Process evaluation of the Invictus Pathways Program.

INTRODUCTION: UniSA's Invictus Pathways Program (IPP), a service program, was originally developed to assist veterans to train for and participate in the Invictus Games. More recently, the scope of the IPP has widened to support and improve wellbeing and facilitate post traumatic growth and recovery among participants who are living with physical and mental health injuries and conditions. This paper describes the components of the IPP and reports its process evaluation. METHODS: Underpinned by a pragmatic approach, data related to participant and student involvement in the IPP, the number of participant training sessions, session attendance, program activities and events, and program fidelity were compiled from process documentation that had been collected between 2017 and 2020, inclusive. Following ethics approval, semi-structured interviews were conducted with participants of the IPP, members of their family support network, and university staff to understand the operations of the IPP and satisfaction with the program. FINDINGS: There was high fidelity for the student-led exercise training aspects of IPP; however, data collection relevant to participants' psychological outcomes, and non-training IPP events and activities did not always occur as intended. Between 2017 and 2020, 53 veterans had participated in or were still participating in the IPP, and 63 allied health students had completed placements as student trainers. Fifty-three individual training sessions were delivered in 2017, increasing to 1,024 in 2020. Seventy-one interviews were completed with key IPP stakeholders. The qualitative analysis identified four higher order themes: Implementation and fidelity of the IPP, Satisfaction with the IPP, Areas of the IPP requiring improvement and suggestions for change, and Sustainability of the IPP. Satisfaction was generally high for the IPP, although there were factors that negatively impacted the experience for some participants and their family support network. Suggestions for improvement to program components and delivery aspects were made during the interviews, and the precariousness of IPP funding and sustainability was raised as an ongoing concern. CONCLUSION: This process evaluation has demonstrated that the physical activity training components of the IPP were delivered with high levels of fidelity, and that satisfaction with the IPP is mostly high, although there are areas that could be improved. There is a need for a more structured approach to the ongoing evaluation of the IPP. This includes ensuring that program staff have a shared understanding of the purpose of evaluation activities and that these activities occur as intended. Beyond this is the need to secure funding to support the sustainability of the IPP, so that it can continue to contribute to the wellbeing of veterans living with physical and mental health conditions, and their families.

The physical, psychological, and social impacts of participation in the Invictus Pathways Program: A qualitative analysis of veterans' perceptions and experiences.

INTRODUCTION: UniSA's Invictus Pathways Program (IPP) is motivated by the spirit of the Invictus Games to mobilise the benefits of sport to aid physical, psychological, and social wellbeing. Originally developed to assist veterans to train for and participate in the Invictus Games, the program has extended its scope to promote recovery and wellbeing for all veterans through physical activity. This paper describes the expectations and experiences of the IPP from the perspective of program participants. METHODS: Objective measures of physical and psychological wellbeing were collected by survey, to enable description of the participating veterans' wellbeing status. Semi-structured interviews were conducted with 15 participants of the IPP who had not participated in an Invictus Games or Warrior Games. Reflexive thematic analysis was used to analyse the interview data. Coding and themes were developed through a mixture of inductive and deductive approaches to analysis. Initial themes related to previous life experience, expectations of participation, and outcomes of participation were preconceived, but the analysis provided scope for an inductive approach to formulate additional themes. FINDINGS: Five of the participants had very high K10 scores, and scores above the norm for PCL-C, whilst one would be classified with an alcohol disorder. The qualitative analysis identified five higher order themes: Life experiences prior to participation in the IPP, Making a choice to participate in the IPP, Expectations of participation in the IPP, Impact of participation in the IPP, and Future Plans. There were perceptions that the IPP was beneficial for the participating veterans, irrespective of their physical and psychological health status. Participants described the positive impact of the IPP on their physical fitness, their social engagement, and their sense of belonging within the IPP and the university. Participants perceived the IPP to be an opportunity for them to 'give back' by contributing to the education of the students delivering the IPP. Participants reported the intention to continue being physically active. For some, this meant selection in an Invictus Games team, for others, this meant getting involved in community sporting organisations. CONCLUSION: The Invictus Pathways Program has been shown to have a positive impact on the physical and psychological wellbeing of the veterans who participated in its initial stages. As the program evolves, the longitudinal impact of participation, for veterans and their families, will be assessed.

The reliability of rehabilitative ultrasound to measure lateral abdominal muscle thickness: A systematic review and meta-analysis.

BACKGROUND: Variations in rehabilitative ultrasound imaging (RUSI) protocols may alter lateral abdominal muscle (LAM) thickness measurements. A standardised protocol is required for clinicians to accurately compare LAM thickness changes. OBJECTIVE: In healthy and lower back pain (LBP) populations, to assess the 1) overall reliability of RUSI to diagnose LAM thickness via meta-analysis, 2) reliability of ultrasound variables to diagnose LAM thickness via systematic review, and 3) propose a RUSI protocol for the LAM using variables associated with excellent reliability (intraclass correlation coefficient [ICC] >0.9). DESIGN: Systematic review and meta-analysis. METHOD: Databases were searched from January 2000 for studies reporting the reliability of RUSI on the LAM at rest. Title, abstract and full-text screening were performed. Reference lists of reviews and included full-text articles were scanned for further articles. Study characteristic, ultrasound procedure and reliability data were extracted, and article quality assessed. Data was synthesised using meta-analysis to determine the overall reliability for RUSI in different subgroups; calculation of the mean ICCs and standard error of measurements of protocol variables; and narrative synthesis of protocols to contrast those of differing reliability. RESULTS: Twenty-seven articles, involving 884 participants were included. Reliability ranged from good-to-excellent (ICC 0.859-0.958) in all subgroups. Protocols ranged in subject selection and position, examiner experience, transducer position with the comprehensiveness of protocol description the main limitation of the reviewed literature. Based on the findings an ultrasound protocol was proposed. CONCLUSIONS: RUSI variables for the LAM at rest show moderate-to-excellent reliability; future research should explore reliability following the proposed protocol.

The impact of the mechanical whole-body vibration experienced during military land transit on the physical attributes underpinning dismounted combatant physical performance: A randomised controlled trial.

OBJECTIVES: The aim of this randomised controlled trial was to explore the impact of the mechanical WBV experienced during simulated military land transit on the physical attributes that underpin tasks performed by dismounted combatants. DESIGN: This study used a parallel group randomised control trial design. METHODS: Sixty participants were randomly assigned to one of four, 2-h laboratory-based simulations (restricted posture, sealed road, cross country or a control condition). A smaller sample of 16 Australian Defence Force infantry personnel served as a validation group and were exposed to the same conditions. Neither the restricted posture nor the control conditions were exposed to any WBV, but the former were secured in place using the built-in seat harness. Prior to, and following the assigned condition, participants performed a series of battlefield relevant physical performance tests including; drop jump, 20-m sprint, reactive agility, arm-hand steadiness, isometric mid-thigh pull, and sit-and-reach. RESULTS: Medium decreases in the drop jump were observed for both the sealed road (effect size [ES]=0.53) and cross-country (ES=0.97) simulation conditions indicating a decrease in performance of the jump phase. A large decrease in 20-m sprint performance was observed in both the sealed road (ES=1.37) and cross-country (ES=0.88) exposure conditions. Additionally, a large decrease in 20-m sprint performance was observed for the restricted posture (ES=1.02) exposure condition. CONCLUSIONS: These findings indicate that exposure to WBV experienced during motorised land transit has a negative influence on aspects of lower body explosive strength.

How Much Allied Health Therapy Care Is Enough? An Evidence Scan.

Purpose: Pressure to eliminate low-value health care is increasing internationally. This pressure has produced an urgent need to identify evidence-based methods to determine the value of allied health (AH) care, particularly to recognize when additional AH care adds no further benefits. This article reports on the published methods of determining the value of AH care. Method: We systematically scanned PubMed, MEDLINE, AMED, CINAHL, PsycINFO, and the Grey Literature Review database from inception until July 2018 for peer-reviewed English-language literature. Hierarchy of evidence and information on study design and the methods or measures used to determine the value of AH care were extracted. Results: Of 189 articles, 30 were potentially relevant; after the full text was read, all were included. Of these, 24 reported on ways of determining the value of AH care, and 6 described the optimal provision of AH episodes of care. No methods were reported that could be applied to establish when enough AH therapy had been provided. Conclusion: This review found a variety of attributes of value in AH care, but no standard value measure or methods to determine what constituted enough AH care. Repeated measurement of the standard attributes of value and costs is required throughout episodes of AH care to better understand the impact of AH care from the different stakeholders' perspectives.

Objectif : les pressions internationales s'accroissent pour éliminer les services de santé de faible valeur. Ainsi, il est urgent de trouver des méthodes fondées sur des données probantes pour déterminer la valeur des soins paramédicaux (SPM), notamment pour déterminer lorsqu'ils n'apportent pas de bienfaits. Le présent article rend compte des méthodes publiées pour déterminer la valeur des SPM. Méthodologie : les chercheurs ont procédé à une recherche systématique dans les bases de données de PubMed, Medline, AMED, CINAHL, PsycINFO et du Grey Literature Report à compter de leur création jusqu'en juillet 2018, pour en tirer des publications révisées par des pairs, en anglais. Ils en ont extrait la hiérarchie des données probantes, l'information sur la méthodologie des études et les méthodes ou les mesures utilisées pour déterminer la valeur des services de SPM. Résultats : trente des 189 articles étaient susceptibles d'être pertinents et ont tous été retenus après leur lecture. De ce nombre, 24 rendaient compte de manières de déterminer la valeur des services de SPM et six décrivaient la prestation optimale de périodes de SPM. Aucune méthode déclarée ne permettait d'établir le moment où des SPM suffisants avaient été fournis. Conclusion : les chercheurs ont trouvé diverses caractéristiques de la valeur des SPM, mais aucune mesure standard ni méthode pour en déterminer la quantité suffisante. Il faut répéter la mesure des caractéristiques standards de valeur et de coûts tout au long des périodes de SPM pour mieux comprendre les répercussions des SPM du point de vue de divers intervenants.

Functional Movement Screen Pain Location and Impact on Scoring Have Limited Value for Injury Risk Estimation in Junior Australian Football Players.

OBJECTIVE: To describe the location and severity of pain during Functional Movement Screen (FMS) testing in junior Australian football players and to investigate its effect on FMS composite score and injury risk. DESIGN: Prospective cohort study. METHODS: Junior male Australian football players (n = 439) completed preseason FMS testing. Pain location and severity (on a 0-to-10 numeric pain-rating scale [NPRS]) were assessed for painful subtests. The FMS composite score was calculated using 3 scoring approaches: "traditional," a score of zero on painful subtests; "moderate," a score of zero on painful subtests if an NPRS pain severity was greater than 4; and "raw," did not adjust painful FMS subtest scores. Players were monitored throughout the competitive season and considered injured when 1 or more matches were missed due to injury. RESULTS: One hundred seventy players reported pain during FMS testing. The pain-scoring approach affected mean composite score values (raw, 14.9; moderate, 14.5; traditional, 13.6; P<.001). Sixty-eight percent of pain was mildly severe (NPRS of 4 or less). Back pain (50%) was more common than upper-limb (24%) or lower-limb (26%) pain (P<.001). Upper-limb pain was associated with a small increase in injury risk (hazard ratio = 1.59, P = .023). No other FMS pain location influenced injury risk, nor did pain severity (P>.280). The FMS composite score was not associated with injury risk, regardless of pain-scoring approach (P≥.500). CONCLUSION: Pain was common during FMS testing in junior Australian football players and had a notable effect on the FMS composite score, but minimal effect on subsequent injury risk. J Orthop Sports Phys Ther 2020;50(2):75-82. Epub 17 Sep 2019. doi:10.2519/jospt.2020.9168.

Practices and risks associated with operation of tie-down lashings in the vehicle transport industry.

Load restraint systems in automobile transport utilise tie-down lashings placed over the car's tyres, which are tensioned manually by the operator using a ratchet assembly. This process has been identified as a significant manual handling injury risk. The aim of this study was to gain insight on the current practices associated with tie-down lashings operation, and identify the gaps between current and optimal practice. We approached this with qualitative and quantitative assessments and one numerical simulation to establish: (i) insight into the factors involved in ratcheting; (ii) the required tension to hold the car on the trailer; and (iii) the tension achieved by drivers in practice and associated joint loads. We identified that the method recommended to the drivers was not used in practice. Drivers instead tensioned the straps to the maximum of their capability, leading to over-tensioning and mechanical overload at the shoulder and elbow. We identified the postures and strategies that resulted in the lowest loads on the upper body during ratcheting (using both hands and performing the task with their full body). This research marks the first step towards the development of a training programme aiming at changing practice to reduce injury risks associated with the operation of tie-down lashings in the automobile transport industry. Practitioner Summary: The study investigated current practice associated with the operation of tie-down lashings through qualitative (interviews) and quantitative (biomechanical analysis) methods. Operators tended to systematically over-tension the lashings and consequently overexert, increasing injury risks.

The Australian 75+ Health Assessment: could it detect early functional decline better?

OBJECTIVE: The aim of the present study was to identify opportunities to improve the reach and impact of the Australian Medicare 75+ Health Assessment (75+HA) to detect early functional decline (FD). METHODS: A comparison of two published review articles produced two outputs: (1) assessments identified in the systematic review that underpinned the 75+HA items were ranked for evidence of effectiveness and compared with the volume of research into assessment areas identified by a recent review on indicators of early FD; and (2) items in the 75+HA were compared with those in the recent review. RESULTS: The review underpinning the 75+HA found 19 assessment areas, with strongest evidence of effectiveness for vision/hearing, teeth/oral, balance/gait, cognitive and service use. The more recent review reported on six domains (eight subdomains) of FD assessment: physical and cognitive elements of the performance capacity domain were the least well assessed, whereas the most comprehensively assessed domains were health service use, performance capacity (mental subdomain), participation (motivation/volition subdomain) and demographics. The 75+HA addresses only some items related to early FD as identified by the recent literature. CONCLUSION: Reassessment of the 75+HA with a view to including current evidence-based assessments for early FD is recommended. Updating the 75+HA items with ways to detect FD earlier may increase its relevance to Australia's ageing population.

Radial nerve measurements in nonsymptomatic upper extremities of Filipinos: A cross-sectional study.

INTRODUCTION: Despite reports on the association of radial nerve (RN) size and lateral epicondylalgia (LE), Filipino normative values on RN size in healthy elbows are not established. An association with upper extremity anthropometric measurements is likewise not reported. METHODS: Musculoskeletal ultrasound measurements of the RN at the level of the lateral epicondyle (RN-LE), posterior interosseous nerve at the level of the radial head and supinator (PIN-RH and PIN-sup), and superficial RN (SRN) in the elbows of healthy Filipinos were made in Manila from January-September 2011. RESULTS: A total of 198 elbows of 99 healthy participants aged 43 years (range, 33-48 years) [median(IQR)] were investigated. Men have larger PIN-RH, PIN-sup, and SRN compared with women. Arm length was associated with PIN-RH, PIN-sup, and SRN (P < 0.05). Activities and elbow circumference measurements (at 2 levels) were associated with PIN-RH. CONCLUSIONS: RN reference values can now be used for comparison in elbows with LE.

Reliability and concurrent validity of knee angle measurement: smart phone app versus universal goniometer used by experienced and novice clinicians.

The use of goniometers to measure joint angles is a key part of musculoskeletal practice. Recently smartphone goniometry applications have become available to clinicians. This study examined the intra- and inter-measurer reliability of novice and experienced clinicians and the concurrent validity of assessing knee range of motion using a smartphone application (the Knee Goniometer App (Ockendon(©))) (KGA) and a standard universal goniometer (UG). Three clinicians, each with over seven years' experience as musculoskeletal physiotherapists and three final year physiotherapy students, measured 18 different knee joint angles three times, using both the universal goniometer and the smartphone goniometric application. The universal goniometer and the smartphone goniometric application were reliable in repeated measures of knee flexion angles (average Concordance Correlation Coefficient (CCC) > 0.98) with both experienced clinicians and final year physiotherapy students (average CCCs > 0.96). There were no significant differences in reliability between the experienced and the novice practitioners for either device. Agreement between the universal goniometer and smartphone goniometric application measurements was also high for all examiners with average CCCs all above 0.96. The Standard Error of Measurement ranged between 1.56° (0.52-2.66) for the UG and 0.62° (0.29-1.27) for the KGA. The universal goniometer and the smartphone goniometric application were reliable in repeated measures of knee flexion angles. Smaller error of measurement values for the smartphone goniometric application might indicate superiority for assessment where clinical situations demand greater precision of knee range of motion.

Chiari Malformation Type I, presenting as scapulothoracic pain: a case report.

Patients presenting with recalcitrant symptoms, which are resistant to a range of physical interventions over an extended period of time, need to be examined with care. A 'forensic' approach to the assessment of these patients, with a sensitive approach to the results of the test procedures is required to ensure the practitioner does not miss the more obscure causes. This case report presents a patient who was referred for a clinical assessment for long standing scapular pain, which had been labelled myofascial pain. Through a thorough approach to examination a number of flags appeared which suggested a need for further investigation. These investigations identified that the patient demonstrated a Chiari Malformation Type 1. On review 5 months following neurosurgical intervention her symptoms were significantly reduced. Chiari Malformations Type 1 are often diagnosed in adulthood when symptoms usually first appear. These symptoms may mimic those found with musculoskeletal conditions. Whilst we lack specific clinical tests for this condition, a thorough assessment should identify sufficient 'flags' for referral for further investigations.

What is adolescent low back pain? Current definitions used to define the adolescent with low back pain.

Adolescent low back pain (ALBP) is a common form of adolescent morbidity which remains poorly understood. When attempting a meta-analysis of observational studies into ALBP, in an effort to better understand associated risk factors, it is important that the studies involved are homogenic, particularly in terms of the dependent and independent variables. Our preliminary reading highlighted the potential for lack of homogeneity in descriptors used for ALBP. This review identified 39 studies of ALBP prevalence which fulfilled the inclusion criteria, ie, English language, involving adolescents (aged 10 to 19 years), pain localized to lumbar region, and not involving specific subgroups such as athletes and dancers. Descriptions for ALBP used in the literature were categorized into three categories: general ALBP, chronic/recurrent ALBP, and severe/disabling ALBP. Whilst the comparison of period prevalence rates for each category suggest that the three represent different forms of ALBP, it remains unclear whether they represented different stages on a continuum, or represent separate entities. The optimal period prevalence for ALBP recollection depends on the category of ALBP. For general ALBP the optimal period prevalence appears to be up to 12 months, with average lifetime prevalence rates similar to 1-year prevalence rates, suggesting an influence of memory decay on pain recall.