Economic Evaluation of an Extended Telehealth Worksite Exercise Intervention to Reduce Lost Work Time from Low Back Pain in Career Firefighters.

Purpose Low back pain (LBP) is a leading cause of lost work time (LWT) in firefighters and is related to poor muscle endurance. Although exercise can improve muscle endurance, it must be continued to sustain benefits, and it is unknown if it can reduce LWT. This study conducted an economic evaluation of an extended worksite exercise intervention in career firefighters. Methods A randomized controlled trial allocated 264 firefighters to telehealth with remote instruction ("telehealth"), direct exercise supervision ("direct"), or brief education ("control"). The telehealth and direct groups performed worksite exercises twice weekly for 12 months. Outcomes included quality adjusted life years, LWT from LBP (24-h shifts), costs of LWT from LBP, and net monetary benefits. Results A total of 216 firefighters were included in the economic analysis (telehealth n = 71, direct n = 75, control n = 70). Sixteen experienced LWT from LBP (telehealth n = 4, direct n = 4, control n = 8). The mean number of 24-h shifts lost from LBP were 0.05 (telehealth), 0.28 (direct), and 0.43 (control). Mean study intervention costs per participant were $1984 (telehealth), $5269 (direct), and $384 (control). Net monetary benefit was $3573 for telehealth vs. direct, - $1113 for telehealth vs. control, and - $4686 for direct vs. control. Conclusions Worksite exercise reduced LWT from LBP in firefighters. Telehealth was less costly and more effective at reducing LWT from LBP than direct exercise supervision. If the costs of telehealth were further reduced, a positive net monetary benefit might also be achieved when compared to no intervention.Clinical trial registration: (clinicaltrials.gov): NCT02362243.

Validity of the Multidimensional Task Ability Profile.

Background The Multidimensional Task Ability Profile (MTAP) is a patient-reported outcome (PRO) measure that provides a global score linked to the physical demand characteristics of work, but needs to be validated against established measures. Purpose To assess the concurrent validity of the MTAP compared with the Oswestry Disability Index (ODI), Neck Disability Index (NDI), Disabilities of the Arm, Shoulder, and Hand (DASH), Lower Extremity Functional Scale (LEFS), and Short Form 12 Health-Related Quality of Life (SF-12) questionnaires. Methods An observational study was conducted in 157 patients undergoing musculoskeletal rehabilitation. At baseline and after 30 days of treatment, patients completed the MTAP, ODI, NDI, DASH, LEFS, and SF-12 and provided self-reported work status. Results At baseline and after 30 days, convergent validity between the MTAP and DASH, LEFS, NDI, and ODI was good to excellent. Concurrent validity between the MTAP and SF-12 physical component score (PCS) and mental component score (MCS) was moderate or fair, respectively. Sensitivity to change over the 30-day treatment interval was established for the MTAP, SF-12 PCS, SF-12 MCS, and LEFS. Fair to moderate predictive validity for work status was found for the MTAP, ODI, NDI, DASH, and SF-12 PCS. Conclusions The MTAP demonstrated adequate concurrent validity, predictive validity, and sensitivity to change compared to other PROs. For patients with various impairment types, the MTAP may be a useful omnibus measure to supplement specialty instruments such as the DASH, NDI, ODI, or LEFS.

Work-Readiness self report lift capacity test short form.

BACKGROUND: The Multidimensional Task Ability Profile (MTAP) is a measure of self reported physical work capacity developed for injured workers with musculoskeletal disorders (MSDs) to determine readiness to return to work. OBJECTIVE: This study compared the concurrent validity of a new short form MTAP (MTAP-SF) comprised of 16 lifting and/or carrying items with the MTAP 55-item version. The hypothesis addressed is whether the validity of a version that imposes less respondent burden (MTAP-SF) would be comparable to the more burdensome instrument (MTAP-55). METHODS: MTAP scores were compared with demonstrated lift capacity in 1,252 healthy adults. Parallel regression analyses were conducted to examine the explanatory power of both MTAP versions. RESULTS: Age, gender, body mass and MTAP-SF explained 55% of the variance (p < 0.001) in demonstrated lift capacity, equivalent to MTAP-55. CONCLUSIONS: Self reported performance in physical work capacity tasks accounts for significant variance in lifting performance. MTAP-SF diminishes respondent burden while maintaining validity and may be useful for managing MSDs by enhancing understanding of the evaluee's psychophysical component in return-to-work rehabilitation planning.

Comparison Between Disability, Physical Performance, and Other Biopsychosocial Factors in Full-Duty Career Firefighters Working With and Without Current Low Back Pain.

INTRODUCTION: Low back pain (LBP) is highly prevalent and a top cause of disability-related early retirement in firefighters. Those with a lifetime history of LBP have various deficiencies that are associated with increased injury risk and absenteeism. However, the influence of working with current LBP on disability, physical performance, and other biopsychosocial factors has not been fully characterized in this population. The purpose of this study was to compare anthropometric measures, exercise habits, physical fitness/performance, disability/work ability, and other biopsychosocial factors of firefighters working with and without current LBP. METHODS: A cross-sectional study was conducted using baseline assessments from 419 full-duty career firefighters without documented work restrictions (age: 37.6 ± 8.8 y; 5 F, 414 M) who were enrolled in a regional wellness initiative in Southern California, USA. Current LBP status was determined by a questionnaire and confirmed by an interview. Anthropometric measures, patient-reported outcomes, and physical fitness tests were used to assess body mass index; body fat %; waist circumference; strengthening, cardiovascular, and flexibility exercise frequency; back and core muscular endurance; functional movement quality, perceived back-related disability, lift and carry ability, and firefighter task ability; sleep quality; and perceptions of fear and fatigue and catastrophic injustice experience. Scores for participants with and without current LBP were compared using analysis of variance and chi-square analysis. RESULTS: The point prevalence of current LBP was 19.81% (83/419). For the entire cohort, those with current LBP had significantly worse scores than those without current LBP for all assessed variables, except core muscular endurance and functional movement quality. These trends held up when analyses were stratified by age and obesity categories, and approximately half of the comparisons retained statistical significance. A significantly greater percentage of participants with current LBP were working with some level of back-related disability and/or perceived physical demand characteristics of work level below the required very heavy job demands. CONCLUSION: Nearly one-fifth of full-duty career firefighters without documented work restrictions reported having current LBP, and these individuals had deficits in several modifiable biopsychosocial factors across five health domains. These findings can help guide future research and implementation efforts in the fire service designed to improve performance, resiliency, work readiness, recovery, and quality of life, as well as to reduce impairment, disability, and absenteeism and increase presenteeism.

The Influence of Active, Passive, and Manual Therapy Interventions on Escalation of Health Care Events After Physical Therapist Care in Veterans With Low Back Pain.

OBJECTIVE: The objective of this study was to examine the associations between active, passive, and manual therapy interventions with the escalation-of-care events following physical therapist care for veterans with low back pain (LBP). METHODS: A retrospective cohort study was conducted in 3618 veterans who received physical therapist care for LBP between January 1, 2015 and January 1, 2018. The VA Corporate Data Warehouse was utilized to identify LBP-related physical therapist visits and procedures, as well as opioid prescription and non-physical therapy clinic encounters. The association between physical therapist interventions with 1-year escalation-of-care events were assessed using adjusted odds ratios from logistic regression. RESULTS: Nearly all veterans (98%) received active interventions but only a minority (31%) received manual therapy. In the 1-year follow-up period, the odds of receiving an opioid prescription were 30% lower for those who received manual therapy in addition to active interventions, as compared with patients who received only active interventions. Moreover, the odds of receiving primary care, specialty care, and diagnostic testing were 30-130% higher for patients who received electrical stimulation or more than 1 passive intervention in addition to active treatments, as compared with patients who received only active interventions. CONCLUSION: The use of manual therapy along with active interventions was associated with reduced prescription of opioids, while utilization of specific passive interventions such as electrical stimulation or multiple modalities in conjunction with active interventions resulted in increased escalation-of-care events. IMPACT STATEMENT: The use of active interventions, which is supported by most Clinical Practice Guidelines (CPGs), was the cornerstone of physical therapist care for veterans with LBP. However, the use of CPG-recommended manual therapy interventions was low but associated with reduced opioid prescriptions. The use of 2 or more different passive interventions along with active interventions was common (34%) and associated with less-than-optimal escalation-of-care outcomes.

Development and reliability testing of Spanish language and english language versions of the multidimensional task ability profile.

PURPOSE: The purpose of this study was to assess the: (1) test-retest reliability of the English and Spanish language versions of the Multidimensional Task Ability Profile (MTAP), (2) cross-cultural adaptation of the Spanish language version of the MTAP, and (3) practicality of both versions in terms of time required for administration. The MTAP is a patient-reported outcome measure of physical function that uses a combination of text and pictorial illustrations. METHODS: An observational study was conducted with a convenience sample of patients with musculoskeletal disorders from three outpatient physical rehabilitation centers. Participants (n = 110) completed the MTAP two times, whereby the second test was completed 24-72 h after the first test. Focus groups were conducted at the end of the study. Correlation analyses were used to assess test-retest reliability and qualitative analyses were used to assess cultural adaptation of the MTAP. RESULTS: The English and Spanish versions of the MTAP displayed good test-retest reliability (ICC 2,1 = 0.87-0.97, p < 0.05). Qualitative analyses demonstrated adequate cross-cultural adaptation of the Spanish language version of the instrument. CONCLUSIONS: The findings of this study indicate that the MTAP has been adequately adapted from its original English version for use with Spanish-speaking individuals. The MTAP in its current form of 50 items is reliable when administered to individuals with musculoskeletal disorders in either English or Spanish.

Body mass normalization for isometric tests of muscle endurance.

The primary purpose of this study was to derive allometric parameters for normalizing Biering-Sorensen and Plank Test scores (measures of isometric back and abdominal muscle endurance, respectively) to body mass. The secondary purpose was to determine if allometric scaling with derived allometric parameters or the theoretical allometric parameter (b = -0.33) is the more appropriate method for normalizing Biering-Sorensen and Plank Test scores to body mass. A sample of 83 male career firefighters (age = 35.7 ± 9.4 years; body mass = 89.5 ± 14.8 kg) participated in this study. Significant correlations were found between body mass and test scores (Biering-Sorensen Test: r = -0.36, p = 0.001; Plank Test: r = -0.55, p < 0.001). Derived allometric parameters for Biering-Sorensen and Plank Tests were b = -0.932 and -1.369, respectively. Allometric scaling with the derived allometric parameters was deemed appropriate at normalizing Biering-Sorensen and Plank Test scores because it caused the correlations between body mass and test scores to become insignificant (Biering-Sorensen Test: r = 0.10, p = 0.354; Plank Test: r = 0.14, p = 0.173). Allometric scaling with the theoretical allometric parameter was deemed inappropriate for normalizing Biering-Sorensen and Plank Test scores because it was not robust enough to get rid of the significant correlations between body mass and test scores (Biering-Sorensen Test: r = -0.23, p = 0.034; Plank Test: r = -0.43, p < 0.001). Allometric scaling with derived allometric parameters should be used to normalize Biering-Sorensen and Plank Test scores to body mass, particularly when attempting to account for changes in body mass across time intervals and differences in body mass across individuals.

Systematic review of core muscle activity during physical fitness exercises.

A consensus has not been reached among strength and conditioning specialists regarding what physical fitness exercises are most effective to stimulate activity of the core muscles. Thus, the purpose of this article was to systematically review the literature on the electromyographic (EMG) activity of 3 core muscles (lumbar multifidus, transverse abdominis, quadratus lumborum) during physical fitness exercises in healthy adults. CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, PubMed, SPORTdiscus, and Web of Science databases were searched for relevant articles using a search strategy designed by the investigators. Seventeen studies enrolling 252 participants met the review's inclusion/exclusion criteria. Physical fitness exercises were partitioned into 5 major types: traditional core, core stability, ball/device, free weight, and noncore free weight. Strength of evidence was assessed and summarized for comparisons among exercise types. The major findings of this review with moderate levels of evidence indicate that lumbar multifidus EMG activity is greater during free weight exercises compared with ball/device exercises and is similar during core stability and ball/device exercises. Transverse abdominis EMG activity is similar during core stability and ball/device exercises. No studies were uncovered for quadratus lumborum EMG activity during physical fitness exercises. The available evidence suggests that strength and conditioning specialists should focus on implementing multijoint free weight exercises, rather than core-specific exercises, to adequately train the core muscles in their athletes and clients.

Lumbar muscle activity during common lifts: a preliminary study using magnetic resonance imaging.

The purpose of this preliminary study was to assess lumbar multifidus, erector spinae, and quadratus lumborum muscle activity during lifts as measured by changes in transverse relaxation time (T2) from magnetic resonance imaging (MRI). Thirteen healthy adults performed dynamic squat, stoop, and asymmetric stoop lifts at a standard load, with each lift followed by MRI. Increase in T2 for the multifidus and erector spinae was greater for the stoop than squat. No difference in T2 increase was noted between the multifidus and erector spinae for the squat or stoop. Increase in T2 for the contralateral multifidus was less for the asymmetric stoop than stoop. Future research using MRI and other biomechanical techniques is needed to fully characterize lumbar muscle activity during lifts for various populations, settings, postures, and loads.

Impact of Indoor Air Quality and Breathing on Back and Neck Pain: A Systematic Review.

Back pain and neck pain are important public health concerns and are among the most common and disabling conditions globally. However, the relationships among indoor air quality (IAQ), breathing parameters (pulmonary function, respiratory disorders), and back pain and neck pain have not been adequately assessed. The purpose of this study was to systematically review the literature about the impact of IAQ and breathing parameters on back pain and neck pain (PROSPERO ID: CRD42022380515). CINAHL, EMBASE, PEDRo, and PubMed databases were searched through January 19, 2023. Inclusion criteria for study eligibility were observational studies (except case reports) or randomized controlled trials (RCTs), published in peer-reviewed journals in the English language, human research, original research, examined the relationships between IAQ, or breathing parameters with back pain or neck pain. Review procedures were conducted and reported according to PRISMA recommendations. Empirical evidence statements were developed for observational studies, and grades of evidence statements were developed for RCTs. Sixty-seven eligible studies were found (54 observational studies and 13 RCTs) that enrolled 345,832 participants. None of the studies assessed the combined impact of IAQ and breathing parameters on back pain or neck pain. No level 1 studies were found, which precludes making strong statements about causality and strong recommendations about the efficacy of IAQ and breathing exercise interventions for reducing pain and disability related to back pain and neck pain. Evidence indicates that poor IAQ and respiratory disorders are related to an increased risk of back pain and neck pain. Conflicting evidence exists about the association between pulmonary function with back pain and neck pain. Evidence for breathing exercise interventions was mixed with numerous limitations. This review provides preliminary evidence on the relationships of IAQ and breathing parameters with back pain and neck pain, which can be used to guide future research and clinical implementation efforts. Assuming positive findings in subsequent research, a wide range of stakeholders involved with this complex human-building-environment interface can be equipped to address IAQ and breathing parameters, along with other established risk factors to help those suffering from back pain and neck pain.

Relationship of Healthy Building Determinants With Musculoskeletal Disorders of the Extremities: A Systematic Review.

Musculoskeletal disorders (MSDs) are a substantial societal burden and various factors affect their causation, recovery, and prognosis. Management of MSDs is complex and requires multifaceted interventions. Given the challenges of MSDs and their continued burden, it is possible that additional elements could impact these disorders that have not been fully researched, for example, indoor environmental quality. Our previous review provided preliminary evidence that healthy building determinants (HBDs) are associated with the risk of back and neck pain. However, the relationship of HBDs with extremity MSDs and general MSDs (i.e., MSDs involving multiple body regions or in which body regions were unspecified in the original reports) has not been formally studied. The purpose of this review was to conduct a systematic literature review to assess the relationship of HBDs with extremity and general MSDs (PROSPERO ID: CRD42022314832). PubMed, CINAHL, Embase, and PEDRo databases were searched through April 2022. Inclusion criteria for study eligibility were as follows: humans of ages ≥18 years, reported on one or more of eight HBDs (1. air quality and ventilation, 2. dust and pests, 3. lighting and views, 4. moisture, 5. noise, 6. safety and security, 7. thermal health, 8. water quality), and compared these HBDs with extremity MSDs or general MSDs, original research, English. Exclusion criteria were as follows: articles not published in peer-reviewed journals, full-text articles unavailable. Review procedures were conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Empirical evidence statements were developed for 33 pairwise comparisons of HBDs with MSDs. The search uncovered 53 eligible studies with 178,532 participants. A total of 74.6% (39/53) of the studies were cross-sectional and 81.1% (43/53) were fair quality. Overall, the majority of uncovered evidence indicates that HBDs are related to risk of extremity and general MSDs. Nineteen comparisons support that as HBDs worsen, the risk of MSDs increases. Six comparisons had conflicting evidence. Three comparisons support that poor HBDs are not related to increased risk of extremity and general MSDs. Five comparisons had no evidence. This systematic review builds upon previous work to provide useful starting points to enhance awareness about the HBD-MSD relationship. These findings can help inform research and public health efforts aimed at addressing suboptimal HBDs through appropriate interventions to improve the lives of those suffering from MSDs.

Relationship of Healthy Building Determinants With Back and Neck Pain: A Systematic Review.

OBJECTIVE: Back pain and neck pain are very common, costly, and disabling. Healthy building determinants within the built environment have not been adequately assessed as contributors to these conditions. The objective of this study was to systematically review the literature on the relationship of healthy building determinants with back and neck pain. DATA SOURCE: PubMed, CINAHL, EMBASE, Google Scholar, and PEDRo. Study Inclusion and Exclusion Criteria: Studies were included if they met the following criteria: Adults, comparison of healthy building determinants (air quality, ventilation, dust and pests, lighting and views, moisture, noise, safety/security, thermal health, water quality) with back and neck pain, original research, English. Studies were excluded if full text articles were unavailable and if the focus was patient and materials handling or ergonomics. DATA EXTRACTION: Data extraction and other review procedures were elaborated according to PRISMA guidelines. Data Synthesis: Data were synthesized with an approach adapted from Oxford Centre for Evidence-Based Medicine and American Physical Therapy Association. RESULTS: 37 articles enrolling 46,223 participants were eligible. Most articles were cross-sectional (31/37) and fair quality (28/37). None were interventional. Evidence was found to generally support a relationship indicating that as healthy building determinants worsen, the risk of back and neck pain increases. CONCLUSION: Although the available evidence precludes interpretations about causality, the study's findings are starting points to guide future research, knowledge creation, and health promotion initiatives about the relationships of the built environment with back and neck pain.

Impact of COVID-19 pandemic on nonpharmacological pain management trials in military and veteran healthcare settings: an evaluation informed by implementation science.

The coronavirus disease (COVID-19) pandemic disrupted healthcare and clinical research, including a suite of 11 pragmatic clinical trials (PCTs), across clinics within the Department of Veterans Affairs (VA) and the Department of Defense (DOD). These PCTs were designed to evaluate an array of nonpharmacological treatments and models of care for treatment of patients with pain and co-occurring conditions. The aims of the study are to (a) describe modifications to PCTs and interventions to address the evolving pandemic and (b) describe the application of implementation science methods for evaluation of those PCT modifications. The project used a two-phase, sequential, mixed-methods design. In Phase I, we captured PCT disruptions and modifications via a Research Electronic Data Capture questionnaire, using Periodic Reflections methods as a guide. In Phase II, we utilized the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) taxonomy to develop a focus group interview guide and checklist that would provide more in-depth data than Phase I. Data were analyzed using directed content analysis. Phase I revealed that all PCTs made between two and six trial modifications. Phase II, FRAME-guided analyses showed that the key goals for modifying interventions were increasing treatment feasibility and decreasing patient exposure to COVID-19, while preserving intervention core elements. Context (format) modifications led eight PCTs to modify parts of the interventions for virtual delivery. Content modifications added elements to enhance patient safety; tailored interventions for virtual delivery (counseling, exercise, mindfulness); and modified interventions involving manual therapies. Implementation science methods identified near-real-time disruptions and modifications to PCTs focused on pain management in veteran and military healthcare settings.

Active-duty personnel and veterans often report pain and seek treatment in military and veteran healthcare settings. Nondrug treatments, such as self-care, counseling, exercise, and manual therapy, are recommended for most patients with chronic pain. The COVID-19 pandemic has affected clinical trials of these nondrug treatments in military and veteran populations. In this study, we explored how 11 research teams adapted study trials on pain to address COVID-19. Team members completed online questions, brief checklists, and a one-time focus group about how they modified their trials. Each of the 11 trials made 2 to 6 changes to their studies. Most paused or delayed recruitment efforts. Many shifted parts of the study to a virtual format. Goals for adapting treatments included improved feasibility and decreased patient exposure to COVID-19. Context or format changes increased virtual delivery of study treatments. Content changes focused on patient safety, tailoring treatments for virtual delivery, and offering varied manual therapies. Provider concerns about technology and patient willingness to seek in-person care during the pandemic also were factors driving changes. These findings may support the increased use of virtual care for pain management in military and veteran health settings.

Electromyographic Analysis of the Lumbar Extensor Muscles during Dynamic Exercise on a Home Exercise Device.

Resistance exercise with devices offering mechanisms to isolate the lumbar spine is effective to improve muscle strength and clinical outcomes. However, previously assessed devices with these mechanisms are not conducive for home exercise programs. The purpose of this study was to assess the surface electromyographic (EMG) activity of the lumbar extensor muscles during dynamic exercise on a home back extension exercise device. Ten adults (5 F, 5 M) performed dynamic lumbar extension exercise on a home device at three loads: 1.00 × body weight (BW), 1.25 × BW and 1.50 × BW. Surface EMG activity from the L3/4 paraspinal region was collected. The effect of exercise load, phase of movement, and position in the range of motion on lumbar extensor EMG activity (normalized to % maximum voluntary isometric contraction) was assessed. Lumbar extensor EMG activity significantly increased from 1.00 BW to 1.50 BW loads (p = 0.0006), eccentric to concentric phases (p < 0.0001), and flexion to extension positions (p < 0.0001). Exercise using a home back extension exercise device progressively activates the lumbar extensor muscles. This device can be used for home-based resistance exercise programs in community-dwelling adults without contraindications.

Comprehensive Assessment of Implementation Factors Related to Worksite Exercise in Firefighters.

OBJECTIVE: This study sought to identify key implementation factors to a 12-month worksite exercise intervention in career firefighters. METHODS: Implementation factors related to the hybrid type 1 effectiveness-implementation trial were assessed by exercise adherence, implementation questionnaires, focus groups, and observations from stakeholders. RESULTS: The primary identified implementation themes spanned intrapersonal, interpersonal, and institutional factors including: 1. Time and desire to exercise on shift; 2. Financial incentives to exercise; 3. Structured fitness programs; 4. Group competition, cohesion, and camaraderie; 5. Leadership engagement and support; and 6. Health, fitness, and occupational preparedness benefits. CONCLUSIONS: Future worksite exercise programs should address the barriers and facilitators identified herein and consider utilizing a hybrid delivery approach combining supervised and telehealth exercise interventions to optimize enthusiasm, adherence and improve safety and health.

Management of chronic low back pain in active individuals.

Chronic low back pain (LBP) is a common and potentially disabling condition in all adults, including those who are physically active. It currently is challenging for clinicians and patients to choose among the numerous treatment options. This review summarizes recommendations from recent clinical practice guidelines and systematic reviews about common primary care and secondary care approaches to the management of chronic LBP. The best available evidence currently suggests that in the absence of serious spinal pathology, nonspinal causes, or progressive or severe neurologic deficits, the management of chronic LBP should focus on patient education, self-care, common analgesics, and back exercises. Short-term pain relief may be obtained from spinal manipulative therapy or acupuncture. For patients with psychological comorbidities, adjunctive analgesics, behavioral therapy, or multidisciplinary rehabilitation also may be appropriate. Given the importance of active participation in recovery, patient preference should be sought to help select from among the recommended treatment options.

Evaluating Nutrient Intake of Career Firefighters Compared to Military Dietary Reference Intakes.

The primary goals of the Dietary Reference Intakes (DRI) are to plan and assess nutrient intakes to promote health, reduce chronic disease, and prevent toxicity. Firefighters have unique nutrient needs compared to the public due to their job demands. The military provides the only published guidance for tactical athletes' nutrient needs. The purpose of this study was to determine whether firefighters were meeting the Military Dietary Reference Intakes (MDRI). A cross-sectional study was conducted in a sample of career firefighters (n = 150, 37.4 ± 8.4 year-old males) employed in Southern California. Data were gathered during baseline assessments from a Federal Emergency Management Agency-funded Firefighter Wellness Initiative. Participants were asked to log their food and beverage consumption over a 72-h period. Descriptive statistics (means, standard deviations, 95% confidence intervals) were calculated for all participant characteristics and average three-day nutrient intakes. A 95% confidence interval compared their nutrient intake to MDRI to identify differences in nutrient intakes, significance accepted at p = 0.05. Compared to MDRI reference values, firefighters consumed an inadequate amount of total calories, linolenic and alpha-linolenic fatty acid, fiber, vitamins D, E, and K, potassium, magnesium, zinc, and carbohydrates. Vitamin D, magnesium, and potassium had the greatest shortcomings (95.3%, 94.0%, and 98.7%, respectively, under MRDA). Thus, firefighters are not meeting the established MDRI for several key nutrients required to promote health, improve performance, and reduce chronic disease. Dietitians and health care providers may use the results of this study to help design health promotion programs for this population. Future research should develop a customized reference intake for firefighters.

Comparison of Supervised and Telehealth Delivery of Worksite Exercise for Prevention of Low Back Pain in Firefighters: A Cluster Randomized Trial.

OBJECTIVE: This study assessed worksite exercise delivered by on-site supervision (supervised) or telehealth to reduce lost work time (LWT) related to low back pain (LBP) in firefighters. METHODS: A cluster randomized controlled trial assigned 264 career firefighters to supervised (n = 86) or telehealth (n = 95) back and core exercises 2×/week for 12 months, or control (n = 83). RESULTS: 58.0% (153/264) of participants reported LBP and 7.6% (20/264) reported LWT related to LBP (control n = 10, supervised n = 5, telehealth n = 5). Participants in the control group experienced 1.15 times as many hours of LWT as the supervised group, and 5.51 times as many hours of LWT as the telehealth group. CONCLUSIONS: Worksite exercise, delivered by on-site supervision or telehealth, can reduce LWT related to LBP in career firefighters.

Sacroiliac Joint Hypermobility Biomechanics and What it Means for Health Care Providers and Patients.

Sacroiliac joint dysfunction is complex with numerous etiologies. Proper stabilization of the sacroiliac joint allows for effective transfer of loads between the trunk and the lower extremities during static and dynamic activities, while maintaining a freely nutating motion. A loss of integrity of the stabilizing soft-tissue structures inhibits the ability to transmit axial loads and creates uneven stresses on the joint and surrounding tissues. Hypermobility of the sacroiliac joint can be caused by ligamentous instability or secondary to adaptive biomechanical changes and increased stresses affecting the joints of the pelvis. This article examines the current evidence related to the loss of stability on sacroiliac joint pain and dysfunction. A review of exercise goals for the hypermobile joint is included.

Comparison of the firefighter candidate physical ability test to weight lifting exercises using electromyography.

BACKGROUND: Muscular strength and endurance are important attributes for structural firefighting. Matching resistance exercises to firefighter job demands is not well-established. OBJECTIVE: This study compared the electromyographic (EMG) activity of major muscles during the Candidate Physical Ability Test (CPAT) and weight lifting exercises in firefighters. METHODS: A repeated measures study was conducted in 13 full-duty career firefighters (1 F, 12 M; age 18-44 years). Participants completed seven weight lifting exercises at a university laboratory. They separately completed the CPAT at a firefighting training grounds. During each activity, surface EMG (% maximum voluntary isometric contraction - MVIC) of major muscle groups was recorded and compared between exercises and CPAT. RESULTS: No difference in EMG activity was observed between exercises and CPAT for the deltoid, trapezius, lumbar multifidus, gluteal, and biceps femoris muscles. EMG activity was significantly greater during the CPAT for the abdominal obliques (32.3% ±27.7% vs. 12.1% ±8.3%, p <  0.001) and for the latissimus dorsi (21.8% ±25.1% vs. 11.4% ±7.7%, p <  0.001). CONCLUSIONS: Standard weight lifting and abdominal oblique exercises should be incorporated into resistance training programs for firefighters.