How can UK public health initiatives support each other to improve the maintenance of physical activity? Evidence from a cross-sectional survey of runners who move from Couch-to-5k to parkrun.

Physical activity improves physical and mental well-being and reduces mortality risk. However, only a quarter of adults globally meet recommended physical activity levels for health. Two common initiatives in the UK are Couch-to-5k (an app-assisted 9-week walk/run programme) and parkrun (a free, weekly, timed 5-km walk/run). It is not known how these initiatives are linked, how Couch-to-5k parkrunners compare to parkrunners, and the extent to which this influences their parkrun performance. The aims were to compare the characteristics and motives and to compare physical activity levels, parkrun performance and the impact of parkrun between Couch-to-5k parkrunners and parkrunners. Three thousand two hundred and ninety six Couch-to-5k parkrunners were compared to 55,923 parkrunners to explore age, sex, ethnicity, employment status, neighbourhood deprivation, motives, physical activity levels, parkrun performance and the impact of parkrun. Couch-to-5k parkrunners were slightly older, more likely to be female and work part-time, but similar in ethnicity, and neighbourhood deprivation compared with other parkrunners. Couch-to-5k parkrunners had different motives for participation and reported high levels of physical activity at registration, which remained to the point of survey completion. This group had slower parkrun times but, when registered for a year, completed a similar number of runs (11) per year. Larger proportions of Couch-to-5k parkrunners perceived positive impacts compared with other parkrunners and 65% of Couch-to-5k parkrunners reported improvements to their lifestyle. parkrun appears to be an effective pathway for those on the Couch-to-5k programme, and the promising positive association between the two initiatives may be effective in assisting previously inactive participants to take part in weekly physical activity.

Running shoes for preventing lower limb running injuries in adults.

BACKGROUND: Lower-limb running injuries are common. Running shoes have been proposed as one means of reducing injury risk. However, there is uncertainty as to how effective running shoes are for the prevention of injury. It is also unclear how the effects of different characteristics of running shoes prevent injury. OBJECTIVES: To assess the effects (benefits and harms) of running shoes for preventing lower-limb running injuries in adult runners. SEARCH METHODS: We searched the following databases: CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus and SPORTDiscus plus trial registers WHO ICTRP and ClinicalTrials.gov. We also searched additional sources for published and unpublished trials. The date of the search was June 2021. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs involving runners or military personnel in basic training that either compared a) a running shoe with a non-running shoe; b) different types of running shoes (minimalist, neutral/cushioned, motion control, stability, soft midsole, hard midsole); or c) footwear recommended and selected on foot posture versus footwear not recommended and not selected on foot posture for preventing lower-limb running injuries. Our primary outcomes were number of people sustaining a lower-limb running injury and number of lower-limb running injuries. Our secondary outcomes were number of runners who failed to return to running or their previous level of running, runner satisfaction with footwear, adverse events other than musculoskeletal injuries, and number of runners requiring hospital admission or surgery, or both, for musculoskeletal injury or adverse event. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility and performed data extraction and risk of bias assessment. The certainty of the included evidence was assessed using GRADE methodology. MAIN RESULTS: We included 12 trials in the analysis which included a total of 11,240 participants, in trials that lasted from 6 to 26 weeks and were carried out in North America, Europe, Australia and South Africa. Most of the evidence was low or very low certainty as it was not possible to blind runners to their allocated running shoe, there was variation in the definition of an injury and characteristics of footwear, and there were too few studies for most comparisons. We did not find any trials that compared running shoes with non-running shoes. Neutral/cushioned versus minimalist (5 studies, 766 participants) Neutral/cushioned shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with minimalist shoes (low-certainty evidence) (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.59 to 1.01). One trial reported that 67% and 92% of runners were satisfied with their neutral/cushioned or minimalist running shoes, respectively (RR 0.73, 95% CI 0.47 to 1.12). Another trial reported mean satisfaction scores ranged from 4.0 to 4.3 in the neutral/ cushioned group and 3.6 to 3.9 in the minimalist running shoe group out of a total of 5. Hence neutral/cushioned running shoes may make little or no difference to runner satisfaction with footwear (low-certainty evidence). Motion control versus neutral / cushioned (2 studies, 421 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral / cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.92, 95% CI 0.30 to 2.81). Soft midsole versus hard midsole (2 studies, 1095 participants) Soft midsole shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with hard midsole shoes (low-certainty of evidence) (RR 0.82, 95% CI 0.61 to 1.10). Stability versus neutral / cushioned (1 study, 57 participants) It is uncertain whether or not stability shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral/cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.49, 95% CI 0.18 to 1.31). Motion control versus stability (1 study, 56 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with stability shoes because the quality of the evidence has been assessed as very low certainty (RR 3.47, 95% CI 1.43 to 8.40). Running shoes prescribed and selected on foot posture (3 studies, 7203 participants) There was no evidence that running shoes prescribed based on static foot posture reduced the number of injuries compared with those who received a shoe not prescribed based on foot posture in military recruits (Rate Ratio 1.03, 95% CI 0.94 to 1.13). Subgroup analysis confirmed these findings were consistent between males and females. Therefore, prescribing running shoes and selecting on foot posture probably makes little or no difference to lower-limb running injuries (moderate-certainty evidence). Data were not available for all other review outcomes. AUTHORS' CONCLUSIONS: Most evidence demonstrates no reduction in lower-limb running injuries in adults when comparing different types of running shoes. Overall, the certainty of the evidence determining whether different types of running shoes influence running injury rates was very low to low, and as such we are uncertain as to the true effects of different types of running shoes upon injury rates. There is no evidence that prescribing footwear based on foot type reduces running-related lower-limb injures in adults. The evidence for this comparison was rated as moderate and as such we can have more certainty when interpreting these findings. However, all three trials included in this comparison used military populations and as such the findings may differ in recreational runners.  Future researchers should develop a consensus definition of running shoe design to help standardise classification. The definition of a running injury should also be used consistently and confirmed via health practitioners. More researchers should consider a RCT design to increase the evidence in this area. Lastly, future work should look to explore the influence of different types or running shoes upon injury rates in specific subgroups.

The palliative care needs and experiences of people with advanced head and neck cancer: A scoping review.

BACKGROUND: The palliative care needs of people with advanced head and neck cancer pose unique complexities due to the impact the illness has on eating, speaking, appearance and breathing. Examining these needs would help provide guidance about developing relevant models of care and identify gaps in research knowledge. AIM: To identify and map out the palliative care needs and experiences for people with advanced head and neck cancer. DESIGN: A scoping literature review following the methods described by the Joanna Briggs Institute. DATA SOURCES: An electronic search of the literature was undertaken in MEDLINE (Ovid), EMBASE and CINAHL covering the years January 1996 to January 2019. RESULTS: People with advanced head and neck cancer often had palliative care needs but there was variability in the timing and access to relevant services. A high prevalence of interventions, for example hospital admissions were needed even during the last month of life. This was not necessarily negated with early engagement of palliative care. Dissonance between patients and family carers about information needs and decision-making was an additional complexity. Studies tended to be descriptive in nature, and often involved a single centre. CONCLUSION: This scoping review demonstrates the complexity of care for people with advanced head and neck cancer and the issues related to the current healthcare systems. Focus on appropriate referral criteria, increased integration and coordination of care and robust evaluation of specific care components seems key. Linkage between research and service design delivery across teams, disciplines and care settings seems pertinent.

Screening for aspiration risk associated with dysphagia in acute stroke.

BACKGROUND: Stroke can affect people's ability to swallow, resulting in passage of some food and drink into the airway. This can cause choking, chest infection, malnutrition and dehydration, reduced rehabilitation, increased risk of anxiety and depression, longer hospital stay, increased likelihood of discharge to a care home, and increased risk of death. Early identification and management of disordered swallowing reduces risk of these difficulties. OBJECTIVES: Primary objective • To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke Secondary objectives • To assess the influence of the following sources of heterogeneity on the diagnostic accuracy of bedside screening tools for dysphagia - Patient demographics (e.g. age, gender) - Time post stroke that the study was conducted (from admission to 48 hours) to ensure only hyperacute and acute stroke swallow screening tools are identified - Definition of dysphagia used by the study - Level of training of nursing staff (both grade and training in the screening tool) - Low-quality studies identified from the methodological quality checklist - Type and threshold of index test - Type of reference test SEARCH METHODS: In June 2017 and December 2019, we searched CENTRAL, MEDLINE, Embase, CINAHL, and the Health Technology Assessment (HTA) database via the Centre for Reviews and Dissemination; the reference lists of included studies; and grey literature sources. We contacted experts in the field to identify any ongoing studies and those potentially missed by the search strategy. SELECTION CRITERIA: We included studies that were single-gate or two-gate studies comparing a bedside screening tool administered by nurses or other healthcare professionals (HCPs) with expert or instrumental assessment for detection of aspiration associated with dysphagia in adults with acute stroke admitted to hospital. DATA COLLECTION AND ANALYSIS: Two review authors independently screened each study using the eligibility criteria and then extracted data, including the sensitivity and specificity of each index test against the reference test. A third review author was available at each stage to settle disagreements. The methodological quality of each study was assessed using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS-2) tool. We identified insufficient studies for each index test, so we performed no meta-analysis. Diagnostic accuracy data were presented as sensitivities and specificities for the index tests. MAIN RESULTS: Overall, we included 25 studies in the review, four of which we included as narratives (with no accuracy statistics reported). The included studies involved 3953 participants and 37 screening tests. Of these, 24 screening tests used water only, six used water and other consistencies, and seven used other methods. For index tests using water only, sensitivity and specificity ranged from 46% to 100% and from 43% to 100%, respectively; for those using water and other consistencies, sensitivity and specificity ranged from 75% to 100% and from 69% to 90%, respectively; and for those using other methods, sensitivity and specificity ranged from 29% to 100% and from 39% to 86%, respectively. Twenty screening tests used expert assessment or the Mann Assessment of Swallowing Ability (MASA) as the reference, six used fibreoptic endoscopic evaluation of swallowing (FEES), and 11 used videofluoroscopy (VF). Fifteen screening tools had an outcome of aspiration risk, 20 screening tools had an outcome of dysphagia, and two narrative papers did not report the outcome. Twenty-one screening tests were carried out by nurses, and 16 were carried out by other HCPs (not including speech and language therapists (SLTs)). We assessed a total of six studies as low risk across all four QUADAS-2 risk of bias domains, and we rated 15 studies as low concern across all three applicability domains. No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing combined water swallow and instrumental tool was the Bedside Aspiration test (n = 50), the best performing water plus other consistencies tool was the Gugging Swallowing Screen (GUSS; n = 30), and the best water only swallow screening tool was the Toronto Bedside Swallowing Screening Test (TOR-BSST; n = 24). All tools demonstrated combined highest sensitivity and specificity and low risk of bias for all domains. However, clinicians should be cautious in their interpretation of these findings, as these tests are based on single studies with small sample sizes, which limits the estimates of reliability of screening tests. AUTHORS' CONCLUSIONS: We were unable to identify a single swallow screening tool with high and precisely estimated sensitivity and specificity based on at least one trial with low risk of bias. However, we were able to offer recommendations for further high-quality studies that are needed to improve the accuracy and clinical utility of bedside screening tools.

Disease trajectories, place and mode of death in people with head and neck cancer: Findings from the 'Head and Neck 5000' population-based prospective clinical cohort study.

BACKGROUND: Few large studies describe initial disease trajectories and subsequent mortality in people with head and neck cancer. This is a necessary first step to identify the need for palliative care and associated services. AIM: To analyse data from the Head and Neck 5000 study to present mortality, place and mode of death within 12 months of diagnosis. DESIGN: Prospective cohort study. PARTICIPANTS: In total, 5402 people with a new diagnosis of head and neck cancer were recruited from 76 cancer centres in the United Kingdom between April 2011 and December 2014. RESULTS: Initially, 161/5402 (3%) and 5241/5402 (97%) of participants were treated with 'non-curative' and 'curative' intent, respectively. Within 12 months, 109/161 (68%) in the 'non-curative' group died compared with 482/5241 (9%) in the 'curative' group. Catastrophic bleed was the terminal event for 10.4% and 9.8% of people in 'non-curative' and 'curative' groups, respectively; terminal airway obstruction was recorded for 7.5% and 6.3% of people in the same corresponding groups. Similar proportions of people in both groups died in a hospice (22.9% 'non-curative'; 23.5% 'curative') and 45.7% of the 'curative' group died in hospital. CONCLUSION: In addition to those with incurable head and neck cancer, there is a small but significant 'curative' subgroup of people who may have palliative needs shortly following diagnosis. Given the high mortality, risk of acute catastrophic event and frequent hospital death, clarifying the level and timing of palliative care services engagement would help provide assurance as to whether palliative care needs are being met.

Knee problems are common in young adults and associated with physical activity and not obesity: the findings of a cross-sectional survey in a university cohort.

BACKGROUND: Obesity and sedentary behaviour, risk factors for knee osteoarthritis in middle-age, are increasing in younger adults. The objectives of this study were to estimate the prevalence of knee problems in young adults, to characterise these problems and explore the relationship with physical activity, physical inactivity and obesity. METHODS: Presence of knee problems was collected through self-report questionnaire from staff and students of one university aged 18-39; direct measurement of weight and height was taken and activity measured using the International Physical Activity Questionnaire. Twelve-month prevalence of knee problems was estimated. Logistic regression was used to investigate the relationship between knee problems and physical activity levels, sitting time and body mass index. RESULTS: The prevalence of knee problems was high (31.8% [95% CI 26.9 to 37.2%]) among the 314 participants; knee pain was the most common dominant symptom (65%). Only high physical activity levels (OR 2.6 [95% CI 1.4-4.9]) and mental distress (OR 2.3 [95% CI 1.2-4.6]) were independent risk factors for knee problems. CONCLUSIONS: Knee problems were common among young adults, who were staff and students of a university. With increasing obesity prevalence, populations are being encouraged to become more active. More attention may need to be paid towards prevention of knee problems in such programmes, and further research is warranted.

The United Kingdom Field Epidemiology Training Programme: meeting programme objectives.

IntroductionMost evaluations of field epidemiology training programmes (FETP) are limited to process measures, but stakeholders may need evidence of impact.ObjectiveTo ascertain if the United Kingdom (UK) FETP met its objectives to: (i) strengthen capacity and provision of national epidemiology services, (ii) develop a network of highly skilled field epidemiologists with a shared sense of purpose working to common standards and (iii) raise the profile of field epidemiology through embedding it into everyday health protection practice.MethodsThe evaluation consisted of: (i) focus groups with training site staff, (ii) individual interviews with stakeholders and (iii) an online survey of FETP fellows and graduates. Findings were synthesised and triangulated across the three evaluation components to identify cross-cutting themes and subthemes.FindingsEight focus groups were undertaken with 38 staff, ten stakeholders were interviewed and 28 (76%) graduates and fellows responded to the survey. Three themes emerged: confidence, application and rigour. FETP was perceived to have contributed to the development, directly and indirectly, of a skilled workforce in field epidemiology, increasing stakeholders' confidence in the service. Graduates applied their learning in practice, collaborating with a wide range of disciplines. Fellows and graduates demonstrated rigour by introducing innovations, supporting service improvements and helping supervisors maintain their skills and share good practice.ConclusionThe UK FETP appears to have met its three key objectives, and also had wider organisational impact. FETPs should systematically and prospectively collect information on how they have influenced changes to field epidemiology practice.

A questionnaire to identify patellofemoral pain in the community: an exploration of measurement properties.

BACKGROUND: Community-based studies of patellofemoral pain (PFP) need a questionnaire tool that discriminates between those with and those without the condition. To overcome these issues, we have designed a self-report questionnaire which aims to identify people with PFP in the community. STUDY DESIGNS: comparative study and cross-sectional study. STUDY POPULATION: comparative study: PFP patients, soft-tissue injury patients and adults without knee problems. Cross-sectional study: adults attending a science festival. INTERVENTION: comparative study participants completed the questionnaire at baseline and two weeks later. Cross-sectional study participants completed the questionnaire once. The optimal scoring system and threshold was explored using receiver operating characteristic curves, test-retest reliability using Cohen's kappa and measurement error using Bland-Altman plots and standard error of measurement. Known-group validity was explored by comparing PFP prevalence between genders and age groups. RESULTS: Eighty-four participants were recruited to the comparative study. The receiver operating characteristic curves suggested limiting the questionnaire to the clinical features and knee pain map sections (AUC 0.97 95 % CI 0.94 to 1.00). This combination had high sensitivity and specificity (over 90 %). Measurement error was less than the mean difference between the groups. Test-retest reliability estimates suggest good agreement (N = 51, k = 0.74, 95 % CI 0.52-0.91). The cross-sectional study (N = 110) showed expected differences between genders and age groups but these were not statistically significant. CONCLUSION: A shortened version of the questionnaire, based on clinical features and a knee pain map, has good measurement properties. Further work is needed to validate the questionnaire in community samples.

Are there three main subgroups within the patellofemoral pain population? A detailed characterisation study of 127 patients to help develop targeted intervention (TIPPs).

BACKGROUND: Current multimodal approaches for the management of non-specific patellofemoral pain are not optimal, however, targeted intervention for subgroups could improve patient outcomes. This study explores whether subgrouping of non-specific patellofemoral pain patients, using a series of low cost simple clinical tests, is possible. METHOD: The exclusivity and clinical importance of potential subgroups was assessed by applying à priori test thresholds (1 SD) from seven clinical tests in a sample of adult patients with non-specific patellofemoral pain. Hierarchical clustering and latent profile analysis, were used to gain additional insights into subgroups using data from the same clinical tests. RESULTS: 130 participants were recruited, 127 had complete data: 84 (66%) female, mean age 26 years (SD 5.7) and mean body mass index 25.4 (SD 5.83), median (IQR) time between onset of pain and assessment was 24 (7-60) months. Potential subgroups defined by the à priori test thresholds were not mutually exclusive and patients frequently fell into multiple subgroups. Using hierarchical clustering and latent profile analysis three subgroups were identified using 6 of the 7 clinical tests. These subgroups were given the following nomenclature: (1) 'strong', (2) 'weak and tighter' and (3) 'weak and pronated foot'. CONCLUSIONS: We conclude that three subgroups of patellofemoral patients may exist based on the results of six clinical tests which are feasible to perform in routine clinical practice. Further research is needed to validate these findings in other data sets and, if supported by external validation, to see if targeted interventions for these subgroups improve patient outcomes.

Do people who consciously attend to their movements have more self-reported knee pain? An exploratory cross-sectional study.

OBJECTIVES: This study explored the relationship between propensity for conscious control of movement (assessed by the Movement-Specific Reinvestment Scale) and self-reported knee pain. DESIGN: Cross-sectional study. SETTING: General population. SUBJECTS: Adults aged 18 to 55 years of age. MEASURES: Participants completed the movement-specific reinvestment scale and a self-report questionnaire on knee pain at the same time on one occasion. RESULTS: Data was collected on 101 adults of whom 34 (33.7%) self-reported knee pain. Mean scores on the conscious motor processing subscale of the movement-specific reinvestment scale, but not the movement self-consciousness subscale, were significantly higher for participants who reported knee pain within the previous year compared with those who did not (mean difference 3.03; t-test 2.66, df = 97, P = 0.009; 95% confidence interval (CI) 0.77 to 5.30). The association between self-reported knee pain and propensity for conscious motor processing was still observed, even after controlling for movement self-consciousness subscale scores, age, gender and body mass index (adjusted odds ratio 1.16, 95% CI 1.04 to 1.30). CONCLUSIONS: Propensity for conscious control of movement may play a role in knee pain.

Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer.

BACKGROUND: This is an update of a Cochrane review first published in The Cochrane Library in Issue 2, 2002 and previously updated in 2004, 2007 and 2010.Radiotherapy, open surgery and endolaryngeal excision (with or without laser) are all accepted modalities of treatment for early-stage glottic cancer. Case series suggest that they confer a similar survival advantage, however radiotherapy and endolaryngeal surgery offer the advantage of voice preservation. There has been an observed trend away from open surgery in recent years, however equipoise remains between radiotherapy and endolaryngeal surgery as both treatment modalities offer laryngeal preservation with similar survival rates. Opinions on optimal therapy vary across disciplines and between countries. OBJECTIVES: To compare the effectiveness of open surgery, endolaryngeal excision (with or without laser) and radiotherapy in the management of early glottic laryngeal cancer. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 8); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 18 September 2014. SELECTION CRITERIA: Randomised controlled trials comparing open surgery, endolaryngeal resection (with or without laser) and radiotherapy. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We identified only one randomised controlled trial, which compared open surgery and radiotherapy in 234 patients with early glottic laryngeal cancer. The overall risk of bias in this study was high.For T1 tumours, the five-year survival was 91.7% following radiotherapy and 100% following surgery and for T2 tumours, 88.8% following radiotherapy and 97.4% following surgery. There were no significant differences in survival between the two groups.For T1 tumours, the five-year disease-free survival rate was 71.1% following radiotherapy and 100.0% following surgery, and for the T2 tumours, 60.1% following radiotherapy and 78.7% following surgery. Only the latter comparison was statistically significant (P value = 0.036), but statistical significance would not have been achieved with a two-sided test.Data were not available on side effects, quality of life, voice outcomes or cost.We identified no randomised controlled trials that included endolaryngeal surgery. A number of trials comparing endolaryngeal resection and radiotherapy have terminated early because of difficulty recruiting participants. One randomised controlled trial is still ongoing. AUTHORS' CONCLUSIONS: There is only one randomised controlled trial comparing open surgery and radiotherapy but its interpretation is limited because of concerns about the adequacy of treatment regimens and deficiencies in the reporting of the study design and analysis.

Postal and face-to-face administration of stroke outcome measures: can mixed modes be used?

BACKGROUND AND PURPOSE: Different modes of administration are used to collect stroke outcomes, even within the same study, potentially leading to different results. We investigated the effect of administration mode (postal questionnaire; face-to-face interview) on self-reports of activities of daily living and mood. METHODS: The study was nested within a poststroke motivational interviewing trial. Activities of daily living (Barthel; Nottingham Extended) and mood (General Health Questionnaire; Yale) were collected at 3 and 12 months via postal questionnaire. Participants were approached to respond again via face-to-face interview. Paired t tests (McNemar test) and intraclass correlation coefficients (Cohen κ) were used, with 95% CI, to compare scores (items). RESULTS: Forty-four participants consented. Only Barthel scores were significantly different; they were 1.0 (95% CI, 0.5-1.6) higher face-to-face. The intraclass correlation coefficient for the Barthel was 0.90; for the other scales it was between 0.83 and 0.87. The Yale κ was 0.72. CONCLUSIONS: Modes of administration might be used interchangeably, albeit in conjunction with corrections for the Barthel.

"Couch-to-5k or Couch to Ouch to Couch!?" Who Takes Part in Beginner Runner Programmes in the UK and Is Non-Completion Linked to Musculoskeletal Injury?

Physical activity has mental and physical health benefits; however, globally, three-quarters of the population do not meet physical activity guidelines. The Couch-to-5k is a beginner runner programme aimed at increasing physical activity. However, this programme lacks an evidence base, and it is unclear who is attracted to the programme; running also has a high rate of musculoskeletal (MSK) injuries. The aims of this study were to identify the characteristics of people taking part and the incidence of MSK injuries as well as exploring the experiences of people who dropped out of a modified 9-week Couch-to-5k programme. A total of 110 runners (average age was 47.1 ± 13.7 years) participated in the study, which involved completion of questionnaires (running experience and footwear information, quality of life (EQ-5D-5L), physical activity level (IPAQ-short form), MSK injury history and knee condition (SNAPPS and KOOS-PS)) at the start, middle and end of the programme and collecting sociodemographic information (age, gender, social economic status, relationship status, education level), as well as body mass index, running experience, footwear information, quality of life, physical activity levels, MSK injuries and knee condition. Fifteen drop-outs were interviewed to explore experiences of the programme. Runners were mainly females (81.8%) with an average age 47.1 years, average body mass index of 28.1 kg.m2, mainly from high socio-economic levels, married and educated to degree level. In total, 64% of the sample had previous running experience and were classified as active. Half the sample self-reported pain/discomfort and 37.2% reported anxiety/depression at the start of the programme via the EQ-5D-5L scale. Self-reported health scores increased (p = 0.047) between baseline (73.1 ± 18.8 out of 100) and at the midpoint (81.2 ± 11.6), but there were no significant differences between any other time points (end point 79.7 ± 17.5, p > 0.05). Twenty-one injuries were reported during the programme (19%). Previous injury increased the risk of new injury (OR 7.56 95% CI from 2.06 to 27.75). Only 27.3% completed the programme. Three themes emerged from interviews; MSK injury, negative emotions linked to non-completion and design of the programme. The Couch-to-5k may not attract diverse inactive populations, but future work with larger sample sizes is needed to substantiate this finding. Dropping out was linked to MSK injury and progressive design, so future programmes should consider including injury prevention advice and more flexible designs.

Do patients with well-functioning total hip arthroplasty achieve typical sagittal plane hip kinematics? A proof of concept study.

BACKGROUND: Total hip arthroplasty (THA) patients have been shown to not achieve normal sagittal plane hip kinematics. However, previous studies have only conducted group level analysis and as such lack the sensitivity to highlight whether individual patients do achieve normal hip kinematics. As such this study looked to determine whether some patients with well-functioning THA achieve typical sagittal plane hip kinematics. METHODS: Sagittal plane hip kinematics were collected on 11 well-functioning THA patients (Oxford Hip Score = 46 ± 3) and 10 asymptomatic controls using a 3-dimensional motion analysis system during self-paced walking. High-functioning THA patients were identified as those who displayed sagittal plane hip kinematics that were within the variance of the control group on average, and low-functioning patients as those who did not. RESULTS: 5 THA patients were identified as high-functioning, displaying hip kinematics within the variance of the control group. High-functioning THA patients displayed peak hip flexion and extension values more closely aligned to asymptomatic control group than low-functioning patients. However, hip range of motion was comparable between high- and low-functioning total hip arthroplasty patients and reduced compared to controls. CONCLUSION: The presence of high-functioning THA patients who display comparable sagittal plane hip kinematics to controls suggests these patients do achieve normative function and challenges the conclusions of previous group level analysis. Understanding why some patients achieve better function post-operatively will aid pre- and post-operative practices to maximise functional recovery.

Exploring pelvis and thigh movement and coordination patterns during walking in patients after total hip arthroplasty.

BACKGROUND: Patients after total hip arthroplasty (THA) have altered hip kinematics compared to healthy controls, specifically hip extension and range of motion are lower. Exploring pelvis-thigh coordination patterns and coordination variability may help to elucidate why differences in hip kinematics are evident in patients following THA. RESEARCH QUESTION: Do sagittal plane hip, pelvis and thigh kinematics, and pelvis-thigh movement coordination and coordination variability differ between patients following THA and healthy controls during walking? METHODS: Sagittal plane hip, pelvis and thigh kinematics were collected using a three-dimensional motion capture system while 10 patients who had undergone THA and 10 controls walked at a self-selected pace. A modified vector coding technique was used to quantify pelvis-thigh coordination and coordination variability patterns. Peak hip, pelvis and thigh kinematics and ranges of motion, and movement coordination and coordination variability patterns were quantified and compared between groups. RESULTS: Patients after THA have significantly (p ≤ .036; g ≥ 0.995) smaller peak hip extension and range of motion, and peak thigh anterior tilt and range of motion compared to controls. Additionally, patients following THA have significantly (p ≤ .037; g ≥ 0.646) more in-phase distally and less anti-phase distally dominated pelvis-thigh movement coordination patterns compared to controls. SIGNIFICANCE: The smaller peak hip extension and range of motion displayed by patients following THA is due to smaller peak anterior tilt of the thigh, which in turn limits thigh range of motion. The lower sagittal plane thigh, and in turn hip, motion used by patients after THA may be due to increases in the in-phase coordination of pelvis-thigh motion patterns, which cause the pelvis and thigh to work as a singular functional unit.

A systematic review of disease related stigmatization in patients living with prostate cancer.

BACKGROUND: Prostate cancer has been shown to be susceptible to significant stigmatisation, because to a large extent it is concealable, it has potentially embarrassing sexual symptoms and has significant impact on the psychosocial functioning. METHODS: This review included studies that focused on qualitative and/or quantitative data, where the study outcome was prostate cancer and included a measure of stigmatization. Electronic databases (CINAHL, Medline, PubMed, PsycInfo, Cochrane Library, PROSPERO, and the Joanna Briggs Institute) and one database for grey literature Opengrey.eu, were screened. We used thematic analysis, with narrative synthesis to analyse these data. We assessed risk of bias in the included studies using the RoBANS. RESULTS: In total, 18 studies met review inclusion criteria, incorporating a total of 2295 participants. All studies recruited participants with prostate cancer, however four studies recruited participants with other cancers such as breast cancer and lung cancer. Of the 18 studies, 11 studies evaluated perceived or felt stigma; four studies evaluated internalised or self-stigma; three studies evaluated more than one stigma domain. DISCUSSION: We found that patients living with prostate cancer encounter stigmatisation that relate to perception, internalisation, and discrimination experiences. We also identified several significant gaps related to the understanding of prostate cancer stigmatization, which provides an opportunity for future research to address these important public health issues. REGISTRATION: This systematic review protocol is registered with PROSPERO, the international prospective register of systematic reviews in health and social care. Registration number: CRD42020177312.

Fear-related barriers to physical activity among adults with overweight and obesity: A narrative synthesis scoping review.

Physical activity is a health behavior contributing to successful weight management. Adults with overweight and obesity find it challenging to meet recommended activity guidelines because of a range of barriers, some of which are not yet fully understood. A barrier receiving limited consideration, compared with other literature within this field, is that of fear. The purpose of this scoping review was to establish the extent of literature on fear-related barriers to physical activity in adults with overweight or obesity and to identify gaps in this literature. The review followed the scoping review framework outlined by Arksey and O'Malley and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The findings of the identified papers were charted thematically using a framework of fears and age group. In total, 34 studies were included that identified nine different fears related to barriers to activity in this population. However, only a small number of studies (n = 5) had explicitly intended to explore fear-related barriers. There were notable knowledge gaps including activity-related fear of pain and movement in adults under 45 years of age. There is a strong rationale to further explore these fears because they may restrict health promoting behavior.

Measuring outcomes in rotator cuff disorders.

Measuring the outcome of treatment for rotator cuff disorders has evolved over the last three decades. Objective surgeon-derived outcomes such as clinical examination findings and imaging of the rotator cuff have the limitation of marginalising the patients perception of their condition. Patient reported outcome measures (PROMs) have evolved and become popular in an attempt to demonstrate meaningful outcome data. There are a large number in use today and as a result, the heterogeneity of scores used across the literature can make comparison difficult. Patient reported outcome scores can be general health related quality of life scores, joint-specific and disease specific. Qualitative outcomes are also being used now, and these help us to better understand the context of quantitative research scores. In this article, we provide an overview of the outcome measures used in rotator cuff disorders.

Validation and utilisation of a digital version of the survey instrument for natural history, Aetiology and Prevalence of Patellofemoral pain studies (eSNAPPS).

OBJECTIVE: This study validated the newly adapted electronic SNAPPS (eSNAPPS) against the original paper SNAPPS. Subsequently, the study estimated the prevalence of PFP in running participants and spectators attending three mass-participant running events in the United Kingdom by using the eSNAPPS tool. DESIGN: This study had two parts. Firstly, a validation of the original paper version of the SNAPPS tool. Secondly, if validation was achieved, eSNAPPS was used in a prevalence study. PARTICIPANTS: A convenience sample of running participants and spectators aged 18-40 years attending the mass participation running events. MAIN OUTCOME MEASURE: The 12-month prevalence of PFP. RESULTS: eSNAPPS was valid in identifying those with PFP (ICC 0.99 for Overall agreement, p < 0.0001). In the prevalence study, a total of 1080 running participants and spectators completed the eSNAPPS. The overall prevalence of PFP was 17.4% (95%CI: 15.2%, 19.8%); 20.5% of males (16.5, 24.9) and 15.7% of females (13.1, 18.7) had PFP. Prevalence was 17.4% (15.2, 19.8) in spectators and 16.7% in running participants (14.5, 19.0). CONCLUSION: The overall PFP prevalence in this study was slightly smaller than those previously reported in the literature. Findings also show that there were similar prevalence estimates in spectators and running participants.

Can health-related quality of life predict survival in adults with cystic fibrosis?

RATIONALE: Advances in the management of cystic fibrosis have led to a significant improvement in survival, although marked differences between individuals are still observed. The value of patient-reported health-related quality of life scores in predicting survival in adults with cystic fibrosis is unknown. OBJECTIVES: To evaluate whether patient-reported health-related quality of life could predict survival in cystic fibrosis. METHODS: From 1996 to 1997 a consecutive series of 223 patients were recruited to evaluate the Cystic Fibrosis Quality of Life Questionnaire. Demographic (age, sex), clinical (FEV(1)% predicted, body mass index, diabetes, B. Cepacia complex, intravenous access device, nutritional and lung transplant status) and health-related quality of life variables were recorded (Cystic Fibrosis Quality of Life Questionnaire and the SF-36). These data were used as baseline measures to explore the prognostic association of health-related quality of life and subsequent survival. MEASUREMENTS AND MAIN RESULTS: At the census date (December 31, 2006) 154 (69.1%) adults were alive, 66 (29.6%) had died, and three (1.3%) were lost to follow-up. Cox proportional hazards models and bootstrapping procedures examined if health-related quality of life domains predicted survival after adjusting for the demographic and clinical factors. The physical functioning domain of the Cystic Fibrosis Quality of Life Questionnaire and the pain domain of the Short Form-36 had the strongest statistical associations with survival. CONCLUSIONS: Aspects of patient-reported quality of life serve as prognostic measures of survival beyond a number of previously known factors in cystic fibrosis. This needs to be investigated further in a larger longitudinal study.