Spinal pain in childhood: prevalence, trajectories, and diagnoses in children 6 to 17 years of age.

This study aimed to investigate the trajectories of spinal pain frequency from 6 to 17 years of age and describe the prevalence and frequency of spinal pain and related diagnoses in children following different pain trajectories. First through fifth-grade students from 13 primary schools were followed for 5.5 years. Occurrences of spinal pain were reported weekly via text messages. Children reporting spinal pain were physically evaluated and classified using International Classification of Disease criteria. Trajectories of spinal pain frequency were modeled from age 6 to 17 years with latent class growth analysis. We included data from 1556 children (52.4% female, mean (SD) baseline age = 9.1 (1.9) years) and identified 10,554 weeks of spinal pain in 329,756 weeks of observation. Sixty-three percent of children reported one or more occurrences of spinal pain. We identified five trajectories of spinal pain frequency. Half the children (49.8%) were classified as members of a "no pain" trajectory. The remaining children followed "rare" (27.9%), "rare, increasing" (14.5%), "moderate, increasing" (6.5%), or "early-onset, decreasing" (1.3%) spinal pain trajectories. The most common diagnoses in all trajectory groups were non-specific (e.g., "back pain"). Tissue-specific diagnoses (e.g., muscle strain) were less common and pathologies (e.g., fracture) were rare.  Conclusion: From childhood through adolescence, spinal pain was common and followed heterogeneous courses comprising stable, increasing, and early-onset trajectories. These findings accord with recommendations from adult back pain guidelines that most children with spinal pain can be reassured that they do not have a serious disease and encouraged to stay active. What is Known: • Spinal pain imposes a large burden on individuals and society. • Although many people first experience the condition in childhood, little is known about the developmental trajectories of spinal pain from childhood to adolescence. What is New: • Data from 1556 children and 329,756 participant weeks showed five unique spinal pain trajectories from 6 to 17 years: most children rarely reported spinal pain, while one in five followed increasing or early-onset trajectories. • Most pain occurrences were non-specific; pathological diagnoses were rare.

Does lower extremity pain precede spinal pain? A longitudinal study.

The main objective was to investigate whether children aged 9-15 years at baseline were more likely to experience an incident event of spinal pain after experiencing lower extremity pain. Children's musculoskeletal pain was monitored by weekly mobile phone text message responses from parents, indicating whether the child had spinal pain, lower extremity pain, or upper extremity pain the preceding week. Data were analyzed using mixed effect logistic regression models and cox regression models. The association between an incident event of spinal pain and LE pain the preceding weeks increased with increasing observation period and was statistically significant for 12 and 20 weeks (OR = 1.34 (95% CI 1.05 to 1.70) and OR = 1.39 (95% CI 1.11 to 1.75), respectively). We found that the likelihood increased in children with more frequent or longer duration of lower extremity pain. The reversed relationship was investigated as well, and we also found a positive association between spinal pain and a subsequent incidence event of lower extremity pain, but less pronounced.Conclusion: Children were more likely to experience an incident event of spinal pain after experiencing lower extremity pain. The likelihood increased in children with more frequent or longer duration of lower extremity pain. What is Known: • Both spinal pain and lower extremity pain often start early in life and is common already in adolescence. What is New: • Children were more likely to experience an incident event of spinal pain after experiencing LE pain. • The likelihood increased in children with more frequent or longer duration of LE pain.

Generalised joint hypermobility and shoulder joint hypermobility, - risk of upper body musculoskeletal symptoms and reduced quality of life in the general population.

BACKGROUND: Generalised Joint Hypermobility (GJH) is a hereditary condition with an ability to exceed the joints beyond the normal range. The prevalence of GJH in the adult population and its impact on upper body musculoskeletal health and quality of life has mostly been studied in selected populations. The aims of this study were therefore, firstly to study the prevalence of GJH and GJH including shoulder hypermobility (GJHS), in the general Danish adult population; secondly to test the associations between GJH or GJHS and upper body musculoskeletal symptoms and health-related quality of life (HRQoL). METHODS: The study was cross-sectional where 2072 participants, aged 25-65, randomly extracted from the Danish Civil Registration System), were invited to answer a questionnaire battery (Five-Part Questionnaire for classification of GJH, Standardised Nordic Questionnaire for musculoskeletal symptoms, EuroQoL-5D for HRQoL). RESULTS: Totally 1006 (49%) participants responded. The prevalence of GJH and GJHS were 30% (n = 300) and 5% (n = 51), respectively. Compared with Non GJH (NGJH), participants with GJH and GJHS had Odds Ratio (OR) of 1.5-3.5 for upper body musculoskeletal symptoms within the last 12 months (mostly shoulders and hands/wrists). GJH and GJHS also had OR 1.6-4.4 for being prevented from usual activities, mostly due to shoulder and neck symptoms. Furthermore, GJH and GJHS had OR 2.2-3.1 for upper body musculoskeletal symptoms lasting for more than 90 days (neck, shoulders, hand/wrists), and 1.5-3.5 for reduced HRQoL (all dimensions, but anxiety/depression) compared with NGJH. Generally, most OR for GJHS were about twice as high as for those having GJH alone. CONCLUSIONS: GJH and GJHS are frequently self-reported musculoskeletal conditions in the Danish adult population. Compared with NGJH, GJH and especially GJHS, present with higher OR for upper body musculoskeletal symptoms, more severe symptoms and decreased HRQoL.

Musculoskeletal extremity pain in Danish school children - how often and for how long? The CHAMPS study-DK.

BACKGROUND: Musculoskeletal pain is common in childhood and adolescence, and may be long-lasting and recurrent. Musculoskeletal problems tend to follow adolescents into adulthood, and therefore it is important to design better prevention strategies and early effective treatment. To this end, we need in-depth knowledge about the epidemiology of musculoskeletal extremity problems in this age group, and therefore, the aim of this study was to determine the prevalence, frequency and course of musculoskeletal pain in the upper and lower extremities in a cohort of Danish school children aged 8-14 years at baseline. METHODS: This was a prospective 3-year school-based cohort study, with information about musculoskeletal pain collected in two ways. Parents answered weekly mobile phone text messages about the presence or absence of musculoskeletal pain in their children, and a clinical consultation was performed in a subset of the children. RESULTS: We found that approximately half the children had lower extremity pain every study year. This pain lasted on average for 8 weeks out of a study year, and the children had on average two and a half episodes per study year. Approximately one quarter of the children had upper extremity pain every study year that lasted on average 3 weeks during a study year, with one and a half episodes being the average. In general, there were more non-traumatic pain episodes compared with traumatic episodes in the lower extremities, whereas the opposite was true in the upper extremities. The most common anatomical pain sites were 'knee' and 'ankle/ft'. CONCLUSION: Lower extremity pain among children and adolescents is common, recurrent and most often of non-traumatic origin. Upper extremity pain is less common, with fewer and shorter episodes, and usually with a traumatic onset. Girls more frequently reported upper extremity pain, whereas there was no sex-related difference in the lower extremities. The most frequently reported locations were 'knee' and 'ankle/ft'.

The extent and risk of knee injuries in children aged 9-14 with Generalised Joint Hypermobility and knee joint hypermobility - the CHAMPS-study Denmark.

BACKGROUND: Generalised Joint Hypermobility (GJH) is suggested as an aetiological factor for knee injuries in adolescents and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of knee injuries during challenging situations like jumping and landing. The aim was to study the extent and risk of knee injuries in children with GJH and knee hypermobility. METHODS: In total, 999 children (9-14 years) were tested twice during spring 2012 and 2013 with Beighton's Tests (BT) for hypermobility, a 0-9 scoring system. GJH was classified with cut-point ≥5/9 on both test rounds. On basis of weekly cell phone surveys of knee pain, children requiring clinical examination were seen. Traumatic and overuse knee injuries were registered by WHO ICD-10 diagnoses. Logistic regression and Poisson regression models with robust standard errors were used to examine the association between GJH and knee injuries, taking into account clustering on school class levels. RESULTS: Totally, 36 children were classified GJH on both test rounds. Overuse knee injuries were the most frequent injury type (86 %), mainly apophysitis for both groups (61 %), other than patella-femoral pain syndrome for the control group (13 %). For traumatic knee injuries, distortions and contusions were most frequent in both groups (51 % resp. 36 %), besides traumatic lesions of knee tendons and muscles for the control group (5 %). No significant association was found between overuse knee injuries and GJH with/without knee hypermobility (OR 0.69, p = 0.407 resp. OR 0.75, p = 0.576) or traumatic knee injuries and GJH with/without knee hypermobility (OR 1.56, p = 0.495 resp. OR 2.22, p = 0.231). CONCLUSIONS: Apophysitis, distortions and contusions were the most frequent knee injuries. Despite the relatively large study, the number of children with GJH and knee injuries was low, with no significant increased risk for knee injuries for this group. This questions whether GJH is a clinically relevant risk factor for knee injuries in school children aged 9-14 years. A fluctuation in the individual child's status of GJH between test rounds was observed, suggesting that inter- and intra-tester reproducibility of BT as well as growth may be considered important confounders to future studies of children with GJH.

Field assessment of balance in 10 to 14 year old children, reproducibility and validity of the Nintendo Wii board.

BACKGROUND: Because body proportions in childhood are different to those in adulthood, children have a relatively higher centre of mass location. This biomechanical difference and the fact that children's movements have not yet fully matured result in different sway performances in children and adults. When assessing static balance, it is essential to use objective, sensitive tools, and these types of measurement have previously been performed in laboratory settings. However, the emergence of technologies like the Nintendo Wii Board (NWB) might allow balance assessment in field settings. As the NWB has only been validated and tested for reproducibility in adults, the purpose of this study was to examine reproducibility and validity of the NWB in a field setting, in a population of children. METHODS: Fifty-four 10-14 year-olds from the CHAMPS-Study DK performed four different balance tests: bilateral stance with eyes open (1), unilateral stance on dominant (2) and non-dominant leg (3) with eyes open, and bilateral stance with eyes closed (4). Three rounds of the four tests were completed with the NWB and with a force platform (AMTI). To assess reproducibility, an intra-day test-retest design was applied with a two-hour break between sessions. RESULTS: Bland-Altman plots supplemented by Minimum Detectable Change (MDC) and concordance correlation coefficient (CCC) demonstrated satisfactory reproducibility for the NWB and the AMTI (MDC: 26.3-28.2%, CCC: 0.76-0.86) using Centre Of Pressure path Length as measurement parameter. Bland-Altman plots demonstrated satisfactory concurrent validity between the NWB and the AMTI, supplemented by satisfactory CCC in all tests (CCC: 0.74-0.87). The ranges of the limits of agreement in the validity study were comparable to the limits of agreement of the reproducibility study. CONCLUSION: Both NWB and AMTI have satisfactory reproducibility for testing static balance in a population of children. Concurrent validity of NWB compared with AMTI was satisfactory. Furthermore, the results from the concurrent validity study were comparable to the reproducibility results of the NWB and the AMTI. Thus, NWB has the potential to replace the AMTI in field settings in studies including children. Future studies are needed to examine intra-subject variability and to test the predictive validity of NWB.

Co-designing municipal multimorbidity rehabilitation leveraging health literacy and social networks: Protocol for the CURIA study.

Background: Managing multimorbidity poses significant challenges for individuals, their families, and society due to issues with health information comprehension, communication with healthcare providers, and navigating the healthcare system. These challenges emphasise the critical need to prioritize individual and organisational health literacy. Multimorbidity is associated with a lack of social support for health; however, social networks and community dynamics can enhance health literacy. The "Co-designing municipal rehabilitation" (CURIA) project targets enhancing individual and organisational health literacy, and social networks for individuals with multimorbidity, with the overall aim of addressing health inequity through a collaborative local co-design process involving stakeholders. Methods: The CURIA study employs a mixed-method approach that initially explores the health literacy experiences of individuals with multimorbidity participating in rehabilitation programs in selected Danish municipalities and the practices of professionals overseeing these programs. The subsequent co-design process will comprise individuals with multimorbidity, their relatives, municipalities, general practitioners, civil society, and knowledge institutions working together. This iterative and collaborative process involves tailoring and aligning health literacy needs with responsiveness within the context of local healthcare systems and developing supportive social networks. Discussion: Given the increasing burden of multimorbidity, there is an urgent need to develop evidence-based practice for multimorbidity rehabilitation practices, developed in collaboration with municipalities and civil society. Emphasising self-care support for individuals, managing complex rehabilitation needs, and involving individuals in intervention prioritisation and customisation are crucial aspects addressed by CURIA to enhance health literacy and align municipal rehabilitation with identified needs.

Inter-tester reproducibility and inter-method agreement of two variations of the Beighton test for determining Generalised Joint Hypermobility in primary school children.

BACKGROUND: The assessment of Generalised Joint Hypermobility (GJH) is usually based on the Beighton tests, which consist of a series of nine tests. Possible methodological shortcomings can arise, as the tests do not include detailed descriptions of performance, interpretation nor classification of GJH. The purpose of this study was, among children aged 7-8 and 10-12 years, to evaluate: 1) the inter-tester reproducibility of the tests and criteria for classification of GJH for 2 variations of the Beighton test battery (Methods A and B) with a variation in starting positions and benchmarks between methods, and 2) the inter-method agreement for the two batteries. METHODS: A standardised three-phase protocol for clinical reproducibility studies was followed including a training phase, an overall agreement phase and a study phase. The number of participants in the three phases was 10, 70 and 39 respectively. For the inter-method study a total of 103 children participated. Two testers judged each test battery. A score of ≥ 5 was set as the cut-off level for GJH. Cohen's kappa statistics and McNemar's test were used to test for agreement and significant differences. RESULTS: Kappa values for GJH (≥ 5) were 0.64 (Method A, prevalence 0.42) and 0.59 (Method B, prevalence 0.46), with no difference between testers in Method A (p = 0.45) and B (p = 0.29). Prevalence of GJH in the inter-method study was 31% (A) and 35% (B) with no difference between methods (p = 0.54). CONCLUSIONS: Inter-tester reproducibility of Methods A and B was moderate to substantial, when following a standardised study protocol. Both test batteries can be used in the same children population, as there was no difference in prevalence of GJH at cut point 5, when applying method A and B. However, both methods need to be tested for their predictive validity at higher cut-off levels, e.g. ≥ 6 and ≥ 7.

Single leg mini squat: an inter-tester reproducibility study of children in the age of 9-10 and 12-14 years presented by various methods of kappa calculation.

BACKGROUND: Multiple studies suggest that reduced postural orientation is a possible risk factor for both patello-femoral joint pain (PFP) and rupture of the anterior cruciate ligament (ACL). In order to prevent PFP and ACL injuries in adolescent athletes, it is necessary to develop simple and predictive screening tests to identify those at high risk. Single Leg Mini Squat (SLMS) is a functional and dynamic real-time screening test, which has shown good validity and reproducibility in evaluation of postural orientation of the knee in an adult population. The aim of this study was to determine the inter-tester reproducibility of SLMS in the age group of 9-10 and 12-14 years by evaluating postural orientation of the ankle, knee, hip and trunk. Further on, this study exemplify the divergence of kappa values when using different methods of calculating kappa for the same dataset. METHODS: A total of 72 non-injured children were included in the study. Postural orientation of the ankle, knee, hip and trunk for both legs was determined by two testers using a four-point scale (ordinal, 0-3). Prevalence, overall agreement as well as four different methods for calculating kappa were evaluated: linear weighted kappa in comparison with un-weighted kappa, prevalence-adjusted bias-adjusted kappa (PABAK) and quadratic weighted kappa. RESULTS: The linear weighted kappa values ranged between 0.54-0.86 (overall agreement 0.86-0.97), reflecting a moderate to almost perfect agreement. When calculating un-weighted kappa (with and without PABAK) and quadratic weighted kappa, the results spread between 0.46-0.88, 0.50-0.94, and 0.76-0.95, reflecting the various results when using different methods of kappa calculation. CONCLUSIONS: The Single Leg Mini Squat test has moderate to almost perfect reproducibility in children aged 9-10 and 12-14 years when evaluating postural orientation of the ankles, knees, hips and trunk, based on the excellent strength of agreement as presented by linear weighted kappa. The inconsistency in results when using different methods of kappa calculation demonstrated the linear weighted kappa being generally 15% lower than the quadratic weighted values. On average, prevalence-adjusted bias-adjusted kappa increased the un-weighted kappa values by 7% and 12% by children aged 9-10 and 12-14, respectively.

Supervised, Heavy Resistance Training Is Tolerated and Potentially Beneficial in Women with Knee Pain and Knee Joint Hypermobility: A Case Series.

Introduction: Adults with generalised joint hypermobility including knee joint hypermobility (GJHk) report more knee joint symptoms when compared to adults without GJHk. There is no consensus on best practice for symptom management. For instance, controversy exists regarding the appropriateness and safety of heavy resistance training as an intervention for this specific group. This case series aims to describe a supervised, progressive heavy resistance training program in adults with GJHk and knee pain, the tolerability of the intervention, and the outcomes of knee pain, knee-related quality of life, muscle strength, proprioception, and patellar tendon stiffness through a 12-week period. Materials and Methods: Adults with GJHk and knee pain were recruited to perform supervised, progressive heavy resistance training twice a week for 12 weeks. The main outcome was the tolerability of the intervention. Secondary outcomes were knee pain during a self-nominated activity (VASNA); Knee injury and Osteoarthritis Outcome Score (KOOS); Tampa Scale of Kinesiophobia (TSK); maximal quadriceps voluntary isometric contraction and rate of torque development; 5 repetition maximum strength in five different leg exercises; single leg hop for distance; knee proprioception and patellar tendon stiffness. Results: In total, 16 women (24.2 years, SD 2.5) completed at least 21/24 training sessions. No major adverse events were observed. On average, VASNA decreased by 32.5 mm (95% CI 21.4-43.6), in addition to improvements in KOOS and TSK scores. These improvements were supported by an increase in all measures of lower extremity muscle strength, knee proprioception, and patellar tendon stiffness. Conclusion: Supervised heavy resistance training seems to be well tolerated and potentially beneficial in young women with GJHk and knee pain.

Danish Health Professional Students' Attitudes Toward Addressing Sexual Health: A Cross-Sectional Survey.

INTRODUCTION: Danish health professional (HP) students' attitudes toward addressing sexual health are unknown. AIM: To investigate Danish HP students' attitudes toward addressing sexual health in their future professions, and to assess differences in perceived competences and preparedness between professional programs. METHODS: A Danish national survey of nursing, occupational therapy, and physiotherapy students was conducted. Totally, 1,212 students were invited to respond to an online questionnaire "The Students' Attitudes toward Addressing Sexual Health." MAIN OUTCOME MEASURE: The main outcome measures investigated were Danish HP students' attitudes toward addressing sexual health in their future professions, and differences in perceived competences and preparedness depending on the professional program. RESULTS: A total of 584 students (48%; nursing 44%, occupational therapy 70%, physiotherapy 43%) responded. Mean total score ranged between 63.7 and 66.3 (±8.3-8.8) classifying students in the low-end of the class: "comfortable and prepared in some situations." No clinically relevant differences were determined between the professional programs with respect to perceived competences and preparedness to address sexual health. CONCLUSION: In the field of addressing sexual health, most Danish HP students reported positive attitudes and a need for basic knowledge, competences, communication training, and education. H Gerbild, C M Larsen, T. Junge, B. S. Laursen, K. Areskoug-Josefsson. Danish Health Professional Students' Attitudes Toward Addressing Sexual Health: A Cross-Sectional Survey. Sex Med 2021;9:100323.

The effect of long-term, group-based physical, cognitive and social activities on physical performance in elderly, community-dwelling people with mild to moderate dementia.

BACKGROUND: Elderly people with dementia are known to be less physically active compared with elderly, healthy people, emphasizing the need for interventions in order to maintain a high level of independence in activities of daily living. The aim was to evaluate the effect of long-term, group-based rehabilitation including physical activity on physical performance in elderly, community-dwelling people with mild to moderate dementia. METHODS: A quasi-experimental study of 18 elderly, community-dwelling people, diagnosed with mild to moderate dementia, participated in an ongoing rehabilitation programme based on integrated physical, cognitive and social activities. The outcome measure was physical performance: the 30-second sit-to-stand test, Guralnik balance test, 10-metre walking speed test, timed 6-metre walk test and a timed dual task walk test. The repeated measure ANOVA was used to analyse any overall differences between related means. RESULTS: No significant effect of time was found for the five outcome measures during the entire period. The variation in the estimate of most outcome scores was higher within subjects than between subjects during the period. Profile plots illustrated that three of the participants, who experienced severe cognitive deterioration, markedly declined in all physical performance tests. CONCLUSION: The expected, progressive deterioration in physical performance was delayed in a small group of home-dwelling people with mild to moderate dementia participating in long-term, group-based rehabilitation. Long-term, group-based rehabilitation may have the overall potential to delay deterioration in activities of daily living performance in home-dwelling people with mild to moderate dementia; however, more studies with larger samples are needed to confirm the findings of this study.

Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8-16 years.

BACKGROUND: Knowledge about the occurrence and distribution of musculoskeletal problems in early life is needed. The objectives were to group children aged 8 to 16 according to their distribution of pain in the spine, lower- and upper extremity, determine the proportion of children in each subgroup, and describe these in relation to sex, age, number- and length of episodes with pain. METHOD: Data on musculoskeletal pain from about 1,000 Danish schoolchildren was collected over 3 school years (2011 to 2014) using weekly mobile phone text message responses from parents, indicating whether their child had pain in the spine, lower extremity and/or upper extremity. Result are presented for each school year individually. RESULTS: When pain was defined as at least 1 week with pain during a school year, Danish schoolchildren could be divided into three almost equally large groups for all three school years: Around 30% reporting no pain, around 40% reporting pain in one region, and around 30% reporting pain in two or three regions. Most commonly children experienced pain from the lower extremities (~ 60%), followed by the spine (~ 30%) and the upper extremities (~ 23%). Twice as many girls reported pain in all three sites compared to boys (10% vs. 5%) with no other statistically significant sex or age differences observed. When pain was defined as at least 3 weeks with pain during a schoolyear, 40% reported pain with similar patterns to those for the more lenient pain definition of 1 week. CONCLUSION: Danish schoolchildren often experienced pain at more than one pain site during a schoolyear, and a significantly larger proportion of girls than boys reported pain in all three regions. This could indicate that, at least in some instances, the musculoskeletal system should be regarded as one entity, both for clinical and research purposes.

The natural course of low back pain from childhood to young adulthood - a systematic review.

Background: Taking the natural course of recurrent and fluctuating low back pain (LBP) seen in longitudinal studies of adults into consideration, the aetiology and development of LBP in children and adolescents also needs to be reflected in a long-term course. Therefore, a systematic critical literature review was undertaken to assess the natural course of LBP in the general population from childhood through adolescence to young adulthood. Methods: A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL and PsycINFO with synonyms of search terms for 1) low back pain; 2) natural course; 3) cohort study and 4) children. Records in English, German, French, Danish, Swedish, and Norwegian were included. To assess the methodological quality of the studies, the NIH quality assessment checklist for cohort studies was adapted and risk of bias was assessed on a study level. Two authors independently reviewed selected studies, assessed quality, and extracted data. A synthesis of results in relation to the natural course of LBP was created. Results: Totally, 3373 records were identified, eight articles were included for quality assessment, and finally, four studies of good to fair quality were included for synthesis of results. Indication of three common patterns of LBP were identified across studies and labelled as 1) ´children and adolescents with no LBP or low probability of LBP´ (49 to 53%), 2) ´children and adolescents with fluctuation of LBP´ (16 to 37%) and 3) ´children and adolescents with repeated reporting of LBP´ (< 1 to 10%). Conclusion: Although methodological heterogeneity, mainly due to different age ranges, an indication of a natural course of LBP was seen across studies. The majority of children and adolescents repeatedly reporting no or low probability of LBP. With recall periods between one week to three months and sampling rates ranging from one to four years, a very low rate repeatedly reported LBP, and approximately one-fifth to one-third of children and adolescents had fluctuating reports of LBP. A need of future research of LBP trajectories with short reporting period lengths and narrower sampling windows in a long-term perspective is emphasized in order to study childhood influences on the development of LBP throughout life.

Generalised joint hypermobility and knee joint hypermobility: prevalence, knee joint symptoms and health-related quality of life in a Danish adult population.

AIM: Several biomechanical factors, such as knee joint hypermobility (KJH), are suggested to play a role in the etiology of knee joint symptoms and knee osteoarthritis. Nevertheless, the prevalence or consequences of KJH solely or included in the classification of generalized joint hypermobility (GJHk) is unknown for a general population. Therefore, the objectives were to report the prevalence of self-reported GJHk and KJH, as well as the association of these conditions to knee joint symptoms, severity and duration of symptoms, and health-related quality of life (HRQoL) in a Danish adult population. METHOD: This study is a cross-sectional population-based survey of 2056 Danish adults. Respondents received online questionnaires of GJHk and KJH, knee joint symptoms, the severity and duration of these, as well as HRQoL. RESULTS: Total response rate was 49% (n = 1006). The prevalence of self-reported GJHk and KJH was 13% and 23%, mostly representing women. More than half of the respondents with GJHk and KJH had knee joint symptoms. The odds for reporting knee joint symptoms, severity of knee joint symptoms and duration of knee joint symptoms were twice as high for respondents with GJHk and KJH. Respondents with GJHk and KJH reported lower HRQoL. CONCLUSION: GJHk and KJH were frequently reported in the Danish adult population, mostly in women. Respondents with GJHk and KJH were two times more likely to report knee joint-related symptoms such as pain, reduced performance of usual activity and lower HRQoL. The impact of these conditions on HRQoL is comparable with knee osteoarthritis.

Hypermobility in Adolescent Athletes: Pain, Functional Ability, Quality of Life, and Musculoskeletal Injuries.

Study Design Cross-sectional. Background Generalized joint hypermobility (GJH) may increase pain and likelihood of injuries and also decrease function and health-related quality of life (HRQoL) in elite-level adolescent athletes. Objective To assess the prevalence of GJH in elite-level adolescent athletes, and to study the association of GJH with pain, function, HRQoL, and musculoskeletal injuries. Methods A total of 132 elite-level adolescent athletes (36 adolescent boys, 96 adolescent girls; mean ± SD age, 14.0 ± 0.9 years), including ballet dancers (n = 22), TeamGym gymnasts (n = 57), and team handball players (n = 53), participated in the study. Generalized joint hypermobility was classified by Beighton score as GJH4 (4/9 or greater), GJH5 (5/9 or greater), and GJH6 (6/9 or greater). Function of the lower extremity, musculoskeletal injuries, and HRQoL were assessed with self-reported questionnaires, and part of physical performance was assessed by 4 postural-sway tests and 2 single-legged hop-for-distance tests. Results Overall prevalence rates for GJH4, GJH5, and GJH6 were 27.3%, 15.9%, and 6.8%, respectively, with a higher prevalence of GJH4 in ballet dancers (68.2%) and TeamGym gymnasts (24.6%) than in team handball players (13.2%). There was no significant difference in lower extremity function, injury prevalence and related factors (exacerbation, recurrence, and absence from training), HRQoL, or lengths of hop tests for those with and without GJH. However, the GJH group had significantly larger center-of-pressure path length across sway tests. Conclusion For ballet dancers and TeamGym gymnasts, the prevalence of GJH4 was higher than that of team handball players. For ballet dancers, the prevalence of GJH5 and GJH6 was higher than that of team handball players and the general adolescent population. The GJH group demonstrated larger sway in the balance tests, which, in the current cross-sectional study, did not have an association with injuries or HRQoL. However, the risk of having (ankle) injuries due to larger sway for the GJH group must be studied in future longitudinal studies. J Orthop Sports Phys Ther 2017;47(10):792-800. doi:10.2519/jospt.2017.7682.

Risk Factors for Knee Injuries in Children 8 to 15 Years: The CHAMPS Study DK.

INTRODUCTION: Knee injuries are frequent in children, with most studies reporting traumatic knee injuries. Evidence of risk factors for knee injuries in children is sparse. The purpose of this study was to report the extent of traumatic and overuse knee injuries in children and to evaluate intrinsic and extrinsic factors for risk of these injuries. METHODS: Weekly musculoskeletal pain, sport participation, and sports type were reported by 1326 school children (8-15 yr). Knee injuries were classified as traumatic or overuse. Multinomial logistic regression was used for analyses. RESULTS: During the study period, 952 (15% traumatic and 85% overuse) knee injuries were diagnosed. Period prevalence for traumatic and overuse knee injuries were 0.8/1000 and 5.4/1000 sport participations, respectively. Participation in tumbling gymnastics was a risk factor for traumatic knee injuries (OR, 2.14). For overuse knee injuries, intrinsic risk factors were sex (girls OR, 1.38) and previous knee injury (OR, 1.78), whereas participation in soccer (OR, 1.64), handball (OR, 1.95), basket (OR, 2.07), rhythmic (OR, 1.98), and tumbling gymnastics (OR, 1.74) were additional risk factors. For both injury types, sport participation above two times per week increased odds (OR, 1.46-2.40). CONCLUSIONS: Overuse knee injuries were the most frequent injury type. For traumatic knee injuries, participation in tumbling gymnastics was a risk factor. Risk factors for overuse knee injuries were being a girl; previous knee injury; and participation in soccer, handball, basket, and rhythmic and tumbling gymnastics. Further risk factors for both types of injury were participation in sports above two times per week. Although growth-related overuse knee injuries are a self-limiting condition, a major part of children are affected by these injuries with unknown short- and long-term consequences.

The association between generalized joint hypermobility and active horizontal shoulder abduction in 10-15 year old competitive swimmers.

BACKGROUND: Increased shoulder mobility and Generalised Joint Hypermobility (GJH) are assumed to be predisposing risk factors for shoulder injuries. The association between GJH and shoulder mobility among competitive swimmers is unknown. The aim was to study the association between GJH and active horizontal shoulder abduction (AHSA) in young, competitive swimmers and to describe normative values of AHSA in this group. METHODS: In total, 92 swimmers (10-15 years) without shoulder pain participated. GJH was evaluated with the Beighton Tests (BT) for joint hypermobility. Shoulder mobility was measured as maximum AHSA. A multiple regression model was used to assess associations between GJH and AHSA. RESULTS: Overall, positive associations were found between GJH and AHSA. An increase of BT score was associated with an increase of AHSA, seen as an increased AHSA of 3.9°, 5.7° and 7.9° by BT cut off points ≥5/9, ≥6/9 and ≥7/9, respectively. Normative values for AHSA ranged from 40° to 52°, depending on age. CONCLUSIONS: Positive associations were found between GJH and AHSA, as maximum AHSA range increased with increasing BT scores. Due to lack of shoulder mobility tests in the BT scoring system, the AHSA test seems to be a promising supplemental test.

Motor Performance as Risk Factor for Lower Extremity Injuries in Children.

PURPOSE: Physical activity-related injuries in children constitute a costly public health matter. The influence of motor performance on injury risk is unclear. The purpose of this study was to examine if motor performance was a risk factor of traumatic and overuse lower extremity injuries in a normal population of children. METHODS: This study included 1244 participants from 8 to 14 yr old at baseline, all participating in the "Childhood Health, Activity and Motor Performance School Study Denmark." The follow-up period was up to 15 months. The motor performance tests were static balance, single leg hop for distance, core stability tests, vertical jump, shuttle run, and cardiorespiratory fitness test. Lower extremity injuries were registered by clinicians using weekly questionnaires and classified according to the International Classification of Diseases, 10th Revision, system. RESULTS: Poor balance increased the risk for traumatic injury in the foot region (incidence rate ratio [IRR] = 1.09-1.15), and good performance in single leg hop for distance protected against traumatic knee injuries (IRR = 0.66-0.68). Good performance in core stability tests and vertical jump increased the risk for traumatic injuries in the foot region (IRR = 1.12-1.16). Poor balance increased the risk for overuse injuries in the foot region (IRR = 1.65), as did good performance in core stability tests and shuttle run, especially for knee injuries (IRR = 1.07-1.18). CONCLUSIONS: Poor balance (sway) performance was a consistent predictor of traumatic injuries, in particular, for traumatic ankle injuries. Good motor performance (core stability, vertical jump, and shuttle run) was positively associated with traumatic and overuse injuries and negatively (single leg hop) associated with traumatic injuries, indicating different influences on injury risk. Previous injury was a confounder affecting the effect size and the significance. More studies are needed to consolidate the findings, to clarify the influence of different performance tests on different types of injuries, and to examine the influence of behavior in relation to injury risk.