Reducing work-related stress among health professionals by using a training-based intervention programme for leaders in a cluster randomised controlled trial.

Healthcare organisations worldwide are affected by the shortage of health professionals due to work-related stress and health professional leaders play an important role by implementing effective strategies. Therefore, this study aims to investigate whether the STRAIN intervention program (using evidence-based training for health professional leaders) can reduce work-related stress among health professionals. This study is based on a cluster randomised controlled trial, consists of three measurements and includes 165 participating hospitals, nursing homes and home care organisations. A total of 206 health professional leaders took part in the intervention programme and 19,340 health professionals participated in the study. Results showed no significant differences (p > 0.05) between the intervention and control group regarding the effort-reward imbalance ratio, quantitative demands, opportunities for development, bond with the organisation, quality of leadership, social community, role clarity, rewards, difficulties with demarcation and work-private life conflict. Pre-/post-test analysis revealed a tendency for significant positive results (p < 0.05) for stressors, stress symptoms and long-term consequences for organisations with a leaders' participation rate of ≥ 75%. Leaders' awareness, commitment and readiness is essential to implement effective strategies reducing work-related stress.

Analysis of Injuries in the Swiss U20 Elite Ice Hockey Season 2019/2020-A Retrospective Survey.

(1) Background: In Switzerland, there is little data on injury characteristics in elite ice hockey players aged under 20 years (U20 Elite juniors). This study aimed to determine the injury rate and type of injury in Swiss U20 ice hockey players. (2) Methods: The present study was carried out in a retrospective, non-experimental design using an online questionnaire provided to the 314 elite players of the 12 Swiss U20 Elite ice hockey teams. The injury rate, rate ratios, injury location, type and severity of injury, and injury mechanism were reported. (3) Results: Seventy-three athletes from 11 teams volunteered (response rate = 24%). A total of 30 out of 45 recorded injuries led to time loss in practice and competition. Injury occurred once or twice during the 2019/2020 season. For each player, the injury rate was 0.66 per 1000 practice hours and 2.98 per 1000 competition hours (injury rate ratio = 4.5). The head/neck region was the most common injury location (45.5%). (4) Conclusions: Knowledge of injury characteristics in ice hockey is necessary for meaningful injury management and injury prevention. The results of the present study provide information on the injury rate, location, types, severity, and mechanism in elite Swiss U20 ice hockey players. Most injuries result from contact with another player. More strict sanctioning for irregular behavior and fair play can serve as preventive measures. Further studies should examine different preventive measures such as wearing full-face coverage.

Bilateral neuromuscular control in patients one year after unilateral ACL rupture or reconstruction. A cross-sectional study.

Objectives: To compare bilateral neuromuscular control in patients one year after anterior cruciate ligament reconstruction (ACL-R) or conservative treatment (ACL-C) to healthy controls (ACL-I). Design: Cross-sectional study. Setting: Electromyography of vastus medialis (VM) and lateralis (VL), biceps femoris (BF) and semitendinosus (ST) was recorded during stair descent and anterior tibial translation. Each step of stair descent was divided into pre-activity, weight-acceptance and push-off phase. Pre-activation, short, medium (MLR) and long latency responses (LLR) were defined for reflex activity. Participants: N = 38 patients one year after ACL reconstruction (ACL-R), N = 26 participants with conservative treatment one year after ACL rupture (ACL-C), N = 38 healthy controls with an intact ACL (ACL-I). Main outcome measures: Normalized root mean squares per muscle and phase (α = 0.05). Results: During stair descent, within-group leg differences were found for the quadriceps in ACL-R during all phases and for the BF in ACL-C during weight-acceptance. Between-group leg differences were found for BF in both patient groups compared to ACL-I during push-off.Between-group differences in pre-activation for VM between ACL-R and ACL-C, and between ACL-C and ACL-I were found, and as LLR between patients and ACL-R versus ACL-I. Pre-activation of BF and MLR of ST differed for each patient group compared to ACL-I. Conclusions: Bilateral neuromuscular alterations are still present one year after ACL rupture or reconstruction.

Neuromuscular control in males and females 1 year after an anterior cruciate ligament rupture or reconstruction during stair descent and artificial tibial translation.

Neuromuscular alterations are reported in patients with anterior cruciate ligament reconstruction (ACL-R) and conservative treatment (copers with ACL deficiency, ACL-C). However, it is unclear whether sex influences neuromuscular control. The objective was to investigate differences in neuromuscular control regarding sex and treatment type one year after ACL rupture in comparison to a group with an intact ACL (ACL-I). Electromyography of vastus medialis (VM) and lateralis, biceps femoris (BF) and semitendinosus (ST) was recorded in ACL-R (N = 38), ACL-C (N = 26), and ACL-I (N = 38) during stair descent and reflex activity by anterior tibial translation while standing. The movements of stair descent were divided into pre-activity, weight-acceptance and push-off phases, reflex activity in pre-activation, short, medium (MLR), and long latency responses (LLR). Normalized root mean squares for each muscle of involved and matched control limb per phase were calculated and analyzed with two-way ANOVA (α = 0.05). During stair descent, neuromuscular differences of BF were significant during push-off only (p = 0.001). Males of ACL-R and ACL-C had higher BF activity compared to ACL-I (p = 0.009, 0.007 respectively). During reflex activity, VM and BF were significantly different between treatment groups for pre-activation (p = 0.013, 0.035 respectively). VM pre-activation of females was higher in ACL-R compared to ACL-C (p = 0.018), and lower in ACL-C compared to ACL-I (p = 0.034). Males of ACL-R showed higher VM and less BF pre-activation (p = 0.025, p = 0.003 respectively) compared to ACL-I. Males of ACL-C had less BF pre-activation compared to ACL-I (p = 0.019). During MLR, intra-group differences in ST were found for treatment (p = 0.011) and females of ACL-R compared to ACL-I (p = 0.015). During LLR, overall intra-group differences in VM were present for treatment (p = 0.034) and in females (ACL-R versus ACL-C (p = 0.015), ACL-I (p = 0.049), respectively). One year after an ACL rupture, neuromuscular alterations persist regardless of treatment and sex. Standard rehabilitation protocols may not be able to restore neuromuscular control. Future research should include long-term follow up and focus on exercises targeting neuromuscular function.

Sex-specific differences in neuromuscular activation of the knee stabilizing muscles in adults - a systematic review.

INTRODUCTION: The rupture of the anterior cruciate ligament (ACL) is one of the most common injuries of the knee. Women have a higher injury rate for ACL ruptures than men. Various indicators for this sex-specific difference are controversially discussed. AIM: A systematic review of the literature that compares surface electromyography (EMG) values of adult female and male subjects to find out if there is a difference in neuromuscular activation of the knee stabilizing muscles. METHODS: This systematic review has been guided and informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies which examined sex-specific differences with surface EMG measurements (integral, root mean squares, mean values, analysis of time and amplitude) of the knee stabilizing muscles were retrieved via searches from the databases PubMed, CINAHL, Embase, CENTRAL and SPORTDiscus. The risk of bias of included studies was assessed with the National Heart, Lung and Blood Institute (NHLBI) study quality assessment tool. A synthesis of results was performed for relevant outcomes. RESULTS: Fifteen studies with 462 healthy participants, 233 women (mean age 21.9 (± 2.29) years) and 299 men (mean age 22.6 (± 2.43) years), were included in the systematic review. The methodological quality of the studies was mostly rated "fair" (40%). A significantly higher activity of the muscles vastus lateralis and vastus medialis was found in females, in three studies. Two studies found significantly lower neuromuscular activity in the muscles biceps femoris and semitendinosus in females. All other included studies found no significant differences or reported even contradicting results. CONCLUSION: The controversial findings do not allow for a concluding answer to the question of a sex-specific neuromuscular activation. Further research with higher statistical power and a more homogeneous methodical procedure (tasks and data normalisation) of the included studies may provide insight into possibly existing sex-specific differences in neuromuscular activation. This systematic review could help to improve the methodical design of future studies to get a more valid conclusion of the issue. TRIAL REGISTRATION: CRD42020189504.

Mixed methods instrument validation: Evaluation procedures for practitioners developed from the validation of the Swiss Instrument for Evaluating Interprofessional Collaboration.

BACKGROUND: Quantitative and qualitative procedures are necessary components of instrument development and assessment. However, validation studies conventionally emphasise quantitative assessments while neglecting qualitative procedures. Applying both methods in a mixed methods design provides additional insights into instrument quality and more rigorous validity evidence. Drawing from an extensive review of the methodological and applied validation literature on mixed methods, we showcase our use of mixed methods for validation which applied the quality criteria of congruence, convergence, and credibility on data collected with an instrument measuring interprofessional collaboration in the context of Swiss healthcare, named the Swiss Instrument for Evaluating Interprofessional Collaboration. METHODS: We employ a convergent parallel mixed methods design to analyse quantitative and qualitative questionnaire data. Data were collected from staff, supervisors, and patients of a university hospital and regional hospitals in the German and Italian speaking regions of Switzerland. We compare quantitative ratings and qualitative comments to evaluate the quality criteria of congruence, convergence, and credibility, which together form part of an instrument's construct validity evidence. RESULTS: Questionnaires from 435 staff, 133 supervisors, and 189 patients were collected. Analysis of congruence potentially provides explanations why respondents' comments are off topic. Convergence between quantitative ratings and qualitative comments can be interpreted as an indication of convergent validity. Credibility provides a summary evaluation of instrument quality. These quality criteria provide evidence that questions were understood as intended, provide construct validity, and also point to potential item quality issues. CONCLUSIONS: Mixed methods provide alternative means of collecting construct validity evidence. Our suggested procedures can be easily applied on empirical data and allow the congruence, convergence, and credibility of questionnaire items to be evaluated. The described procedures provide an efficient means of enhancing the rigor of an instrument and can be used alone or in conjunction with traditional quantitative psychometric approaches.

Neuromuscular Control During Stair Descent and Artificial Tibial Translation After Acute ACL Rupture.

Background: Anterior cruciate ligament (ACL) rupture has direct effect on passive and active knee stability and, specifically, stretch-reflex excitability. Purpose/Hypothesis: The purpose of this study was to investigate neuromuscular activity in patients with an acute ACL deficit (ACL-D group) compared with a matched control group with an intact ACL (ACL-I group) during stair descent and artificially induced anterior tibial translation. It was hypothesized that neuromuscular control would be impaired in the ACL-D group. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Surface electromyographic (EMG) activity of the vastus medialis (VM), vastus lateralis (VL), biceps femoris (BF), and semitendinosus (ST) muscles was recorded bilaterally in 15 patients with ACL-D (mean, 13.8 days [range, 7-21 days] since injury) and 15 controls with ACL-I during stair descent and artificially induced anterior tibial translation. The movements of stair descent were divided into preactivity, weight acceptance, and push-off phases. Reflex activity during anterior tibial translation was split into preactivity and short, medium, and late latency responses. Walking on a treadmill was used for submaximal EMG normalization. Kruskal-Wallis test and post hoc analyses with Dunn-Bonferroni correction were used to compare normalized root mean square values for each muscle, limb, movement, and reflex phase between the ACL-D and ACL-I groups. Results: During the preactivity phase of stair descent, the hamstrings of the involved leg of the ACL-D group showed 33% to 51% less activity compared with the matched leg and contralateral leg of the ACL-I group (P < .05). During the weight acceptance and push-off phases, the VL revealed a significant reduction (approximately 40%) in the involved leg of the ACL-D group compared with the ACL-I group. At short latency, the BF and ST of the involved leg of the ACL-D group showed a significant increase in EMG activity compared with the uninvolved leg of the ACL-I group, by a factor of 2.2 to 4.6. Conclusion: In the acute phase after an ACL rupture, neuromuscular alterations were found mainly in the hamstrings of both limbs during stair descent and reflex activity. The potential role of prehabilitation needs to be further studied.

Which assessments are used to analyze neuromuscular control by electromyography after an anterior cruciate ligament injury to determine readiness to return to sports? A systematic review.

BACKGROUND: Adequate neuromuscular control of the knee could be one element to prevent secondary injuries after an anterior cruciate ligament (ACL) injury. To assess neuromuscular control in terms of time, amplitude and activity, electromyography (EMG) is used. However, it is unclear which assessments using EMG could be used for a safe return to sports (RTS). Therefore, we aimed to summarize EMG-related assessments for neuromuscular control of the knee in adult patients after an ACL injury to decide upon readiness for RTS. METHODS: This systematic review followed guidelines of Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), SPORTDiscus and the Web of Science were searched from inception to March 2019 and updated in November 2020. Studies identifying electromyographic assessments for neuromuscular control during dynamic tasks in adult, physically active patients with an anterior cruciate ligament injury were eligible and qualitatively synthesized. Two independent reviewers used a modified Downs and Black checklist to assess risk of bias of included studies. RESULTS: From initially 1388 hits, 38 mainly cross-sectional, case-controlled studies were included for qualitative analysis. Most studies provided EMG outcomes of thigh muscles during jumping, running or squatting. Outcomes measures described neuromuscular control of the knee in domains of time, amplitude or activity. Risk of bias was medium to high due to an unclear description of participants and prior interventions, confounding factors and incompletely reported results. CONCLUSIONS: Despite a wide range of EMG outcome measures for neuromuscular control, none was used to decide upon return to sports in these patients. Additional studies are needed to define readiness towards RTS by assessing neuromuscular control in adult ACL patients with EMG. Further research should aim at finding reliable and valid, EMG-related variables to be used as diagnostic tool for neuromuscular control. Moreover, future studies should aim at more homogenous groups including adequately matched healthy subjects, evaluate gender separately and use sport-specific tasks. Registration The protocol for this systematic review was indexed beforehand in the International Prospective Register of Systematic Reviews (PROSPERO) and registered as CRD42019122188.

Alterations in sensorimotor function after ACL reconstruction during active joint position sense testing. A systematic review.

BACKGROUND: The anterior cruciate ligament (ACL) rupture can lead to impaired knee function. Reconstruction decreases the mechanical instability but might not have an impact on sensorimotor alterations. OBJECTIVE: Evaluation of the sensorimotor function measured with the active joint position sense (JPS) test in anterior cruciate ligament (ACL) reconstructed patients compared to the contralateral side and a healthy control group. METHODS: The databases MEDLINE, CINAHL, EMBASE, PEDro, Cochrane Library and SPORTDiscus were systematically searched from origin until April 2020. Studies published in English, German, French, Spanish or Italian language were included. Evaluation of the sensorimotor performance was restricted to the active joint position sense test in ACL reconstructed participants or healthy controls. The Preferred Items for Systematic Reviews and Meta-Analyses guidelines were followed. Study quality was evaluated using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data was descriptively synthesized. RESULTS: Ten studies were included after application of the selective criteria. Higher angular deviation, reaching significant difference (p < 0.001) in one study, was shown up to three months after surgery in the affected limb. Six months post-operative significantly less error (p < 0.01) was found in the reconstructed leg compared to the contralateral side and healthy controls. One or more years after ACL reconstruction significant differences were inconsistent along the studies. CONCLUSIONS: Altered sensorimotor function was present after ACL reconstruction. Due to inconsistencies and small magnitudes, clinical relevance might be questionable. JPS testing can be performed in acute injured persons and prospective studies could enhance knowledge of sensorimotor function throughout the rehabilitative processes.

Neuromuscular activity during stair descent in ACL reconstructed patients: A pilot study.

BACKGROUND: The anterior cruciate ligament (ACL) rupture is a severe knee injury. Altered kinematics and kinetics in ACL reconstructed (ACL-R) patients compared to healthy participants (ACL-I) are known and attributed to an altered sensorimotor control. However, studies on neuromuscular control often lack homogeneous patient cohorts. The objective was to examine neuromuscular activity during stair descent in patients one year after ACL reconstruction. METHOD: Neuromuscular activity of vastus medialis (VM) and lateralis (VL), biceps femoris (BF) and semitendinosus (ST) was recorded by electromyography in 10 ACL-R (age: 26  ±  10   years; height: 175  ±  6  cm; mass: 75  ±  14   kg) and 10 healthy matched controls (age: 31  ±  7  years; height: 175  ±  7  cm; mass: 68  ±  10  kg). A 10-minute walking treadmill warm-up was used for submaximal normalization. Afterwards participants descended 10 times a six-step stairway at a self-selected speed. The movement was separated into pre-activation (PRE), weight acceptance (WA) and push-off phase (PO). Normalized root mean squares for each muscle, limb and movement phase were calculated. Kruskal-Wallis ANOVA compared ACL-R injured and contralateral leg and the ACL-I leg (α  =  0.05). RESULTS: Significant increased normalised activity in ST during WA in ACL-R injured leg compared to ACL-I and during PO in VL in the ACL-R contralateral leg compared to ACL-I. Decreased activity was shown in VM in ACL-R injured compared to contralateral leg (p < 0.05). CONCLUSION: Altered neuromuscular activations are present one year after ACL reconstruction compared to the contralateral and healthy matched control limb. Current standard rehabilitation programs may not be able to fully restore sensorimotor control and demand further investigations.

Wavelet analyses of electromyographic signals derived from lower extremity muscles while walking or running: A systematic review.

Surface electromyography is often used to assess muscle activity and muscle function. A wavelet approach provides information about the intensity of muscle activity and motor unit recruitment strategies at every time point of the gait cycle. The aim was to review papers that employed wavelet analyses to investigate electromyograms of lower extremity muscles during walking and running. Eleven databases were searched up until June 1st 2017. The composition was based on the PICO model and the PRISMA checklist. First author, year, subject characteristics, intervention, outcome measures & variables, results and wavelet specification were extracted. Eighteen studies included the use of wavelets to investigate electromyograms of lower extremity muscles. Three main topics were discussed: 1.) The capability of the method to correctly assign participants to a specific group (recognition rate) varied between 68.4%-100%. 2.) Patients with ankle osteoarthritis or total knee arthroplasty presented a delayed muscle activation in the early stance phase but a prolonged activation in mid stance. 3.) Atrophic muscles did not contain type II muscle fiber components but more energy in their lower frequencies. The simultaneous information of time, frequency and intensity is of high clinical relevance because it offers valuable information about pre-and reflex activation behavior on different walking and running speeds as well as spectral changes towards high or low frequencies at every time point of the gait cycle.

Intra- and interday reliability of the dynamic navicular rise, a new measure for dynamic foot function: A descriptive, cross-sectional laboratory study.

BACKGROUND: The lack of reliable parameters to evaluate dynamic foot function, emphasizes the need for a deeper insight in foot biomechanics. The aims were to investigate the reliability of a new parameter (dynamic navicular rise dNR), and its relationship with the dynamic navicular drop (dND). METHODS: Twenty healthy participants (mean age 30.2±8.1years) had to walk on even ground and downstairs. Data of ten trials per task on two measurement days were recorded. The dNR was defined as the difference in millimetres (mm) between the minimum navicular height (NH) during stance and the NH at toe off. To test intra- and interday reliability, Intraclass Correlation Coefficients (ICC2.1) and repeatability were calculated. To obtain the absolute repeatability (RP) in mm, the equation RP=1.96×SDdifferences was used. Furthermore, the relationship between the dNR and the dND was examined by calculating Pearson (r) or Spearman (rs) correlation coefficients. RESULTS: Included participants showed a mean dNR of (12.2±3.7) mm for level walking and (14.8±3.4) mm for stair descent. The ICC2.1 for the dNR were 0.98 (intraday), 0.91 (interday) for level walking and 0.97 (intraday), 0.94 (interday) for stair descent. The interday repeatability was 3.2mm (level walking), 2.7mm (stair descent) respectively. For level walking, r was 0.31 (p=0.049), and rs=0.88 (p<0.001) for stair descent. CONCLUSIONS: The dNR seems to be highly reliable (ICCs), however, repeatability is unacceptable. For level walking, the dNR might be an independent measure, but not for stair climbing.

Acute effects of partial-body vibration in sitting position.

AIM: To investigate the acute effects of sinusoidal and stochastic resonance partial-body vibration in sitting position, including muscle activity, heart rate variability, balance and flexibility. METHODS: Fifty healthy participants were assigned randomly to two training conditions: A sinusoidal partial-body vibration (SIN, 8 Hz) or a stochastic resonance partial-body vibration (STOCH, 8 ± 2 Hz). For baseline assessment participants sat on the vibration platform without vibration. Both training conditions consisted of five series of a one-minute vibration training and a one-minute break between them. In this experimental study surface electromyography (EMG) of the erector spinae (ES), one of the back muscles, and heart rate variability (HRV) was measured at baseline and during training. Balance and flexibility were assessed at baseline and immediately after training. Balance was measured with the modified star excursion balance test (mSEBT) and flexibility was assessed through the modified fingertip-to-floor method (mFTF). RESULTS: Paired sample t-test showed a significant increase in balance that was restricted to STOCH (t = -2.22, P = 0.018; SIN: t = -0.09, P = 0.466). An increase in flexibility was also restricted to STOCH (t = 2.65, P = 0.007; SIN: t = 1.41, P = 0.086). There was no significant change of muscle activity in the ES-EMG in STOCH or SIN conditions. In both training conditions, HRV decreased significantly, but remained in a low-load range (STOCH: t = 2.89, P = 0.004; SIN: t = 2.55, P = 0.009). CONCLUSION: In sitting position, stochastic resonance partial-body vibration can improve balance and flexibility while cardiovascular load is low. STOCH can be a valuable training option to people who are unable to stand (e.g., people, who are temporarily wheelchair-bound).

A minimal markerset for three-dimensional foot function assessment: measuring navicular drop and drift under dynamic conditions.

BACKGROUND: The validity of predicting foot pronation occurring mainly at the midfoot by surrogate measures from the rearfoot, like eversion excursion, is limited. The dynamic navicular mobility in terms of vertical navicular drop (dNDrop) and medial navicular drift (dNDrift) may be regarded as meaningful clinical indicators to represent overall foot function. This study aimed to develop a minimal approach to measure the two parameters and to examine their intra- and interday reliability during walking. METHODS: The minimal markerset uses markers at the lateral and medial caput of the 1st and 5th metatarsals, respectively, at the dorsal calcaneus and at the tuberosity of the navicular bone. Dynamic navicular drop and drift were assessed with three-dimensional motion capture in 21 healthy individuals using a single-examiner test-retest study design. RESULTS: Intra- and interday repeatability were 1.1 mm (ICC21 0.97) and 2.3 mm (ICC21 0.87) for dynamic navicular drop and 1.5 mm (ICC21 0.96) and 5.3 mm (ICC21 0.46) for dynamic navicular drift. The contribution of instrumental errors was estimated to 0.25 mm for dynamic navicular drop and 0.86 mm for dynamic navicular drift. CONCLUSIONS: Interday reliability was generally worse than intraday reliability primary due to day-to-day variations in movement patterns and the contribution of instrumental errors was below 23% for dynamic navicular drop but reached 57% for dynamic navicular drift. The minimal markerset allows to simply transfer the known concepts of navicular drop and drift from quasi-static clinical test conditions to functional tasks, which is recommended to more closely relate assessments to the functional behavior of the foot.

[Effect of Core Muscle Strengthening Exercises (Including Plank and Side Plank) on Injury Rate in Male Adult Soccer Players: A Systematic Review]. / Effekt eines Rumpfkräftigungsprogramms (inklusive Unterarm- und seitlichem Unterarmstütz) auf die Verletzungsrate von erwachsenen Fußballspielern: eine systematische Literaturübersicht.

BACKGROUND: Soccer is seen as highly intensive sport with an increased injury rate. Male adults are the players with the highest injury incidence. Accordingly, the importance of core muscle strengthening to prevent injury has increased in the past few years. Up to date, core muscle strengthening plays an important role in different prevention programs, such as the "FIFA 11 +". The aim of this systematic review was to investigate the effect of core muscle strengthening on injury rate in male adult soccer players, including at least the known and easy exercises "plank" and "side plank", on injury rate in male adult soccer players. SUBJECTS/MATERIAL AND METHODS: The databases PubMed, PEDro, Cochrane Library, SPORTDiscus and Cinahl were searched systematically. Included studies had to comprise exercises for core muscles as an intervention (as a part of a prevention program) for adult male soccer players. The control group had to continue their usual exercise routine. The exercises "plank" and "side plank" were mandatory elements of the training program. The number of injuries and/or the injury rate (per 1000 hours) were defined as outcomes. The quality of the included studies was assessed with the PEDro scale and the Risk of Bias tool. RESULTS: Seven studies with 2491 participants in total could be included. Two studies found a significant decrease in the injury rate in the intervention group (p < 0.05, p < 0.001 respectively). In two studies, no significance level was reported, but the training showed preventive effects in the intervention group. In the other three studies, no significant changes in the injury rate were found (p > 0.05). CONCLUSION: The seven included studies differed greatly with respect to the applied methods, the chosen interventions and the obtained results. Furthermore, core muscles were never trained separately but were always part of a program containing other preventive elements. Therefore, it was difficult to compare the studies. However, prevention programs including strengthening exercises for core muscles tend to positively affect the injury rate. Based on the literature found, the research question cannot definitively be answered. In the future, further studies are needed which investigate the effect of isolated core muscle training on the injury rate of soccer players.

Work-family conflict and neck and back pain in surgical nurses.

OBJECTIVE: Surgical nurses' work is physically and mentally demanding, possibly leading to work-family conflict (WFC). The current study tests WFC to be a risk factor for neck and lower back pain (LBP). Job influence and social support are tested as resources that could buffer the detrimental impact of WFC. METHODS: Forty-eight surgical nurses from two university hospitals in Germany and Switzerland were recruited. WFC was assessed with the Work-Family Conflict Scale. Job influence and social support were assessed with the Copenhagen Psychosocial Questionnaire, and back pain was assessed with the North American Spine Society Instrument. RESULTS: Multiple linear regression analyses confirmed WFC as a significant predictor of cervical pain (ß = 0.45, p < 0.001) and LBP (ß = 0.33, p = 0.012). Job influence and social support did not turn out to be significant predictors and were not found to buffer the impact of WFC in moderator analyses. CONCLUSION: WFC is likely to affect neck and back pain in surgery nurses. Work-life interventions may have the potential to reduce WFC in surgery nurses.

Analysis of accuracy in optical motion capture - A protocol for laboratory setup evaluation.

Validity and reliability as scientific quality criteria have to be considered when using optical motion capture (OMC) for research purposes. Literature and standards recommend individual laboratory setup evaluation. However, system characteristics such as trueness, precision and uncertainty are often not addressed in scientific reports on 3D human movement analysis. One reason may be the lack of simple and practical methods for evaluating accuracy parameters of OMC. A protocol was developed for investigating the accuracy of an OMC system (Vicon, volume 5.5×1.2×2.0m(3)) with standard laboratory equipment and by means of trueness and uncertainty of marker distances. The study investigated the effects of number of cameras (6, 8 and 10), measurement height (foot, knee and hip) and movement condition (static and dynamic) on accuracy. Number of cameras, height and movement condition affected system accuracy significantly. For lower body assessment during level walking, the most favorable setting (10 cameras, foot region) revealed mean trueness and uncertainty to be -0.08 and 0.33mm, respectively. Dynamic accuracy cannot be predicted based on static error assessments. Dynamic procedures have to be used instead. The significant influence of the number of cameras and the measurement location suggests that instrumental errors should be evaluated in a laboratory- and task-specific manner. The use of standard laboratory equipment makes the proposed procedure widely applicable and it supports the setup process of OCM by simple functional error assessment. Careful system configuration and thorough measurement process control are needed to produce high-quality data.

The effect of kinesio tape on neuromuscular activity of peroneus longus.

BACKGROUND: Functional ankle instability is the result of sensorimotor or structural deficits. The commonly used kinesio tape (KT) is supposed to have a positive influence on sensorimotor functions. METHODS: Eight women and two men (mean ± SD, age 24.4 ± 3.3 years) with functional ankle instability with recurrent ankle sprains ran downhill on a treadmill (3.3 m/s and a negative slope of 5°). The first trial was without KT, the second with KT on the peroneus longus (PL) muscle. Neuromuscular activity was measured using surface electromyography for 15 seconds. Sensation of giving way was assessed with a visual analog scale (VAS). Comparisons were made between measurements with and without KT using the Wilcoxon rank sum test. The level of significance was set at P ≤ 0.05. RESULTS: None of the chosen parameters for preactivation, reflex activation, or total activation showed statistically significant differences between the two trials (P > 0.05). The mean values for the sensation of giving way were lower with KT (VAS, median 1.2, range 0-2.8) than without (VAS, median 1.8, range 0-3.9), but did not reach statistical significance (P = 0.102) or clinical relevance. CONCLUSION: KT in participants with functional ankle instability (FAI) seems to have no effect on the neuromuscular activity of PL and sensation of giving way during downhill running.

Non-surgical treatment of pain associated with posterior tibial tendon dysfunction: study protocol for a randomised clinical trial.

BACKGROUND: Symptoms associated with pes planovalgus or flatfeet occur frequently, even though some people with a flatfoot deformity remain asymptomatic. Pes planovalgus is proposed to be associated with foot/ankle pain and poor function. Concurrently, the multifactorial weakness of the tibialis posterior muscle and its tendon can lead to a flattening of the longitudinal arch of the foot. Those affected can experience functional impairment and pain. Less severe cases at an early stage are eligible for non-surgical treatment and foot orthoses are considered to be the first line approach. Furthermore, strengthening of arch and ankle stabilising muscles are thought to contribute to active compensation of the deformity leading to stress relief of soft tissue structures. There is only limited evidence concerning the numerous therapy approaches, and so far, no data are available showing functional benefits that accompany these interventions. METHODS: After clinical diagnosis and clarification of inclusion criteria (e.g., age 40-70, current complaint of foot and ankle pain more than three months, posterior tibial tendon dysfunction stage I & II, longitudinal arch flattening verified by radiography), sixty participants with posterior tibial tendon dysfunction associated complaints will be included in the study and will be randomly assigned to one of three different intervention groups: (i) foot orthoses only (FOO), (ii) foot orthoses and eccentric exercise (FOE), or (iii) sham foot orthoses only (FOS). Participants in the FOO and FOE groups will be allocated individualised foot orthoses, the latter combined with eccentric exercise for ankle stabilisation and strengthening of the tibialis posterior muscle. Participants in the FOS group will be allocated sham foot orthoses only. During the intervention period of 12 weeks, all participants will be encouraged to follow an educational program for dosed foot load management (e.g., to stop activity if they experience increasing pain). Functional impairment will be evaluated pre- and post-intervention by the Foot Function Index. Further outcome measures include the Pain Disability Index, Visual Analogue Scale for pain, SF-12, kinematic data from 3D-movement analysis and neuromuscular activity during level and downstairs walking. Measuring outcomes pre- and post-intervention will allow the calculation of intervention effects by 3×3 Analysis of Variance (ANOVA) with repeated measures. DISCUSSION: The purpose of this randomised trial is to evaluate the therapeutic benefit of three different non-surgical treatment regimens in participants with posterior tibial tendon dysfunction and accompanying pes planovalgus. Furthermore, the analysis of changes in gait mechanics and neuromuscular control will contribute to an enhanced understanding of functional changes and eventually optimise conservative management strategies for these patients. TRIAL REGISTRATION: ClinicalTrials.gov Protocol Registration System: ClinicalTrials.gov ID NCT01839669.

Translation, cross-cultural adaptation, and psychometric properties of the German version of the hip disability and osteoarthritis outcome score.

STUDY DESIGN: Clinical measurement. OBJECTIVES: To translate and cross-culturally adapt the Hip disability and Osteoarthritis Outcome Score (HOOS) from English into German, and to study its psychometric properties in patients after hip surgery. BACKGROUND: There is no specific hip questionnaire in German that not only measures symptoms and function but also contains items about hip-related quality of life. METHODS: The translation and cross-cultural adaptation involved forward translation, harmonization, cognitive debriefing, back translation, and comparison to the original HOOS following international guidelines. The German version was tested in 51 Swiss inpatients 8 weeks after different types of hip surgery, mainly total hip replacement. The mean age of the participants was 62.5 years, and the age range was from 27 to 87 years. Thirty (58.8%) of the participants were women. Internal consistency and test-retest reliability were estimated using Cronbach alpha and intraclass correlation coefficients for agreement. For construct validity, total scores of the German HOOS were correlated with those of the Western Ontario and McMaster Universities Osteoarthritis Index. The HOOS was also compared to the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS: Cronbach alpha values for all German HOOS subscales were between .87 and .93. For test-retest reliability, the intraclass correlation coefficient for agreement was 0.85 for the total scores of the German HOOS. The Spearman rho for the Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning subscale compared to the sum of all HOOS subscales was 0.71, and that for the Medical Outcomes Study 36-Item Short-Form Health Survey physical component summary was 0.97. CONCLUSION: The German HOOS has demonstrated adequate reliability and validity. Use of the German HOOS is recommended for assessment of patients after hip surgery, with the proviso that additional psychometric testing should be done in future research.