The reliability of a linear position transducer for measuring countermovement jump performance in national-level road cyclists.

BACKGROUND: Jump tests have applications in fatigue monitoring, training intervention evaluations, and talent identification in cycling populations. Due to competitive cycling's inherent travel demands, linear position transducers (LPTs) are suitable for assessing jump performance in this population as they are a mobile and validated technology. Understanding the reliability and sensitivity of LPTs in assessing jump performance in cycling populations is required to support the development of sports science protocols. Using an LPT, this study aimed to determine the reliability and sensitivity of countermovement jump (CMJ) variables in road cyclists. METHODS: Ten national-level male road cyclists performed three maximal CMJ trials twice per week for two weeks, with an LPT measuring force, power, velocity, repetition rate, vertical distance, and concentric time from each trial. Using the mean and best CMJ results from three trials per testing session, the upper limit 90% confidence interval for the coefficient of variation (CV) and smallest worthwhile change (SWC) determined inter-day and -week reliability (CV ≤ 10%) and sensitivity (acceptable sensitivity = CV ≤ SWC) for CMJ variables. RESULTS: Mean power and force, velocity (mean and peak), vertical distance (VD), and concentric time had acceptable inter-day and -week reliability when using either the mean or best CMJ results (CV upper limit 90% confidence interval range = 3.54-10.13%). Moreover, the CV and SWC were typically lower when based on the mean rather than the best of three CMJ trials. Lastly, poor sensitivity (CV > SWC) was evident for all CMJ variables. CONCLUSIONS: CMJ-derived mean power and force, velocity (peak and mean), VD, and concentric time have acceptable inter-day and -week reliability when assessed via an LPT in national-level road cyclists. When using an LPT, sports scientists should consider that, while they typically have poor sensitivity, the reliability of CMJ-derived variables improves when expressed as the mean of three trials in national-level road cyclists.

Froude Efficiency and Velocity Fluctuation in Forearm-Amputee Front Crawl: Implications for Para Swimming Classification.

PURPOSE: The impact of physical impairment on Froude efficiency and intracyclic velocity fluctuation in Para swimmers is not well documented. Identification of differences in these variables between disabled and nondisabled swimmers could help develop a more objective system for assigning Para swimmers to classes for competition. This study quantifies Froude efficiency and intracyclic velocity fluctuation in unilateral forearm-amputee front crawl swimmers and evaluates associations between these variables and performance. METHODS: Ten unilateral forearm-amputee swimmers completed front crawl trials at 50- and 400-m pace; three-dimensional video analysis provided mass center, and wrist and stump velocities. Intracyclic velocity fluctuation was calculated as follows: 1) maximum-minimum mass center velocity, expressed as percent of mean velocity, and 2) coefficient of variation in mass center velocity. Froude efficiency was the ratio between mean swimming velocity and wrist plus stump velocity during each segment's respective 1) underwater phase and 2) propulsive underwater phase. RESULTS: Forearm amputees' intracyclic velocity fluctuation (400 m: 22% ± 7%, 50 m: 18% ± 5%) was similar to published values for nondisabled swimmers, whereas Froude efficiencies were lower. Froude efficiency was higher at 400-m (0.37 ± 0.04) than 50-m pace (0.35 ± 0.05; P < 0.05) and higher for the unaffected limb (400 m: 0.52 ± 0.03, 50 m: 0.54 ± 0.04) than the residual limb (400 m: 0.38 ± 0.03, 50 m 0.38 ± 0.02; P < 0.05). Neither intracyclic velocity fluctuation nor Froude efficiency was associated with swimming performance. CONCLUSIONS: Froude efficiency may be a valuable measure of activity limitation in swimmers with an upper limb deficiency and a useful metric for comparing swimmers with different types and severity of physical impairment.

Passive Heating Increases Bench-Pull Power Output in Highly Trained Swimmers.

PURPOSE: Determine the effects of skin temperature change on bench-pull power following a passive warm-up intervention with highly trained swimmers using multiple heated clothing garments. METHODS: Using a crossover design, 8 high-performance swimmers (mean [SD]; age, 22.4 [4.4] y; body mass, 74.9 [8.1] kg; height, 1.79 [0.09] m; world record ratio, 107.3% [5.1%]) completed a pool-based warm-up followed by a 35-minute transition phase before completing 3 repetitions at 50% of 1-repetition maximum of the bench-pull exercise. During transition, swimmers wore either a warm (control) or a heated (heat) clothing condition. RESULTS: Following heating, mean skin temperature was 0.7 °C higher in heat (P = .011), though no change was seen in tympanic temperature. Bench-pull mean and peak power improved by 4.5% and 4.7% following heating, respectively. A large repeated-measures correlation was observed between skin temperature and mean (r [90% CI] = .94 [.65 to .99], P < .01) and peak (r [90% CI] = .89 [.45 to .98], P < .01) power output. Thermal sensation and comfort at all regions were higher with heating (P ≤ .02). CONCLUSION: Combined upper- and lower-limb passive heating can increase whole-body skin temperature and improve short-duration upper-limb power output during the bench-pull exercise. Improvements in power output were directly related to the skin temperature increase facilitated by the heated clothing.

Swimming performance, physiology, and post-activation performance enhancement following dryland transition phase warmup: A systematic review.

BACKGROUND: In swimming, the period between the end of the swimming warmup and the beginning of competition is critical to performance, here termed the transition phase. Several options are available during this phase, necessitating a systematic review to understand if optimal strategies exist. OBJECTIVES: To synthesise and critically evaluate the current literature investigating land-based warmup interventions on subsequent performance in competitive swimmers. METHODS: A search of three electronic databases (PubMed, EBSCO SPORTDiscus and Web of Science) was conducted to identify original studies until February 2022. Selection criteria dictated that (i) a control condition was used, (ii) participants were ≥ 15 years of age, (iii) a pool-based warmup was done prior to the land-based warmup. A total of 25 articles met the selection criteria. RESULTS: Reducing the transition phase duration by at least half led to consistently faster time-trial times of between 1.1-1.5% for all included studies. Passive warmups using clothing interventions resulted in mostly faster time-trial's of 0.4-0.8% with increases in skin temperature frequent, though little change occurred in core temperature. The methodology of passive respiratory warmups were vastly different with positive time-trial's effects ranging between 0.9-1.1% for two studies, though one reported no meaningful difference. Active warmups led to consistently faster time-trial's between 0.7-0.9%, though the unpinning factors are not clear. Warmups which combined passive and active options frequently led to faster time-trial's between 0.8-3%. Upper and combined limb post-activation performance enhancement led to mostly unfavourable time-trial changes. Lower limb exclusive protocols results were inconsistent, with limited beneficial effects on time-trial or start performance reported following plyometric protocols. However, there does appear merit in heavier loaded lower limb protocols. CONCLUSION: Each of a reduced transition phase length, and passive, active or combination warmup have demonstrated improvements in swimming performance. Conversely, PAPE protocols should be used with caution, especially when including the upper limbs.

Body composition in professional female netball players within and between seasons: a cohort study.

BACKGROUND: There is limited information on the physique attributes of female netball players from the highest playing standards and the typical body composition changes that occur with training and competition in these athletes. The purpose of this study was to examine the body composition of professional female netball players and changes that occur within and between national premier netball seasons. METHODS: Dual-energy X-ray absorptiometry (DXA) assessments were conducted in 20 female netball players (age = 26.5 [4.7] years, body mass = 77.3 [9.7] kg, stature = 182.7 [9.5] cm) contracted to a Suncorp Super Netball team. Total body lean mass, fat mass, bone mass and bone mineral density were derived for 127 assessments collected over three seasons. Linear mixed effects modelling was used to examine changes in body composition measures within and between seasons. RESULTS: Goal circle players were heavier (12.3 [3.5] kg, p < 0.001, g = 1.51) and taller (15.0 [2.7] cm, p < 0.001, g = 2.30) than midcourt players, and midcourt players had greater lean mass (3.1 [1.6] %, p = 0.07, g = 0.85) and less fat mass (-3.3 [1.7] %, p = 0.06, g = -0.84) than goal circle players when values were normalised to body mass. Players achieved increases in lean mass (2,191 [263] g, p < 0.01, g = 0.45) and decreases in fat mass (-835 [351] g, p = 0.09, g = -0.16) following a preseason preparation period. There were no changes in lean mass (-394 [295] g, p = 0.54, g = 0.07) or fat mass (102 [389] g, p = 0.99, g = 0.04) from the start to the end of the 14-week competition period. CONCLUSIONS: Professional female netball players achieve small changes in lean mass and fat mass during preseason preparation and maintain their physique over the competitive season. The results of this study can inform practitioners on the training content necessary to promote or maintain desired body composition changes in these athletes.

Improving the objectivity of the current World Para Swimming motor coordination test for swimmers with hypertonia, ataxia and athetosis using measures of movement smoothness, rhythm and accuracy.

The current protocol for classifying Para swimmers with hypertonia, ataxia and athetosis involves a physical assessment where the individual's ability to coordinate their limbs is scored by subjective clinical judgment. The lack of objective measurement renders the current test unsuitable for evidence-based classification. This study evaluated a revised version of the Para swimming assessment for motor coordination, incorporating practical, objective measures of movement smoothness, rhythm error and accuracy. Nineteen Para athletes with hypertonia and 19 non-disabled participants performed 30 s trials of bilateral alternating shoulder flexion-extension at 30 bpm and 120 bpm. Accelerometry was used to quantify movement smoothness; rhythm error and accuracy were obtained from video. Para athletes presented significantly less smooth movement and higher rhythm error than the non-disabled participants (p < 0.05). Random forest algorithm successfully classified 89% of participants with hypertonia during out-of-bag predictions. The most important predictors in classifying participants were movement smoothness at both movement speeds, and rhythm error at 120 bpm. Our results suggest objective measures of movement smoothness and rhythm error included in the current motor coordination test protocols can be used to infer impairment in Para swimmers with hypertonia. Further research is merited to establish the relationship of these measures with swimming performance.

Passive drag in Para swimmers with physical impairments: Implications for evidence-based classification in Para swimming.

The inherent hydrodynamic resistance force, or passive drag, of a swimmer directly influences how they move through the water. For swimmers with physical impairments, the strength of association between passive drag and swimming performance is unknown. Knowledge on this factor could improve the World Para Swimming classification process. This study established the relationship between passive drag and 100 m freestyle race performance in Para swimmers with physical impairments. Using a cross-sectional study design, an electrical-mechanical towing device was used to measure passive drag force in 132 international-level Para swimmers. There was a strong, negative correlation between normalized passive drag force and 100 m freestyle race speed in the combined participant cohort (ρ = -0.77, p < 0.001). Type of physical impairment was found to affect the relationship between passive drag and 100 m freestyle race speed when included in linear regression (R2  = 0.65, χ2  = 11.5, p = 0.025). These findings contribute to the body of evidence that passive drag can provide an objective assessment of activity limitation in Para swimmers with physical impairments. The effect of physical impairment type on the relationship between passive drag and swimming performance should be accounted for in Para swimming classification.

Modelling the age-related trajectory of performance in Para swimmers with physical, vision and intellectual impairment.

This study is the first to provide information on the age-related trajectories of performance in Para swimmers with physical, vision and intellectual impairment. Race times from long-course swim meets between 2009 and 2019 were obtained for Para swimmers with an eligible impairment. A subset of 10 661 times from 411 Para swimmers were included in linear mixed effects modelling to establish the relationship between age and performance expressed relative to personal best time and world record time. The main findings were: (a) age has the most noticeable influence on performance between the ages of 12-20 years before performances stabilize and peak in the early to late twenties, (b) women have faster times relative to personal best and world record time than men during early adolescence and their performances stabilize, peak and decline at younger ages, and (c) Para swimmers from different sport classes show varying age-related trajectories in performance after maturation and when training-related factors are more likely to explain competitive swim performance. The results of this study can guide talent identification and development of Para swimmers at various stages of their career and help to inform decision-making on the allocation of sport class and sport class status in Para swimming classification.

Maximal Fully Tethered Swim Performance in Para Swimmers With Physical Impairment.

The assessment of swimming propulsion should be a cornerstone of Paralympic swimming classification. However, current methods do not objectively account for this component. PURPOSE: To evaluate the swimming propulsion of swimmers with and without physical impairment using a 30-second maximal fully tethered freestyle swim test. METHODS: Tethered forces were recorded during maximal fully tethered swimming in 80 competitive swimmers with (n = 70) and without (n = 10) physical impairment. The relationships between absolute and normalized tether forces and maximal freestyle swim speed were established using general additive models. RESULTS: Para swimmers with physical impairment had lower absolute and normalized tether forces than able-bodied swimmers, and there were moderate positive correlations found between tether forces and sport class (τ = .52-.55, P < .001). There was a nonlinear relationship between tether force and maximal freestyle swim speed in the participant cohort (adjusted R2 = .78-.80, P < .001). Para swimmers with limb deficiency showed stronger relationships between tether force and maximal freestyle swim speed (adjusted R2 = .78-.82, P < .001) than did Para swimmers with hypertonia (adjusted R2 = .54-.73, P < .001) and impaired muscle power (adjusted R2 = .61-.70, P < .001). CONCLUSIONS: Physical impairments affect Para swimmers' tether forces during maximal fully tethered freestyle swimming, explaining a significant proportion of their activity limitation. It is recommended that maximal fully tethered swimming be included in Paralympic swimming classification as an objective assessment of swimming propulsion.

The impact of limb deficiency impairment on Para swimming performance.

Swimmers with limb deficiency are a core population within Para Swimming, accordingly this study examined the contribution of limb segments to race performance in these swimmers. Data were obtained for 174 male Para swimmers with limb deficiency. Ensemble partial least squares regression showed accurate predictions when using relative limb segment lengths to estimate Para swimmers' personal best race performances. The contribution of limb segments to performance in swim events was estimated using these regression models. The analysis found swim stroke and event distance to influence the contributions of limb segments to performance. For freestyle swim events, these changes were primarily due to the increased importance of the hand, and decreased importance of the foot and shank, as the distance of the event increased. When comparing swim strokes, higher importance of the thigh and shank in the 100 m breaststroke compared with other swim strokes confirms the separate SB class. Varied contributions of the hand, upper arm and foot suggest that freestyle could also be separated from backstroke and butterfly events to promote fairer classification. This study shows that swim stroke and event distance influence the activity limitation of Para swimmers with limb deficiency suggesting classification should account for these factors.

Active Drag as a Criterion for Evidence-based Classification in Para Swimming.

INTRODUCTION: Paralympic classification should provide athletes with an equitable starting point for competition by minimizing the impact their impairment has on the outcome of the event. As swimming is an event conducted in water, the ability to overcome drag (active and passive) is an important performance determinant. It is plausible that the ability to do this is affected by the type and severity of the physical impairment, but the current World Para Swimming classification system does not objectively account for this component. The aim of this study was to quantify active and passive drag in Para swimmers and evaluate the strength of association between these measures and type of physical impairment, swimming performance, and sport class. METHODS: Seventy-two highly trained Para swimmers from sport classes S1 to S10 and 14 highly trained nondisabled swimmers were towed by a motorized winch while the towing force was recorded. Passive drag was measured with the arms held by the side; active drag was determined during freestyle swimming using an assisted towing method. RESULTS: Active and passive drag were higher in Para swimmers with central motor and neuromuscular impairments than for nondisabled swimmers and were associated with severity of swim-specific impairment (sport class) and maximal freestyle performance in these swimmers (r = -0.40 to -0.50, P ≤ 0.02). Para swimmers with anthropometric impairments showed similar active and passive drag to nondisabled swimmers, and between swimmers from different sport classes. CONCLUSIONS: Para swimmers with central motor and neuromuscular impairments are predisposed to high active drag during freestyle swimming that impacts on their performance. It is recommended that drag measures be considered in revised classification for these swimmers, but not for those with anthropometric impairments.

Effects of Water Immersion on Squat and Split Squat Kinematics in Older Adults.

This study examined the effect of water immersion on trunk and lower limb kinematics during squat exercises in older participants. A total of 24 active older adults (71.4 ± 5.4 years) performed squats and split squats on land and while partially submerged in water. Inertial sensors (100 Hz) were used to record trunk and lower body kinematics. Water immersion increased the squat depth (squat: p = .028, d = 0.63 and split squat: p = .005, d = 0.83) and reduced the trunk flexion range (squat: p = .006, d = 0.76 and split squat: p < .001, d = 1.35) during both exercises. In addition, water immersion increased the hip range of motion during the split squat (p = .002, d = 0.94). Waveform analyses also indicated differences in the timing of the movements. These results showed that water-based exercise generates a different exercise outcome and appears to provide an alternative option for older adults, enabling exercisers to perform these tasks in a manner not possible on land.

A battery of strength tests for evidence-based classification in Para swimming.

This study examined the validity of isometric strength tests for evidence-based classification in Para swimming. Thirty non-disabled participants and forty-two Para swimmers with physical impairment completed an isometric strength test battery designed to explain activity limitation in the freestyle discipline. Measures pertaining to dominant and non-dominant limb strength and symmetry were derived from four strength tests that were found to be reliable in a cohort of non-disabled participants (ICC = 0.85-0.97; CV = 6.4-9.1%). Para swimmers had lower scores in strength tests compared with non-disabled participants (d = 0.14-1.00) and the strength test battery successfully classified 95% of Para swimmers with physical impairment using random forest algorithm. Most of the strength measures had low to moderate correlations (r = 0.32 to 0.53; p ≤ 0.05) with maximal freestyle swim speed in Para swimmers. Although, fewer correlations were found when Para swimmers with hypertonia or impaired muscle power were analysed independently, highlighting the impairment-specific nature of activity limitation in Para swimming. Collectively, the strength test battery has utility in Para swimming classification to infer loss of strength in Para swimmers, guide minimum eligibility criteria, and to define the impact that strength impairment has on Para swimming performance.

The Spine Functional Index: development and clinimetric validation of a new whole-spine functional outcome measure.

BACKGROUND CONTEXT: Most spine patient-reported outcome measures are divided into neck and back subregions. This prevents their use in the assessment of the whole spine. By contrast, whole-spine patient-reported outcome measures assess the spine from cervical to lumbar as a single kinetic chain. However, existing whole-spine patient-reported outcomes have been critiqued for clinimetric limitations, including concerns with practicality. PURPOSE: To develop the Spine Functional Index (SFI) as a new whole-spine patient-reported outcome measure that addressed the limitations of existing whole-spine questionnaires; and to determine the SFI's clinimetric and practical characteristics concurrently with a recognized criterion, the Functional Rating Index (FRI). STUDY DESIGN: Observational cohort study within 10 physical therapy outpatient clinics. PATIENT SAMPLE: Spine-injured patients were recruited from a convenience sample referred by a medical practitioner to physical therapy. A pilot study (n=52, 57% female, age 47.6±17.5 years) followed by the main study (n=203, 48% female, age 41.0±17.8 years) that had an average symptom duration of less than 5 weeks. OUTCOME MEASURES: Spine Functional Index, FRI, and Numerical Rating Scale (NRS). METHODS: The SFI was developed through three stages: 1) item generation, 2) item reduction with an expert panel and patient focus group, and 3) pilot field testing to provide provisional clinimetric properties and sample size requirements and to determine suitability for a larger study. Participants completed the SFI, FRI, and NRS every 2 weeks for 6 weeks, then every 4 weeks until discharge or study completion at 6 months. Responses were assessed to provide individual psychometric and practical characteristics for both patient-reported outcomes, with the overall performance evaluated by the Measurement of Outcome Measures and Bot clinimetric assessment scales. RESULTS: The SFI demonstrated a high criterion validity with the FRI (Pearson r=0.87, 95% confidence interval [CI]), equivalent internal consistency (α=0.91), and a single-factor structure. The SFI and FRI demonstrated suitable reliability (intraclass correlation coefficient2,1=0.97:0.95), responsiveness (standardized response mean=1.81:1.68), minimal detectable change with 90% CI (6.4%:9.7%), Flesch scale reading ease (64%:47%), and user errors (1.5%:5.3%). The clinimetric performance was higher for the SFI on the Measurement of Outcome Measures (96%:64%) and on the Bot scale (100%:75%). CONCLUSIONS: The SFI demonstrated sound clinimetric properties with lower response errors, efficient completion and scoring, and improved responsiveness and overall clinimetric performance compared with the FRI. These results indicated that the SFI was suitable for functional outcome measurement of the whole spine in both the research and clinical settings.

Classifying motor coordination impairment in Para swimmers with brain injury.

OBJECTIVES: The International Paralympic Committee has mandated that International Sport Federations develop sport-specific classification systems that are evidence-based. This study examined the predictive and convergent validity of instrumented tapping tasks to classify motor coordination impairments in Para swimming. DESIGN: Cross-sectional. METHODS: Thirty non-disabled participants and twenty-one Para swimmers with brain injury completed several instrumented tapping tasks as an assessment of upper and lower limb motor coordination. Para swimmers also completed a maximal freestyle swim to obtain a performance measure. The predictive and convergent validity of instrumented tapping tasks was examined by establishing differences in test measures between participants with and without brain injury and defining the strength of association between test measures and maximal freestyle swim speed in Para swimmers, respectively. RESULTS: Random forest successfully classified 96% of participants with and without brain injury using test measures derived from instrumented tapping tasks. Most test measures had moderate to high correlations (r=0.54 to 0.72; p<0.01) with maximal freestyle swim speed and collectively explained up to 72% of the variance in maximal freestyle swim performance in Para swimmers with brain injury. CONCLUSIONS: The results of this study evidence the predictive and convergent validity of instrumented tapping tasks to classify motor coordination impairments in Para swimmers with brain injury. These tests can be included in revised Para swimming classification to improve the objectivity and transparency in determining athlete eligibility and sport class for these Para athletes.

Establishing the reliability of a novel battery of range of motion tests to enable evidence-based classification in Para Swimming.

OBJECTIVES: To evaluate the reliability of swimming-specific range of movement tests developed in order to permit evidenced-based classification in the sport of para swimming. DESIGN: Test-retest intra- and inter-examiner reliability. SETTING: International Swimming training camps and university exercise science departments. PARTICIPANTS: 42 non-disabled participants (mean age 23.2 years) and 24 Para swimmers (mean age 28.5 years). MAIN OUTCOME MEASURES: Intra- and inter-examiner reliability of a battery of novel active range of motion tests. RESULTS: Good to excellent intra-examiner reliability was found for the majority (32/34) of tests in non-disabled participants (ICC = 0.85-0.98). SEM values ranged from 1.18° to 6.11°. Similarly, good to excellent inter-examiner reliability was found for the majority (35/42) of tests in non-disabled participants (ICC = 0.85-0.98). SEM values range from 0.73° to 6.52°. Para swimmers exhibited significantly reduced range of motion compared to non-disabled participants. CONCLUSIONS: The large majority of ROM tests included in this novel battery were reliable both within and between examiners in non-disabled participants. The tests were found to differentiate between non-disabled participants and Para swimmers with hypertonia or impaired muscle power.

Performance Characteristics of Para Swimmers: How Effective Is the Swimming Classification System?

Swimming is one of the inaugural sports within the Olympic and Paralympic Games, the key difference between the Olympic and Paralympic games being the classification system. The aim of this study was to investigate how effective the current classification system creates clearly differentiated Paralympic competition classes, based on performance time for all swimming strokes and events. Based on the performance characteristics of swimmers within the current classification system, the relationship between impairment and swimming performance is inconsistent, potentially disadvantaging some athletes. Appropriate sports medicine tests are required for the development of an evidence-based swimming classification system.

Commitment to physical activity and health: a case study of a Paralympic Gold medallist.

BACKGROUND: Physical activity has been documented as both beneficial and detrimental for individuals with multiple sclerosis (MS). The varied experience highlights challenges associated with physical activity and MS, requiring a greater understanding of the experiences of exercise for individuals with MS. OBJECTIVE: The purpose of this study was to explore how physical activity played a role in the life of a Paralympic Gold medallist. Carol was diagnosed with MS and went onto achieve the highest accolade in Paralympic sport. METHODS: Narrative inquiry, within a single-case design, explored how physical activity played a role in Carol's life. The narrative was analysed through the lens of a salutogenic framework, which explores how individuals create health despite adverse circumstances. FINDINGS: Carol's physical activity pathway explores life before and after her diagnosis, motivations to return to exercise and pathway to Paralympic Gold. Carol's experiences highlight how physical activity played a role during various stages of her life. Exercise had a significant role in Carol's life prior to diagnosis, it assisted in the management of MS and she cycled the elite level, winning a Paralympic Gold medal in para-cycling. Implications for Rehabilitation Physical activity has been reported as beneficial for multiple sclerosis management; however, there can be a fine line between the benefits and an overload that can harm. An elite athlete with multiple sclerosis maintained and sustained physical activity to the highest level in elite sport, incorporating a positive health outlook throughout different stages of her life. The case highlights how commitment and self-awareness of capabilities and limits may be useful self-management tools in increasing physical activity for individuals living with multiple sclerosis.

Cost-effectiveness of bone-anchored prostheses using osseointegrated fixation: Myth or reality?

BACKGROUND: In principle, lower limb bone-anchored prostheses could alleviate expenditure associated with typical socket manufacturing and residuum treatments due to socket-suspended prostheses. OBJECTIVE: This study reports (a) the incremental costs and (b) heath gain as well as (c) cost-effectiveness of bone-anchored prostheses compared to socket-suspended prostheses. STUDY DESIGN: Retrospective individual case-controlled observations and systematic review. METHODS: Actual costs were extracted from financial records and completed by typical costs when needed over 6-year time horizon for a cohort of 16 individuals. Health gains corresponding to quality-adjusted life-year were calculated using health-related quality-of-life data presented in the literature. RESULTS: The provision of bone-anchored prostheses costed 21% ± 41% more but increased quality-adjusted life-years by 17% ± 5% compared to socket-suspended prostheses. The incremental cost-effectiveness ratio ranged between -$25,700 per quality-adjusted life-year and $53,500 per quality-adjusted life-year with indicative incremental cost-effectiveness ratio of approximately $17,000 per quality-adjusted life-year. Bone-anchored prosthesis was cost-saving and cost-effective for 19% and 88% of the participants, respectively. CONCLUSION: This study indicated that bone-anchored prostheses might be an acceptable alternative to socket-suspended prostheses at least from a prosthetic care perspective in Australian context. Altogether, this initial evidence-based economic evaluation provided a working approach for decision makers responsible for policies around care of individuals with lower limb amputation worldwide. Clinical relevance For the first time, this study provided evidence-based health economic benefits of lower limb bone-anchored prostheses compared to typical socket-suspended prostheses from a prosthetic care perspective that is essential to clinicians and decision makers responsible for policies.

Synthesis of phosphine oxide based amphiphilic molecules via ring-opening Wittig olefination of a macrocyclic phosphoranylidene and their property study as non-ionic surfactants.

A novel ring-opening Wittig olefination approach was developed for the synthesis of amphiphilic phosphine oxides (PO) as non-ionic surfactants. The approach concurrently introduces the crucial functional groups (lipophilic chain and phosphine oxide moiety) present in the known PO surfactants and additional hydrophilic group (i.e., ethylene glycol units) in one step via Wittig olefination of a macrocyclic phosphoranylidene. A series of novel PO compounds were obtained from a variety of aldehydes and selected compounds were examined for their physiochemical properties (surface tension, critical micelle concentration and interfacial tension) and also for their abilities to form emulsions as non-ionic surfactants.