Active cycle of breathing technique versus oscillating PEP therapy versus walking with huffing during an acute exacerbation of bronchiectasis: a randomised, controlled trial protocol.

BACKGROUND: Airway clearance techniques (ACTs) for individuals with bronchiectasis are routinely prescribed in clinical practice and recommended by international guidelines, especially during an acute exacerbation. However, there is limited evidence of the efficacy of these techniques during an exacerbation to improve sputum expectoration, health-related quality-of-life (HRQOL) or exercise tolerance. The primary aim of this study is to compare the effects of the active cycle of breathing technique (ACBT), oscillating positive expiratory pressure (O-PEP) therapy, and walking with huffing on sputum expectoration for adults hospitalised with an acute exacerbation of bronchiectasis. Secondary aims are to compare the effects of these interventions on HRQOL, health status, exacerbation rates and hospital admissions in a six-month period following hospital discharge. METHODS: This multi-centre randomised controlled trial will recruit adults with an acute exacerbation of bronchiectasis requiring hospital admission. Participants will be randomised to receive one of three interventions: ACBT, O-PEP therapy, and walking with huffing. Outcome measures including sputum volume during and 1-h post ACT session, and 24-h sputum, as well as health status, HRQOL and exercise capacity will be completed during inpatient stay on day 2 and day 6 of admission, and within 24 h of hospital discharge. Time to first exacerbation, and time to first hospitalisation will be monitored via monthly phone calls for six months post hospital discharge. Health status and HRQOL will be assessed after discharge at two and six months, and exercise capacity will be assessed at six months post hospital discharge. DISCUSSION: Despite recommendations regarding the importance of ACT for individuals with bronchiectasis during an acute exacerbation, there is a gap in the literature regarding effectiveness of ACT when undertaken by individuals in this clinical state. This study will add to the evidence base regarding the effectiveness of commonly implemented ACTs during a hospital admission with an exacerbation of bronchiectasis. Additionally, it will contribute to knowledge of the long term effects on important and patient-centred outcomes, including incidence of future exacerbations, and HRQOL, which has not been previously established. Trial registration Registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12621000428864).

Injury rates in female and male military personnel: a systematic review and meta-analysis.

BACKGROUND: An effective military force is required to be agile, capable, efficient, and potent. Injuries to military personnel interrupt active-duty service and can detract from overall capability. These injuries are associated with a high individual and organizational burden, with lost work time and financial costs-all problematic for the ongoing functioning of a military force. Injury control strategies have therefore been described as force multipliers. Female personnel form an integral part of any modern defence force, but little research has examined their specific experiences of injury, to inform targeted injury control efforts. The aim of this review was to identify and synthesise findings from studies of injury rates and patterns in female military personnel, comparing them to those of male personnel. METHODS: A systematic search was conducted for studies which compared injury rates between the sexes at any stage of military service, from basic training through to deployment. Databases searched included PUBMED, CINAHL and Medline through OVID. Methodological quality of eligible articles was assessed using the Critical Appraisal Skills Program (CASP), and AXIS tools and data were extracted, synthesized, and, where possible, underwent meta-analysis. RESULTS: Of 2287 identified studies, a total of 25 studies were eligible and included. Methodological quality ranged from 60% up to a perfect score of 100%, with an average of 82% across all studies. Relative risks for injuries (reported as RR [95%CI]) to females when compared to males were 2.10 [1.89-2.33] during basic training, 1.70 [1.33-2.17] during officer training, and 1.23 [1.05-1.43] post initial training. After adjustment for differences between the sexes in average fitness levels (2-mile run time), there was no longer a significant difference in injury rates (adjusted RR: 0.95 [0.86-1.05]). Female personnel tended to make bigger improvements in their fitness during basic training than males and tended to report their injuries more frequently and sooner than males. CONCLUSION: While this review found a higher rate of reported injuries in female military personnel when compared to male personnel, differences between the sexes in average fitness levels and injury reporting behaviours may largely explain this rate difference. The difference in rates of reported injuries was greatest during basic training, and reduced thereafter, possibly due in part to a reduced difference in fitness between the sexes or increased opportunity to self-determine workloads relative to fitness levels.

A profile of injuries suffered by female soldiers serving in the Australian Army.

INTRODUCTION: Female soldiers comprise an important component of any modern army, yet little research has been performed to investigate differences in the profiles of injuries reported by qualified female and male army personnel. AIM: The aim of this study was to compare injury rates and patterns between female and male soldiers of the Australian Regular Army (ARA). METHODS: Data pertaining to all injuries reported by ARA members over a two-year period were accessed from the SENTINEL database and analysed descriptively. Findings regarding injury patterns were reported by most common location, nature, mechanism, and activity being performed at the time of injury. Injury incidence rates (IR) were calculated based on population size, and injury incidence rate ratios (IRR) comparing female and male injury rates were determined. RESULTS: A total of 8750 injuries were recorded across the two-year time period (2018-2020) of the study (minor injuries: n = 1766 female, n = 6870 male; serious injuries: n = 19 female, n = 95 male). Higher incidence rates of minor injuries were reported for female soldiers (IR = 20.75 injuries/100 soldiers/year) when compared to male soldiers (IR = 13.60 injuries/100 soldiers/year), with an IRR of 1.53 [95% CI = 1.46-1.60]. More serious injuries were reported at a similar rate between female (IR = 0.22/100 soldiers/year) and male soldiers (IR = 0.21/100 soldiers/year), with an IRR of 1.05 [95% CI = 0.65-1.72]. Female soldiers tended to report more ankle injuries than male soldiers who reported more knee injuries. Physical training and combat training were the most common causes of injury for both sexes. DISCUSSION: There were subtle differences in body locations of minor injuries within female and male soldiers. Both minor and more serious injury profiles were otherwise similar between sexes. Therefore, strategies required to minimise injuries in female soldiers may be similar in many respects to strategies required for male soldiers but require some differences to account for the subtle differences in body locations of injury, and so to ensure effectiveness across all personnel.

Profiling lower extremity injuries sustained in a state police population: a retrospective cohort study.

BACKGROUND: Tactical populations, such as military, firefighter and law enforcement populations, are known to suffer a relatively high number of musculoskeletal injuries, with the lower extremity of notable concern. The aim of this retrospective cohort study was to determine the profile of lower extremity musculoskeletal injuries within a state police agency. METHODS: Injury data were collected by an Australian state police force over a 7-year period (2009-2016) and records not meeting the definition for lower extremity musculoskeletal injury were excluded. Statistical analyses were descriptive, with frequencies, means and standard deviations calculated where applicable. Chi-square analysis was performed to compare injury profiles by gender. Ethics approval was granted by Bond University Human Research Ethics Committee (Research Protocol 15360). RESULTS: Of the initial 65,579 incident records, 12,452 (19%) related to lower extremity musculoskeletal injuries. The knee was the most commonly injured site (31.4%) with sprains/strains (42.3%) the most common nature of injury and arresting offenders (24.2%) the most common activity at time of injury. Slips/trips/falls (37.8%) was found to be the most common cause of injury. Variations were found between genders, most notably within the injury activity (p < .001). 27.1% of male officers were injured when arresting offenders compared to 16.5% for female officers. Walking/running contributed to 17.9% of female officer incidents compared to 9.3% for male officers. The mean number of hours worked prior to injury occurrence was 6.00 ± 3.56 h with significantly more injuries occurring in the middle third of the shift (4.34-8.67 h, p < 0.001). CONCLUSIONS: While the proportion of injuries that affected the lower extremity was lower for police, the leading sites of injuries (knees and ankles) were similar to those of military and fire and rescue populations. Variations between genders suggest there may need to be differences in return-to-work rehabilitation.

Associations between motor proficiency and academic performance in mathematics and reading in year 1 school children: a cross-sectional study.

BACKGROUND: A key priority for learning during the early years of school is for children to develop skills in numeracy and literacy. Consequently, less time may be allocated in the curriculum to foster other important developmental areas, including the ongoing motor skill development of school children, which has been positively linked to academic performance. In order to promote holistic approaches to teaching and learning in the early years of school, it is necessary to further delineate the nature of associations between motor skills and foundation academic skills. The aim of this study was to examine associations between fine and gross motor proficiency and academic performance in mathematics and reading in Year 1 children. METHODS: A cross-sectional study was conducted with Year 1 children from two primary schools in New South Wales, Australia (N = 55; 25 boys, 30 girls; mean age 6.77 ± 0.40 years). The Bruininks-Oseretsky Test of Motor Proficiency (2nd Edition) and the Wechsler Individual Achievement Test II (Australian Edition) were used to assess motor proficiency and academic performance in mathematics and reading, respectively. Associations between the components of motor proficiency and academic outcomes were examined using Pearson's and Spearman's correlation analyses. Hierarchical multiple linear regression analyses were conducted to determine how much variance in mathematics and reading composite scores could be explained by motor proficiency after controlling for age. RESULTS: A significant moderate positive association was found between total motor composite and mathematics composite scores (r = .466, p < .001). Fine manual control composite scores were significantly associated with both mathematics (rs = .572, p < .001) and reading (rs = .476, p = .001) composite scores. After controlling for age, fine motor integration was the only component of motor proficiency that explained significant variance in mathematics and reading composite scores. CONCLUSIONS: The results of the study revealed that Year 1 children's overall motor proficiency was significantly related to their mathematical ability. Children's fine motor integration skills were also predictive of mathematics and reading ability. These study findings may interest both early childhood educators and paediatric health professionals.

Prognostic factors for inpatient functional recovery following total hip and knee arthroplasty: a systematic review.

Background and purpose - Essential for safe and timely hospital discharge, inpatient functional recovery following lower limb arthroplasty is also variable. A previous systematic review reported moderate and conflicting levels of evidence regarding patient-related predictors of inpatient recovery for primary total hip arthroplasty (THA). A systematic review of surgical prognostic factors for inpatient recovery following THA or total knee arthroplasty (TKA) is yet to be undertaken. We identified patient and surgical prognostic factors for inpatient functional recovery following THA and TKA; determined whether inpatient functional recovery varies between these procedures; and established whether validated outcome measures relevant to the patient's functional requirements for hospital discharge are routinely assessed.Patients and methods - Critical Appraisal Skills Programme checklists assessed methodological quality, and a best-evidence synthesis approach determined the levels of evidence supporting individual prognostic factors. PubMed, CINAHL, Embase, Scopus, and PEDro databases were searched from inception to May 2019. Included studies examined patient or surgical prognostic factors and a validated measure of post-operative function within 2 weeks of primary, unilateral THA or TKA.Results - Comorbidity status and preoperative function are supported by a strong level of evidence for TKA. For THA, no strong level of evidence was found for patient-related prognostic factors, and no surgical factors were independently prognostic for either arthroplasty site. Limited evidence supports fast-track protocols in the TKA population.Interpretation - Preoperative screening and optimization is recommended. Assessment of Enhanced Recovery Pathways using validated outcome measures appropriate for the early postoperative period is warranted.

Nasolabial outcomes in a nationwide study of orofacial cleft in New Zealand.

OBJECTIVES: To (a) assess nasolabial outcomes across four main cleft subgroups, (b) assess agreement using a categorical and a continuous scoring measure and (c) compare outcomes to international studies. SETTINGS AND SAMPLE POPULATION: Analysis of 470 images of which 218 was unilateral cleft lip and palate (UCLP), 128 unilateral cleft lip (UCL), 90 bilateral cleft lip and palate (BCLP) and 34 bilateral cleft lip (BCL). Images were taken around five (n = 279) and eight-ten (n = 191) years of age. MATERIALS & METHODS: Cropped images were assessed using the Asher-McDade (AM) and a 100 mm visual analogue scale (VAS) by a panel of six raters. Scoring was undertaken for vermillion border and nasal form, symmetry and profile. Analysis was undertaken for each subscore, a total score with sensitivity analysis using a total score based on the subscores for each patient. AM intra- and inter-rater reliability was assessed using weighted kappa and for the VAS components reliability was assessed using Pearson correlation. RESULTS: The AM intra-rater reliability was moderate/substantial, whilst inter-rater reliability was fair. The VAS intra-rater correlations were high, and inter-rater correlations were moderate. Better outcomes were found with cleft lip (CL) vs cleft lip and palate (CLP). No differences were found for sex, ethnicity, age and cleft laterality (unilateral). The AM found no difference between unilateral or bilateral. The VAS found bilateral scored worse than unilateral for both CL and CLP. CONCLUSIONS: The nasolabial outcomes differ by cleft type. The correlation was relatively high for the VAS whilst the AM had relatively poor reliability.

Injuries in Australian Army full-time and part-time personnel undertaking basic training.

BACKGROUND: Musculoskeletal injuries are a problem in military personnel as they detract from force readiness and may prevent deployment. Injuries occur during basic training at three times the rate observed in post-training military service and more commonly in part time (PT) when compared to full time (FT) army personnel. The purpose of this study was to examine differences in rates and patterns of reported injuries between full time (FT) and part time (PT) personnel undertaking army basic training. METHODS: A retrospective cohort study was conducted to determine and compare rates and patterns of injuries which occurred during basic training in PT and FT personnel. Injury data from the period 01 July 2012 to 30 June 2014 was obtained in a non-identifiable format from the Workplace Health, Safety, Compensation and Reporting (WHSCAR) database of the Australian Department of Defence. Analysis included descriptive statistics and the calculation of injury rates and injury rate ratios. RESULTS: A total of 1385 injuries were reported across FT and PT cohorts, with an injury rate ratio for FT:PT of 1.06 [0.80-1.40], when accounting for exposure. In FT personnel, 1192 (90%) were Minor Personal Injuries (MPIs) and 43 (3.2%) Serious Personal Injuries (SPIs). In PT personnel, 147 (94.8%) were MPIs and three (1.9%) SPIs. In both FT and PT personnel, injuries most commonly: occurred during Physical Training (41.7% FT, 515 MPIs, 10 SPIs, 32% PT. 48 MPIs, 1 SPI); affected the knee (FT 41.7% 159 MPIs, 7 SPIs, PT 36.0%, 22 MPIs, 0 SPIs); involved soft tissue damage (FT 60.9%, 744 MPIs, 8 SPIs, PT 69.3%, 103 MPIs, 1 SPI); and were due to muscular stress (FT 41.7%, 509 MPIs, 6 SPIs, PT 36%, 54 MPIs, 0 SPIs). CONCLUSIONS: FT and PT recruits exhibited similar injury profiles, with mechanisms, sites and types of injuries in agreement with other research. Given these similarities, effective interventions that reduce injury risks in either population will likely benefit both.

The effects of body armour on the power development and agility of police officers.

A study was conducted in which 11 police officers wore one of three different types of Individual Light Armour Vests (ILAV), or normal station wear, for an entire day while completing power and agility-based tasks including a vertical jump (VJ), agility test, 20 m sprint and counter movement jump (CMJ). Despite all three ILAVs being significantly (p < .05) heavier than normal station wear, there were no significant differences between any of the ILAVs in VJ, time to complete the agility test, 20 m sprint time, peak force, velocity, power and jump distance in the CMJ. There was a significantly (p < .05) higher mean force produced in the CMJ while wearing all three ILAVs. The ILAV's investigated do not appear to be heavy enough to significantly affect the power or agility of police officers. The utilisation of ILAVs by police officers does not appear to hinder policing tasks that involve agility or power development. Practitioner summary: The addition of the extra load of military-styled body armour is known to decrease performance and mobility. When compared to normal station wear, the wearing of three different ILAV types used in policing do not appear to be heavy enough to affect the power or agility of police officers. Abbreviations: ILAV: individual light armour vest; VJ: vertical jump; CMJ: counter movement jump; N: normal station wear.

Ageing well: Pilot evaluation of a dual-task training program in a rural community.

OBJECTIVE: This pilot trial examined the feasibility and effectiveness of "Ageing Well," a community-based program for improving cognitive skills and mobility of rural older people. DESIGN AND SETTING: The non-randomised, wait-list-controlled pilot trial was conducted at a regional NSW university clinic. PARTICIPANTS: Twenty-three community-dwelling adults aged 60+ who had begun to experience a decline in their physical or cognitive abilities or both. INTERVENTIONS: Dual-tasking activities simultaneously challenged participants' motor and cognitive abilities. Student facilitators encouraged participants to progress through increasing complex functional tasks in a range of contexts, including a café, supermarket and a simulated "home." MAIN OUTCOME MEASURES: The Patient Reported Evaluation of Cognitive State measured the impact of an individual's cognitive state in terms of how much they were "bothered" by problems with their cognition. Functional mobility was measured by the Timed Up-and-Go, a test of static and dynamic balance, and the Six Minute Walk Test. RESULTS: Intervention participants' Patient Reported Evaluation of Cognitive State ratings in relation to impacts on their performance of everyday skills improved substantially, whereas the control group did not change. Intervention participants walked 12% further in the Six Minute Walk Test post-intervention, while the control group distance did not change. Timed Up-and-Go time was reduced by 1 second in the intervention group. CONCLUSIONS: There is a strong interest in this dual-tasking program among older community-dwelling residents in this rural setting. The results of this pilot study support the feasibility and effectiveness of the Ageing Well program. But further trials are warranted.

Utility of Mayo Clinic's early screen for discharge planning tool for predicting patient length of stay, discharge destination, and readmission risk in an inpatient oncology cohort.

PURPOSE: To examine the feasibility of using the Mayo Clinic's Early Screen for Discharge Planning (ESDP) tool in determining its predictive ability in an inpatient oncology hospital setting for variables including length of stay (LOS), discharge destination, and readmission risk. METHODS: A prospective observational study was conducted at a metropolitan tertiary cancer centre in Melbourne, Australia. The ESDP score, along with patient outcomes and characteristics, were collected to examine the relationships between positive and negative ESDP scores and patient outcomes. RESULTS: A total of 136 participants met inclusion criteria for this study. The proportion with positive ESDP scores was greater in those with unplanned hospital admissions compared with planned admissions (χ2(1, n = 136) = 3.94, p = 0.047). The ESDP status was not a significant predictor of oncology hospital LOS (rpb = 0.116, p = 0.178); however, the ESDP scores did predict discharge destination (χ2(2, n = 136) = 20.22, p < .001). Those re-admitted within 14 days were more likely to have negative ESDP scores than those not readmitted within this time period (χ2(1, n = 136) = 5.22, p = 0.022). Those with positive ESDP scores received a greater number of hospital services whilst admitted than those with negative scores (rpb = 0.388, p < .001) and were more likely to receive particular types of services. CONCLUSION: The findings from this study suggest that the ESDP tool could be useful in an adult inpatient oncology population in a hospital with defined specialised hospital discharge planning services (SHDCPS). The ESDP may be beneficial for early identification of service types likely to be required in care and likely discharge destination, both of which can assist discharge planning (DP); however, the ESDP was not useful for predicting LOS or readmission risk in the adult inpatient oncology population without a SHDCPS model in place.

Exploration of older people's perceptions of behavioural factors associated with falls.

Background: falls rates in older people continue to rise despite concerted efforts to manage falls risks. As more effective strategies to reduce falls in older people may arise from better understanding their perspectives on falls risk, this study aimed to explore perceptions and behavioural decisions that may affect risk of falling among older people living in regional Australia. Method: this qualitative research, informed by hermeneutics, explored older people's perspectives on decisions they made that could affect their falls risk. The study involved 26 participants (21 females) aged 65-84 years, residing in regional Australia. In total, 13 participated in semi-structured focus groups and 13 in semi-structured, in-depth interviews. Results: six key themes illuminated the challenges older people faced in relation to falls risk. These were: the role that independence played in decision making regarding risk; the influence of previous falls experience; older people's level of understanding of risks; ability and willingness to engage with support; the need or desire to cover up a fall history; and the influence of finances in managing risk. Older people's accounts demonstrated they experienced competing influences that impacted upon decisions they made with respect to falls risks. Most significantly, the complex interplay of these influences drove the decisions older people made, sometimes placing them at greater risk of falling. Conclusion: consideration of the multifaceted issues older people face when managing falls risk, and the influence these factors have on their behaviours, is vital to successfully reducing rates of fall related injuries in this population.

Assessing Differences in Anthropometric and Fitness Characteristics Between Police Academy Cadets and Incumbent Officers.

Orr, RM, Dawes, JJ, Pope, R, and Terry, J. Assessing differences in anthropometric and fitness characteristics between police academy cadets and incumbent officers. J Strength Cond Res 32(9): 2641-2650, 2018-The physical fitness of police officers must be developed in new cadets and sustained in incumbent officers. The aims of this study were to profile and compare the anthropometric and fitness characteristics of police academy cadets and incumbent officers of varying ages from a single police force. Retrospective data for 84 police academy cadets (♂ = 66, mean age = 27.96 ± 5.73 years; ♀ = 18, mean age = 30.50 ± 5.76 years) and 80 incumbent police officers (♂ = 73, mean age = 39.43 ± 8.28 years; ♀ = 7, mean age = 37.86 ± 3.67 years) were compiled. Data included participant age, anthropometric (body mass, lean mass, and fat mass), and fitness measurements (1-minute push-up, 1-minute sit-up, 1 repetition maximum bench press, vertical jump, 300-m, and 1.5-mile run). Male cadets exhibited significantly lower fat mass than male officers (12.4 vs. 15.1 kg, p = 0.003). These differences were fully explained by the age differences between these groups (p = 0.046). Male cadets were more aerobically fit with greater muscular endurance than male officers (p < 0.001 for all measures). This difference was not explained by age differences (p > 0.80 for all measures). Male cadets also exhibited higher anaerobic fitness than male officers (p < 0.001). Age differences only partially explained this difference (p = 0.01). Female cadets exhibited greater upper-body strength and muscular endurance than female officers (p < 0.004 for all measures), independent of age. Being a police officer, rather than age progression, may largely account for observed lower levels of fitness in incumbent officers when compared with cadets. Formalized physical training programs for incumbent police officers are needed if their fitness is to be maintained and risk of cardiovascular disease minimized.

A retrospective cohort study of QuickDASH scores for common acute trauma conditions presenting for hand therapy.

STUDY DESIGN: Retrospective cohort study. INTRODUCTION: The QuickDASH outcome measure is a valid and reliable measurement tool for assessing disabilities of the arm, shoulder and hand. PURPOSE OF STUDY: There is limited literature providing typical QuickDASH scores for upper limb conditions. Therefore, the aim of this study was to determine the QuickDASH scores typically observed in specific upper limb pathologies. METHODS: This study examined QuickDASH scores for acute trauma conditions presenting for hand therapy. A sample of 481 patient cases were identified, across five upper limb conditions involving a flexor or extensor tendon injury or repair, distal radius fracture, metacarpal fracture, or complex trauma. RESULTS: Typical scores were determined at initial and final therapy sessions for these upper limb conditions. CONCLUSION: The summary data from different diagnostic subgroups provides comparison data for clinicians to use when making comparisons, or setting goals. LEVEL OF EVIDENCE: Level 3.

Reliability and validity of inexpensive and easily administered anthropometric clinical evaluation methods of postural asymmetry measurement in adolescent idiopathic scoliosis: a systematic review.

PURPOSE: As accurate and reproducible measurements of spinal curvature are crucial in the examination of patients with adolescent idiopathic scoliosis (AIS), this systematic review aims to report on the reliability and validity of a range of inexpensive and easily administered anthropometric methods of postural asymmetry measurement in an AIS population, to inform practice in a clinical setting. METHODS: A systematic search of health research databases located studies assessing reliability and validity of inexpensive and easily administered anthropometric measures. RESULTS: Fourteen studies satisfied eligibility criteria. The methodological quality of included studies ranged from low to high. Validity studies were of moderate to high quality. In total, nine clinically applicable, inexpensive and easily administered anthropometric methods were identified, for assessing AIS curvature. All methods demonstrated high to very high inter-observer and intra-observer reliability. Reported criterion validity of the scoliometer and 2D photographs, when compared to Cobb angle assessed from radiographs, ranged from low to very high. iPhone measurements correlated well with scoliometer measurements. 2D photography results had a moderate to high correlation with 3D topography results. CONCLUSIONS: Overall, strong levels of evidence exist for iPhone and scoliometer measurements, with a high to very high reliability and moderate to very high validity. Moderate levels of evidence exist for scoliometer with mathematical formula and clinical examination with moderate and low validity, respectively. Limited evidence exists for aesthetic tools TRACE and AI and 2D photography. These results indicate there are accurate and reproducible anthropometric measures that are inexpensive and applicable in therapy settings to assess postural asymmetry; however, these only exist for measurement in the transverse plane, despite 3D characteristics of AIS. Further research is required into an inexpensive and easily administered method that can assess postural asymmetry in all anatomical planes.

Gender differences in load carriage injuries of Australian army soldiers.

BACKGROUND: With the removal of gender restrictions and the changing nature of warfare potentially increasing female soldier exposure to heavy military load carriage, the aim of this research was to determine relative risks and patterns of load carriage related injuries in female compared to male soldiers. METHODS: The Australian Defence Force Occupational Health, Safety and Compensation Analysis and Reporting workplace injury database was searched to identify all reported load carriage injuries. Using key search terms, the narrative description fields were used as the search medium to identify records of interest. Population estimates of the female: male incident rate ratio (IRR) were calculated with ninety-five percent confidence interval (95% CI) around the population estimate of each IRR determined. RESULTS: Female soldiers sustained 10% (n = 40) of the 401 reported injuries, with a female to male IRR of 1.02 (95% CI 0.74 to 1.41). The most common site of injury for both genders was the back (F: n = 11, 27%; M: n = 80, 22%), followed by the foot in female soldiers (n = 8, 20%) and the ankle (n = 60, 17%) in male soldiers. Fifteen percent (n = 6) of injuries in female soldiers and 6% (n = 23) of injuries in males were classified as Serious Personal Injuries (SPI) with the lower back the leading site for both genders (F: n = 3, 43%: M: n = 8, 29%). The injury risk ratio of SPI for female compared to male soldiers was 2.40 (95% CI 0.98 to 5.88). CONCLUSIONS: While both genders similarly have the lower back as the leading site of injury while carrying load, female soldiers have more injuries to the foot as the second leading site of injury, as opposed to ankle injuries in males. The typically smaller statures of female soldiers may have predisposed them to their observed higher risk of suffering SPI while carrying loads.

A functional movement screen profile of an Australian state police force: a retrospective cohort study.

BACKGROUND: Police officers are required to perform dynamic movements in unpredictable environments, the results of which can lead to injury. Early identification of poor movement patterns of a police population, and potential sub groups within this population, may provide opportunities to treat and minimise injury risks. The aim of this study was to profile the functional movement capabilities of an Australian state police force and potential sub groups through a retrospective cohort study. METHODS: Retrospective data from an Australian State Police Force were provided for analysis (♂ n = 1155, mean (±SD) age = 31.34 ± 8.41 years: ♀ n = 357, mean age = 27.99 ± 8.02 years). Data consisted of Functional Movement Screen (FMS) assessment results of male and female trainees and qualified police officers with all assessments conducted by a qualified Police Physical Training Instructor. RESULTS: Significantly higher (U = 253863, p < .001) FMS total scores were found for recruits (mean 15.23 ± SD 2.01 points) when compared to attested officers (14.57 ± 2.96 points) and differences in FMS total scores also approached significance for females (15.24 ± 2.35 points) when compared to males (14.84 ± 2.55 points, U = 186926, p = .007), with age found to be a key, significant factor in explaining these observed differences (F (1,1507) = 23.519, p < .001). The FMS components demonstrating poorest movement performance across all groups were the hurdle step and rotary stability. CONCLUSIONS: Generally, police personnel (both attested officers and recruits of both genders) of greater age have a lower functional movement capability when compared to younger personnel, with greater percentages scoring 14 or below on the FMS. Specific conditioning programs to improve strength, range of motion and stability during identified key movement types in those demonstrating poorer movement performance may serve to reduce injuries in police personnel.

National Rugby League athletes and tendon tap reflex assessment: a matched cohort clinical study.

BACKGROUND: Limited research suggests elite athletes may differ from non-athletes in clinical tendon tap reflex responses. METHODS: In this matched cohort study, 25 elite rugby league athletes were compared with 29 non-athletes to examine differences in tendon reflex responses. Relationships between reflex responses and lengths of players' careers were also examined. Biceps, triceps, patellar and Achilles tendon reflexes were clinically assessed. RESULTS: Right and left reflexes were well correlated for each tendon (rS = 0.7-0.9). The elite rugby league athletes exhibited significantly weaker reflex responses than non-athletes in all four tendons (p < 0.005). Biceps reflexes demonstrated the largest difference and Achilles reflexes the smallest difference. Moderate negative correlations (rS = -0.3-0.6) were observed between reflex responses and lengths of players' careers. CONCLUSIONS: Future research is required to further elucidate mechanisms resulting in the observed differences in tendon reflexes and to ensure clinical tendon tap examinations and findings can be interpreted appropriately in this athletic population.

Reported load carriage injuries of the Australian army soldier.

INTRODUCTION: Many injuries experienced by soldiers can be attributed to the occupational loads they are required to carry. PURPOSE: The aim of this study was to determine whether contemporary military load carriage is a source of injuries to Australian Regular Army soldiers and to profile these injuries. METHODS: The Australian Defence Force 'Occupational Health, Safety and Compensation Analysis and Reporting' database was searched to identify all reported injuries sustained during load carriage events. Key search terms were employed and narrative description fields were interrogated to increase data accuracy. RESULTS: A total of 1,954 injury records were extracted from the database. Of these, 404 injuries were attributed to load carriage. The majority of these load carriage injuries involved either the lower limb or back, with bones and joints accounting for the most frequently reported body structures to be injured. Field activities were the leading activities being performed at the time that load carriage injuries occurred, and muscular stress was identified as the mechanism of injury for over half of reported load carriage injuries. CONCLUSION: This study suggests that load carriage is a substantial source of injury risk to Australian Army soldiers. Physical training may fail to adequately prepare soldiers for load carriage tasks during field training exercises.

Load Carriage: An Integrated Risk Management Approach.

Military load carriage (LC) gives rise to substantial risks to soldier health, tactical performance, and mission success. The aim of this article was to extract and synthesize the key findings of a series of LC research reports previously published by the authors. Five reviews and 6 studies were included, with key findings extracted and synthesized in tabulated and critical narrative form. The weight of a soldier's load is a source of risk for soldier's injuries and tactical task performance. The resulting level of risk is influenced by risk modifiers (like speed of march, terrain grade, and task type and duration) and risk controls (like administrative controls and physical conditioning). In the Australian context, these risk controls were limited, with soldiers carrying heavier loads than those mandated by doctrine and policy, and LC conditioning not meeting best practice. The diversity of LC contexts, combined with the influence of risk modifiers and risk controls, means that levels of risk associated with LC are not consistent and must be assessed on a case-by-case basis. Load weight and marching routes (terrains, gradients), distances, speed, and duration are all potentially treatable sources of LC-related risk. Potential risk treatments include not only commanders directly addressing these specific sources of risk to the extent feasible, on a case-by-case basis, when planning or conducting LC tasks but also improving administration controls (i.e., doctrine and policies) and personal protection (i.e., the physical conditioning of the soldier) as part of the hierarchy of controls. Practical application would involve commanders developing and implementing dedicated LC doctrine and policies and implementing and enforcing LC conditioning programs that meets best practice.