Return on investment of fracture liaison services: a systematic review and analysis.

Fracture liaison services (FLS) have been proven clinically effective and cost-effective in preventing subsequent fractures among patients with an existing fragility fracture. Little is known about their monetary benefits such as their return on investment (ROI). This systematic review aimed to investigate the ROI of FLS and identify the FLS characteristics with better ROI. Studies on the cost-effectiveness of FLS published between January 2000 and December 2022 were searched from MEDLINE, EMBASE, PubMed, and Cochrane Central. Two independent reviewers conducted study selection and data extraction. ROI was calculated based on the difference between monetary benefits and FLS costs divided by the FLS costs. Subgroup analysis of ROI was performed across FLS types and FLS design details. A total of 23 FLS were included in this review. The majority of them were targeting patients aged over 50 years having fractures without identified sites. The mean ROI of these FLS was 10.49 (with a median ROI of 7.57), and 86.96% of FLS had positive ROI. FLS making treatment recommendations yielded the highest ROI (with a mean ROI of 18.39 and a median of 13.60). Incorporating primary care providers (with a mean ROI of 16.04 and a median of 13.20) or having them as program leaders (with a mean ROI of 12.07 and a median of 12.07) has demonstrated a high ROI. FLS for specific fracture sites had great monetary return. Intensive FLS such as type A and B FLS programs had higher ROI than non-intensive type C and D FLS. This review revealed a 10.49-fold monetary return of FLS. Identified characteristics contributing to greater economic return informed value-for-money FLS designs. Findings highlight the importance of FLS and the feasibility of expanding their contribution in mitigating the economic burden of osteoporotic fracture and are conducive to the promotion of FLS internationally.

Greener neighborhoods, slimmer people? Evidence from 246,920 Australians.

Although there is growing consensus that population-level improvements in cardiovascular health depend upon environments that promote healthy lifestyles, evidence to support large-scale investments in neighborhood greenery to tackle obesity is inconsistent and has not focused on adults in middle-to-old age who experience the greatest burden of chronic health problems. Multilevel linear and multinomial logit regression models were fitted to investigate association between body mass index and an objective measure of green space in a sample of 246,920 Australian adults aged 45 years and older (The 45 and Up Study). Proximity to green space was constructed using catchment areas of 1 km radius around each participant. Women with over 80% proximity to green space had relative risk ratios of 0.90 (95% confidence interval: 0.83, 0.97) for overweight and 0.83 (0.74, 0.94) for obese. No similarly protective association was found for men. These results were consistent after controlling for moderate-to-vigorous physical activity (MVPA) and sitting time, each of which was favorably associated with green space proximity in men and women. Large-scale investments to enhance green spaces may promote MVPA and reduce sedentary behavior in middle-to-older-aged adults, but the impact on obesity may not benefit everyone to the same extent.

Pedometer steps in primary school-aged children: a comparison of school-based and out-of-school activity.

While studies of the physical activity habits of New Zealand children have been carried out, the findings have been restricted by the use of proxy and self-report measures and limited to total overall daily activity. Objective measurement of children's in-school and out-of school physical activity using pedometry is likely to provide more accurate data on habitual daily activity. To date, no such data are available for New Zealand children. In the present study, children from school years 1-6 (girls, n=46; boys, n=45) at a New Zealand primary school wore a Yamax Digiwalker SW-200 pedometer to record school-based and out-of-school steps over a 3-day period. Mean daily steps for the overall sample were 14 333 (S.D.=4110). Boys (X=15 606; S.D.=4601) were significantly more active than girls (X=13 031; S.D.=3079) (p=.00). Mean steps were also significantly higher in older age groups for both boys (p=.03) and in particular, girls (p=.00). Of note, for the overall sample, steps taken out of school made up 52.4% of total daily steps. Girls (53.6%) and boys (51.3%) took a similar proportion of their overall daily steps outside of the school environment. While a significant difference was found between the most and least active tertiles in steps taken during both during school hours (p=.00) and outside of school hours (p=.00), the most active third of the sample completed significantly more of their daily steps outside of school (55.1%) than did their least active (46.7%) counterparts (p=.00). These results suggest that physical activity outside of the school environment is a key contributor to a child's overall level of physical activity, reinforcing the need for interventions targeting the family and community as well as the school environment.

Adherence to rehabilitation in patients with low back pain.

This study investigated adherence to low back pain rehabilitation in the clinical setting. Adherence was assessed in 105 (71 male and 34 female) patients attending private physiotherapy clinics for rehabilitation of low back pain. Three aspects of adherence were measured over the 4-week study period: attendance at clinic-based rehabilitation sessions, adherence to a home exercise component of rehabilitation, and adherence to activities and advice during clinic-based rehabilitation. Rehabilitation outcome was measured using the Patients' Measure of Perceived Rehabilitation (McDonald & Hardy 1990) and the Physiotherapists' Measure of Perceived Rehabilitation (McDonald & Hardy 1990). It was found that patients attended 87.7% of their scheduled physiotherapy rehabilitation appointments and reported completing 71.6% of their prescribed home exercises. In relation to adherence to clinic-based rehabilitation activities (as measured by the Sport Injury Rehabilitation Adherence Scale, Brewer et al. 2000), patients scored an average of 11.6/15. Although no gender differences were found, compensable patients adhered significantly less to clinic-based rehabilitation activities than did their non-compensable counterparts. Further, it was found that higher levels of adherence to clinic-based activities significantly predicted both the patients' and physiotherapists' perception of degree of rehabilitation at the end of the 4-week rehabilitation period. These findings are discussed in relation to rehabilitation strategies for physiotherapists.

Injury toll following the 1997 Maccabiah Games bridge collapse: implications of major disasters for sports medicine teams.

A major disaster was encountered at the 1997 Maccabiah Games in Israel. As the Australian team was about to enter the main stadium for the opening ceremony, a pedestrian bridge they were crossing collapsed, killing 4 athletes and injuring many others. The aim of this paper is to establish the rates, types and anatomical locations of musculoskeletal injuries incurred by members of the Australian Maccabiah Games team, with particular reference to the impact of the bridge collapse. In total, the 410 members of the team (360 athletes and coaches and 50 team officials) reported 166 injuries from their participation in sport and 30 musculoskeletal injuries associated with the collapse of the bridge. The most common sports-related injuries were sprains and strains to the hip/thigh, lumbar spine and ankle/foot regions, while the bridge collapse resulted in, most commonly, sprains and contusions to the hip/thigh, knee, lower leg and ankle/foot regions. In addition, team members incurred many medical and psychological conditions. This paper makes several recommendations for sports medicine staff based on the experience of this significant sport disaster.

Measurement of anterior-to-posterior translation of the glenohumeral joint using the KT-1000.

STUDY DESIGN: Single-group repeated measures. OBJECTIVES: To adapt an existing arthrometer to allow simple quantification of glenohumeral translation and to assess the arthrometer's reliability. BACKGROUND: The measurement of glenohumeral translation is an integral part of the clinical examination of the shoulder. However, no objective and reliable measure for glenohumeral translation has been reported. METHODS AND MEASURES: The KT-1000 Knee Ligament Arthrometer was used to measure the amount of anterior-to-posterior (AP) translation of the humeral head at the glenohumeral joints of 28 (16 women and 12 men) nonimpaired undergraduate university students (age 22.1 +/- 2.9 years). Two assessments were made (20 minutes apart), by a single tester, of the dominant and nondominant shoulders of each participant. RESULTS: Anterior-to-posterior translation varied from 10 to 32 mm (20.9 +/- 4.9). The test-retest reliability of the KT-1000 when measuring the nondominant shoulders was good (ICC [intraclass correlation coefficient] 0.76), and it was moderate (ICC = 0.67) when measuring the dominant shoulders. The reliability findings were influenced by large amounts of random error. Analysis by ANOVA showed that compared to women (dominant shoulder, 22.6 +/- 4.6 mm; nondominant, 23.8 +/- 4.2 mm), men showed significantly less glenohumeral translation (dominant, 17.1 +/- 3.7 mm; nondominant, 18.3 +/- 3.7 mm). CONCLUSIONS: The KT-1000 arthrometer has the potential to provide therapists with a clinically viable method of measuring glenohumeral translation.

Epidemiology of injury in elite and subelite female gymnasts: a comparison of retrospective and prospective findings.

OBJECTIVES: An 18 month prospective injury survey was conducted on 64 Australian elite and subelite female gymnasts. The aims were to determine the rate of injury, anatomical location, and types of injury incurred by female competitive gymnasts, and to compare the findings with data collected retrospectively from the same sample of gymnasts. METHODS: The gymnasts recorded (weekly) in an injury record booklet the number of hours trained and information on any injuries suffered over that week. RESULTS: The sample reported 349 injuries, a rate of 5.45 per person (6.29 for the elite and 4.95 for subelite gymnasts) over the 18 month survey. Injuries to the ankle and foot (31.2%) were the most commonly reported, followed by the lower back (14.9%). The most prevalent type of injury were sprains (29.7%), followed by strains (23.2%), and growth plate injuries (12.3%). The elite gymnasts reported that, for each injury, they missed fewer training sessions (p = 0.01), but modified more sessions (p = 0.0001) than their subelite counterparts. Further, the elite gymnasts spent 21.0% of the year training at less than full capacity because of injury. Although a significantly higher number of injuries were recorded in the prospective study (p = 0.0004), no differences were found between the distribution of injury by anatomical location or type between the two methods of data collection. CONCLUSIONS: The findings have important implications in terms of training procedures and periodic screening of gymnasts.

Participation motives of young Australian and Chinese gymnasts.

Reasons for participating in gymnastics were investigated with 280 Australian and 103 Chinese youth. The participants, aged 8 to 15 years, completed modified versions of the Participation Motivation Questionnaire. Treatment of the scores by principal components analysis yielded seven factors. Further analyses showed that the samples differed significantly on six of these factors. Comparisons of individual items indicated that the Australian gymnasts rated having fun and liking the rewards as more important than did the Chinese respondents. Chinese athletes allocated higher ratings to being part of a club, having a good body, liking to win, and wanting to be popular. Both groups assigned high values to reasons associated with improving skills, being fit, and getting exercise. It was suggested that the findings reflected cultural differences between Australian and Chinese societies as well as particular characteristics of the Chinese sample.

Self-esteem and injury in competitive field hockey players.

A volunteer sample of 50 competitive field hockey players completed the Coopersmith Self-esteem Inventory at pre- and postseason and prospectively collected injury data over a 20-wk. season. Multiple regression analysis showed no relationship between scores on Self-esteem and the number of injuries, the participation time affected due to injury, and sex of players. Further multiple regression analysis showed that frequency of the more severe injuries significantly predicted scores on Self-esteem. This finding can be interpreted as evidence of the relationship between low self-esteem and injury in sport.

Cultural factors in exercise participation of older adults.

Participation motives were investigated in 81 Australian-born and 42 overseas-born older Australians (M age = 67.8 yr.) involved in community-organised exercise programs. Australians born overseas scored significantly higher on factors of Affiliation/Personal, Recognition/Achievement, and Exercise Involvement of the Participation Motivation Questionnaire but not on Fitness.

Injury, anxiety, and mood in competitive gymnasts.

Psychological factors related to injury were investigated in 115 competitive gymnasts. The subjects were administered the Profile of Mood States-Bipolar Form (POMS-BI) and Competitive State Anxiety Inventory-2 (CSAI-2). Direct discriminant function analysis showed that the best predictors for distinguishing between gymnasts with four or more injuries and those with fewer than four injuries were CSAI-2 Cognitive Anxiety and the POMS-BI Composed-Anxious and Energetic-Tired scores. The more-injured gymnasts were more anxious and tired, and reported higher scores on the CSAI-2 Cognitive Anxiety scale. Males could be differentiated from females by scores on the CSAI-2 Self-confidence and the POMS-BI Composed-Anxious, Confident-Unsure, Energetic-Tired, and Clearheaded-Confused scales. The female gymnasts were more anxious, unsure, tired, and confused, and reported lower levels of CSAI-2 Self-confidence. The findings were interpreted as further evidence of the anxiety-injury link in athletes.