Student physiotherapists perceptions of online curriculum delivery during the COVID-19 pandemic.

BACKGROUND: As a result of the COVID-19 pandemic a rapid transformation from face-to-face curriculum delivery to an online teaching and learning environment, was adopted in a number of higher education institutions globally. Allied Health Profession courses such as physiotherapy, traditionally utilising an in person teaching model to prepare students for practice, needed to swiftly adopt new methods of delivery, involving both synchronous and asynchronous approaches. Understanding physiotherapy student perceptions of this transition is important to allow faculty to develop their delivery of online teaching and provide an evidence base for future course curricula. METHODS: Cross-sectional survey of UK higher education students studying either an undergraduate or post-graduate pre-registration degree in physiotherapy was conducted between October 2020 and February 2021. The survey investigated the student's perception of the transition to either an online or hybrid model of learning during the COVID-19 pandemic. A mixed method approach was adopted allowing respondents to share their experiences and facilitate the exploration of questions which required in-depth thought. RESULTS: Two hundred thirty-six respondents completed the questionnaire. Online learning was perceived to be a flexible (49%, n=116,CI 95% 43 to 55) and convenient (49, 116, 43 to 55) method of learning. Despite this, 79% of the students surveyed felt that the online learning experience had a negative impact on their understanding of the subject and were disadvantaged compared to traditional face-to-face teaching provision (mean 4.14 ± SD 1.06). Online physiotherapy delivery produced low student satisfaction, leaving respondents feeling disadvantaged. Decreased levels of engagement and the lack of ability to practice 'hands-on' skills were detrimental aspects of the online approach, with 55% (n=106) reporting they did not perceive the academic staff had the necessary skills to deliver effective online content. CONCLUSIONS: The majority of UK physiotherapy students surveyed were dissatisfied and lacked engagement with an online learning approach within the curricula, compared with the traditional face-to-face delivery. Although several positives of both a synchronous and asynchronous delivery were highlighted, faculty must consider how they best deliver online learning content, making use of pedagogical strategies that will create as many learning and engagement opportunities as possible.

The Uptake of Nordic Hamstring Exercise Program for Injury Prevention in Major League Soccer and Its Barriers to Implementation in Practice.

CONTEXT: It is well demonstrated that Nordic hamstring (NH) program has poor compliance across European soccer clubs, but little is known about its implementation in Major League Soccer (MLS). The authors aimed to investigate MLS hamstring prevention practices and compliance with the NH program and understand the reasons for its inclusion or exclusion. DESIGN: A cross-sectional electronic survey was completed by 24 of the 26 (92%) MLS top-division soccer clubs. METHODS: The survey, based on the Reach, Efficacy, Adoption, Implementation, and Maintenance framework, was sent to team medical staff. Medical staff were also asked for opinions on barriers to implementation. RESULTS: Eighteen clubs (75%) reported a formal hamstring injury prevention program, with eccentric exercises (94%; 95% CI [confidence interval], 74%-99%), high-speed running (94%; 95% CI, 74%-99%), and NH exercises (89%; 95% CI, 67%-97%) the most common strategies adopted. Fifteen clubs partially implemented the NH program, but only 5 (21%; 95% CI, 9%-40%) completed the full program and were classed as compliant. A total of 20 respondents reported that player perception and muscle soreness (83%; 95% CI, 64%-93%) were barriers to the implementation of the NH program. On a 5-point Likert scale, respondents "partially agreed" (4.13 [0.80]) that the NH exercise could substantially reduce injuries and would be "effective" at their own club (3.88 [0.61]). CONCLUSIONS: The NH exercise was valued, but negative player perception and muscular soreness were identified as barriers to implementing the full program. Manipulation of volume and frequency should inform future "effectiveness" research to prospectively assess such modifications in the context of MLS.

The Effects of Unilateral Versus Bilateral Motor Training on Upper Limb Function in Adults with Chronic Stroke: A Systematic Review.

OBJECTIVES: Rehabilitation goals for chronic stroke patients are largely focused around regaining functional ability and independence, with particular focus on upper limb motor function. Unilateral and Bilateral motor training may help achieve this. Our objective was to evaluate and compare the effects of unilateral and bilateral motor training on upper limb motor function in chronic stroke patients. MATERIALS AND METHODS: A comprehensive literature search was conducted until June 2020 through several electronic databases (CENTRAL, Medline, CINAHL, EBSCO, AMED and PEDro) to identify relevant studies. Studies that used the Fugl Meyer Assessment (FMA) as a minimum, to assess upper limb motor function following unilateral versus bilateral training in chronic stroke patients, qualified for inclusion within the review. Randomised controlled trial (RCT), cohort study and cross-sectional study designs were considered. The Cochrane risk of bias tool was used to assess Randomised Controlled Trials (RCTs). The findings were qualitatively synthesised. RESULTS: From a total of 838 studies identified, 7 RCTs were included in this review. All except one of the studies included reported an unclear risk of bias, with one low risk of bias reported. Overall, the studies reported that unilateral and bilateral training improved upper limb function in chronic stroke patients. Improvements between interventions were equivocal. Bilateral upper limb training however may be more efficacious for increasing upper limb strength and quality of movement, with unilateral training more beneficial for recovering functional ability for activities of daily living. CONCLUSION: While the findings of the included studies support the use of unilateral and bilateral motor training post chronic stroke, the seven studies that were included methodologically all presented with limitations, hence strong conclusions cannot be drawn and further research is warranted.

The elite player performance plan: the impact of a new national youth development strategy on injury characteristics in a premier league football academy.

The objective of this study was to investigate the injury incidence and patterns in elite youth football at a category 1 Premier League Academy before and after the introduction of a new development strategy, the Elite Player Performance Plan (EPPP). A prospective study was performed over six consecutive seasons encompassing three years before and after the introduction of the EPPP. The findings revealed a most likely moderate increase in total exposure per player per season when the post-EPPP football exposure (640.86 ± 83.25 hours per player per year) was compared with the pre-EPPP football exposure (539.08 ± 71.59). The total injury incidence pre-EPPP was 3.0/1000 hours compared to 2.1/1000 hours post-EPPP (rate ratio 1.43). 6% of all injuries were re-injuries (20.24 ± 33.43 days) but did not result in a substantially longer absence (16.56 ± 15.77 days). The injury burden decreased for the U12-U15 from pre- to post-EPPP, whereas the injury burden increased for the U16-U18 (respectively 125 and 47% higher). These findings suggest that following the introduction of the EPPP there has been a reduction in injuries in the younger age groups U12-U15 but in the older age groups U16-U18 there has been an increase in the severity of the injuries sustained at this club.

The British Athletics Muscle Injury Classification grading system as a predictor of return to play following hamstrings injury in professional football players.

OBJECTIVES: Investigate the British Athletics Muscle Injury Classification (BAMIC) grading system as a predictor of return to play (RTP) following primary hamstring strain injury (HSI) and its agreement with the Peetron's classification system in professional footballers. METHODS: A retrospective cohort study of 39 hamstrings strains in a professional English football club were identified. Two musculoskeletal radiologists reviewed historical MRI's and classified them against the BAMIC and Peetron's grading system. Classification, oedema length and cross-sectional area were compared against RTP. RESULTS: Pearson's correlation coefficient demonstrated a weak but statistically significant correlation between BAMIC and RTP (r = 0.32; 95%CI 0.01 to 0.58; p = 0.05). Maximum length of intramuscular oedema demonstrated weak correlations with RTP (r = 0.3; 95%CI -0.02 to 0.56; p = 0.06). Percentage cross sectional demonstrated a weak correlation with RTP (r = 0.02; 95%CI -0.3 to 0.33; p = 0.91). Multiple regression demonstrated that 16% of the variance in RTP was explained by the model. Kappa for the agreement between BAMIC and Peetron's was 0.21 (95%CI 0 to 0.42). CONCLUSIONS: A significant association between the grade of HSI on the BAMIC system and RTP was found. Findings suggest BAMIC could provide valuable prognostic information on the RTP.

The uptake of the Nordic hamstring exercise programme as an injury prevention strategy in professional cricket in the United Kingdom and barriers to implementation.

OBJECTIVES: To report hamstring prevention strategies of professional male cricket clubs in the United Kingdom, identify the application of the Nordic hamstring programme (NHP) and gain knowledge of medical teams' reasons for the NHP's inclusion or exclusion. DESIGN: Cross-sectional questionnaire. SETTING: Online survey. PARTICIPANTS: 15 (75%) of professional cricket clubs in the United Kingdom. MAIN OUTCOME MEASURES: Survey based on the RE-AIM framework. RESULTS: Twelve clubs reported having a formal hamstring injury prevention programme. The Nordic hamstring exercise and eccentric exercises (100%) were the most used interventions. Three clubs implemented the NHP, with one classed as fully compliant. Respondents partially agreed, on a 5 point Likert scale, that the Nordic hamstring exercise was effective at reducing injuries at their club (Mean 3.73 ± SD 0.70) and across professional cricket (3.87 ± 0.64). Barriers to implementation across cricket included players not positively perceiving the programme (60%) with a cultural change required (60%) for its adoption. CONCLUSIONS: The Nordic hamstring exercise is positively received by medical personnel in professional cricket in conjunction with other prevention strategies. Three clubs have utilised the NHP in the last three seasons with one club considered fully compliant. A cultural shift from players and coaches may be required for successful NHP implementation.