Work-related outcomes in individuals with and without lower limb osteoarthritis: an online survey.

OBJECTIVE: While osteoarthritis (OA) affects people who are still participating in the workforce, there is limited data about the impact of OA on work. The aim of this study was to compare work participation in individuals with and without lower limb OA. METHODS: This cross-sectional study included workers with (n = 124) and without (n = 106) lower limb OA. Work participation was assessed as work status (full/part time work), work ability (Work Ability Index (WAI)), absenteeism and presenteeism (World Health Organization's Health and Work Performance Questionnaire (WHO-HPQ)), and perceived difficulties meeting work demands (Work Role Functioning Questionnaire (WRFQ)). The data were analyzed using an analysis of covariance with age, body mass index and physical job demands included as covariates. RESULTS: Work ability was poorer (p < 0.001) and loss of work performance (p < 0.001) was higher among workers with OA than healthy controls. There was no statistical difference in absenteeism or overall ability to meet work demands between participants with and without lower limb OA. However, workers with lower limb OA had more difficulty with work scheduling demands (p = 0.05) and physical demands (p = 0.003) than healthy workers. CONCLUSION: Lower limb OA was associated with poorer work ability, loss of work performance and difficulty in meeting physical and work scheduling demands. Health professionals and employers should consider these challenges when managing individuals with lower limb OA and supporting them to remain in the workforce.

Experiences of Working with Lower Limb Osteoarthritis: A Qualitative Study.

PURPOSE: Pain and disability associated with lower limb osteoarthritis (OA) may contribute to difficulties at work. This study aimed to understand the perspectives of workers with lower limb OA on difficulties, concerns, and coping strategies used at work. METHODS: Twenty-two individuals with lower limb OA who were working in paid employment participated in semi-structured interviews. Data were qualitatively analyzed using an inductive thematic approach. Codes were identified and refined through review of interview transcripts and discussion with the research team. RESULTS: Six themes were identified in relation to experiences working with lower limb OA. Themes were as follows: weight-bearing physical demands are challenging; lower limb OA can affect work performance; emotional consequences of pain; concerns about work in the future; positive experiences of supportive colleagues and managers; and minimal effects on sedentary work. Three themes were identified relating to strategies to manage at work: adjustments at work help manage pain and avoid exacerbations; regular strategies to manage pain; and healthcare professionals are consulted, but usually not specifically for work. CONCLUSIONS: Workers with lower limb OA experience physical and emotional difficulties at work that can impact work performance. Workers are concerned about longevity and job security and use a range of strategies to manage symptoms and remain at work. Employers, employees, and healthcare professionals may need to work together to create workplace accommodations to help workers with lower limb OA confidently remain in work.

Experiences of people with cancer who have participated in a hospital-based exercise program: a qualitative study.

PURPOSE: Exercise interventions for people with cancer and cancer survivors improve physical health, fatigue, and quality of life. Despite these benefits, poor adherence to exercise is an ongoing challenge among this population. In order to improve adherence in clinical services, this study aims to explore the benefits, challenges, barriers, and facilitators experienced by people with cancer and cancer survivors who participated in a hospital-based exercise program, specifically those who completed or did not complete the full program. METHODS: This study involved a qualitative approach. People with a cancer diagnosis who did complete (completers, n = 11) and did not complete (non-completers, n = 4) a 12-session exercise program at a tertiary hospital were recruited. Semi-structured interviews were conducted and thematic analysis was employed to identify emergent themes. RESULTS: Perceived benefits of exercise was the most prominent theme to emerge, with most participants recognizing improvements in physical, mental, and/or social well-being. Non-completers focused on treatment-related side effects, whereas completers saw an opportunity to return to a healthy lifestyle. The transition from a supervised environment to everyday life presented as the most significant barrier to exercise beyond the program among both program completers and non-completers. CONCLUSIONS: Most people with cancer identified physical, mental, and social benefits from exercising. However, people with cancer and cancer survivors had difficulty maintaining exercise participation beyond completion of a supervised hospital-based program. IMPLICATIONS: Improving exercise participation in people with cancer and cancer survivors may require supervised exercise interventions plus the implementation of strategies to manage side effects and to facilitate the transition of exercise into everyday life to enhance long-term adherence.

Do women runners report more pelvic floor symptoms than women in CrossFit®? A cross-sectional survey.

INTRODUCTION AND HYPOTHESIS: Women who perform high-impact activities might be at greater risk of pelvic floor dysfunction (PFD) than those participating in low-impact exercise; however, little is known about whether PFD is more common in one type of high-impact activity than another. The aim of this study was to compare the prevalence of PFD symptoms in women who engage in high-impact activity compared with CrossFit®-brand training (CF). METHODS: An online survey collected data from 1,379 women (521 runners, 858 CF) on exercise participation, parity, and PFD symptoms, via the Pelvic Floor Distress Inventory (PFDI-20). Specific questions from each PFDI-20 subscale further investigated symptoms of pelvic organ prolapse (POP), anal incontinence (AI), as well as stress (SUI) and urgency (UUI) urinary incontinence. RESULTS: Symptoms of POP and AI were significantly higher in runners (POP 12.7%, AI 34.0%) than in CF (POP 7.8%, p = 0.003; AI 27.7%, p = 0.014). There was no significant difference in SUI symptoms between groups (37.0% vs 41.0% respectively, p = 0.141). Vaginally parous runners reported significantly more symptoms of POP (19.0% vs 12.2%, p = 0.023), AI (39.3% vs 27.2%, p = 0.001), and UUI (36.3% vs 29.0%, p = 0.037) than CF. CONCLUSION: Women, particularly parous women, who participate in running, have a higher prevalence of POP and AI symptoms than women who participate in CF. This suggests that CrossFit®-brand training might not be more detrimental to PFD symptoms than other high-impact activity, such as running. This study does not conclude a pelvic floor health benefit of one exercise over another, but highlights that exercise options can be provided to women.

Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework-an international multidisciplinary consensus.

BACKGROUND: Despite being the most commonly incurred sports injury with a high recurrence rate, there are no guidelines to inform return to sport (RTS) decisions following acute lateral ankle sprain injuries. We aimed to develop a list of assessment items to address this gap. METHODS: We used a three-round Delphi survey approach to develop consensus of opinion among 155 globally diverse health professionals working in elite field or court sports. This involved surveys that were structured in question format with both closed-response and open-response options. We asked panellists to indicate their agreement about whether or not assessment items should support the RTS decision after an acute lateral ankle sprain injury. The second and third round surveys included quantitative and qualitative feedback from the previous round. We defined a priori consensus being reached at >70% agree or disagree responses. RESULTS: Sixteen assessment items reached consensus to be included in the RTS decision after an acute lateral ankle sprain injury. They were mapped to five domains with 98% panellist agreement-PAASS: Pain (during sport participation and over the last 24 hours), Ankle impairments (range of motion; muscle strength, endurance and power), Athlete perception (perceived ankle confidence/reassurance and stability; psychological readiness), Sensorimotor control (proprioception; dynamic postural control/balance), Sport/functional performance (hopping, jumping and agility; sport-specific drills; ability to complete a full training session). CONCLUSION: Expert opinion indicated that pain severity, ankle impairments, sensorimotor control, athlete perception/readiness and sport/functional performance should be assessed to inform the RTS decision following an acute lateral ankle sprain injury. TRIAL REGISTRATION NUMBER: ACTRN12619000522112.

Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to determine the prevalence of symptoms of pelvic organ prolapse (POP), defined as the sensation of a vaginal bulge, and associated risk factors in women over 18 years of age who lift light (≤15 kg), moderate (16-50 kg), and heavy (>50 kg) weights for exercise, and those who do not lift weights for exercise. METHODS: Women completed an online survey about risk factors for pelvic floor dysfunctions, physical activity history, and pelvic floor symptoms. A question about a vaginal bulge sensation from the validated Pelvic Floor Distress Inventory (PFDI-20) was used to indicate symptoms of POP. Relationships between symptoms of POP and possible risk factors were assessed through logistic regression analysis. RESULTS: Of the 3,934 survey participants, the total prevalence of POP symptoms was 14.4% (n = 566). Category of weight lifted, age, vaginal parity, history of constipation or hemorrhoids, and family history of POP were significantly associated with symptoms. Physically active women lifting weights ≤15 kg were more likely to report symptoms of pelvic organ prolapse than women lifting weights greater than 50 kg (59.7% vs 15.2%; adjusted odds ratio 2.1; 95% confidence interval 1.7-3.4). There was no relationship between POP symptoms and body mass index, forceps delivery, cesarean section, hysterectomy, or menopausal status. CONCLUSION: Physically active women who lift heavy weights for exercise do not have an increased prevalence of POP symptoms. Advice on the contribution of heavy weight lifting as part of a physical activity regime to the pathophysiology of POP requires further investigation.

Is chronic ankle instability associated with impaired muscle strength? Ankle, knee and hip muscle strength in individuals with chronic ankle instability: a systematic review with meta-analysis.

OBJECTIVE: Determine whether impairments in lower limb muscle strength exist in individuals with chronic ankle instability (CAI) compared with uninjured controls. DESIGN: Systematic review with meta-analysis. DATA SOURCE: A comprehensive search of PubMed, Cochrane, CINAHL, Web of Science and EMBASE electronic databases from inception to 10 February 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Cross-sectional and case-control studies were included if they objectively measured lower limb muscle strength in individuals with CAI compared with controls. Risk of bias and quality of included studies were assessed. Data of included studies were extracted, and meta-analysis was conducted where appropriate. RESULTS: 12 397 unique studies were identified, of which 20 were included and 16 were eligible for meta-analysis. Reviewed studies clearly described the aim/hypothesis and main outcome measure, but most lacked sample size calculation and assessor blinding. Meta-analyses showed individuals with CAI had lower eccentric and concentric evertor strength (30 and 120°/s; Nm; standardised mean difference (SMD) between -0.73 and -0.95), eccentric invertor strength (60 and 120°/s; both Nm and Nm/kg; SMD between -0.61 and -1.37), concentric invertor strength (60 and 120°/s; Nm; SMD=-0.7) and concentric knee extensor strength (SMD=-0.64) compared with control participants. Ankle eccentric dorsiflexor strength was not different between groups. Although pooling was not possible, data from three separate studies indicated that hip flexor, abductor and external rotator strength, but not hip adductor and extensor strength, was lower in individuals with CAI than in control participants. CONCLUSION: Individuals with CAI have ankle inversion and eversion strength deficits. Our data also point to differences between individuals with CAI and controls in hip and knee strength. These elements of the kinetic chain should be evaluated by clinicians who rehabilitate individuals with CAI. PROSPERO REGISTRATION NUMBER: CRD42016037759.

The experience of persistent pain and quality of life among women following treatment for breast cancer: An attachment perspective.

OBJECTIVES: The aims of this study were to investigate associations between attachment and the presence of persistent pain in women following treatment for breast cancer and to investigate the relationship between attachment, pain, and quality of life (QOL) in women with persistent pain. METHODS: Women (N = 335) previously diagnosed with primary non-metastatic breast cancer completed an online survey with measures of attachment, pain, QOL, demographics, and medical history. Variables were compared between women with (N = 128) and without (N = 207) persistent pain. For those reporting pain, regression analyses were conducted to investigate relationships between attachment, pain, and QOL. RESULTS: Higher attachment anxiety, but not attachment avoidance, was related to the presence of persistent pain. Among women with persistent pain, associations between attachment anxiety and avoidance and greater pain intensity were lost when pain catastrophizing was considered in analysis. Significant associations between attachment and diminished QOL and perceived effectiveness of pain management were identified in multivariate analysis. CONCLUSIONS: These findings extend the available literature regarding associations between pain and attachment insecurity. In women with pain after breast cancer treatment, attachment anxiety and avoidance were associated with negative pain and QOL outcomes. Further attention regarding the use of attachment-informed approaches in supporting women following breast cancer treatment is indicated.

Skill not athleticism predicts individual variation in match performance of soccer players.

Just as evolutionary biologists endeavour to link phenotypes to fitness, sport scientists try to identify traits that determine athlete success. Both disciplines would benefit from collaboration, and to illustrate this, we used an analytical approach common to evolutionary biology to isolate the phenotypes that promote success in soccer, a complex activity of humans played in nearly every modern society. Using path analysis, we quantified the relationships among morphology, balance, skill, athleticism and performance of soccer players. We focused on performance in two complex motor activities: a simple game of soccer tennis (1 on 1), and a standard soccer match (11 on 11). In both contests, players with greater skill and balance were more likely to perform better. However, maximal athletic ability was not associated with success in a game. A social network analysis revealed that skill also predicted movement. The relationships between phenotypes and success during individual and team sports have potential implications for how selection acts on these phenotypes, in humans and other species, and thus should ultimately interest evolutionary biologists. Hence, we propose a field of evolutionary sports science that lies at the nexus of evolutionary biology and sports science. This would allow biologists to take advantage of the staggering quantity of data on performance in sporting events to answer evolutionary questions that are more difficult to answer for other species. In return, sports scientists could benefit from the theoretical framework developed to study natural selection in non-human species.

Inequalities in long term health-related quality of life between partnered and not partnered breast cancer survivors through the mediation effect of social support.

OBJECTIVE: To compare long-term quality of life outcomes by marital status among women living with breast cancer, and to test the mediation effects of social support as an underlying factor. METHODS: Data are drawn from 1996 to 2010 of the Australian Longitudinal Study on Women's Health. The sample included 505 women with breast cancer with six years of follow-up data. Social support was measured by the Medical Outcomes Study Social Support Survey (MOS-SSS). Physical and mental health-related quality of life (HRQOL) was measured using the Short-Form Health Survey (SF-36). RESULTS: Breast cancer survivors who did not have a partner, compared to those who had a partner, had significantly lower levels of social support, which was associated with poorer HRQOL. Social support mediated the relationship between not having a partner and poorer HRQOL. Results were consistent after taken into consideration socio-demographic characteristics, which included age, highest level of education, country of birth, and area of residence. CONCLUSIONS: Women recovering from breast cancer who do not have partners have poorer physical and mental HRQOL, than those with partners, with a lack of social support as an underlying inequality. Partners of breast cancer survivors are importance sources in the provision of social support to help them maintain well-being and quality of life. Copyright © 2016 John Wiley & Sons, Ltd.

Multivariate analyses of individual variation in soccer skill as a tool for talent identification and development: utilising evolutionary theory in sports science.

The development of a comprehensive protocol for quantifying soccer-specific skill could markedly improve both talent identification and development. Surprisingly, most protocols for talent identification in soccer still focus on the more generic athletic attributes of team sports, such as speed, strength, agility and endurance, rather than on a player's technical skills. We used a multivariate methodology borrowed from evolutionary analyses of adaptation to develop our quantitative assessment of individual soccer-specific skill. We tested the performance of 40 individual academy-level players in eight different soccer-specific tasks across an age range of 13-18 years old. We first quantified the repeatability of each skill performance then explored the effects of age on soccer-specific skill, correlations between each of the pairs of skill tasks independent of age, and finally developed an individual metric of overall skill performance that could be easily used by coaches. All of our measured traits were highly repeatable when assessed over a short period and we found that an individual's overall skill - as well as their performance in their best task - was strongly positively correlated with age. Most importantly, our study established a simple but comprehensive methodology for assessing skill performance in soccer players, thus allowing coaches to rapidly assess the relative abilities of their players, identify promising youths and work on eliminating skill deficits in players.

MLi-2, a Potent, Selective, and Centrally Active Compound for Exploring the Therapeutic Potential and Safety of LRRK2 Kinase Inhibition.

Mutations in the leucine-rich repeat kinase 2 (LRRK2) gene are the most common genetic cause of familial and sporadic Parkinson's disease (PD). That the most prevalent mutation, G2019S, leads to increased kinase activity has led to a concerted effort to identify LRRK2 kinase inhibitors as a potential disease-modifying therapy for PD. An internal medicinal chemistry effort identified several potent and highly selective compounds with favorable drug-like properties. Here, we characterize the pharmacological properties of cis-2,6-dimethyl-4-(6-(5-(1-methylcyclopropoxy)-1H-indazol-3-yl)pyrimidin-4-yl)morpholine (MLi-2), a structurally novel, highly potent, and selective LRRK2 kinase inhibitor with central nervous system activity. MLi-2 exhibits exceptional potency in a purified LRRK2 kinase assay in vitro (IC50 = 0.76 nM), a cellular assay monitoring dephosphorylation of LRRK2 pSer935 LRRK2 (IC50 = 1.4 nM), and a radioligand competition binding assay (IC50 = 3.4 nM). MLi-2 has greater than 295-fold selectivity for over 300 kinases in addition to a diverse panel of receptors and ion channels. Acute oral and subchronic dosing in MLi-2 mice resulted in dose-dependent central and peripheral target inhibition over a 24-hour period as measured by dephosphorylation of pSer935 LRRK2. Treatment of MitoPark mice with MLi-2 was well tolerated over a 15-week period at brain and plasma exposures >100× the in vivo plasma IC50 for LRRK2 kinase inhibition as measured by pSer935 dephosphorylation. Morphologic changes in the lung, consistent with enlarged type II pneumocytes, were observed in MLi-2-treated MitoPark mice. These data demonstrate the suitability of MLi-2 as a compound to explore LRRK2 biology in cellular and animal models.

Senior physiotherapy students as standardised patients for junior students enhances self-efficacy and satisfaction in both junior and senior students.

BACKGROUND: Standardised patients are used in medical education to expose students to clinical contexts and facilitate transition to clinical practice, and this approach is gaining momentum in physiotherapy programs. Expense and availability of trained standardised patients are factors limiting widespread adoption, and accessing clinical visits with real patients can be challenging. This study addressed these issues by engaging senior students as standardised patients for junior students. It evaluated how this approach impacted self-reported constructs of both the junior and senior students. METHODS: Learning activities for undergraduate physiotherapy students were developed in five courses (Neurology, Cardiorespiratory and three Musculoskeletal courses) so that junior students (Year 2 and 3) could develop skills and confidence in patient interview, physical examination and patient management through their interaction with standardised patients played by senior students (Year 4). Surveys were administered before and after the interactions to record junior students' self-reported confidence, communication, preparedness for clinic, and insight into their abilities; and senior students' confidence and insight into what it is like to be a patient. Satisfaction regarding this learning approach was surveyed in both the junior and senior students. RESULTS: A total of 253 students completed the surveys (mean 92.5% response rate). Across all courses, junior students reported a significant (all P < 0.037) improvement following the standardised patient interaction in their: preparedness for clinic, communication with clients, confidence with practical skills, and understanding of their strengths and weaknesses in relation to the learning activities. Senior students demonstrated a significant improvement in their confidence in providing feedback and insight into their own learning (P < 0.001). All students reported high satisfaction with this learning experience (mean score 8.5/10). CONCLUSION: This new approach to peer-assisted learning using senior students as standardised patients resulted in positive experiences for both junior and senior students across a variety of physiotherapy areas, activities, and stages within a physiotherapy program. These findings support the engagement of senior students as standardised patients to enhance learning within physiotherapy programs, and may have application across other disciplines to address challenges associated with accessing real patients via clinical visits or utilising actors as standardised patients.

Concerns beyond ankle symptoms predominate healthcare professionals' views of patients with ankle osteoarthritis: A qualitative study.

OBJECTIVES: Explore healthcare professionals' perspectives on the main problems that their patients with ankle osteoarthritis experience and to propose health-related domains. METHODS: A qualitative study using semi-structured interviews was conducted with an international multidisciplinary group of healthcare professionals identified as ankle experts. Eligibility criteria were aged ≥18 years, and a certified healthcare professional with ≥ 5-year experience post-qualification in working with ankle osteoarthritis and/or chronic ankle pain. Interviews were recorded, transcribed verbatim and thematically analysed. RESULTS: Twenty-one healthcare professionals (20 males; mean (range) age 49 (34-72) years) from four professions (orthopaedic surgeons (n = 9), athletic trainers (n = 5), physiotherapists (n = 4) and podiatrists (n = 3)) were interviewed. Four main themes were identified: 1) people with ankle osteoarthritis have difficulty with weight-bearing activities; 2) symptoms of pain and stiffness predominate, alongside swelling, instability, weakness and poor balance; 3) chronic pain in ankle osteoarthritis has psychosocial consequences; and 4) the loss of activities of daily living and independence compromises quality of life. We proposed 15 health-related domains that emerge from the interview data. CONCLUSION: Healthcare professionals recognise that ankle osteoarthritis patients have difficulty in physical, sporting, and occupational weight-bearing activities, and they live with persistent ankle pain, stiffness and other symptoms that have physical and psychosocial consequences. The health-related domains derived from interviews with expert healthcare professionals will contribute to the development of a core domain set for ankle osteoarthritis.

Work-related interventions are not commonly included in physiotherapy management of lower limb osteoarthritis: A cross-sectional survey of Australian Physiotherapists.

BACKGROUND: Lower limb osteoarthritis (OA) is a leading cause of disability and can affect an individual's ability to work. OBJECTIVES: To explore Australian physiotherapists' use of work-related interventions in managing patients with lower limb OA, and identify current management practices. METHODS: Physiotherapists with at least two years of experience treating patients with lower limb OA were invited to complete an online survey to understand how physiotherapists manage patients with lower limb OA, specifically regarding interventions related to work. RESULTS: A total of 132 physiotherapists completed the survey. In free text responses, only 1.5% and 2.3% of physiotherapists nominated work-related items in their key components of treatment or educational topics discussed with patients with lower limb OA, respectively. From a range of work-related activities presented, over half of physiotherapists indicated they regularly/always provided education about the benefits of remaining in work (63.5%) and advice on managing symptoms at work (57.4%). Less than 10% of physiotherapists regularly/always used a validated scale to identify barriers for work (9.6%), discussed absences from work (9.6%), conducted a workplace assessment (4.4%), and discussed submitting workers' compensation claims (2.6%). Exercise and patient education were the most frequently nominated physiotherapy treatments in free text (96.2% and 86.3%, respectively) and fixed response (99.2% and 93.9%, respectively) questions. CONCLUSION: Many physiotherapists do not address work-related activities in their management of patients with lower limb OA. In light of work-related challenges commonly experienced by individuals with lower limb OA, this is an important aspect of management of this condition.

Coach perspectives on factors that influence the implementation of injury prevention programs in community netball: A qualitative study.

OBJECTIVE: The Netball KNEE Program is an injury prevention program (IPP) developed by Netball Australia. It is promoted to coaches, but implementation is limited. This study explored community netball coaches' perspectives on factors that influence IPP implementation, and ideas on how it could be improved. METHODS: Twenty-four coaches from 16 netball clubs participated in semi-structured interviews that asked about their beliefs about injury prevention, use of and confidence in delivering IPP, barriers and facilitators to implementation, and suggestions to ease IPP implementation. Interviews were analysed using inductive thematic analysis. RESULTS: Two themes were identified - Factors that influence IPP implementation (4 sub-themes), and Suggestions to improve IPP implementation (2 sub-themes). Coaches thought early development of injury prevention habits was important. Life roles, coaching experience and engagement with development courses influenced IPP delivery. Coaches expressed concerns about Netball KNEE program length and complexity and lack of implementation support. They suggested the need for a short simple IPP and engagement with health/exercise professionals for implementation. CONCLUSIONS: This study engaged with stakeholders to identify barriers that need to be addressed to improve IPP implementation in netball. Coaches desired a short simple standardised IPP, and training from physiotherapists or exercise professionals on implementation.

An exploration of footwear preferences, attitudes and beliefs in people with knee osteoarthritis: A qualitative study.

BACKGROUND: Although footwear can improve pain and function in individuals with knee osteoarthritis (OA), perspectives about footwear in this population have not been explored. OBJECTIVES: This qualitative study explored preferences, attitudes and beliefs about footwear in adults with knee OA. METHODS: Twenty individuals with a clinical diagnosis of knee OA (aged 45-79 years, 65% women) participated in semi-structured interviews about factors which influence footwear selection, the effect of footwear on knee symptoms, and footwear modifications. Data were analysed thematically. RESULTS: Four themes, with sub-themes, were identified: i) there are specific footwear characteristics people look for, with comfort as their top priority; ii) shoe appearance is important; iii) footwear can aggravate or ease symptoms; and iv) people with knee OA find footwear in a variety of ways. Participants related built-in arch support, a cushioned insole and low/no heel, without addition of foot orthoses, to comfort, and were willing to pay more for comfort and quality. Appearance was also a consideration, and participants indicated they would tolerate short periods of symptom aggravation for aesthetic shoes. Participants felt that footwear choice affected their knee symptoms and risk of slipping/twisting. Participants reported that their footwear choices were determined through trial-and-error, and sometimes on advice from health professionals or shoe store salespersons. CONCLUSIONS: There are specific footwear features important to individuals with knee OA. Knowledge of these features can be used by health professionals to inform footwear discussions with knee OA patients and serve as considerations when developing footwear targeted for this population.

Implementing good life with osteoArthritis from Denmark (GLA:D®) in Australian public hospitals. Part 2: Service providers' perceptions.

BACKGROUND: Previous literature has reported the successful implementation of the Good Life with osteoArthritis in Denmark (GLA:D®) program into predominantly private practice settings. There may be unique challenges present within the public hospital setting that influence GLA:D® implementation in public health. OBJECTIVE: Explore the attitudes and experiences of service providers directly involved in implementing GLA:D® in Australian public tertiary hospitals. DESIGN: Qualitative descriptive study design. METHOD: Service providers (n = 14) from three participating hospitals took part in semi-structured focus groups at the completion of the 6-month implementation period. Inductive thematic analysis was employed to identify primary domains across all facilities. RESULTS: Four broad domains were identified. Factors that influenced uptake included GLA:D® being a recognisable, evidence-based product requiring minimal development or adaptation. The fidelity of the GLA:D® Australia program was challenged by referral of patients with multiple/complex medical comorbidities, and patient preference to complete registry data via paper rather than online. Several operational considerations are required when delivering GLA:D® in a public hospital setting, including adequate numbers of GLA:D®-trained staff, additional screening requirements, obtaining appropriate clinical space, and persisting patient barriers to attending the service. GLA:D® provided benefits beyond improvement in pain and function, including social interactivity, high attendance and promotion of long-term self-management, while also maximising service efficiencies. CONCLUSIONS: Implementing GLA:D® in Australian public hospitals was supported by service providers. Specific operational and administrative factors, including staff training, patient complexity, and registry requirements should be considered when attempting to embed and sustain GLA:D® in large Australian public tertiary hospitals.

Implementing good life with osteoArthritis from Denmark (GLA:D®) in australian public hospitals. Part 1: Feasibility.

BACKGROUND: Literature reporting positive outcomes from the Good Life with osteoArthritis in Denmark (GLA:D®) program in Australia mainly involves patients attending private physiotherapy services. OBJECTIVE: Evaluate the feasibility of implementing GLA:D® in Australian public hospitals. DESIGN: Implementation study in three metropolitan tertiary public hospitals over six months. METHOD: Patients aged ≥18 years with knee or hip joint-related problems deemed appropriate for non-surgical care were invited to participate in GLA:D®. Feasibility was evaluated using RE-AIM framework components (Implementation, Effectiveness, Maintenance) using service-level metrics, patient-level data, and program fidelity assessment. Findings of qualitative interviews with service providers are presented in Part 2. RESULTS: Implementation: 70 patients (69 with knee osteoarthritis) participated (13 cohorts). 55 (79%) patients attended both education sessions, and 49 patients (70%) attended 10-12 exercises sessions. Fidelity was met based on environmental, therapist, participant- and program-related criteria. EFFECTIVENESS: At 3 months, patients reported lower average pain (visual analogue scale [0-100 mm]: effect size -0.56, 95% CI -0.88 to -0.23) and disability (HOOS/KOOS-12 [100-0]: 0.67, 0.28 to 1.05), and improved quality of life (EQ-5D overall score: 0.46, 0.11 to 0.80). No adverse events were reported. All patients who completed 3-month assessment (n = 52) would recommend GLA:D®. Maintenance: All participating services elected to continue delivering GLA:D® beyond the study. CONCLUSIONS: Implementing GLA:D® in Australian public hospitals is feasible, safe, and acceptable to patients with knee osteoarthritis. Public hospital patients with knee osteoarthritis reported improvements in pain, disability, and quality of life similar to previous GLA:D® cohorts.

Identification of 2-aminooxazole amides as acyl-CoA: diacylglycerol acyltransferase 1 (DGAT1) inhibitors through scaffold hopping strategy.

A scaffold hopping strategy was successfully applied in discovering 2-aminooxazole amides as potent DGAT1 inhibitors for the treatment of dyslipidemia. Further optimization in potency and PK properties resulted in a lead series with oral in vivo efficacy in a mouse postprandial triglyceridemia (PPTG) assay.