Motor Skill Interventions in Children With Developmental Coordination Disorder: A Systematic Review and Meta-Analysis.

OBJECTIVES: To determine the characteristics and effectiveness of motor skill interventions in children with developmental coordination disorder (DCD) and to identify potential moderators of training effects using meta-analysis. DATA SOURCES: A search was conducted in 6 databases (CINAHL Plus, Cochrane Library, Embase, ERIC, PsycINFO, and PubMed) for articles published between 1995 and August 2017 using search items which were grouped into 3 components (motor skill interventions, DCD, and age group of interest). STUDY SELECTION: Studies were included if they recruited children 3 to 17 years of age with DCD, reported performance of motor-related skills as outcomes, were published in peer-reviewed journals, and were written in English. Qualitative synthesis was conducted for all included studies. Quantitative synthesis (meta-analysis) was only conducted for studies using a (quasi) randomized controlled trial design. DATA EXTRACTION: Methodology, participant characteristics, intervention components, outcomes, and statistically significant training effects of each included study were extracted. DATA SYNTHESIS: Sixty-six studies met the inclusion criteria with 18 of the studies eligible for meta-analysis. Motor performance and cognitive, emotional, and other psychological factors were the most common outcomes. Other 3 outcome categories included perceptions and/or satisfaction regarding the children's improvement from significant others, physical fitness, and physical activity and participation. Immediate and moderate training effects were found for motor performance (Hedges g=.63; 95% confidence interval [CI], .31-.94; P<.001) and cognitive, emotional, and other psychological factors (Hedges g=0.65; 95% CI, 0.25-1.04; P=.001). Additionally, dose (minutes in total) and frequency of the intervention were significant moderators of training effect on motor performance. CONCLUSIONS: Motor skill interventions are effective in improving motor competence and performance on cognitive, emotional, and other psychological aspects in children with DCD in the short term. These effects are more robust in interventions using a large training dose and a practicing schedule of high frequency.

A comprehensive strength testing protocol offers no clinical value in predicting risk of hamstring injury: a prospective cohort study of 413 professional football players.

BACKGROUND: Hamstring injuries remain prevalent across a number of professional sports. In football, the incidence has even increased by 4% per year at the Champions League level over the last decade. The role of muscle strength or strength ratios and their association with risk of hamstring injury remain restricted by small sample sizes and inconclusive results. PURPOSE: The purpose of this study is to identify risk factors for hamstring injury in professional football players in an adequately powered, prospective cohort study. Using both established (isokinetic) and novel (eccentric hamstring test device) measures of muscle strength, we aimed to investigate the relationship between these strength characteristics over the entire range of motion with risk of hamstring injury. METHODS: All teams (n=18) eligible to compete in the premier football league in Qatar underwent a comprehensive strength assessment during their annual periodic health evaluation at Aspetar Orthopaedic and Sports Medicine Hospital in Doha, Qatar. Variables included isokinetic strength, Nordic hamstring exercise strength and dynamic hamstring: quadriceps ratios. RESULTS: Of the 413 players included (68.2% of all league players), 66 suffered a hamstring injury over the two seasons. Only isokinetic quadriceps concentric at 300°/s (adjusted for bodyweight) was associated with risk of hamstring injury when considered categorically. Age, body mass and playing position were also associated with risk of hamstring injury. None of the other 23 strength variables examined were found to be associated with hamstring injury. CONCLUSION: The clinical value of isolated strength testing is limited, and its use in musculoskeletal screening to predict future hamstring injury is unfounded.

An exploration of familial associations of two movement pattern-derived subgroups of chronic disabling low back pain; a cross-sectional cohort study.

BACKGROUND: Altered movement patterns with pain have been demonstrated in children, adolescents and adults with chronic disabling low back pain (CDLBP). A previously developed classification system has identified different subgroups including active extension and multidirectional patterns in patients with CDLBP. While familial associations have been identified for certain spinal postures in standing, it is unknown whether a familial relationship might exist between movement pattern-derived subgroups in families with CDLBP. OBJECTIVES: This study explored whether familial associations in movement pattern-derived subgroups within and between members of families with CDLBP existed. DESIGN: Cross-sectional cohort study. METHOD: 33 parents and 28 children with CDLBP were classified into two subgroups based on clinical analysis of video footage of postures and functional movements, combined with aggravating factors obtained from Oswestry Disability Questionnaire. Prevalence of subgroups within family members was determined, associations between parent and child's subgroup membership was evaluated using Fisher's exact test, and spearman's correlation coefficient was used to determine the strength of association between familial dyads. RESULTS: The majority of parents were classified as active extenders, sons predominately multidirectional and daughters were evenly distributed between the two subgroups. No significant association was found when comparing subgroups in nine parent-child relationships. CONCLUSIONS: The exploration of a small cohort of family dyads in this study demonstrated that children's movement pattern-derived subgroups could not be explained by their parents' subgroup membership. These results cannot be generalised to the CLBP population due to this study's small sample. Larger sample studies are needed to further elucidate this issue.

Development and measurement properties of a putting skill test for high-level golf.

Despite a recent increase in the amount of research investigating performance in golf, a comprehensive putting skill test has not been reported in the peer-reviewed literature. In this study, the Golf Australia Putting Test (GAPT) was developed and a series of measurement properties were assessed. Elite (n = 18) and high-level amateur (HLA; n = 22) participants completed six single putts from various areas on six concentric circles (circle radii = 0.9, 1.5, 3.0, 4.6, 6.1 and 7.6 m). Using a scoring system that rewarded participants for holing putts from longer distances, the maximum score from a single round of the test (i.e. 36 putts) was 27 points. After two rounds of the test were completed by all players, a subsample of participants (elite, n = 15; HLA, n = 7) had their putting performance recorded during tournament play for a period of 90 days to assess criterion (predictive) validity of the test. The reliability, sensitivity and discriminative validity of the GAPT were also assessed. Better agreement between Rounds 1 and 2 scores was noted in the elite group, whilst reliability values were similar for both groups. Further, the GAPT scores were shown to predict players from the elite and high-ability groups with a low classification error. An equation for predicting on-course performance from GAPT scores was also developed. Findings from this study indicate that the GAPT is a valid and reliable tool for high-level players and the GAPT may be used for player evaluation in the field.

Low back pain beliefs are associated to age, location of work, education and pain-related disability in Chinese healthcare professionals working in China: a cross sectional survey.

BACKGROUND: Low back pain (LBP) is the leading cause of disability worldwide. Evidence pointing towards a more efficacious model of care using a biopsychosocial approach for LBP management highlights the need to understand the pain-related beliefs of patients and those who treat them. The beliefs held by healthcare professionals (HCPs) are known to influence the treatment advice given to patients and consequently management outcomes. Back pain beliefs are known to be influenced by factors such as culture, education, health literacy, place of work, personal experience of LBP and the sequelae of LBP such as disability. There is currently a knowledge gap among these relationships in non-western countries. The aim of this study was to examine the associations between LBP-related beliefs among Chinese HCPs and characteristics of these HCPs. METHODS: A convenience sample of 432 HCPs working in various health settings in Shanghai, China, completed a series of questionnaires assessing their demographic characteristics, LBP status, pain-related disability and their beliefs about their own LBP experience, using the Back beliefs Questionnaire (BBQ) and the Fear Avoidance Beliefs Questionnaire (FABQ). RESULTS: Younger Chinese HCPs (20-29 years) held more negative beliefs and attitudes related to LBP compared to older HCPs (>40years; BBQ mean difference [95% CI]: 2.4 [0.9 - 3.9], p = 0.001). HCPs working outside tertiary hospitals had poorer beliefs concerning the inevitable consequences of LBP (BBQ mean difference [95% CI]: -2.4 [-3.8 - -1.0], p = 0.001). HCPs who experienced LBP had higher level of fear avoidance beliefs when experiencing high LBP-related disability (FABQ-physical mean difference [95% CI]: 2.8 [1.5 - 4.1], p < 0.001; FABQ-work mean difference [95% CI]: 6.2 [4.0 - 8.4], p < 0.001)) and had lower level of fear avoidance beliefs if they had completed postgraduate study (FABQ-physical mean difference [95% CI]: 2.9 [-5.8 - 0.0], p = 0.049). CONCLUSION: This study suggests that LBP-related beliefs and attitudes among Chinese HCPs are influenced by age, location of work, level of LBP-related disability and education level. Understanding back pain beliefs of Chinese HCPs forms an important foundation for future studies into the condition and its management in China.

Two tests of approach-iron golf skill and their ability to predict tournament performance.

The aim of this study was to investigate the convergent and predictive validity of two skill tests that examine the ability of golfers to hit accurate approach-iron shots. Twenty-four high-level golfers (handicap = 2.6 ± 1.7) performed the Nine-Ball Skills Test (assesses the ability to shape/control ball trajectory with high accuracy) and the Approach-Iron Skill Test (assesses the ability to hit straight shots from varying distances with high accuracy). Participants then completed at least eight rounds of tournament golf over the following 90 days and reported an indicator of approach-iron accuracy (per cent error index). A moderate correlation (r = 0.50, P < 0.05) was noted between scores for both tests. Generalised estimating equations, using two covariates (lie of the ball and distance to hole), were used to determine model fit and the amount of variance explained for tournament per cent error index. Results showed that the Approach-Iron Skill Test was the slightly stronger predictor of on-course per cent error index. With both test scores considered together, a minimal amount of additional variance was explained. These findings suggest that either of the tests used individually or combined may be used to predict tournament approach iron performance in high-level golfers.

Tests examining skill outcomes in sport: a systematic review of measurement properties and feasibility.

BACKGROUND: A high level of participant skill is influential in determining the outcome of many sports. Thus, tests assessing skill outcomes in sport are commonly used by coaches and researchers to estimate an athlete's ability level, to evaluate the effectiveness of interventions or for the purpose of talent identification. OBJECTIVE: The objective of this systematic review was to examine the methodological quality, measurement properties and feasibility characteristics of sporting skill outcome tests reported in the peer-reviewed literature. DATA SOURCES: A search of both SPORTDiscus and MEDLINE databases was undertaken. STUDY SELECTION: Studies that examined tests of sporting skill outcomes were reviewed. Only studies that investigated measurement properties of the test (reliability or validity) were included. A total of 22 studies met the inclusion/exclusion criteria. STUDY APPRAISAL AND SYNTHESIS METHODS: A customised checklist of assessment criteria, based on previous research, was utilised for the purpose of this review. RESULTS: A range of sports were the subject of the 22 studies included in this review, with considerations relating to methodological quality being generally well addressed by authors. A range of methods and statistical procedures were used by researchers to determine the measurement properties of their skill outcome tests. The majority (95%) of the reviewed studies investigated test-retest reliability, and where relevant, inter and intra-rater reliability was also determined. Content validity was examined in 68% of the studies, with most tests investigating multiple skill domains relevant to the sport. Only 18% of studies assessed all three reviewed forms of validity (content, construct and criterion), with just 14% investigating the predictive validity of the test. Test responsiveness was reported in only 9% of studies, whilst feasibility received varying levels of attention. LIMITATIONS: In organised sport, further tests may exist which have not been investigated in this review. This could be due to such tests firstly not being published in the peer-review literature and secondly, not having their measurement properties (i.e., reliability or validity) examined formally. CONCLUSIONS: Of the 22 studies included in this review, items relating to test methodological quality were, on the whole, well addressed. Test-retest reliability was determined in all but one of the reviewed studies, whilst most studies investigated at least two aspects of validity (i.e., content, construct or criterion-related validity). Few studies examined predictive validity or responsiveness. While feasibility was addressed in over half of the studies, practicality and test limitations were rarely addressed. Consideration of study quality, measurement properties and feasibility components assessed in this review can assist future researchers when developing or modifying tests of sporting skill outcomes.

Development and validation of the Approach-Iron Skill Test for use in golf.

The primary aim of this study was to develop and validate a golf-specific approach-iron test for use with elite and high-level amateur golfers. Elite (n=26) and high-level amateur (n=23) golfers were recruited for this study. The 'Approach-Iron Skill Test' requires players to hit a total of 27 shots. Specifically, three shots are hit at each of nine targets on a specially constructed driving range in a randomised order. A real-time launch monitor positioned behind the player, measured the carry distance for each of these shots. A scoring system was developed based on the percentage error index of each shot, meaning that 81 points was the maximum score possible (with a maximum of three points per shot). Two rounds of the test were performed. For both rounds of the test, elite-level golfers scored significantly higher than their high-level amateur counterparts (56.3 ± 5.6 and 58.5 ± 4.6 points versus 46.0 ± 6.3 and 46.1 ± 6.7 points, respectively) (P<0.05). For both elite and high-level players, 95% limits of agreement statistics also indicated that the test showed good test-retest reliability (2.1 ± 7.9 and 0.2 ± 10.8, respectively). Due to the clinimetric properties of the test, we conclude that the Approach-Iron Skill Test is suitable for further examination with the players examined in this study.

Lumbar spine repositioning sense in adolescents with and without non-specific chronic low back pain--an analysis based on sub-classification and spinal regions.

OBJECTIVE: To identify differences in repositioning error in adolescents with and without non-specific chronic low back pain (NSCLBP), sub-groups of NSCLBP and in different spinal regions. METHODS: Spinal repositioning error was measured during a seated task. Variables were constant error (CE), absolute error (AE) and variable error (VE) for lower lumbar, upper lumbar and lumbar angles. 28 subjects with NSCLBP were sub-classified using O'Sullivans system and compared to 28 healthy controls. RESULTS: Significant differences were noted for AE between adolescents with and without NSCLBP, but no differences were found for CE or VE. When sub-grouped there was a pattern for lower AE and higher VE in the flexion sub-group. This group also displayed a tendency to undershoot the criterion position in the lower lumbar spine. Greater VE was noted in the extension sub-group and those with no NSCLBP in the upper lumbar compared to the lower lumbar spine. CONCLUSIONS: Differences in spinal repositioning errors were noted between adolescents with and without NSCLBP and sub-groups of NSCLBP. Those with flexion-pattern NSCLBP had the lowest levels of spinal repositioning ability. Individuals with no-LBP (low-back pain) or extension-pattern NSCLBP displayed greater variability in the upper lumbar spine.

Chronic low back pain is associated with reduced vertebral bone mineral measures in community-dwelling adults.

BACKGROUND: Chronic low back pain (CLBP) experienced in middle-age may have important implications for vertebral bone health, although this issue has not been investigated as a primary aim previously. This study investigated the associations between CLBP and dual energy X-ray absorptiometry (DXA)-derived vertebral bone mineral measures acquired from postero-anterior and lateral-projections, among community-dwelling, middle-aged adults. METHODS: Twenty-nine adults with CLBP (11 male, 18 female) and 42 adults with no history of LBP in the preceding year (17 male, 25 female) were evaluated. Self-reported demographic and clinical data were collected via questionnaires. Areal bone mineral density (aBMD) was measured in the lumbar spine by DXA. Apparent volumetric (ap.v) BMD in the lumbar spine was also calculated. Multiple linear regression models were used to examine associations between study group (CLBP and control) and vertebral DXA variables by gender, adjusting for height, mass and age. RESULTS: There was no difference between groups by gender in anthropometrics or clinical characteristics. In the CLBP group, the mean (SD) duration of CLBP was 13.3 (10.4) years in males and 11.6 (9.9) years in females, with Oswestry Disability Index scores of 16.2 (8.7)% and 15.4 (9.1)%, respectively. Males with CLBP had significantly lower adjusted lateral-projection aBMD and lateral-projection ap.vBMD than controls at L3 with mean differences (standard error) of 0.09 (0.04) g/cm2 (p = 0.03) and 0.02 (0.01) g/cm3 (p = 0.04). These multivariate models accounted for 55% and 53% of the variance in lateral-projection L3 aBMD and lateral-projection L3 ap.vBMD. CONCLUSIONS: CLBP in males is associated with some lumbar vertebral BMD measures, raising important questions about the mechanism and potential clinical impact of this association.

Development of the Nine-Ball Skills Test to discriminate elite and high-level amateur golfers.

Currently, there is a lack of appropriate skill assessments available for use in golf. The aim of this study was to examine the discriminative validity and the test-retest reliability of the newly developed "Nine-Ball Skills Test". Participants of two ability levels (elite, n = 14; high-level amateur, n = 16) each hit nine golf shots of differing combinations of trajectory (straight, fade, draw) and height (normal, high, low) at an individually determined target area. Each shot was scored on its percent error index from the target and whether it achieved the maximum height as required. Participants completed the test twice using a 5-iron club. The elite group scored significantly higher (P < 0.05) than the amateur group for both the first and second rounds of the test as well as the combined scores. The between-round test-retest reliability was deemed to be not acceptable, thus we propose that the test's protocol should include use of the two rounds as standard. Due to the importance of ball striking and flight control to performance in golf, the Nine-Ball Skills Test is appropriate for providing a measure of this skill component in elite and high-level amateur golfers.

Levels of muscle activation in strength and conditioning exercises and dynamometer hiking in junior sailors.

Although strength and conditioning exercises have been prescribed to enhance performance and prevent injury in sailors, little is known about these exercises in comparison to the demands placed on the sailor's musculature while hiking maximally. Because of the difficulty in collecting hiking-related data on water, a 3-minute maximal hiking test (HM180) has been previously developed for use in the laboratory setting. There were 2 aims of this study. The first aim was to determine whether discriminative validity could be shown for the HM180 test in a group of junior sailors of differing ability level and gender. The second aim was to determine whether differences in muscle activation existed between selected strength and conditioning exercises and the HM180 test. Twenty-nine adolescent boy and girl sailors aged between 14 and 16 years from the Singaporean National Byte Class training squad (n = 12) and the Singapore High Participation Group (n = 17) were recruited for this study. The average levels of normalized muscle activation in selected lower limb and trunk muscles in 4 selected strength and conditioning exercises (leg extension, back squat, and back extension exercises, a 30-second hiking hold) and a maximal 3-minute hiking test (the HM180 test) were quantified. Discriminative validity of the HM180 test was shown, and it was confirmed that the strength and conditioning exercises provide an overload stimulus for the HM180 test. Further, similar levels of muscle activation were found for the vastus lateralis in the leg extension and back squat exercises, and the superficial lumbar multifidus in the back extension and back squat exercises. This study has the potential to inform the design of strength and conditioning programs for junior sailors.

Individuals with chronic low back pain have greater difficulty in engaging in positive lifestyle behaviours than those without back pain: an assessment of health literacy.

BACKGROUND: Despite the large volume of research dedicated to understanding chronic low back pain (CLBP), patient outcomes remain modest while healthcare costs continue to rise, creating a major public health burden. Health literacy - the ability to seek, understand and utilise health information - has been identified as an important factor in the course of other chronic conditions and may be important in the aetiology of CLBP. Many of the currently available health literacy measurement tools are limited since they measure narrow aspects of health literacy. The Health Literacy Measurement Scale (HeLMS) was developed recently to measure broader elements of health literacy. The aim of this study was to measure broad elements of health literacy among individuals with CLBP and without LBP using the HeLMS. METHODS: Thirty-six community-dwelling adults with CLBP and 44 with no history of LBP responded to the HeLMS. Individuals were recruited as part of a larger community-based spinal health study in Western Australia. Scores for the eight domains of the HeLMS as well as individual item responses were compared between the groups. RESULTS: HeLMS scores were similar between individuals with and without CLBP for seven of the eight health literacy domains (p > 0.05). However, compared to individuals with no history of LBP, those with CLBP had a significantly lower score in the domain 'Patient attitudes towards their health' (mean difference [95% CI]: 0.46 [0.11-0.82]) and significantly lower scores for each of the individual items within this domain (p < 0.05). Moderate effect sizes ranged from d = 0.47-0.65. CONCLUSIONS: Although no differences were identified in HeLMS scores between the groups for seven of the health literacy domains, adults with CLBP reported greater difficulty in engaging in general positive health behaviours. This aspect of health literacy suggests that self-management support initiatives may benefit individuals with CLBP.

An exploration of the relationship between back muscle endurance and familial, physical, lifestyle, and psychosocial factors in adolescents and young adults.

STUDY DESIGN: Cross-sectional investigation. OBJECTIVE: To explore the relationship between back muscle endurance (BME) and a range of familial, physical, lifestyle, and psychosocial variables in adolescents and young adults. BACKGROUND: There is evidence that low back pain interventions which focus on improved BME are effective. However, the mechanisms associated with BME performance in adolescents and young adults are largely unclear. In particular, the potential familial relationship between parents and their children remains unexplored. METHODS: This study utilized a subset of participants from the Joondalup Spinal Health Study cohort. One hundred nine children (47 boys, 62 girls) and 101 parents (39 fathers, 62 mothers) completed a series of physical, lifestyle, and psychosocial assessments. The univariable relationship between each covariate and BME was explored. Those found to have an association with child BME (P<.2) were included in an initial multivariable model and sequentially removed, until all remaining covariates were statistically significant (P<.05). RESULTS: Mothers' BME performance was related to children's performance, accounting for 14.4% of the variance in the children's BME. Fathers' BME performance had a similar, albeit nonsignificant effect. Children's sitting trunk angle, pain sensitivity, percent trunk fat, waist girth, and body mass index were associated with their BME performance, accounting for between 5.2% and 20.9% of BME. CONCLUSIONS: The final multivariable model, including mother's BME, percent trunk fat, and sitting trunk angle, explained 28% of the variance in BME performance, suggesting that for successful BME intervention a range of multidimensional variables should be considered.

An exploration of familial associations in spinal posture defined using a clinical grouping method.

The primary aim of this study was to examine familial associations in spinal posture, defined using postural angles and a clinical classification method. A secondary aim was to investigate the reliability of clinical postural classification. Postural angles were calculated from sagittal photographs, while two experienced clinicians made use of standing sagittal images to classify participants into one of four postural groups (sway, flat, hyperlordotic, neutral). Parent-child associations in postural angles and postural groups were evaluated using Pearson's correlation and Fisher's exact test, respectively. Inter-rater reliability was expressed using percentage agreement and Kappa coefficients (K). Daughters whose father or mother had a hyperlordotic posture were 4.0 or 3.5 times, respectively, more likely to have a hyperlordotic posture than daughters whose parents did not have a hyperlordotic posture. These participants in the hyperlorotic group had a significantly higher body mass index than members of the other postural groups (p < 0.03). Percentage agreement between clinicians was 63.5% (K = 0.48). These results provide preliminary evidence of a familial association in the hyperlordotic posture and support the use of postural classification.

Differences in spinopelvic kinematics in sweep and scull ergometer rowing.

OBJECTIVE: The spinopelvic kinematics of sweep and scull have yet to be investigated, despite evidence suggesting that sweep rowing may be provocative for low back pain (LBP). The aim of this study was to determine whether differences existed in spinopelvic kinematics in high-level rowers without LBP in sweep and scull ergometer rowing. DESIGN: Repeated measures study. SETTING: Institute of Sport Laboratory. PARTICIPANTS: Ten high-level rowers. INTERVENTIONS: Kinematics of the pelvis, lower lumbar, upper lumbar, and lower thoracic regions during the drive phase of the rowing stroke were measured while rowing on an interchangeable sweep/scull ergometer. MAIN OUTCOME MEASURES: Total and segmental spinopelvic kinematics. RESULTS: Sweep rowing showed greater lateral bend (P < 0.05) throughout the stroke, which was predominately due to movement of the upper lumbar and lower thoracic regions. Furthermore, sweep rowing displayed a greater magnitude (P < 0.05) of axial rotation at the catch (created at the pelvis). Both sweep and scull rowing showed values close to end range flexion for the lower lumbar spine at the catch and early drive phases. No difference (P > 0.05) was evident in lateral bend or axial rotation values for the lower lumbar region. CONCLUSIONS: Some differences exist in spinopelvic kinematics between sweep and scull ergometer rowing. However, it may be speculated that the lack of differences in lateral bend and axial rotation at the lower lumbar spine in sweep rowing may represent an adaptive and protective approach of experienced rowers. This may be the focus of future research studies.

Health literacy and beliefs among a community cohort with and without chronic low back pain.

Health literacy, the ability to seek, understand and utilise health information, is important for good health. Suboptimal health literacy has been associated with poorer health outcomes in many chronic conditions although this has not been studied in chronic low back pain (CLBP). We examined the health literacy of individuals with CLBP using a mixed methods approach. One-hundred and seventeen adults, comprising 61 with no history of CLBP and 56 with CLBP (28 with low and high disability, respectively, as determined by a median split in Oswestry scores) participated. Data regarding severity of pain, LBP-related disability, fear avoidance, beliefs about LBP and pain catastrophizing were collected using questionnaires. Health literacy was measured using the Short-form Test of Functional Health Literacy in Adults (S-TOFHLA). A sub-sample of 36 participants with CLBP also participated in in-depth interviews to qualitatively explore their beliefs about LBP and experiences in seeking, understanding and using information related to LBP. LBP-related beliefs and behaviours, rather than pain intensity and health literacy skills, were found to be important correlates of disability related to LBP. Individuals with CLBP-high disability had poorer back pain beliefs and increased fear avoidance behaviours relating to physical activity. Health literacy (S-TOFHLA) was not related to LBP beliefs and attitudes. Qualitatively, individuals with CLBP-high disability adopted a more passive coping style and had a pathoanatomic view of their disorder compared to individuals with CLBP-low disability. While all participants with CLBP had adequate health literacy scores (S-TOFHLA), qualitative data highlighted difficulties in seeking, understanding and utilising LBP information.

Biopsychosocial factors are associated with low back pain in female nursing students: a cross-sectional study.

BACKGROUND: Occupational low back pain is a significant problem among nurses. Recent literature suggests current occupational preventative strategies for nurses have not been effective. Given low back pain is already prevalent before commencing employment, nursing students should be the target of preventative interventions. Modifiable personal factors which contribute to low back pain have proven difficult to identify, but are thought to play an important role in the biopsychosocial nature of low back pain. OBJECTIVES: To evaluate the contribution of personal biopsychosocial factors to low back pain in nursing students. DESIGN: Cross-sectional study comprising physical testing and questionnaires. SETTINGS: Two university undergraduate nursing schools in Western Australia. PARTICIPANTS: 170 female undergraduate nursing students. METHODS: Low back pain and control subjects were compared across social, lifestyle (physical activity), psychological (stress, anxiety, depression, back pain beliefs, coping strategies and catastrophising) and physical (spinal postures and spinal kinematics in functional tasks, leg and back muscle endurance, spinal repositioning error and cardiovascular fitness) characteristics. Low back pain was considered as either "minor" or "significant" depending upon pain severity, duration, impact and level of disability. RESULTS: Over 30% of all subjects (mean age 22.5+/-4.5 years) reported "significant" low back pain in the preceding 12 months. Univariate analysis: social measures did not distinguish between groups. Subjects with "significant" low back pain were more physically active (p=0.04), had higher stress scores (p=0.01) and used passive coping strategies (p<0.001) more than other subjects. "Significant" low back pain subjects held their lower lumbar spine in a more extended posture during transfers at bed height than other subjects. No differences between groups were found for sagittal spinal mobility, static spinal posture, muscle endurance, spinal repositioning error, cardiovascular fitness or other psychological measures. Multivariate analysis: regression analysis revealed stress, coping, physical activity, spinal kinematics, and age all contributed independently to the presence of low back pain, representing a significant 23% of variance. CONCLUSIONS: Modifiable lifestyle, psychological and physical factors were independently associated with low back pain in nursing students. Targeting personal factors associated with low back pain in nursing students, rather than occupational factors in working nurses may help improve the impact of low back pain in nurses. Prospective studies are required to confirm the relevance of these findings for risk of future low back pain in nurses.

Regional differences in lumbar spinal posture and the influence of low back pain.

BACKGROUND: Spinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP) patients. However, the link between spinal posture and LBP is not fully understood. Recent evidence suggests that considering regional, rather than total lumbar spine posture is important. The purpose of this study was to determine; if there are regional differences in habitual lumbar spine posture and movement, and if these findings are influenced by LBP. METHODS: One hundred and seventy female undergraduate nursing students, with and without LBP, participated in this cross-sectional study. Lower lumbar (LLx), Upper lumbar (ULx) and total lumbar (TLx) spine angles were measured using an electromagnetic tracking system in static postures and across a range of functional tasks. RESULTS: Regional differences in lumbar posture and movement were found. Mean LLx posture did not correlate with ULx posture in sitting (r = 0.036, p = 0.638), but showed a moderate inverse correlation with ULx posture in usual standing (r = -0.505, p < 0.001). Regional differences in range of motion from reference postures in sitting and standing were evident. BMI accounted for regional differences found in all sitting and some standing measures. LBP was not associated with differences in regional lumbar spine angles or range of motion, with the exception of maximal backward bending range of motion (F = 5.18, p = 0.007). CONCLUSION: This study supports the concept of regional differences within the lumbar spine during common postures and movements. Global lumbar spine kinematics do not reflect regional lumbar spine kinematics, which has implications for interpretation of measures of spinal posture, motion and loading. BMI influenced regional lumbar posture and movement, possibly representing adaptation due to load.

Validation of an EMG-driven, graphically based isometric musculoskeletal model of the cervical spine.

EMG-driven musculoskeletal modeling is a method in which loading on the active and passive structures of the cervical spine may be investigated. A model of the cervical spine exists; however, it has yet to be criterion validated. Furthermore, neck muscle morphometry in this model was derived from elderly cadavers, threatening model validity. Therefore, the overall aim of this study was to modify and criterion validate this preexisting graphically based musculoskeletal model of the cervical spine. Five male subjects with no neck pain participated in this study. The study consisted of three parts. First, subject-specific neck muscle morphometry data were derived by using magnetic resonance imaging. Second, EMG drive for the model was generated from both surface (Drive 1: N=5) and surface and deep muscles (Drive 2: N=3). Finally, to criterion validate the modified model, net moments predicted by the model were compared against net moments measured by an isokinetic dynamometer in both maximal and submaximal isometric contractions with the head in the neutral posture, 20 deg of flexion, and 35 deg of extension. Neck muscle physiological cross sectional area values were greater in this study when compared to previously reported data. Predictions of neck torque by the model were better in flexion (18.2% coefficient of variation (CV)) when compared to extension (28.5% CV) and using indwelling EMG did not enhance model predictions. There were, however, large variations in predictions when all the contractions were compared. It is our belief that further work needs to be done to improve the validity of the modified EMG-driven neck model examined in this study. A number of factors could potentially improve the model with the most promising probably being optimizing various modeling parameters by using methods established by previous researchers investigating other joints of the body.