The Physical Demands of Wheelchair Tennis Match Play: A Systematic Review with Meta-analysis.

BACKGROUND: Wheelchair tennis, a globally popular sport, features a professional tour spanning 40 countries and over 160 tournaments. Despite its widespread appeal, information about the physical demands of wheelchair tennis is scattered across various studies, necessitating a comprehensive systematic review to synthesise available data. OBJECTIVE: The aim was to provide a detailed synthesis of the physical demands associated with wheelchair tennis, encompassing diverse factors such as court surfaces, performance levels, sport classes, and sexes. METHODS: We conducted comprehensive searches in the PubMed, Embase, CINAHL, and SPORTDiscus databases, covering articles from inception to March 1, 2023. Forward and backward citation tracking from the included articles was carried out using Scopus, and we established eligibility criteria following the Population, Exposure, Comparison, Outcome, and Study design (PECOS) framework. Our study focused on wheelchair tennis players participating at regional, national, or international levels, including both juniors and adults, and open and quad players. We analysed singles and doubles matches and considered sex (male, female), sport class (open, quad), and court surface type (hard, clay, grass) as key comparative points. The outcomes of interest encompassed play duration, on-court movement, stroke performance, and physiological match variables. The selected study designs included observational cross-sectional, longitudinal, and intervention studies (baseline data only). We calculated pooled means or mean differences with 95% confidence intervals (CIs) and employed a random-effects meta-analysis with robust variance estimation. We assessed heterogeneity using Cochrane Q and 95% prediction intervals. RESULTS: Our literature search retrieved 643 records, with 24 articles meeting our inclusion criteria. Most available information focused on international male wheelchair tennis players in the open division, primarily competing in singles on hard courts. Key findings (mean [95% CI]) for these players on hard courts were match duration 65.9 min [55.0-78.8], set duration 35.0 min [28.2-43.5], game duration 4.6 min [0.92-23.3], rally duration 6.1 s [3.7-10.2], effective playing time 19.8% [18.9-20.7], and work-to-rest ratio 1:4.1 [1:3.7-1:4.4]. Insufficient data were available to analyse play duration for female players. However, for the available data on hard court matches, the average set duration was 34.8 min [32.5-37.2]. International male players on hard court covered an average distance per match of 3859 m [1917-7768], with mean and peak average forward speeds of 1.06 m/s [0.85-1.32] and 3.55 m/s [2.92-4.31], respectively. These players executed an average of 365.9 [317.2-422.1] strokes per match, 200.6 [134.7-299.0] per set, 25.4 [16.7-38.7] per game, and 3.4 [2.6-4.6] per rally. Insufficient data were available for a meta-analysis of female players' on-court movement and stroke performance. The average and peak heart rates of international male players on hard court were 134.3 [124.2-145.1] and 166.0 [132.7-207.6] beats per minute, and the average match heart rate expressed as a percentage of peak heart rate was 74.7% [46.4-100]. We found no studies concerning regional players or juniors, and only one study on doubles match play. CONCLUSIONS: While we present a comprehensive overview of the physical demands of wheelchair tennis, our understanding predominantly centres around international male players competing on hard courts in the open division. To attain a more comprehensive insight into the sport's physical requirements, future research should prioritise the inclusion of data on female and quad players, juniors, doubles, and matches played on clay and grass court surfaces. Such endeavours will facilitate the development of more tailored and effective training programmes for wheelchair tennis players and coaches. The protocol for this systematic review was registered a priori at the International Platform of Registered Systematic Review and Meta-analysis Protocols (Registration https://doi.org/10.37766/inplasy2023.3.0060 ).

Characteristics of transformational leadership development programs: A scoping review.

The effectiveness of transformational leadership (TFL) on various outcomes is well known. Accordingly, researchers have developed training programs to enhance TFL behaviours of leaders. Yet, no reviews summarizing the characteristics of TFL training programs exist. The purpose of this review was to examine the characteristics, reporting, and application of TFL-informed programs. A search of six databases yielded 4032 articles, 31 of which met the inclusion criteria. Program characteristics were analyzed using the Template for Intervention Description and Replication (TIDieR) checklist tool, while outcomes were analyzed according to the Kirkpatrick model of evaluation. The most common context for TFL program implementation was healthcare (n = 9). Programs were tailored and often delivered using group workshops and individual feedback. Studies reported variation in the dose of programs, rarely evaluated outcomes multiple times post-baseline, and typically employed Level 3a (subjective ratings of behaviour) evaluation measures. Reporting on program location, modifications, and fidelity was poor. Varying conceptualizations of TFL in different contexts lead to disparities in programs and protocols. Evaluation specialists should consider using tools like the TIDiER checklist to ensure that program characteristics are reported appropriately. Program planners should develop common approaches for planning and evaluating TFL programs to improve transparency and replicability of programs.

Identifying the outcomes of participating in peer mentorship for adults living with spinal cord injury: a qualitative meta-synthesis.

OBJECTIVE: Peer mentorship is a flagship program utilized by Canadian community-based spinal cord injury (SCI) organizations. Through connecting trained SCI peer mentors with fellow adults with SCI, these programs help adults adapt and thrive following their injury. The objective of this meta-synthesis was to work with SCI community organizations and to identify outcomes of participating in community- or rehabilitation-based peer mentorship programs using an integrated knowledge translation approach. DESIGN: A meta-synthesis of 21 qualitative peer-reviewed studies and 66 community documents was conducted. MAIN OUTCOME MEASURES: A total of 87 outcomes of peer mentorship were identified. RESULTS: The outcomes of peer mentorship were grouped according to six higher-order themes: 1) Independence: enhanced self-sufficiency; 2) Personal growth: positive psychological changes; 3) Activities and participation: greater participation in activities and events; 4) Adaptation: adapting to life with disability; 5) Knowledge: obtaining new information, resources, and opportunities; and 6) Connection: developing and maintaining social relationship. CONCLUSION: The positive nature of the identified outcomes suggests that participating in peer mentorship can promote improved health and quality of life for adults with SCI. Furthermore, the integrated knowledge translation approach helped identify outcomes that were previously not examined within SCI peer mentorship research, thus providing important insight for future research.

Investigating the influence of interaction modality on the communication patterns of spinal cord injury peer mentors.

OBJECTIVES: To examine how the quality of spinal cord injury peer mentorship relationships and mentor-mentee behaviors are impacted by interaction modality. METHODS: Using a within-subjects, repeated measures, experimental design, peer mentors (n = 8) completed two mentoring sessions with a standardized mentee in a telephone and a video chat condition. Measures of therapeutic alliance and autonomy supportiveness were administered following each session. Mentors' leadership behaviors, motivational interviewing skills, and behavior change techniques were compared across conditions. Mentors' and mentees' use of motivational interviewing skills and behavior change techniques were further analyzed using state space grids. RESULTS: Mentors' therapeutic alliance, autonomy supportiveness, use of leadership behaviors, motivational interviewing skills, and behavior change techniques did not significantly differ across the two conditions (ps > 0.123; Cohen's d range = 0.218-0.619). State space grids analyses revealed that the dynamic structure of mentoring conversations was similar when interactions occurred through the telephone versus video chat. CONCLUSIONS: Mentors were effective at forming positive, autonomy supportive relationships with mentees in telephone and video chat interaction conditions. Mentors also used leadership/counselling behaviors to a similar extent when interacting through these two modalities. PRACTICE IMPLICATIONS: Organizations that provide peer mentorship can have confidence in using both telephone and video chat modalitites.

Using ecological momentary assessment to evaluate neuropathic pain experienced by adults with SCI: recommendations and participant perceptions.

PURPOSE: Neuropathic pain is a debilitating consequence of spinal cord injury. Ecological momentary assessment can be a valuable research tool for understanding temporal fluctuations in neuropathic pain and designing effective management strategies. The objectives of this study were to (a) describe strategies necessary to adapt ecological momentary assessment to measure neuropathic pain in adults with spinal cord injury, and (b) explore participant perceptions of using ecological momentary assessment to measure pain sensations. METHODS: End-users with spinal cord injury provided input to guide development of an ecological momentary assessment protocol. Six adults with spinal cord injury (ages 27-50 years, M = 39.33 ± 8.24) engaged in the six-day protocol and completed six daily neuropathic pain assessments. Upon finishing participants completed a semi-structured interview regarding their protocol experiences. A qualitative content analysis was used to analyze the interview data. RESULTS: Participants reported that this specific ecological momentary assessment protocol was unobtrusive to their daily routines, and effectively captured their neuropathic pain sensations. However, participants experienced increased neuropathic pain due to the repeated nature of assessments. CONCLUSION: Ecological momentary assessment can capture the dynamic nature of neuropathic pain experienced by persons with spinal cord injury. However, caution should be taken when designing intensive pain-related protocols to minimize pain exacerbation.IMPLICATIONS FOR REHABILITATIONNeuropathic pain affects up to 75% of people with spinal cord injury and is one of the most frequently occurring, debilitating forms of pain.Appropriate and feasible pain data collection methods are necessary to acquire a better understanding of how neuropathic pain manifests in people with spinal cord injury.Implementing ecological momentary assessment in a rehabilitation setting may help facilitate the monitoring of neuropathic pain for both rehabilitation professionals and persons with SCI.Using ecological momentary assessment may lead to a better understanding of individual temporal patterns of neuropathic pain that could inform the design of tailored neuropathic pain management techniques.

Physical activity interventions, chronic pain, and subjective well-being among persons with spinal cord injury: a systematic scoping review.

STUDY DESIGN: Scoping review of experimental and quasi-experimental studies. OBJECTIVE: To systematically synthesize research testing the effects of leisure time physical activity (LTPA) interventions on chronic pain and subjective well-being (SWB) among adults with spinal cord injury (SCI). METHODS: Literature searches were conducted using multiple databases (Web of Science, Embase, CINAHL, Medline, PsychINFO and SPORTDiscus) to identify studies involving persons with SCI that measured and reported the effects of LTPA interventions on both chronic pain and at least one measure of SWB (e.g., affect, life satisfaction, satisfaction with various life domains). Relevant data were extracted from the studies and synthesized. RESULTS: A total of 3494 articles were screened. Fifteen published articles, consisting of 12 different studies met the review inclusion criteria. Four different patterns of findings were observed regarding the effect of LTPA on chronic pain and SWB outcomes: (1) increased chronic pain, decreased SWB (1 article); (2) decreased chronic pain, improved SWB (12 articles); (3) increased chronic pain, improved SWB (1 article); and (4) unchanged levels of pain, improved SWB (1 article). CONCLUSIONS: Results of most articles included in this scoping review suggest that LTPA interventions can reduce chronic pain and improve SWB for persons with SCI. Further research is needed to identify the mechanisms by which LTPA affects pain and SWB, in order to formulate LTPA prescriptions that maximize improvements in these outcomes.

A Scoping Review of Peer Mentorship Studies for People with Disabilities: Exploring Interaction Modality and Frequency of Interaction.

Given our understanding of the importance of peer mentorship for people with disabilities, research needs to begin exploring characteristics of the mentor-mentee relationship that could contribute to the observed positive outcomes. To date, no review has examined characteristics of peer mentorship (i.e. interaction modality, interaction frequency) that could impact the quality and effectiveness of this service. The primary purpose was to synthesize the peer-reviewed peer mentorship literature for people with disabilities and report on the interaction modality and frequency employed in each study. A secondary purpose was to document the results of studies that have tested relationships between the outcomes of peer mentorship and interaction modality or frequency. A scoping review was performed that involved a systematic search of MEDLINE, EMBASE, PsychINFO, CINAHL, Web of Science, and SPORTDiscus. Thirteen studies met the inclusion criteria. Articles reported five different interaction modalities; the telephone (n = 12) was the most common. Frequency of interactions was reported in nine studies with mentees reporting between 3 and 77 interactions with their mentor. Only one study attempted to analyze the mediating or moderating effects of modality and frequency on the reported outcomes. In conclusion, peer mentorship is occurring through various interaction modalities and at varying frequencies. Future research should focus on examining the impact that modality and frequency of interaction have on outcomes of peer mentorship.

Physical activity among individuals with spinal cord injury who ambulate: a systematic scoping review.

STUDY DESIGN: Systematic scoping review. OBJECTIVES: The purpose of this project was to conduct a scoping review to understand the amounts, types, correlates, and outcomes of physical activity (PA) participation for ambulators with SCI. METHODS: A systematic search was employed among five large databases and two theses/dissertation databases, yielding 3257 articles. Following a two-phase screening process by independent coders, 17 articles were included in the review. Data were charted and summarized, and correlates were coded using the COM-B model. RESULTS: 11 studies were cross-sectional, 5 studies involved an exercise intervention, and 1 study used mixed methods. Overall, ambulators with SCI participated in low levels of PA. The type of PA investigated across all studies was leisure-time PA (e.g., sports, exercise). Psychological and physical capability (e.g., perceived behavioral control, fatigue), social and environmental opportunity (e.g., perceptions of disability, cost), and automatic and reflective motivation (e.g., boredom, intentions) were correlates of PA measured within studies. Exercise intervention studies measured physical (e.g., strength, fitness) and one psychological outcome (i.e., depression). No studies examined the quality of PA experiences. CONCLUSIONS: Only leisure-time PA has been investigated among ambulators with SCI, and low levels of leisure-time PA have been reported. Correlates of leisure-time PA can be mapped onto all COM-B model constructs and are potential targets for PA-enhancing interventions. Further investigation is warranted into the physical and psychosocial outcomes across all types of LTPA in addition to understanding the quality of LTPA experiences.

Co-development of a physiotherapist-delivered physical activity intervention for adults with spinal cord injury.

STUDY DESIGNS: Cross-sectional survey, semi-structured interview, and randomized-controlled trial. OBJECTIVES: Optimal spinal cord injury (SCI)-specific PA intervention strategies appropriate for the physiotherapist setting are unknown. The purpose of this paper is to describe the rigorous co-development process of a theory-based, physiotherapist-led PA intervention for people with SCI and assess its feasibility for implementation in the rehabilitation setting. SETTING: Community. METHODS: Co-development of the intervention included (1) a review of the literature; (2) key informant interviews with people with SCI (n = 26); (3) a national online survey of physiotherapists' barriers, needs, and preferences (n = 239); (4) a review of the evidence and recommendations for the intervention from a stakeholder expert panel (n = 13); and (5) a randomized controlled trial of intervention training and its effects on implementation determinants amongst physiotherapists (n = 20). RESULTS: Almost 300 people with SCI and physiotherapists were engaged in the intervention development process. Optimal intervention delivery should be tailored and include (1) education on safety, PA guidelines, and behaviour change techniques, (2) referral to other peers, local programmes, and health professionals, and (3) adapted exercise prescriptions. Following intervention implementation training, physiotherapists demonstrated stronger tested and perceived knowledge, skills, resources, and confidence for promoting PA to people with SCI, ps < 0.05. CONCLUSIONS: This development process serves as an example methodology for using theory to co-create a leisure-time physical activity behaviour change intervention tailored for people with SCI.

Operationalizing the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework to evaluate the collective impact of autonomous community programs that promote health and well-being.

BACKGROUND: The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a useful tool for evaluating the impact of programs in community settings. RE-AIM has been applied to evaluate individual programs but seldom used to evaluate the collective impact of community-based, public health programming developed and delivered by multiple autonomous organizations. The purposes of this paper were to (a) demonstrate how RE-AIM can be operationalized and applied to evaluate the collective impact of similar autonomous programs that promote health and well-being and (b) provide preliminary data on the collective impact of Canadian spinal cord injury (SCI) peer mentorship programs on the delivery of peer mentorship services. METHODS: Criteria from all five RE-AIM dimensions were operationalized to evaluate multiple similar community-based programs. For this study, nine provincial organizations that serve people with SCI were recruited from across Canada. Organizations completed a structured self-report questionnaire and participated in a qualitative telephone interview to examine different elements of their peer mentorship program. Data were analyzed using summary statistics. RESULTS: Having multiple indicators to assess RE-AIM dimensions provided a broad evaluation of the impact of Canadian SCI peer mentorship programs. Peer mentorship programs reached 1.63% of the estimated Canadian SCI population. The majority (67%) of organizations tracked the effectiveness of peer mentorship through testimonials and reports. Setting-level adoption rates were high with 100% of organizations offering peer mentorship in community and hospital settings. On average, organizations allocated 10.4% of their operating budget and 9.8% of their staff to implement peer mentorship and 89% had maintained their programming for over 10 years. Full interpretation of the collective impact of peer mentorship programs was limited as complete data were only collected for 52% of survey questions. CONCLUSIONS: The lack of available organizational data highlights a significant challenge when using RE-AIM to evaluate the collective impact of multiple programs that promote health and well-being. Although researchers are encouraged to use RE-AIM to evaluate the collective impact of programs delivered by different organizations, documenting limitations and providing recommendations should be done to further the understanding of how best to operationalize RE-AIM in these contexts.

Investigating Characteristics of Quality Peer Mentors With Spinal Cord Injury.

OBJECTIVE: To identify characteristics (1) of high- and low-quality spinal cord injury (SCI) peer mentors; (2) that should be used to match SCI peer mentors and mentees. DESIGN: The study was conducted in partnership with three Canadian provincial SCI organizations using an integrated knowledge translation approach. The Delphi exercise was completed in three rounds. In Round 1, people with SCI completed a thought-listing exercise to identify characteristics of high- and low-quality peer mentors and for matching. In Rounds 2 and 3, people with SCI and community organization staff rated characteristics from the previous round on an 11-point scale. After the final round, the remaining characteristics were thematically analyzed. SETTING: Community-based peer mentorship programs in three Canadian provinces. PARTICIPANTS: People with SCI and SCI community organization staff (Round 1, n=45; Round 2, n=27; Round 3, n=25). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Consensus-based list of characteristics. RESULTS: Participants reached consensus on 215 characteristics of quality peer mentors and 11 characteristics for peer mentor-mentee matching (ICC=0.96). A consensus-based characterization of high- and low-quality peer mentorship was created and included six overarching themes: competencies, personality characteristics, emotional state, mentor outlook, reason for mentoring, and role model. CONCLUSION: A consensus-based characterization of quality peer mentorship was co-developed with input from over 50 members of the SCI community. Findings highlight that peers have both interpersonal and intrapersonal characteristics that contribute to quality mentorship. The findings highlighted the importance of matching mentors on lived experience and shared interests. Findings will inform future research and SCI peer mentorship programs.

Correction: Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline.

Authors Victoria L. Goosey-Tolfrey and Karen M. Smith were listed under the incorrect affiliations at the time of publication.

Pilot study of a training program to enhance transformational leadership in Spinal Cord Injury Peer Mentors.

STUDY DESIGN: Experimental, pragmatic design. OBJECTIVES: (1) To determine the effects of a transformational leadership (TFL) training program on spinal cord injury (SCI) peer mentors and their mentees; (2) To document characteristics of mentorship within a community-based SCI peer mentor program. METHODS: In total 23 SCI peer mentors (70% male; M age = 47.4 ± 12.1) were randomly allocated to an Experimental or Control condition. Experimental condition mentors received a half-day TFL workshop and bi-weekly emailed information on using TFL in SCI peer mentorship. Sixteen SCI mentees (50% male; M age = 49.1 ± 12.9) enrolled in the study and 9 completed measures of self-efficacy and their mentors' use of TFL and supportiveness at 3 and 6-months. Mentors completed monthly reports of mentorship activities. SETTING: Community-based peer mentorship program in British Columbia, Canada. RESULTS: There were no between-groups differences in mentee self-efficacy, mentor use of TFL or mentor supportiveness. In the Experimental condition only, total mentorship time and sessions were positively correlated with mentors' use of TFL and supportiveness. Mentorship occurred in-person, by phone, text, and email and mentors discussed an average of 11 topics. CONCLUSIONS: The intervention did not increase SCI peer mentors' use of TFL relative to a Control condition. Nevertheless, there may be merit in coaching SCI peer mentors to use TFL given the positive correlations between mentorship time and sessions, TFL use, and perceived supportiveness of the mentor. Although inherently challenging, research involving community-based SCI peer mentorship programs provides opportunities for scientists and community organizations to extend knowledge of peer mentorship beyond the context of hospital-based programs. SPONSORSHIP: Research supported by a SSHRC Partnership Development Grant.

Transformational mentoring: Leadership behaviors of spinal cord injury peer mentors.

OBJECTIVE: The purpose of this study was to investigate the leadership behaviors of spinal cord injury (SCI) peer mentors and examine whether behaviors of peer mentors align with the tenets of transformational leadership theory. METHOD: A total of 12 SCI peer mentors aged 28-75 (M = 49.4) who had between 3 and 56 years (M = 13.9) of mentoring experience were recruited for the study. Utilizing a qualitative methodology (informed by a social constructionist approach), each mentor engaged in a semistructured interview about their experiences as a peer mentor. Interviews were transcribed verbatim and subjected to a directed content analysis. RESULTS: SCI peer mentors reported using mentorship behaviors and engaging with mentees in a manner that closely aligns with the core components of transformational leadership theory: idealized influence, inspirational motivation, individualized consideration, and intellectual stimulation. A new subcomponent of inspirational motivation described as 'active promotion of achievement' was also identified and may be unique to the context of peer mentorship. CONCLUSIONS: SCI peer mentors inherently use behaviors associated with transformational leadership theory when interacting with mentees. The results from this study have the potential to inform SCI peer mentor training programs about specific leadership behaviors that mentors could be taught to use and could lead to more effective mentoring practices for people with SCI. (PsycINFO Database Record

Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline.

OBJECTIVES: To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI). SETTING: International. METHODS: Using Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines' scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d). RESULTS: For cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation). CONCLUSIONS: Through a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.

The technical quality of online leisure time physical activity resources for people with physical disabilities.

BACKGROUND: The internet is an important information source for people with disabilities. Unfortunately, little is known about the quality of online leisure time physical activity resources provided for people with physical disabilities. OBJECTIVE: To assess the quality of leisure time physical activity resources available online for people with physical disabilities. METHODS: A purposive internet search was conducted to locate Canadian-developed resources that promoted leisure time physical activity for people with physical disabilities. Community disability organizations across Canada were also contacted to obtain additional resources. Resource quality was evaluated using a modified version of the Journal of the American Medical Association benchmarks to assess technical quality of health information. Other pertinent information (i.e., descriptive characteristics, targeting strategies) were also assessed. RESULTS: None of the resources satisfied all seven technical quality benchmarks, with 4 benchmarks being the median number achieved. Resources were easily accessed from their respective websites and the majority (76.1%) provided links to additional resources related to leisure time physical activity. A limited number of resources tailored their information for a specific disability (28.4%) or age demographic (36.4%), while no resources targeted their information to individuals based on their time since disablement. CONCLUSION: This study highlights the concerning state of leisure time physical activity resources available online for people with physical disabilities. Based on the results of this study, recommendations are provided for resource developers to ensure newly developed resources are of higher technical quality.

Aesthetic and functional satisfaction after monsplasty in the massive weight loss population.

BACKGROUND: The mons region is often affected by massive weight loss (MWL), with descent of the pubic area and residual adiposity. Thinning and resuspension are often performed concomitantly with abdominal contouring procedures. OBJECTIVES: Assess patient satisfaction, as well as functional and aesthetic results, after monsplasty in the MWL population. METHODS: The authors identified 54 consecutive female MWL patients (≥50 lbs) who had undergone abdominal contouring and completed at least 3 months of follow-up as potential subjects. Subjects were asked to complete a Mons Satisfaction Survey, either by phone or in person. Demographic and procedural data were collected from our prospective registry. Descriptive statistics were calculated with significance set at P value <.05. RESULTS: Thirty-one patients (57.8%) completed the survey. Average patient age was 46 ± 11.3 years. Mean maximum body mass index (BMI) was 52.0 ± 8.81 kg/m(2), mean current BMI was 31.0 ± 6.22 kg/m(2), and mean delta BMI was 20.7 ± 6.00 kg/m(2). Average pannus resection weight was 3.25 ± 2.03 kg. Visualization of the genitalia improved from 25.8% to 100% (P < .01). Patients rated the appearance of their mons as 3.18 ± 2.11 prior to surgery and 8.58 ± 1.73 after surgery (P < .001) on a scale of 1 to 10. Hygiene improved in 61.3% of patients, and sex life improved in 51.6%, with 32.3% of patients reporting increased genital sensitivity. Incontinence decreased from 22.6% to 12.9%, and 6 patients reported a change in urinary stream. CONCLUSIONS: Monsplasty at the time of abdominal contouring yields significant improvement in patient satisfaction levels and functional scores. With proper incisional design, monsplasty can be performed safely during abdominal contouring with high patient satisfaction to improve both form and function of the pubic region.

Facial bone density: effects of aging and impact on facial rejuvenation.

BACKGROUND: Facial bone aging has recently been described as primarily resulting from volume loss and morphologic changes to the orbit, midface, and mandible. OBJECTIVE: The authors demonstrate how the facial skeleton bone mineral density (BMD) changes with age in both men and women and compare these changes to those of the axial skeleton. They also explore the aesthetic implications of such changes in bone density. METHODS: Dual-energy X-ray absorptiometry (DXA) scans of the facial bones and lumbar spine were obtained from 60 white subjects, 30 women and 30 men. There were 10 men and 10 women in each of 3 age categories: young (20-40 years), middle (41-60 years), and old (61+ years). The following measurements were obtained: lumbar spine BMD (average BMD of L1-L4 vertebrae), maxilla BMD (the average BMD of the right and left maxilla), and mandible BMD (the average BMD of the right and left mandibular ramus). RESULTS: The lumbar spine BMD decreased significantly for both sexes between the middle and old age groups. There was a significant decrease in the maxilla and mandible BMD for both sexes between the young and middle age groups. CONCLUSIONS: Our results suggest that the BMD of the face changes with age, similar to the axial skeleton. This change in BMD may contribute to the appearance of the aging face and potentially affect facial rejuvenation procedures.