TENDINopathy Severity assessment-Achilles (TENDINS-A): evaluation of reliability and validity in accordance with COSMIN recommendations.

OBJECTIVE: To evaluate the construct validity (structural validity and hypothesis testing), reliability (test-retest reliability, measurement error and internal consistency) and minimal important change (MIC) of the 13-item TENDINopathy Severity assessment-Achilles (TENDINS-A). METHODS: Participants with Achilles pain completed an online survey including: demographics, TENDINS-A, Foot and Ankle Outcome Score (FAOS) and Victorian Institute of Sport Assessment-Achilles (VISA-A). Exploratory factor analysis (EFA) assessed dimensionality. Confirmatory factor analysis (CFA) assessed structural validity (root mean square error of approximation (RMSEA); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); standardised root measure square (SRMS)). Correlations between TENDINS-A and the FAOS or VISA-A assessed hypothesis testing. Intraclass correlation (ICC) assessed test-retest reliability. Cronbach's alpha assessed internal consistency. SE of the measurement (SEM) assessed measurement error. A distribution-based approach assessed MIC. RESULTS: 79 participants (51% female) with a mean (SD) age=42.6 (13.0) years, height=175.0 (11.7) cm and body mass=82.0 (19.1) kg were included. EFA identified three meaningful factors, proposed as pain, symptoms and function. The best model identified using CFA for TENDINS-A had structural validity (RMSEA=0.101, CFI=0.959, TLI=0.947, SRMS=0.068), which included three factors (pain, symptoms and function), but excluded three items from the original TENDINS-A. TENDINS-A exhibited moderate positive correlation with FAOS (r=0.598, p<0.001) and a moderate negative correlation with VISA-A (r=-0.639, p<0.001). Reliability of the TENDINS-A was excellent (ICC=0.930; Cronbach's α=0.808; SEM=6.54 units), with an MIC of 12 units. CONCLUSIONS: Our evaluation of the revised 10-item TENDINS-A determined it has construct validity and excellent reliability, compared with the VISA-A and FAOS which lack content and construct validity. The TENDINS-A is recommended as the preferred patient-reported outcome measure to assess disability in people with Achilles tendinopathy.

Technology-guided assessment of vocalisations and their diagnostic value as pain indicators for people living with dementia.

BACKGROUND: during pain assessment in persons unable to self-report, such as people living with dementia, vocalisations are commonly used as pain indicators. However, there is a lack of evidence from clinical practice regarding their diagnostic value and relationship with pain. We aimed to explore vocalisations and pain in people with dementia undergoing pain assessments in clinical practice settings. METHODS: a total of 22,194 pain assessments were reviewed in people with dementia (n = 3,144) from 34 different Australian aged care homes and two dementia specific programs. Pain assessments were conducted by 389 purposely trained health care professionals and cares using PainChek pain assessment tool. Vocalised expressions were determined based on nine vocalisation features included in the tool. Linear mixed models were used to examine the relationship of pain scores with vocalisation features. Using a single pain assessment for each of the 3,144 people with dementia, additional data analysis was conducted via Receiver Operator Characteristic (ROC) analysis and Principal Component Analysis. RESULTS: vocalisation scores increased with increasing pain intensity. High pain scores were more likely with the presence of sighing and screaming (8 times). The presence of vocalisation features varied depending on the intensity of pain. The ROC optimal criterion for the voice domain yielded a cut-off score of ≥2.0 with a Youden index of 0.637. The corresponding sensitivity and specificity were 79.7% [confidence interval (CI): 76.8-82.4%] and 84.0% (CI: 82.5-85.5%), respectively. CONCLUSION: we describe vocalisation features during presence of different levels of pain in people with dementia unable to self-report, therefore providing evidence in regard to their diagnostic value in clinical practice.

The Clinical Suitability of an Artificial Intelligence-Enabled Pain Assessment Tool for Use in Infants: Feasibility and Usability Evaluation Study.

BACKGROUND: Infants are unable to self-report their pain, which, therefore, often goes underrecognized and undertreated. Adequate assessment of pain, including procedural pain, which has short- and long-term consequences, is critical for its management. The introduction of mobile health-based (mHealth) pain assessment tools could address current challenges and is an area requiring further research. OBJECTIVE: The purpose of this study is to evaluate the accuracy and feasibility aspects of PainChek Infant and, therefore, assess its applicability in the intended setting. METHODS: By observing infants just before, during, and after immunization, we evaluated the accuracy and precision at different cutoff scores of PainChek Infant, which is a point-of-care mHealth-based solution that uses artificial intelligence to detect pain and intensity based solely on facial expression. We used receiver operator characteristic analysis to assess interpretability and establish a cutoff score. Clinician comprehensibility was evaluated using a standardized questionnaire. Other feasibility aspects were evaluated based on comparison with currently available observational pain assessment tools for use in infants with procedural pain. RESULTS: Both PainChek Infant Standard and Adaptive modes demonstrated high accuracy (area under the curve 0.964 and 0.966, respectively). At a cutoff score of ≥2, accuracy and precision were 0.908 and 0.912 for Standard and 0.912 and 0.897 for Adaptive modes, respectively. Currently available data allowed evaluation of 16 of the 17 feasibility aspects, with only the cost of the outcome measurement instrument unable to be evaluated since it is yet to be determined. PainChek Infant performed well across feasibility aspects, including interpretability (cutoff score defined), ease of administration, completion time (3 seconds), and clinician comprehensibility. CONCLUSIONS: This work provides information on the feasibility of using PainChek Infant in clinical practice for procedural pain assessment and monitoring, and demonstrates the accuracy and precision of the tool at the defined cutoff score.

Association of developmental coordination disorder and low motor competence with impaired bone health: A systematic review.

AIMS: Individuals with developmental coordination disorder (DCD) and low motor competence (LMC) may be at increased risk of low bone health due to their lifetime physical activity patterns. Impaired bone health increases an individual's risk of osteoporosis and fracture; therefore, it is necessary to determine whether a bone health detriment is present in this group. Accordingly, this systematic review explores the association between DCD/LMC and bone health. METHODS AND PROCEDURES: Studies were included with assessment of bone health in a DCD/LMC population. Study bias was assessed using the JBI critical appraisal checklist. Due to heterogeneity, meta-analysis was not possible and narrative synthesis was performed with effect size and direction assessed via harvest plots. OUTCOMES AND RESULTS: A total of 16 (15 paediatric/adolescent) studies were included. Deficits in bone measures were reported for the DCD/LMC group and were more frequent in weight-bearing sites. Critical appraisal indicated very low confidence in the results, with issues relating to indirectness and imprecision relating to comorbidities. CONCLUSIONS AND IMPLICATIONS: Individuals with DCD or LMC are at increased risk of bone health deficits. Bone impairment locations indicate insufficient loading via physical activity as a potential cause of bone deficits. Results indicate a potential for earlier osteoporosis onset.

Assessment and monitoring of Achilles tendinopathy in clinical practice: a qualitative descriptive exploration of the barriers clinicians face.

Our primary objective was to explore the barriers preventing clinicians from implementing what they think is ideal practice as it relates to using tools to aid diagnosis and monitor progress in mid-portion Achilles tendinopathy. Our secondary objectives were to describe the assessments employed by clinicians in their own practice to aid with (a) diagnosis and (b) monitoring progress in Achilles tendinopathy and explore the outcome measure domains clinicians believe to be the most and least important when managing patients with Achilles tendinopathy. We employed a qualitative descriptive study design. Thirteen participants (eight female, five male) from across Australia, consisting of two junior physiotherapists, five senior physiotherapists working in private practice, four senior physiotherapists working within elite sports organisations and two sport and exercise medicine doctors, were included and one-on-one interviews were performed. Audio was transcribed then entered into NVivo for coding and analysis. Four main themes were perceived as barriers to implementing ideal practice of assessment and monitoring in people with Achilles tendinopathy: financial constraints, time constraints, access to equipment and patient symptom severity. Assessments related to function, pain on loading, pain over a specified time frame and palpation are commonly used to assist diagnosis. Assessments related to disability, pain on loading, pain over a specified time frame and physical function capacity are used to monitor progress over time. Furthermore, pain on loading and pain over a specified time frame were considered the most important outcome measure domains for assisting diagnosis whereas pain on loading, patient rating of the condition and physical function capacity were the most important outcome measure domains for monitoring progress. A number of barriers exist that prevent clinicians from implementing what they view as ideal assessment and monitoring for Achilles tendinopathy. These barriers should be considered when developing new assessments and in clinical practice recommendations.

Physical activity estimated by osteogenic potential and energy expenditure has differing associations with bone mass in young adults: the raine study.

Ground impacts during physical activity may be important for peak bone mass. We found differences in how energy expenditure and impact scores estimated from a physical activity questionnaire related to bone health in young adults. Using both estimate types can improve our understanding of the skeletal benefits of physical activity. PURPOSE: It is unclear whether mechanical loading during physical activity, estimated from physical activity questionnaires which assess metabolic equivalents of task (METs), is associated with skeletal health. This longitudinal study investigated how physical activity loading scores, assessed at ages 17 and 20 years, (a) compares with physical activity measured in METs, and (b) is associated with bone mass at age 20 years. METHODS: A total of 826 participants from the Raine Study Gen2 were assessed for physical activity energy expenditure via the International Physical Activity Questionnaire (IPAQ) at age 17 and 20 years. Loading scores (the product of peak force and application rate) per week were subsequently estimated from the IPAQ. Whole-body and appendicular bone mineral density (BMD) at age 20 years were assessed by dual-energy X-ray absorptiometry. RESULTS: Bland-Altman minimal detectable difference for physical activity Z- scores at age 17 and 20 years were 1.59 standard deviations (SDs) and 1.33 SDs, respectively, greater than the a priori minimal clinically important change of 0.5 SDs. Loading score, but not IPAQ score, had significant positive associations with whole-body and leg BMD after adjustment for covariates (ß = 0.008 and 0.012 g/cm2, respectively, for age 17 and 20 years loading scores). IPAQ score at age 20 years, but not loading score, had a significant positive association with arm BMD (ß = 0.007 g/cm2). CONCLUSION: This study revealed disagreement in associations of self-reported METs and loading score estimates with bone health in young adults. Coupling traditional energy expenditure questionnaire outcomes with bone-loading estimates may improve understanding of the location-specific skeletal benefits of physical activity in young adults.

Faces of Pain in Dementia: Learnings From a Real-World Study Using a Technology-Enabled Pain Assessment Tool.

Pain is common in people living with dementia (PLWD), including those with limited verbal skills. Facial expressions are key behavioral indicators of the pain experience in this group. However, there is a lack of real-world studies to report the prevalence and associations of pain-relevant facial micro-expressions in PLWD. In this observational retrospective study, pain-related facial features were studied in a sample of 3,144 PLWD [mean age 83.3 years (SD = 9.0); 59.0% female] using the Face domain of PainChek®, a point-of-care medical device application. Pain assessments were completed by 389 users from two national dementia-specific care programs and 34 Australian aged care homes. Our analysis focused on the frequency, distribution, and associations of facial action units [AU(s)] with respect to various pain intensity groups. A total of 22,194 pain assessments were completed. Of the AUs present, AU7 (eyelid tightening) was the most frequent facial expression (48.6%) detected, followed by AU43 (closing eyes; 42.9%) and AU6 (cheek raising; 42.1%) during severe pain. AU20 (horizontal mouth stretch) was the most predictive facial action of higher pain scores. Eye-related AUs (AU6, AU7, AU43) and brow-related AUs (AU4) were more common than mouth-related AUs (e.g., AU20, AU25) during higher pain intensities. No significant effect was found for age or gender. These findings offer further understanding of facial expressions during clinical pain in PLWD and confirm the usefulness of artificial intelligence (AI)-enabled real-time analysis of the face as part of the assessment of pain in aged care clinical practice.

Characterising running economy and change of direction economy between soccer players of different playing positions, levels and sex.

Traditional movement economy (ME) measures the energetic cost of in-line running. However, it is debatable whether such a measure is representative of movement efficiency for team sport athletes who are required to run and change direction repeatedly. This study evaluated ME during both in-line running and runs with directional changes and provided a preliminary exploration as to whether these abilities discriminate soccer players according to playing position, level, and sex. Forty-three soccer players were assessed for ME as extrapolated from oxygen uptake during in-line running (RE) and running with changes of directions (using 20 and 10 m shuttle runs [SRE20 and SRE10]) at 8.4 km/h mean speed. ME worsened with change of direction frequency (p < 0.001). Coefficient of determination was high between RE and SRE20 (r2 = 0.601) but dropped below 0.5 for RE and SRE10 (r2 = 0.280) as change of direction frequency increased. No significant differences were observed between different player positions, however, centre midfielders reported the best ME across any position and running mode, with the largest differences observed in centre backs over SRE10 (41.9 ± 2.7 ml/kg/min [centre midfielders] vs 45 ± 1.8 ml/kg/min [centre backs]; ES = 1.19). No significant differences were observed for ME over any running condition for male players of different playing levels. Female players exhibited better ME than male players with significant differences observed for SRE10 (41.5 ± 2.6 ml/kg/min [females] vs 44 ± 2.6 ml/kg/min [males]; p = 0.013; ES = 0.94). RE does not adequately account for efficiency during activities that involve changes of direction. SRE10 is a stronger discriminator of ME between soccer players of different position and sex.

Modulators of Change-of-Direction Economy After Repeated Sprints in Elite Soccer Players.

PURPOSE: To investigate the acute effect of repeated-sprint activity (RSA) on change-of-direction economy (assessed using shuttle running economy [SRE]) in soccer players and explore neuromuscular and cardiorespiratory characteristics that may modulate this effect. METHODS: Eleven young elite male soccer players (18.5 [1.4] y old) were tested on 2 different days during a 2-week period in their preseason. On day 1, lower-body stiffness, power and force were assessed via countermovement jumps, followed by an incremental treadmill test to exhaustion to measure maximal aerobic capacity. On day 2, 2 SRE tests were performed before and after a repeated-sprint protocol with heart rate, minute ventilation, and blood lactate measured. RESULTS: Pooled group analysis indicated no significant changes for SRE following RSA due to variability in individual responses, with a potentiation or impairment effect of up to 4.5% evident across soccer players. The SRE responses to RSA were significantly and largely correlated to players' lower-body stiffness (r = .670; P = .024), and moderately (but not significantly) correlated to players' force production (r = -.455; P = .237) and blood lactate after RSA (r = .327; P = .326). CONCLUSIONS: In summary, SRE response to RSA in elite male soccer players appears to be highly individual. Higher lower-body stiffness appears as a relevant physical contributor to preserve or improve SRE following RSA.

High-intensity Interval Training Shock Microcycle Improves Running Performance but not Economy in Female Soccer Players.

This study aimed to evaluate the effect of high-intensity interval training shock microcycles (HIITSM) on endurance, running economy and change of direction economy in female soccer players. Nineteen sub-elite female soccer players were randomised to two groups: HIITSM (10 HIIT sessions over 13 days) or HIITTRAD (4 HIIT sessions over 13 days) interventions. Endurance performance was evaluated through the 30-15 intermittent fitness test (30-15IFT); running economy over a 5-min treadmill run; and change of direction economy over two conditions: (1) 5-min 20m shuttle run, and (2) 5-min 10m shuttle run. HIITSM significantly improved 30-15IFT scores compared to baseline (+4.4%, p=0.009; d=0.96) and 30-15IFT scores relative to HIITTRAD (p=0.002; d=2.01). There was no significant interaction (group×time) for running economy and change of direction economy. Pre- to post- intervention there was a significant main time effect for blood lactate over 20m and 10m shuttle runs (p<0.001 and p=0.037, respectively), with large (d=0.93) and moderate (d=0.53) changes observed for the HIITSM over the two distances, respectively. HIITSM may be more effective than HIITTRAD to improve 30-15IFT over shorter training periods but may not affect running economy and change of direction economy.

Association between developmental coordination disorder or low motor competence, and risk of impaired bone health across the lifespan: protocol for a systematic review and meta-analysis.

OBJECTIVE: This systematic review will assess the association between developmental coordination disorder or low motor competence and impairments in bone health across the lifespan. INTRODUCTION: Individuals with developmental coordination disorder tend to have a pattern of physical activity associated with bone health impairments. Preliminary studies have found impairments in bone health measures, including fractures, throughout the lifespan with potential public health ramifications. As studies in this area are of small samples across wide age ranges, no comprehensive picture of bone health in this group has been formed, hindering action. A systematic review is needed to determine the potential risk of bone impairment in this population. INCLUSION CRITERIA: Studies that assess the relationship between developmental coordination disorder/low motor competence and bone health, regardless of measures used, will be included in the review. There will be no exclusions based on region, study design, or participant demographic characteristics. METHODS: Published studies and gray literature will be searched, with no limits on publication date or language. Assessment of studies for inclusion, as well as data extraction, will be performed by two reviewers, with data cross checked for accuracy. Studies will be appraised using the appropriate JBI tool for the study design. Data to be extracted include unadjusted results and effect sizes for bone health measures. A narrative synthesis will be performed and if there is a sufficient number of studies, a meta-analysis using the same outcome measures will be performed on odds ratios of abnormal bone phenotype and fracture in this population. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020167301.

Reliability of Change-of-Direction Economy in Soccer Players.

PURPOSE: To evaluate the reliability of new change-of-direction-economy tests (assessing energetic efficiency when performing continuous shuttle runs) compared with common running-economy tests in soccer players Methods: Sixteen subelite, male soccer players were recruited to perform a testing battery involving running economy (RE), 10-m shuttle-running economy (SRE10), and 20-m shuttle-running economy (SRE20) at 8.4 km·h-1 mean speed on 2 different days within 48 hours. SRE10 and SRE20 consisted of continuous shuttle runs interspersed with 180° directional changes. During the RE, SRE20, and SRE10 tests, respiratory exchange ratio and oxygen uptake were collected and used to calculate the movement-economy values over any running condition as oxygen cost and energetic cost. The secondary variables (carbon dioxide production, heart rate, minute ventilation, and blood lactate) were also monitored during all tests. RESULTS: Depending on expression (oxygen cost or energetic cost), reliability was established for RE (CV: 5.5%-5.8%; ICC = .77-.88), SRE10 (CV: 3.5%-3.8%; ICC = .78-.96), and SRE20 (CV: 3.5%-3.8%; ICC = .66-.94). All secondary physiological variables reported good reliability (CV < 10%), except for blood lactate (CV < 35.8). The RE, SRE10, and SRE20 tests show good reliability in soccer players, whereas blood lactate has the highest variability among physiological variables during the economy tests. CONCLUSION: The assessment of change-of-direction economy through performing 20- and 10-m shuttle runs is reliable and can be applied to evaluate soccer players' energetic movement efficiency under more soccer-specific running conditions.

Impact of a multimodal exercise program on tibial bone health in adolescents with Development Coordination Disorder: an examination of feasibility and potential efficacy.

OBJECTIVES: Developmental coordination disorder (DCD) compromises bone health purportedly due to lower levels of physical activity. The potential of an exercise intervention to improve bone health parameters in adolescents with DCD has not previously been studied. This study thus aimed to determine the impact of a multimodal exercise intervention on bone health in this population at-risk of secondary osteoporosis. METHODS: Twenty-eight adolescents (17 male, 11 female) aged between 12-17 years (Mage=14.1) with DCD participated in a twice weekly, 13-week generalised multimodal exercise intervention. Peripheral quantitative computed tomography scans of the tibia (4% and 66%) were performed over a six month period. Generalised estimating equations were used to examine the impact of fitness measures on bone parameters over time. RESULTS: An overall improvement trend was observed for bone health, with significant increases at the 66% tibial site for bone mass (4.12% increase, dcohen=0.23, p=0.010) and cortical area (5.42% increase, η2 =12.09, p=0.014). Lower body fitness measures were significantly associated with improvements in bone health parameters, tempered by the degree of motor impairment. CONCLUSION: A multimodal exercise intervention may be effective in improving bone health of adolescents with DCD. Given the impact of motor impairments, gains may be greater over an extended period of study.

Care After Lymphoma (CALy) trial: A phase II pilot pragmatic randomised controlled trial of a nurse-led model of survivorship care.

PURPOSE: Post-treatment follow-up for lymphoma potentially fails to address the supportive care needs of survivors. A nurse-led lymphoma survivorship model of care was developed and tested in a phase II pilot pragmatic randomised controlled trial (RCT). The intervention comprised three face-to-face appointments, delivery of tailored resources and an individualised survivorship care plan and treatment summary (SCPTS), shared with the general practitioner (GP). METHOD: Three months' post-treatment completion, eligible lymphoma patients were randomised 1:1 to usual care (control) or usual care plus intervention. Survivorship unmet needs (Short-Form Survivor Unmet Needs Survey), distress (Depression Anxiety Stress Scale 21), adjustment to cancer (Mini-Mental Adjustment to Cancer scale) and self-empowerment (Patient Empowerment Scale) were assessed at baseline, three and six months. Univariate and multivariate analyses examined changes within and between groups at the three time points. A GP evaluation survey sought information on the perceived utility of the SCPTS. RESULTS: Statistical significance was set at 0.05 (2-tailed). Although not statistically significant, by study completion, intervention participants (n = 30), reported less unmet needs (M = 21.41 vs M = 25.72, p = .506), less distress ((M = 13.03 vs M = 15.14, p = .558) and an increase in empowerment (M = 50.21 vs M = 47.21, p = .056) compared with control participants (n = 30). The SCPTS was rated good to very good by a majority of GPs (n = 13, 81%). CONCLUSIONS: The nurse-led lymphoma survivorship model of care may be a helpful intervention for lymphoma patients who had completed treatment. Survivors require individualised and tailored support and resources. A tailored SCPTS may promote survivor self-management and increase GP engagement.

Movement Economy in Soccer: Current Data and Limitations.

Soccer is an intermittent team-sport, where performance is determined by a myriad of psychological, technical, tactical, and physical factors. Among the physical factors, endurance appears to play a key role into counteracting the fatigue-related reduction in running performance observed during soccer matches. One physiological determinant of endurance is movement economy, which represents the aerobic energy cost to exercise at a given submaximal velocity. While the role of movement economy has been extensively examined in endurance athletes, it has received little attention in soccer players, but may be an important factor, given the prolonged demands of match play. For this reason, the current review discusses the nature, impact, and trainability of movement economy specific to soccer players. A summary of current knowledge and limitations of movement economy in soccer is provided, with an insight into future research directions, to make this important parameter more valuable when assessing and training soccer players' running performance.

Knowledge, attitudes, and practice of oncologists and oncology health care providers in promoting physical activity to cancer survivors: an international survey.

OBJECTIVE: To investigate knowledge, attitudes, and practices of oncologists towards physical activity (PA) in cancer survivors, and the association between oncologists' own PA behavior and PA promotion. METHODS: Oncologists (n = 123) completed a survey based on the Theory of Planned Behavior (TPB). Participants reported PA promotion behavior, PA involvement, attitudes, intentions, social norm, perceived behavioral control (PBC), and confidence and knowledge of exercise prescription. Structural equation modeling (SEM) evaluated these associations. RESULTS: Less than half of oncologists reported regularly promoting PA to patients (46%), with 20% providing written information and 23% referrals. Only 26% were physically active. TPB SEM pathways explained 54.6% of the variance in PA promotion (comparative fit index (CFI) = 0.905, standardized root mean square residual (SRMR) = 0.040). Social norm was not only the significant pathway to intention but also a significant indirect pathway to PA promotion (p = 0.007). Confidence to promote PA, PBC, and intentions were direct significant pathways to PA promotion (p < 0.05). Exploratory SEM pathways explained 19.6% of the variance of PA behavior, which in turn explained 13.1% social norm, 10.7% attitude, 10.0% confidence to recommend, and 17.8% PA promotion behavior (CFI = 0.921, SRMR = 0.076). Instrumental attitude was a direct significant pathway to PA behavior (p = 0.001). PA behavior was a direct significant pathway to social norms, attitude, confidence to recommend, and PA promotion (p < 0.05). CONCLUSIONS: Oncologists reported a modest ability to promote PA, low PA promotion rates, and limited knowledge of exercise prescription. Patient physical activity promotion may be improved through strategies that increase oncologists' PBC, confidence, and their own personal PA participation.