considered core/recommended (approximately 80% vs. 50%). These findings will now be considered and deliberated in accordance with the International Federation of Associations of Anatomists modified Delphi approach.

Reliability of Cervicocephalic Proprioception Assessment: A Systematic Review.

OBJECTIVE: The purpose of this systematic review was to determine the reliability and, where possible, the validity of cervicocephalic proprioceptive (CCP) tests in healthy adults and clinical populations. METHODS: A systematic search, utilizing 7 databases from the earliest possible date to April 14, 2021, identified studies that measured reliability of CCP tests. Studies were screened for eligibility, and included studies were appraised using Quality Appraisal Tool for Studies of Diagnostic Reliability (QAREL) and Quality Assessment and Diagnostic Accuracy Studies-2 Tool (QUADAS-2) tools. Validity outcomes were assessed for included studies. RESULTS: Of 34 included studies, 29 investigated reliability for sense of position tests, 10 involved sense of movement tests, and 1 used a sense of force test. The head to neutral test was reliable and valid when 6 or more repetitions were performed within the test, discriminating between those with and without neck pain. Head tracking tests were reliable with 6 repetitions, and 1 study found discriminative validity in a whiplash population. Studies that found discriminative validity in sense of position reported mean joint position error generally >4.5° in the neck pain group and <4.5° in the asymptomatic group. No sense of force test was applied to a clinical population. Convergent validity analysis showed that these proprioceptive tests have low correlations with each other. CONCLUSION: The reliability and validity of CCP tests for sense of position and movement are dependent upon equipment and repetitions. Six repetitions are generally required for good reliability, and joint position error >4.5° is likely to indicate impairment in sense of position.

Efficacy of Exercise-Based Rehabilitation Programs for Improving Muscle Function and Size in People with Hip Osteoarthritis: A Systematic Review with Meta-Analysis.

OBJECTIVE: To determine the effect of exercise-based rehabilitation programs on hip and knee muscle function and size in people with hip osteoarthritis. METHODS: Seven databases were systematically searched in order to identify studies that assessed muscle function (strength or power) and size in people with hip osteoarthritis after exercise-based rehabilitation programs. Studies were screened for eligibility and assessed for quality of evidence using the GRADE approach. Data were pooled, and meta-analyses was completed on 7 of the 11 included studies. RESULTS: Six studies reported hip and/or knee function outcomes, and two reported muscle volumes that could be included in meta-analyses. Meta-analyses were conducted for four strength measures (hip abduction, hip extension, hip flexion, and knee extension) and muscle size (quadriceps femoris volume). For hip abduction, there was a low certainty of evidence with a small important effect (effect size = 0.28, 95% CI = 0.01, 0.54) favouring high-intensity resistance interventions compared to control. There were no other comparisons or overall meta-analyses that identified benefits for hip or knee muscle function or size. CONCLUSION: High-intensity resistance programs may increase hip abduction strength slightly when compared with a control group. No differences were identified in muscle function or size when comparing a high versus a low intensity group. It is unclear whether strength improvements identified in this review are associated with hypertrophy or other neuromuscular factors.

Associations Between Measures of Physical Activity and Muscle Size and Strength: A Systematic Review.

OBJECTIVE: To determine whether physical activity is associated with lower limb muscle size and strength within the general population. DATA SOURCES: Six databases were systematically searched from inception using 3 main constructs: lower extremity, muscle volume, and muscle strength. STUDY SELECTION: Studies that measured physical activity (using either objective or subjective measurements), lower limb muscle size, and strength were included. Available discrete group data were standardized using previously published age- and sex-specific normative values prior to analysis. DATA EXTRACTION: The final analysis included 47 studies from an initial yield of 5402 studies. Standardized scores for outcome measures were calculated for 97 discrete groups. DATA SYNTHESIS: As anticipated, lower limb muscle size was positively correlated with lower limb muscle strength (r=0.26, P<.01; n=4812). Objectively measured physical activity (ie, accelerometry, pedometry) (n=1944) was positively correlated with both lower limb muscle size (r=0.30, P<.01; n=1626) and lower limb strength (r=0.24, P<.01; n=1869). However, subjectively measured physical activity (ie, questionnaires) (n=3949) was negatively associated with lower limb muscle size (r=-0.59, P<.01; n=3243) and lower limb muscle strength (r=-0.48, P<. 01; n=3882). CONCLUSIONS: This review identified that objective measures of physical activity are moderately associated with lower limb muscle size and muscle strength and can, therefore, be used to predict muscle changes within the lower limbs associated with exercise-based rehabilitation programs.

Anatomy Students That are "Team-Taught" May Achieve Better Results Than Those That are "Sole-Taught".

Anatomy practical classes have traditionally been taught by a team of demonstrators (team-taught) in a large dissection room. More recently, particularly in nonmedical contexts, practical classes have been taught by one teacher (sole-taught) to smaller student groups. The aim of this study was to compare student outcomes when the same course was delivered with practical classes team-taught at one campus (metropolitan) and sole-taught at a second campus (regional) while maintaining similar staff to student ratios. This anatomy course, for physiotherapy and lower academically credentialed exercise science/physiology students, utilized blended delivery whereby most content was delivered online and practical classes comprised the main face-to-face teaching. In 2018, the metropolitan campus introduced team-teaching practical classes while the regional campus continued with sole-teaching. Student marks and engagement with online content were compared between campuses and to the previous year (2017) when both campuses had sole-taught practical classes. While final marks for the course increased overall in 2018 (P < 0.01), exercise science/physiology students at the metropolitan campus (team-taught) improved their final marks (53.5 ± 1.1%) compared to a slight decrease for the regional (sole-taught) campus (44.8 ± 1.4%) (P < 0.01). There were no differences between campuses for physiotherapy students in 2018. Student engagement with online content did not contribute to the improvement in marks for exercise science/physiology students. Introduction of a team-teaching format improved student marks, particularly for the lower academically credentialed students. Team-teaching should be considered as the preferred format for anatomy practical classes, particularly in courses involving students with diverse academic credentials.

Innervation of supraclavicular adipose tissue: A human cadaveric study.

Functional brown adipose tissue (BAT) was identified in adult humans only in 2007 with the use of fluorodeoxyglucose positron emission tomography imaging. Previous studies have demonstrated a negative correlation between obesity and BAT presence in humans. It is proposed that BAT possesses the capacity to increase metabolism and aid weight loss. In rodents it is well established that BAT is stimulated by the sympathetic nervous system with the interscapular BAT being innervated via branches of intercostal nerves. Whilst there is evidence to suggest that BAT possesses beta-3 adrenoceptors, no studies have identified the specific nerve branch that carries sympathetic innervation to BAT in humans. The aim of this study was to identify and trace the peripheral nerve or nerves that innervate human BAT in the supraclavicular region. The posterior triangle region of the neck of cadaveric specimens were dissected in order to identify any peripheral nerve branches piercing and/or terminating in supraclavicular BAT. A previously undescribed branch of the cervical plexus terminating in a supraclavicular adipose depot was identified in all specimens. This was typically an independent branch of the plexus, from the third cervical spinal nerve, but in one specimen was a branch of the supraclavicular nerve. Histological analysis revealed the supraclavicular adipose depot contained tyrosine hydroxylase immunoreactive structures, which likely represent sympathetic axons. This is the first study that identifies a nerve branch to supraclavicular BAT-like tissue. This finding opens new avenues for the investigation of neural regulation of fat metabolism in humans.

Gluteus medius and minimus activity during stepping tasks: Comparisons between people with hip osteoarthritis and matched control participants.

BACKGROUND: Altered gluteus minimus (GMin) activity has been identified in people with hip osteoarthritis (OA) during gait with some evidence of altered gluteus medius (GMed) activity in patients with advanced OA. It is not known whether these muscles also exhibit altered activity during other functional tasks. RESEARCH QUESTION: Does gluteal muscle activity during stepping tasks differ between people with hip OA and healthy older adults? METHODS: Participants included 20 people with unilateral hip OA and 20 age-and sex-matched controls. Muscle activity in the three segments within GMed and two segments of GMin were examined using intramuscular electromyography during step-up, step-down and side-step tasks. RESULTS: Participants in the OA group demonstrated reduced muscle activity early in the step-up task and a later time to peak activity in most muscle segments. Greater activity was identified in anterior GMin in people with hip OA during the side-step task. A delay in time to peak activity was identified in most muscle segments in people with OA during the side-step task. SIGNIFICANCE: For participants with OA, reduced activity in most muscle segments and increased time spent in double limb stance during the step-up task could reflect the decreased strength and pain associated with single limb stance on the affected limb. This study provides further evidence of altered function of the deep gluteal muscles in people with hip OA and highlights the importance of addressing these muscles in rehabilitation.

Forced Disruption of Anatomy Education in Australia and New Zealand: An Acute Response to the Covid-19 Pandemic.

Australian and New Zealand universities commenced a new academic year in February/March 2020 largely with "business as usual." The subsequent Covid-19 pandemic imposed unexpected disruptions to anatomical educational practice. Rapid change occurred due to government-imposed physical distancing regulations from March 2020 that increasingly restricted anatomy laboratory teaching practices. Anatomy educators in both these countries were mobilized to adjust their teaching approaches. This study on anatomy education disruption at pandemic onset within Australia and New Zealand adopts a social constructivist lens. The research question was "What are the perceived disruptions and changes made to anatomy education in Australia and New Zealand during the initial period of the Covid-19 pandemic, as reflected on by anatomy educators?." Thematic analysis to elucidate "the what and why" of anatomy education was applied to these reflections. About 18 anatomy academics from ten institutions participated in this exercise. The analysis revealed loss of integrated "hands-on" experiences, and impacts on workload, traditional roles, students, pedagogy, and anatomists' personal educational philosophies. The key opportunities recognized for anatomy education included: enabling synchronous teaching across remote sites, expanding offerings into the remote learning space, and embracing new pedagogies. In managing anatomy education's transition in response to the pandemic, six critical elements were identified: community care, clear communications, clarified expectations, constructive alignment, community of practice, ability to compromise, and adapt and continuity planning. There is no doubt that anatomy education has stepped into a yet unknown future in the island countries of Australia and New Zealand.

A comparison of glenohumeral joint translation between young and older asymptomatic adults using ultrasonography: a secondary analysis.

Background: The rotator cuff muscles are subject to age-related changes, but the effect of aging on glenohumeral joint stability is poorly understood. Objectives: This study aimed to compare glenohumeral joint translation in asymptomatic young and older people. Methods: Twenty young (23.6 ± 5.3 years) and twenty older (66.5 ± 7.8 years) participants with no symptomatic shoulder pathology were recruited. Anterior and posterior glenohumeral joint translations were measured using real-time ultrasound in two positions: (1) shoulder neutral; and (2) shoulder at 90 degrees' abduction and four testing conditions: (1) rest; (2) passive accessory motion testing (PAMT) force alone; (3) PAMT with isometric internal rotation contraction; and (4) PAMT with external rotation contraction. Results: In both groups, there were significant differences between the amount of translation limited by anterior and posterior rotator cuff muscles in response to anterior and posterior PAMT force (p < 0.03), indicating rotator cuff activity-limited translation in a direction-specific manner. Young participants demonstrated increased passive posterior glenohumeral joint translation in the neutral shoulder position (p < 0.001) and their rotator cuff muscle contraction led to greater reductions in glenohumeral joint translation in the neutral shoulder position (p < 0.001), as compared with older participants. Conclusions: Rotator cuff contraction limits glenohumeral joint translation in a direction-specific manner in both young and older participants. However, younger age is associated with increased passive translation but greater ability to reduce glenohumeral joint translation with rotator cuff muscle contraction. Age-related changes should be considered when assessing and treating glenohumeral joint stability.

Comparison of gluteus medius and minimus activity during gait in people with hip osteoarthritis and matched controls.

The gluteal muscles act as stabilizers of the hip joint and are important for the maintenance of hip function. Atrophy and weakness of the gluteal muscles have been identified in people with hip OA, but it is not known whether these muscles also exhibit altered activity patterns. The aim of this study was to compare gluteal muscle activity in people with hip OA and healthy older adults. Fine-wire intramuscular electrodes were inserted into the three segments of gluteus medius (GMed) and two segments of gluteus minimus (GMin) in 20 participants with unilateral hip OA and 20 age- and gender-matched controls. Electromyographic activity of these muscle segments was examined during walking along a 10 m walkway. Peak amplitude, average amplitude, and time to peak were compared between groups during the stance phase of the gait cycle. During early stance, the OA group demonstrated a higher burst of activity in posterior GMin (P = 0.02) and trends toward a higher peak in anterior GMin. Both groups displayed peak activity in anterior GMin in the early stance phase in contrast to previous reports in young adults. This early burst of muscle activity was more pronounced with increasing severity of OA. No differences were identified in GMed activity. While altered GMin activity is associated with aging, these changes were more pronounced in participants with hip OA. To reduce disability associated with hip OA, future rehabilitation programs should consider targeted gait strategies and exercises for GMin.

The capacity for oestrogen to influence obesity through brown adipose tissue thermogenesis in animal models: A systematic review and meta-analysis.

Pharmacological interventions to aid weight loss have historically targeted either appetite suppression or increased metabolic rate. Brown adipose tissue (BAT) possesses the capacity to expend energy in a futile cycle, thus increasing basal metabolic rate. In animal models, oestrogen has been implicated in the regulation of body weight, and it is hypothesized that oestrogen is acting by modulating BAT metabolism. A systematic search was performed, to identify research articles implementing in vivo oestrogen-related interventions and reporting outcome measures that provide direct or indirect measures of BAT metabolism. Meta-analyses were conducted where sufficient data were available. The final library of 67 articles were predominantly in rodent models and provided mostly indirect measures of BAT metabolism. Results of this review found that oestrogen's effects on body weight, in rats and possibly mice, are likely facilitated by both metabolic and appetitive mechanisms but are largely only found in ovariectomized models. There is a need for further studies to clarify the potential effects of oestrogen on BAT metabolism in gonad-intact and castrated male animal models.

The development of a core syllabus for teaching musculoskeletal anatomy of the vertebral column and limbs to medical students.

The study of human anatomy is fundamental to medical education globally. Knowledge of musculoskeletal anatomy is essential for safe and effective clinical practice, yet this topic often receives insufficient medical program time and perceptions differ regarding which knowledge is core. Given the lack of syllabuses specific to musculoskeletal anatomy, this article aims to provide a detailed syllabus for the vertebral column and limbs relevant to medical students. A Delphi panel comprising anatomists and clinicians rated 2,260 anatomical structures and concepts as "essential," "important," "acceptable," or "not required," with evaluations based around the core knowledge deemed acceptable for a competent medical student. Based on the percentage of panelist agreement for an item to be considered "essential," each item was then classified as core (≥60%), recommended (30%-59%), not recommended (20%-29%), or not core (<20%). Items not classified as core or recommended but rated important by greater than 50% of the panel were highlighted for future consideration. A total of 252/389 musculoskeletal concept items were categorized as core or recommended. The number of core or recommended items for the vertebral column, upper limb, and lower limb were 220/438, 322/663, and 318/770, respectively. Ninety-six items were recommended for future consideration. The results of this Delphi panel will be published on the International Federation of Associations of Anatomists website for continuing international consideration and deliberation by relevant stakeholders. The aim is to set an internationally recognized syllabus, that covers the minimum musculoskeletal content that is academically and clinically relevant. Clin. Anat. 32:974-1007, 2019. © 2019 Wiley Periodicals, Inc.

Glenohumeral joint translation and muscle activity in patients with symptomatic rotator cuff pathology: An ultrasonographic and electromyographic study with age-matched controls.

OBJECTIVES: To determine whether patients with symptomatic rotator cuff pathology had more glenohumeral joint translation and different patterns of rotator cuff muscle activity compared to controls. DESIGN: Repeated measurements of glenohumeral translation and muscle activity in two positions and six testing conditions in two groups. METHODS: Twenty participants with a symptomatic and diagnosed rotator cuff tear and 20 age, and gender matched controls were included. Neuromuscular activity was tested by inserting intramuscular electrodes in the rotator cuff muscles. Anterior and posterior glenohumeral translations were measured using real time ultrasound in testing conditions (with and without translation force, with and without isometric internal and external rotation), in two positions (shoulder neutral, 90° of abduction) and two force directions (anterior, posterior). RESULTS: Symptomatic pathology group demonstrated increased passive glenohumeral translation with posterior translation force (p<0.05). Overall, rotator cuff muscle contraction in the pathology group limited joint translation in a similar manner to the control group, but they did not show the normal direction specific pattern in the neutral posterior position (p<0.03). The pathology group demonstrated reduced EMG activity in the upper infraspinatus muscle relative to the reference position (p<0.02) with anterior translation force and in the supraspinatus (p<0.05) muscle with anterior and posterior translation force in the abducted position. CONCLUSIONS: Symptomatic pathology resulted in increased passive glenohumeral joint translation. Although there were some reductions in muscle activity with injury, their rotator cuff still controlled glenohumeral translation. These results highlight the need to consider joint translation in the assessment and management of patients with rotator cuff injury.

Atrophy of hip abductor muscles is related to clinical severity in a hip osteoarthritis population.

Osteoarthritis mainly affects weight-bearing joints such as the hip and knee and is the most common form of arthritis. Greater muscle atrophy with fatty infiltration of gluteal muscles and decreased hip abduction strength has previously been identified with increasing severity of radiological hip OA. However, it is well documented that radiographic findings of OA do not always correlate with clinical severity. The aim of this secondary analysis was to examine whether atrophy and strength of gluteus maximus (GMax), medius (GMed), minimus (GMin), and tensor fascia lata (TFL) is associated with the clinical severity of OA. Twenty participants with unilateral hip OA and 20 age- and sex-matched asymptomatic controls were classified on the basis of clinical severity (mild, moderate-severe and asymptomatic groups) using the Oxford hip score. Muscle volumes of GMax, GMed, GMin, and TFL were determined using magnetic resonance imaging and expressed as asymmetry between limbs. A hand-held dynamometer was used to identify hip rotation and abduction strength. Regression analyzes were used to identify the association between muscle asymmetry and patient-reported severity of hip OA. Both symptomatic groups (mild and moderate-severe) demonstrated significant asymmetry in GMax (P < 0.01) and GMin (P < 0.01). GMed asymmetry was associated with only the moderate-severe symptomatic group. Hip abduction strength was reduced in both symptomatic groups. Gluteal muscle atrophy was associated with the clinical severity of OA. Clinical severity could be a useful tool for clinicians interpreting likely gluteal muscle changes and planning rehabilitation strategies for hip OA patients. Clin. Anat. 31:507-513, 2018. © 2018 Wiley Periodicals, Inc.

The relationship between student engagement with online content and achievement in a blended learning anatomy course.

Blended learning has become increasingly common in higher education. Recent findings suggest that blended learning achieves better student outcomes than traditional face-to-face teaching in gross anatomy courses. While face-to-face content is perceived as important to learning there is less evidence for the significance of online content in improving student outcomes. Students enrolled in a second-year anatomy course from the physiotherapy (PT), exercise physiology (EP), and exercise science (ES) programs across two campuses were included (n = 500). A structural equation model was used to evaluate the relationship of prior student ability (represented by grade in prerequisite anatomy course) and final course grade and whether the relationship was mediated by program, campus or engagement with the online elements of the learning management system (LMS; proportion of documents and video segments viewed and number of interactions with discussion forums). PT students obtained higher grades and were more likely to engage with online course materials than EP and ES students. Prerequisite grade made a direct contribution to course final grade (P < 0.001) but was also mediated by engagement with LMS videos and discussion forums (P < 0.001). Student learning outcomes in a blended anatomy course can be predicted the by level of engagement with online content. Anat Sci Educ 11: 471-477. © 2017 American Association of Anatomists.

The upper and lower segments of subscapularis muscle have different roles in glenohumeral joint functioning.

Subscapularis muscle is divided into two independent segments, upper and lower (USUB and LSUB), but the role of each segment in glenohumeral functioning is unclear. We compared the electromyographic (EMG) activity of USUB and LSUB during a variety of shoulder movements, with and without an external translation force. Intramuscular electrodes were inserted in USUB and LSUB segments of 20 adults without pathology and EMG activity was measured in stabilization trials (with and without an anterior or posterior directed force at the humerus and isometric rotations) and two shoulder positions (shoulder neutral, abduction). Maximal voluntary isometric contraction (MVIC) trials were performed in abduction, internal and external rotation of the shoulder. In MVIC trials, USUB showed higher activity during internal rotation (p=0.03), whereas LSUB showed higher activity during external rotation (p<0.01). In stabilization trials, the interaction effects were significant for muscle segment×condition (p<0.01), and approached significance for muscle segment×position (p=0.06). In the neutral position, the pattern of activity for LSUB was similar to USUB. In the abducted position the LSUB, unlike USUB, was more active during external rotation (p=0.06) and also showed increased activity in response to the posterior directed force at the humerus (p=0.04). Our results suggest that USUB primarily acts asan agonist for internal rotation. In contrast LSUB was particularly active in external rotation in the abducted position and demonstrated increased EMG activity in response to the posteriorly directed force at the humerus in that position, suggesting more of a role in glenohumeral stabilization.

Measurement of glenohumeral joint translation using real-time ultrasound imaging: A physiotherapist and sonographer intra-rater and inter-rater reliability study.

BACKGROUND: Ultrasonography is an economical and non-invasive method for measuring real-time joint movements. Although physiotherapists are increasingly using ultrasound imaging for rotator cuff disorders, there is a lack of evidence on their reliability in using ultrasonography to measure glenohumeral translation. OBJECTIVE: The aim of this study was to evaluate the reliability of a physiotherapist in measuring anterior and posterior glenohumeral joint translation with ultrasound. METHODS: Study design: within day reliability. Anterior and posterior glenohumeral translations were measured at rest, in response to passive accessory motion testing force, and with isometric internal and external rotation in 12 young healthy adults. All the measurements were made in real time by a physiotherapist and an experienced sonographer in two positions (neutral and abducted) and in two views (anterior and posterior). Intra-rater and inter-rater reliability were expressed using intraclass correlation coefficients (ICC) and measurement error (mm). RESULTS: Intra-rater reliability was good for both raters (ICCP: 0.86-0.98; ICCS: 0.85-0.96). The inter-rater reliability between the physiotherapist and sonographer was moderate to good for posterior measurements (ICC 0.50-0.75) and poor to moderate for anterior measurements (ICC 0.31-0.53). For both intra-rater and inter-rater measurements, posterior translation was more reliable than the anterior translation with smaller measurement errors (posterior: 0.1-0.2 mm, anterior: 0.2-0.3 mm). CONCLUSION: A physiotherapist with minimal training was reliable in measuring glenohumeral joint translations. The ultrasound method was reliable for repeated measurement of both anterior and posterior glenohumeral translations with posterior measurements being more reliable than anterior. This method is recommended for future research to investigate the stabilising role of rotator cuff muscles.

Impact of introduction of blended learning in gross anatomy on student outcomes.

Blended learning has become increasingly common, in a variety of disciplines, to take advantage of new technology and potentially increase the efficiency and flexibility of delivery. This study aimed to describe blended delivery of a gross anatomy course and to evaluate the effectiveness of the delivery in terms of student outcomes. A gross anatomy course for second-year physiotherapy students across two campuses was delivered in traditional face-to-face teaching mode in 2013 (n = 150 students), some online content was introduced in 2014 (n = 160) and the subject was fully blended in 2015 (n = 151). The final 'blend' consisted of one lecture per week with most content delivered using online video resources (prepared by staff using a structured peer-reviewed process) and retention of face-to-face practical classes. Outcomes evaluated included student grades, student engagement with content through online discussion forums and student feedback using both quantitative and qualitative analysis. Grades were higher in 2014 and 2015 than in 2013 (P < 0.01). There were no differences in student engagement with online discussion forums. Student feedback identified some negative comments and lower levels of intellectual stimulation (P < 0.05) with the initial introduction of online content in 2014. The fully blended version in 2015 resulted in more balanced comments about online content but higher perceived workload (P < 0.05). All cohorts listed practical classes as a major factor contributing to learning. Blended learning appears to be well-suited to gross anatomy teaching on the proviso that face-to-face practical classes are maintained, but may result in higher perceived workloads. Anat Sci Educ 9: 422-430. © 2016 American Association of Anatomists.

Do collaborative practical tests encourage student-centered active learning of gross anatomy?

Benefits of collaborative testing have been identified in many disciplines. This study sought to determine whether collaborative practical tests encouraged active learning of anatomy. A gross anatomy course included a collaborative component in four practical tests. Two hundred and seven students initially completed the test as individuals and then worked as a team to complete the same test again immediately afterwards. The relationship between mean individual, team, and difference (between team and individual) test scores to overall performance on the final examination (representing overall learning in the course) was examined using regression analysis. The overall mark in the course increased by 9% with a decreased failure rate. There was a strong relationship between individual score and final examination mark (P < 0.001) but no relationship for team score (P = 0.095). A longitudinal analysis showed that the test difference scores increased after Test 1 which may be indicative of social loafing and this was confirmed by a significant negative relationship between difference score on Test 4 (indicating a weaker student) and final examination mark (P < 0.001). It appeared that for this cohort, there was little peer-to-peer learning occurring during the collaborative testing and that weaker students gained the benefit from team marks without significant active learning taking place. This negative outcome may be due to insufficient encouragement of the active learning strategies that were expected to occur during the collaborative testing process. An improved understanding of the efficacy of collaborative assessment could be achieved through the inclusion of questionnaire based data to allow a better interpretation of learning outcomes. Anat Sci Educ 9: 231-237. © 2015 American Association of Anatomists.