Interventions for Behaviour Change and Self-Management of Risk in Stroke Secondary Prevention: An Overview of Reviews.

INTRODUCTION: Optimised secondary prevention strategies that include lifestyle change are recommended after stroke. While multiple systematic reviews (SRs) address behaviour change interventions, intervention definitions, and associated outcomes differ between reviews. This overview of reviews addresses the pressing need to synthesise high-level evidence for lifestyle-based behavioural and/or self-management interventions to reduce risk in stroke secondary prevention in a structured, consistent way. METHODS: Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were applied to meta-analyses, demonstrating statistically significant effect sizes to establish the certainty of existing evidence. Electronic databases MEDLINE, Embase, Epistemonikos, and the Cochrane Library of Systematic Reviews were systematically searched, current to March 2023. RESULTS: Fifteen SRs were identified following screening, with moderate overlap of primary studies demonstrated (5.84% degree of corrected covered area). Interventions identified could be broadly categorised as multimodal; behavioural change; self-management; psychological talk therapies, albeit with overlap between some theoretical domains. Seventy-two meta-analyses addressing twenty-one preventive outcomes of interest were reported. Best-evidence synthesis identifies that for primary outcomes of mortality and future cardiovascular events post-stroke, moderate certainty GRADE evidence supports multimodal interventions to reduce cardiac events, with no available evidence for outcomes of mortality (all-cause or cardiovascular) or recurrent stroke events. For secondary outcomes addressing risk-reducing behaviours, best-evidence synthesis identifies moderate certainty GRADE evidence for multimodal lifestyle-based interventions to increase physical activity participation, and low certainty GRADE evidence for behavioural change interventions to improve healthy eating post-stroke. Similarly, low certainty GRADE evidence supports self-management interventions to improve preventive medication adherence. For mood self-management post-stroke, moderate GRADE evidence supports psychological therapies for remission and/or reduction of depression and low/very low certainty GRADE evidence for reduction of psychological distress and anxiety. Best-evidence for outcomes addressing proxy physiological measures identified low GRADE evidence supporting multimodal interventions to improve blood pressure, waist circumference, and LDL cholesterol. CONCLUSION: Effective strategies to redress risk-related health behaviours are required in stroke survivors to complement current pharmacological secondary prevention. Inclusion of multimodal interventions and psychological talk therapies in evidence-based stroke secondary prevention programmes is warranted given the moderate GRADE of evidence that supports their role in risk reduction. Given the overlap in primary studies across reviews, often with overlapping theoretical domains between broad intervention categories, further research is required to identify optimal intervention behavioural change theories and techniques employed in behavioural/self-management interventions.

'More than likely the men come first. That's just very frustrating'. A qualitative exploration of contextual factors affecting the implementation of injury prevention initiatives and the provision of effective injury management in elite-level women's club football in Ireland.

OBJECTIVES: The aim of our study was to explore the contextual factors that affect the implementation of football injury prevention initiatives and the provision of effective injury management in the Irish Women's National League (WNL). METHODS: We used a criterion-based purposive sampling approach to recruit coaches (n=7), players (n=17) and medical personnel (n=8) representing eight of the nine clubs in the WNL to participate in one-to-one semistructured interviews. Our study was located within an interpretivist, constructivist research paradigm. The interview data were analysed using reflexive thematic analysis. RESULTS: The participants identified academic and work pressures, financial challenges, conflict with college football, inadequate facilities and gender inequity as being barriers to the implementation of injury prevention initiatives and the provision of effective injury management. Financial constraints within clubs were perceived to limit the provision of medical care and strength and conditioning (S&C) support and this was deemed to be associated with a heightened risk of injuries. CONCLUSION: Specific contextual factors were identified which curtail the implementation of injury prevention initiatives and the provision of effective injury management in elite-level women's club football in Ireland. Gender inequity was identified as one of the factors impacting the availability of high-quality medical care, S&C support, as well as access to training and match facilities. Our results provide new insights that could be used to inform the design and implementation of injury prevention and management initiatives for women football players in Ireland.

Long-term outcome collection after hip fracture in Ireland: a systematic review of traditional and grey literature.

This review aimed to describe the methods and results from recent Irish research about post-acute hip fracture outcomes. Meta-analyses estimate the 30-day and 1-year mortality rate at 5% and 24% respectively. There is a need for standardised recommendations about which data should be recorded to aid national and international comparisons. PURPOSE: Over 3700 older adults experience hip fracture in Ireland annually. The Irish Hip Fracture Database national audit records acute hospital data but lacks longer-term outcomes. This systematic review aimed to summarise and appraise recent Irish studies that collected long-term hip fracture outcomes and to generate pooled estimates where appropriate. METHODS: Electronic databases and grey literature were searched in April 2022 for articles, abstracts, and theses published from 2005 to 2022. Eligible studies were appraised by two authors and outcome collection details summarised. Meta-analyses of studies with common outcomes were conducted where the sample was generalisable to the broad hip fracture population. RESULTS: In total, 84 studies were identified from 20 clinical sites. Outcomes commonly recorded were mortality (n = 48 studies; 57%), function (n = 24; 29%), residence (n = 20; 24%), bone-related outcomes (n = 20; 24%), and mobility (n = 17; 20%). One year post-fracture was the most frequent time point, and patient telephone contact was the most common collection method used. Most studies did not report follow-up rates. Two meta-analyses were performed. The pooled estimate for one-year mortality was 24.2% (95% CI = 19.1-29.8%, I2 = 93.8%, n = 12 studies, n = 4220 patients), and for 30-day mortality was 4.7% (95% CI = 3.6-5.9%, I2 = 31.3%, n = 7 studies, n = 2092 patients). Reports of non-mortality outcomes were deemed inappropriate for meta-analysis. CONCLUSION: Hip fracture long-term outcomes collected in Irish research are broadly in line with international recommendations. Heterogeneity of measures and poor reporting of methods and findings limits collation of results. Recommendations for standard outcome definitions nationally are warranted. Further research should explore the feasibility of recording long-term outcomes during routine hip fracture care in Ireland to enhance national audit.

A systematic review and meta-analysis of respiratory dysfunction in Parkinson's disease.

INTRODUCTION: Respiratory dysfunction in Parkinson's disease (PD) is common and associated with increased hospital admission and mortality rates. Central and peripheral mechanisms have been proposed in PD. To date no systematic review identifies the extent and type of respiratory impairments in PD compared with healthy controls. METHODS: PubMed, EMBASE, CINAHL, Web of Science, Pedro, MEDLINE, Cochrane Library and OpenGrey were searched from inception to December 2021 to identify case-control studies reporting respiratory measures in PD and matched controls. RESULTS: Thirty-nine studies met inclusion criteria, the majority with low risk of bias across Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) domains. Data permitted pooled analysis for 26 distinct respiratory measures. High-to-moderate certainty evidence of impairment in PD was identified for vital capacity (standardised mean difference [SMD] 0.75; 95% CI 0.45-1.05; p < 0.00001; I2  = 10%), total chest wall volume (SMD 0.38; 95% CI 0.09-0.68; p = 0.01; I2  = 0%), maximum inspiratory pressure (SMD 0.91; 95% CI 0.64-1.19; p < 0.00001; I2  = 43%) and sniff nasal inspiratory pressure (SMD 0.58; 95% CI 0.30-0.87; p < 0.00001; I2  = 0%). Sensitivity analysis provided high-moderate certainty evidence of impairment for forced vital capacity and forced expiratory volume in 1 s during medication ON phases and increased respiratory rate during OFF phases. Lower certainty evidence identified impairments in PD for maximum expiratory pressure, tidal volume, maximum voluntary ventilation and peak cough flow. CONCLUSIONS: Strong evidence supports a restrictive pattern with inspiratory muscle weakness in PD compared with healthy controls. Limited data for central impairment were identified with inconclusive findings.

Injury incidence rates in women's football: a systematic review and meta-analysis of prospective injury surveillance studies.

OBJECTIVE: To review the literature to establish overall, match and training injury incidence rates (IIRs) in senior (≥18 years of age) women's football (amateur club, elite club and international). DESIGN: Systematic review and meta-analysis of overall, match and training IIRs in senior women's football, stratified by injury location, type and severity. DATA SOURCES: MEDLINE via PubMed; EMBASE via Ovid; CINAHL via EBSCO and Web of Science were searched from earliest record to July 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: (1) football players participating in a senior women's football league (amateur club or elite club) or a senior women's international football tournament; (2) the study had to report IIRs or provide sufficient data from which this outcome metric could be calculated through standardised equations; (3) a full-text article published in a peer-reviewed journal before July 2021; (4) a prospective injury surveillance study and (5) case reports on single teams were ineligible. RESULTS: 17 articles met the inclusion criteria; amateur club (n=2), elite club (n=10), international (n=5). Overall, match and training 'time-loss' IIRs are similar between senior women's elite club football and international football. 'Time-loss' training IIRs in senior women's elite club football and international football are approximately 6-7 times lower than their equivalent match IIRs. Overall 'time-loss' IIRs stratified by injury type in women's elite club football were 2.70/1000 hours (95% CI 1.12 to 6.50) for muscle and tendon, 2.62/1000 hours (95% CI 1.26 to 5.46) for joint and ligaments, and 0.76/1000 hours (95% CI 0.55 to 1.03) for contusions. Due to the differences in injury definitions, it was not possible to aggregate IIRs for amateur club football. CONCLUSION: Lower limb injuries incurred during matches are a substantial problem in senior women's football. The prevention of lower limb joint, ligament, muscle and tendon injuries should be a central focus of injury prevention interventions in senior women's amateur club, elite club and international football. PROSPERO REGISTRATION NUMBER: CRD42020162895.

Contact injuries in field hockey and the potential role for personal protective equipment.

Field hockey is played with sticks and a hard ball. It is fast-paced, with athletes playing together in close proximity. Athletes may be at increased risk of sustaining injuries through contact. The aim of this study was to investigate the epidemiological characteristics of contact injuries in field hockey. Data were collected during the 2017/2018 and 2018/2019 Irish Hockey League seasons. This study included two methods of data collection among male athletes: self-reported injuries and via those reported by the teams' physiotherapists. Injuries were defined as any physical complaint sustained during field hockey, supplemented by medical attention and time-loss injuries. Only contact injuries were included for analysis. Overall, 107 contact injuries were incurred, giving rise to an injury incidence rate of 3.1/1000 h, and accounting for 33.1% of all injuries. Athletes had an absolute risk of 0.372 of sustaining a contact injury. Contusions (48.6%) were the most common type of contact injury, while injuries to the head/face (20.6%) were the most frequently reported location. Contact injuries represent an important proportion of all injuries. Rule changes to mandate the use of personal protective equipment in field hockey may assist in reducing the absolute risk and severity of contact injuries in field hockey.

Ways to improve surgical outcomes in low- and middle-income countries.

Global surgery initiatives such as the Lancet Commission on Global Surgery have highlighted the need for increased investment to enhance surgical capacity in low- and middle-income countries. A neglected issue, however, is surgery-related rehabilitation, which is known to optimize functional outcomes after surgery. Increased investment to enhance surgical capacity therefore needs to be complemented by promotion of rehabilitation interventions. We make the case for strengthening surgery-related rehabilitation in lower-resource countries, outlining the challenges but also potential solutions and policy directions. Proposed solutions include greater leadership and awareness, augmented by recent global efforts around the World Health Organization's Rehabilitation 2030 initiative, and professionalization of the rehabilitation workforce. More research on rehabilitation is needed in low- and middle-income countries, along with support for system approaches, notably on strengthening and integrating rehabilitation within the health systems. Finally, we outline a set of policy implications and recommendations, aligned to the components of the national surgical plan proposed by the Lancet Commission: infrastructure, workforce, service delivery, financing, and information management. Collaboration and sustained efforts to embed rehabilitation within national surgical plans is key to optimize health outcomes for patients with surgical conditions and ensure progress towards sustainable development goal 3: health and well-being for all.

À l'instar de la Commission Lancet sur la chirurgie mondiale, des initiatives internationales consacrées à ce sujet ont mis en évidence le besoin d'investir davantage dans le renforcement des capacités chirurgicales dans les pays à revenu faible et intermédiaire. Néanmoins, la réadaptation post-chirurgicale, connue pour améliorer les résultats fonctionnels après une intervention, reste un enjeu largement ignoré. Ces investissements accrus visant à renforcer les capacités chirurgicales doivent donc aller de pair avec une promotion des services de réadaptation. Dans le présent document, nous plaidons pour le développement d'une réadaptation post-chirurgicale dans les pays à revenu faible et intermédiaire, en identifiant les défis mais aussi les orientations politiques et les solutions possibles. Parmi elles, un meilleur leadership et une prise de conscience, favorisée par les récents efforts mondiaux qui ont entouré l'initiative Réadaptation 2030 de l'Organisation mondiale de la Santé, ainsi qu'une professionnalisation du personnel dédié à la réadaptation. D'autres recherches sur la réadaptation sont nécessaires dans les pays à revenu faible et intermédiaire, tout comme l'apport d'un soutien aux approches systémiques, en particulier pour consolider et intégrer de telles pratiques dans les systèmes de santé. Enfin, nous dégageons une série de recommandations et d'implications politiques inspirés des éléments du plan chirurgical national proposé par la Commission Lancet: infrastructures, main-d'œuvre, prestations de services, financement et gestion des informations. La collaboration et la poursuite des efforts en vue d'inclure la réadaptation dans les plans chirurgicaux nationaux jouent un rôle crucial dans l'amélioration des résultats cliniques chez les patients souffrant de complications post-opératoires. En outre, elles permettront de progresser vers le troisième objectif de développement durable: santé et bien-être pour tous à tout âge.

Las iniciativas de cirugía a nivel mundial, como la Comisión Lancet sobre Cirugía Mundial, han destacado la necesidad de aumentar la inversión para mejorar la capacidad quirúrgica en los países de ingresos bajos y medios. Sin embargo, se ha descuidado la rehabilitación relacionada con la cirugía, que se sabe que optimiza los resultados funcionales después de la intervención. Por lo tanto, el incremento de la inversión para mejorar la capacidad quirúrgica se debe complementar con la promoción de intervenciones de rehabilitación. En este artículo se defiende la necesidad de reforzar la rehabilitación relacionada con la cirugía en los países con menos recursos, y se exponen los desafíos, pero también las posibles soluciones y orientaciones políticas. Las soluciones propuestas incluyen un mayor liderazgo y concienciación, potenciados por los recientes esfuerzos mundiales en torno a la iniciativa Rehabilitación 2030 de la Organización Mundial de la Salud, y la profesionalización del personal de rehabilitación. Se necesita más investigación sobre la rehabilitación en los países de ingresos bajos y medios, junto con el apoyo a los enfoques sistémicos, en particular sobre el fortalecimiento y la integración de la rehabilitación dentro de los sistemas sanitarios. Por último, se expone un conjunto de implicaciones y recomendaciones políticas, alineadas con los componentes del plan quirúrgico nacional que propone la Comisión Lancet: infraestructura, personal, prestación de servicios, financiación y gestión de la información. La colaboración y los esfuerzos sostenidos para integrar la rehabilitación en los planes quirúrgicos nacionales son fundamentales para optimizar los resultados sanitarios de los pacientes con afecciones quirúrgicas y asegurar el progreso hacia el tercer objetivo de desarrollo sostenible: salud y bienestar para todos.

The Efficacy, Adverse Events, and Withdrawal Rates of the Pharmacological Management of Chronic Spinal Cord Injury Pain: A Systematic Review and Meta-Analysis.

OBJECTIVE: To establish the efficacy of medications, incidence of adverse events (AEs), and withdrawal rates associated with the pharmacological management of chronic spinal cord injury pain. METHODOLOGY: PubMed, MEDLINE, Embase, CINAHL, Web of Science, CENTRAL, and PsycINFO were searched (November 2017) and updated (January 2020). Two independent review authors screened and identified papers for inclusion. RESULTS: Twenty-one studies met inclusion requirements for efficacy analysis and 17 for AE and withdrawal rate analysis; no additional papers were included from the updated 2020 search. Treatments were divided into six categories: anticonvulsants (n = 6), antidepressants (n = 3), analgesics (n = 8), anti-spasticity medications (n = 2), cannabinoids (n = 1), and other (n = 2). Trials of anticonvulsants, antidepressants, and cannabinoids included long-term follow-up trials (2 weeks to 4 months), and trials of analgesics and anti-spasticity medications, among others, were short-term trials (0-2 days). Effectiveness for neuropathic pain was found for pregabalin (3/3 studies) and lidocaine (2/3 studies). Studies using ketamine also reported effectiveness (2/2), but the quality of these papers was rated as poor. The most frequently reported AEs included dizziness, dry mouth, nausea, and constipation. Pregabalin was associated with a higher risk of somnolence (risk ratio [RR] 3.15, 95% confidence interval [CI]: 2.00-4.98) and dizziness (RR 2.9, 95% CI: 1.58-5.30). Ketamine was associated with a higher risk of reduced vision (RR 9.00, 95% CI: 0.05-146.11), dizziness (RR 8.33, 95% CI: 1.73-40.10), and somnolence (RR 7.00, 95% CI: 1.73-40.1). Withdrawal rates ranged from 18.4% for antidepressants to 0-30% for anticonvulsants, 0-10% for anti-spasticity medications, 0-48% for analgesics, 28.6% for cannabinoids, and 0-22.2% for other medications. CONCLUSION: Pregabalin was found to be effective for neuropathic pain vs placebo. Cannabinoids were ineffective for neuropathic pain. AEs are a common cause for withdrawal. The nature of AEs was poorly reported, and AE reporting should be improved in future randomized controlled trials.

Injuries in elite-level women's football-a two-year prospective study in the Irish Women's National League.

We investigated the pattern of injuries in elite-level women's football in Ireland, during a two-season prospective injury surveillance study in the Women's National League (WNL). Seven out of the eight clubs (271 players) in the WNL were followed prospectively during the 2018 and 2019 seasons. The injury incidence rate in matches (19.2/1000 h) was 7.5 times higher than in training (2.5/1000 h). Players, on average, sustained 0.69 injuries per season (266 injuries/383 player seasons), which equates to 15 time-loss injuries per season for a squad of 22 players. The majority of the injuries sustained by players were lower extremity injuries (85%), of which, 46% had a non-contact injury mechanism. Muscle, ligament, and contusion injuries were the most common injury types, while the ankle, knee, and thigh were the most commonly injured body sites. The most common injuries sustained over the two seasons were lateral ankle sprains (13.9%), hamstring strains (12.4%), knee meniscus/cartilage injuries (7.5%), adductor strains (6%), quadriceps strains (4.5%), and ankle contusions (4.5%). The injuries with the highest injury burden were ACL injuries (59 days lost/1000 h), knee meniscus/cartilage injuries (23/1000 h), lateral ankle sprains (21/1000 h), hamstring strains (12/1000 h), MCL sprains (11/1000 h), and quadriceps strains (11/1000 h). There were 8 ACL tears documented over the 2 seasons, which accounted for 28% of all time lost to injury with a mean days lost per injury of 247. We recommend that clubs in the WNL in Ireland should implement injury risk mitigation strategies, with a particular focus on injuries with a high injury burden.

Longitudinal Vestibular and Oculomotor Impairments Among Amateur Athletes 1 Year Following Sport-Related Concussion: A Prospective Follow-Up.

OBJECTIVES: To investigate (i) the presence of vestibular and oculomotor impairments and (ii) the self-perceived effects of concussion-associated dizziness on health-related quality of life among amateur athletes 6 months and 1 year following sport-related concussion compared with nonconcussed, control athletes. DESIGN: Prospective, matched-cohort study. SETTING: Clinical assessment laboratory. PARTICIPANTS: Amateur athletes who were diagnosed with sport-related concussion within 1 week of injury, and sex-, age-, and activity-matched nonconcussed, control athletes. MAIN MEASURES: Participants were evaluated 6 months and 1 year following sport-related concussion and enrollment in the longitudinal study using the Vestibular and Oculo-Motor Screening and the Dizziness Handicap Inventory. We performed multivariate analyses of variance and chi-square analyses to compare concussion and control group scores at each study assessment. RESULTS: Forty-seven participants with concussion and 47 control participants completed the study. The concussion group reported similar mean symptom provocation scores on the Vestibular and Oculo-Motor Screening and exhibited a similar near-point convergence distance compared with the control group at the 6-month and 1-year study assessments. The concussion and control groups had similar perceptions of the effects of dizziness on their health-related quality of life at both study assessments. CONCLUSION: Meaningful differences in vestibular and oculomotor symptom provocation and self-perceived effects of dizziness on everyday life were not observed between concussed and nonconcussed, control athletes 6 months and 1 year following sport-related concussion.

The burden of injury in field hockey: A secondary analysis of prospective cohort data.

Most studies report injuries based upon their incidence rate, or the number of injuries which occur in a sport per unit of time. While this is recommended across numerous consensus statements on reporting injury data in sport, it may be of benefit to consider injury burden also. Reporting injuries as the duration of injury per 1000 exposure hours highlights those injuries which will likely cause greater disruption within a team. Therefore, the primary aim of this study was to report the burden of injury in field hockey. This secondary analysis of epidemiological data employed two methods of data collection: self-reported through an online reporting software, and through contact with the team physiotherapist. Athletes reported injury-related symptoms for 4170 days in total, giving rise to an injury burden of 121.0/1000 h, of which 61.4/1000 h were days lost through injury. Injuries to the hamstring, as well as muscle strain injuries, caused the most significant injury burden in athletes (22.6 and 35.8/1000 h respectively). Reporting injuries as the duration of injuries per 1000 hours highlights those injuries which cause the most significant disruption within a squad. Future injury prevention strategies in field hockey should prioritize the injuries which are most burdensome.

Clinical Detection and Recovery of Vestibular and Oculomotor Impairments Among Amateur Athletes Following Sport-Related Concussion: A Prospective, Matched-Cohort Study.

OBJECTIVE: To (1) quantify the diagnostic accuracy of the vestibular/oculomotor screening (VOMS), and (2) determine the recovery of vestibular and oculomotor impairments exhibited by concussed athletes compared with nonconcussed athletes using the VOMS. SETTING: Clinical assessment laboratory. PARTICIPANTS: Amateur athletes who were diagnosed with sport-related concussion by emergency department physicians, and non-concussed, control athletes. DESIGN: Prospective, longitudinal study. MAIN MEASURES: Participants were assessed 1 week following sport-related concussion, upon clearance to return-to-sporting activity, and 2 weeks following return-to-sporting activity by a study investigator who administered the VOMS. We calculated test sensitivity, specificity, and positive and negative predictive values to estimate the diagnostic accuracy of the VOMS. We performed a mixed-design analysis of variance to assess differences in VOMS symptom scores reported by concussed athletes compared with control athletes. RESULTS: Fifty concussion participants and 50 control participants completed the study. The VOMS demonstrated sensitivity and specificity of 96% and 46%, respectively, and produced positive and negative predictive values of 64% and 92%, respectively. The concussion group exhibited a significantly greater symptom provocation change score from baseline than the control group for all test domains of the VOMS only in the first week following concussion. CONCLUSION: The VOMS may be most useful as a clinical screening tool to rule out, rather than confirm, the presence of sport-related concussion. The VOMS may be appropriate to inform the recovery of vestibular and oculomotor impairments exhibited by concussed individuals over time.

Detecting subtle mobility changes among older adults: the Quantitative Timed Up and Go test.

BACKGROUND: The Quantitative Timed Up and Go (QTUG) test uses wearable sensors, containing a triaxial accelerometer and an add-on triaxial gyroscope, to quantify performance during the TUG test with potential to capture more minor changes in mobility. AIMS: To examine the responsiveness, minimum detectable change (MDC) and observed effect size of QTUG in a cohort of socially active adults aged 50 years and over participating in a structured community exercise program. METHODS: 54 participants (91% females, mean age 63.6 ± 6.5 years) completed repeated QTUG testing under single- and dual-task conditions. Responsiveness of the QTUG was assessed by correlation of change in standard TUG with QTUG change (Pearson's correlation coefficient). MDC and effect sizes (standardized mean difference and Cohen's d) were also calculated for QTUG. RESULTS: There was a strong positive correlation between change in the standard TUG and change in QTUG (single task r = 0.91, p < 0.001). MDC in QTUG was calculated as 0.77 (Sd, 1.39; ICC 0.96) seconds (single task) and 2.33 (Sd 2.18; ICC 0.85) seconds (dual task). Several QTUG parameters showed improvements in mean values with small effect sizes (sit -to-stand transition time d = 0.418; walk time d = 0.398; cadence d = 0.306, swing time d = 0.314; step time d = 0.479; gait velocity d = 0.365; time to reach turn d = 0.322) under single-task conditions and with a moderate effect size (d = 0.549) in time taken to turn under the dual-task condition. CONCLUSION: Initial evidence of QTUG's responsiveness to change in mobility in active middle to older age adults has been demonstrated with small to moderate effect sizes observed in specific QTUG parameters.

Development of real world learning opportunities in community exercise prescription for healthcare professional programmes - 'Physio Hub'.

BACKGROUND: Given the challenge of chronic lifestyle diseases, the shift in healthcare focus to primary care and recognised importance of a preventive approach to health, including exercise prescription, the embedding of related learning in healthcare professional programmes is critical. METHODS: In response to these contemporary demands, a complex curriculum development project was undertaken at University College Dublin, employing a four dimensional curriculum framework for the development of health professional curricula, that focused on (1) future orientation of healthcare practices (the why?), (2) defining capabilities of graduates (the what?), (3) teaching, learning and assessment (the how?) and (4) organisation/institution delivery (the where)? The process was informed by latest exercise, health promotion, educational and health policy literature, alongside engagement with multiple internal university and external community stakeholders. RESULTS: Having sufficient clinical education opportunity for translating exercise theory into practice was identified as a key need (the Why?). Development of strategies for health promotion and design and delivery of evidence based exercise programmes with inter-professional and inter-sectoral network building were some of the graduate capabilities identified as being critically important. (the what?) The resultant UCD Physio Hub model of clinical education combines 'on campus' and 'community outreach' activity to facilitate inter-sectoral 'real world' experiential student learning in health promotion and exercise prescription for both healthy and clinical populations. Underpinned by social constructivist educational theory, students are encouraged to be creative and to collaborate in responding to identified health needs of specific community groups by designing and delivering community services. (the how?) In developing new student learning opportunities to enhance curriculum, a supportive organisational culture and context was critical with UCD having excellent exercise infrastructure and the Physio Hub project aligning with a community engagement ethos articulated in the university's strategy. (the where?) CONCLUSION: This paper provides an overview of Physio Hub, its services, educational practices and translational research ethos, all of which are combined to deliver a rich exercise and health promotion learning experience. Although developed for physiotherapy in this instance, the curriculum process and resultant education model could be applied across medical and other health professional programmes and to facilitate interdisciplinary learning.

Exploring the Use of Mobile Athlete Self-report Measures in Elite Gaelic Games: A Qualitative Approach.

ABSTRACT: Duignan, CM, Slevin, PJ, Caulfield, BM, and Blake, C. Exploring the use of mobile athlete self-report measures in elite Gaelic games: A qualitative approach. J Strength Cond Res 35(12): 3491-3499, 2021-Athlete self-report measures (ASRMs) are used in research and practice as an accurate, practical, and accessible method of athlete monitoring. Mobile adaptations of constructs from validated ASRM have increasingly been used for athlete monitoring in various sports settings; however, insights on the user experience and perceived value of these systems in the applied team sport setting have been limited. This study aimed to portray the experiences of stakeholders using a pre-existing mobile ASRM (M-ASRM) in elite Gaelic games. Twenty-one stakeholders in elite Gaelic games were recruited for this study (players n = 10, coaches and support staff n = 11). Subjects completed a semistructured interview with the lead researcher regarding their experience of using an M-ASRM in practice. Thematic analysis of the transcripts was conducted using NVivo 12 software. Results were defined under the themes of positive and negative user experience. Positive user experience was portrayed through M-ASRM uses and perceived value: communication and information disclosure, remote player monitoring, decision making and advanced planning, and player education and self-management. Negative user experience was portrayed through M-ASRM challenges: player adherence, player dishonesty, coach time and expertise requirements, and sociotechnical and system factors. Results outline the major uses of M-ASRM in elite Gaelic games and, importantly, highlight the key challenges experienced by stakeholders. These results can be applied by coaches, sports medicine professionals, and sports scientists using or intending to use an M-ASRM, providing key considerations to employ for effective use in team sport.

Users of rehabilitation services in 14 countries and territories affected by conflict, 1988-2018.

OBJECTIVE: To analyse the demographic and clinical characteristics of people attending physical rehabilitation centres run or supported by the International Committee of the Red Cross in countries and territories affected by conflict. METHODS: Of 150 such rehabilitation centres worldwide, 38 use an electronic patient management system. We invited all 38 centres to participate. We extracted de-identified data from 1988 to 2018 and categorized them by sex, age, country or territory and reason for using rehabilitation services. FINDINGS: Thirty-one of the 38 rehabilitation centres in 14 countries and territories participated. We included data for 287 274 individuals. Of people using rehabilitation services, 61.6% (176 949/287 274) were in Afghanistan, followed by 15.7% (44 959/287 274) in Cambodia. Seven places had over 9000 service users each (Afghanistan, Cambodia, Gaza Strip, Iraq, Myanmar, Somalia and Sudan). Overall, 72.6% (208 515/287 274) of service users were male. In eight countries, more than half of the users were of working age (18-59 years). Amputation was the most common reason for using rehabilitation services; 33.3% (95 574/287 274) of users were people with amputations, followed by 13.7% (39 446/287 274) with cerebral palsy. The male predominance was greater in the population aged 18-34 years (83.1%; 71 441/85 997) and in people with amputations (88.6%; 84 717/95 574) but was evident across all places, age groups and health conditions. CONCLUSION: The considerably lower attendance of females at the rehabilitation centres highlights the need to understand the factors that affect the accessibility and acceptability of rehabilitation for women and girls in conflict settings.

The relationship between collision metrics from micro-sensor technology and video-coded events in rugby union.

This study aimed to determine the relationship between collision metrics from a commercially available micro-sensor technology unit (MST) and the count of collisions coded by expert video analysts in professional rugby union. Forty-four professional rugby union players wore MST units during match play. We analyzed 245 combined data files from 11 competitive matches, resulting in the inclusion of a total of 9202 individual collision events. Collision metrics (the count of collisions and the Collision Load™) were analyzed via the manufacturer's software. Each match was also video recorded and evaluated by two expert video analysts. Pearson's correlation coefficients were used to determine the relationship between the count of collisions coded by the expert video analysts, and both MST collision metrics. One-way ANOVA was used to determine whether differences in the Collision Load™ for individual collision events existed between different playing positions. Very large-nearly perfect correlations were observed between the count of collisions coded by the expert video analysts and both MST collision metrics (the count of collisions: r = 0.91, 90% CI = 0.89-0.93; the Collision Load™: r = 0.89; 90% CI = 0.87-0.91). Differences in the Collision Load™ for individual collision events were identified between different playing positions. Collision metrics registered by the MST software relate very strongly with the count of collisions coded by expert video analysts. The typical Collision LoadTM per individual collision event varies depending on player position. The application of automated collision detection for rugby union appears feasible.

Association between eccentric knee flexor strength and hamstring injury risk in 185 elite Gaelic football players.

Hamstring strains are the most common time-loss injury in elite Gaelic football affecting over 20% of players per season. Thus, there is a need to identify factors contributing to the onset of hamstring injuries in order to inform injury risk management strategies. The current study investigated whether eccentric knee flexor strength and between-limb imbalances were associated with increased risk of sustaining a time-loss hamstring injury in elite Gaelic football players. A total of 185 elite male players (26.9 ± 2.7 years, 86.4 ± 6.2 kg, 183.4 ± 5.6) were prospectively followed for 12 weeks from the day of testing. Injury data were provided by the team medical staff. Twenty-eight players (16%) sustained a time-loss hamstring injury following testing. Players that did not sustain a hamstring injury had greater average between-limb asymmetries (uninjured = 9.1%, 95% CI 7.8-10.1; injured = 5.1%, 95% CI 3.7-6.7; P = .001). Eccentric knee flexor strength profiles were not associated with increased or decreased risk of sustaining a hamstring injury and did not alter the post-test probability of sustaining a hamstring injury across the investigation period. These findings do not support the use of eccentric knee flexor strength metrics in managing hamstring injury risk in elite male Gaelic football players.

Concussed athletes walk slower than non-concussed athletes during cognitive-motor dual-task assessments but not during single-task assessments 2 months after sports concussion: a systematic review and meta-analysis using individual participant data.

OBJECTIVES: To determine whether individuals who sustained a sports concussion would exhibit persistent impairments in gait and quiet standing compared to non-injured controls during a dual-task assessment . DESIGN: Systematic review and meta-analysis using individual participant data (IPD). DATA SOURCES: The search strategy was applied across seven electronic bibliographic and grey literature databases: MEDLINE, EMBASE, CINAHL, SportDISCUS, PsycINFO, PsycARTICLES and Web of Science, from database inception until June 2017. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Studies were included if; individuals with a sports concussion and non-injured controls were included as participants; a steady-state walking or static postural balance task was used as the primary motor task; dual-task performance was assessed with the addition of a secondary cognitive task; spatiotemporal, kinematic or kinetic outcome variables were reported, and; included studies comprised an observational study design with case-control matching. DATA EXTRACTION AND SYNTHESIS: Our review is reported in line with the Preferred Reporting Items for Systematic review and Meta-Analyses-IPD Statement. We implemented the Risk of Bias Assessment tool for Non-randomised Studies to undertake an outcome-level risk of bias assessment using a domain-based tool. Study-level data were synthesised in one of three tiers depending on the availability and quality of data: (1) homogeneous IPD; (2) heterogeneous IPD and (3) aggregate data for inclusion in a descriptive synthesis. IPD were aggregated using a 'one-stage', random-effects model. RESULTS: 26 studies were included. IPD were available for 20 included studies. Consistently high and unclear risk of bias was identified for selection, detection, attrition, and reporting biases across studies. Individuals with a recent sports concussion walked with slower average walking speed (χ2=51.7; df=4; p<0.001; mean difference=0.06 m/s; 95% CI: 0.004 to 0.11) and greater frontal plane centre of mass displacement (χ2=10.3; df=4; p=0.036; mean difference -0.0039 m; 95% CI: -0.0075 to -0.0004) than controls when evaluated using a dual-task assessment up to 2 months following concussion. SUMMARY/CONCLUSIONS: Our IPD evidence synthesis identifies that, when evaluated using a dual-task assessment, individuals who had incurred a sports concussion exhibited impairments in gait that persisted beyond reported standard clinical recovery timelines of 7-10 days. Dual-task assessment (with motion capture) may be a useful clinical assessment to evaluate recovery after sports concussion. PROTOCOL PRE-REGISTRATION: This systematic review was prospectively registered in PROSPERO CRD42017064861.

Epidemiology of injuries in senior men's field hockey: A two-season prospective observational injury surveillance study.

Determining the rate and severity of injuries incurred through sport is accepted as the primary step towards designing, implementing and evaluating injury prevention programmes. The aim of this study was to determine the injury incidence rate and characteristics of male field hockey athletes participating in the Irish Hockey League. Athletes from eight field hockey teams were assigned to an online reporting system, where they logged injuries as they were incurred. Injuries were defined as any physical complaint. Coaches and physiotherapists were contacted weekly to corroborateinjuries. Overall 323 injuries were reported across 34,449 exposure hours, giving rise to an incidence rate of 9.4/1000 h. On average, athletes sustained one injury over the course of two seasons. Muscle strains, pain and contusions were the most common types of injury, while the hamstring, knee and hip/groin were the most frequently reported locations. While 66.9% of injuries occurred through non-contact mechanisms, contact injuries were also common. Injury recurrences accounted for 16.1% of injuries. In conclusion, the incidence of injury in field hockey is high, occurring from a variety of mechanisms. Future injury prevention strategies should prioritise injuries to the hamstring, knee and ankle, and be specific to particular playing positions.