An exploration of footwear preferences, attitudes and beliefs in people with knee osteoarthritis: A qualitative study.

BACKGROUND: Although footwear can improve pain and function in individuals with knee osteoarthritis (OA), perspectives about footwear in this population have not been explored. OBJECTIVES: This qualitative study explored preferences, attitudes and beliefs about footwear in adults with knee OA. METHODS: Twenty individuals with a clinical diagnosis of knee OA (aged 45-79 years, 65% women) participated in semi-structured interviews about factors which influence footwear selection, the effect of footwear on knee symptoms, and footwear modifications. Data were analysed thematically. RESULTS: Four themes, with sub-themes, were identified: i) there are specific footwear characteristics people look for, with comfort as their top priority; ii) shoe appearance is important; iii) footwear can aggravate or ease symptoms; and iv) people with knee OA find footwear in a variety of ways. Participants related built-in arch support, a cushioned insole and low/no heel, without addition of foot orthoses, to comfort, and were willing to pay more for comfort and quality. Appearance was also a consideration, and participants indicated they would tolerate short periods of symptom aggravation for aesthetic shoes. Participants felt that footwear choice affected their knee symptoms and risk of slipping/twisting. Participants reported that their footwear choices were determined through trial-and-error, and sometimes on advice from health professionals or shoe store salespersons. CONCLUSIONS: There are specific footwear features important to individuals with knee OA. Knowledge of these features can be used by health professionals to inform footwear discussions with knee OA patients and serve as considerations when developing footwear targeted for this population.

'It's more emotionally based': Prince Edward Island horse owner perspectives of horse weight management.

Horse obesity is a growing concern that can result in negative welfare. The role horse owners play in horse weight management is not well understood. This study aimed to: (1) explore the attitudes, beliefs, and perceptions of owners with overweight or obese horses regarding their horses' weight; and (2) understand the motivators and barriers for owners to implement, improve and maintain weight management-related strategies. A semi-structured interview guide based on the Theoretical Domains Framework was developed. Qualitative interviews were conducted with 24 owners in Prince Edward Island, Canada whose horse(s) were previously classified as overweight or obese by a veterinarian. Interviews were analysed using template analysis, organising patterns in the data into a codebook and overarching themes. Owners believed horse weight management was important, however, their perceived complexity of the issue made the implementation of the weight management practices difficult. Owners held conflicting perceptions, viewing overweight horses as well cared for, yet recognised these horses were at increased risk for negative health outcomes. Ultimately, participants felt emotionally torn about compromising their horse's mental well-being to address weight issues. Owners considered the practicality of weight-management strategies, the strategies' effectiveness, and whether recommended strategies aligned with their beliefs regarding good horse care practices. Knowledge was embedded into owners' understanding of horse weight, however, some highlighted that traditional knowledge dominates the equine industry hindering systemic industry change. Increased understanding of the effectiveness and impacts of weight management strategies on horses and fostering a society that recognises and accepts horses within a healthy weight range are warranted.

Experiences of Working with Lower Limb Osteoarthritis: A Qualitative Study.

PURPOSE: Pain and disability associated with lower limb osteoarthritis (OA) may contribute to difficulties at work. This study aimed to understand the perspectives of workers with lower limb OA on difficulties, concerns, and coping strategies used at work. METHODS: Twenty-two individuals with lower limb OA who were working in paid employment participated in semi-structured interviews. Data were qualitatively analyzed using an inductive thematic approach. Codes were identified and refined through review of interview transcripts and discussion with the research team. RESULTS: Six themes were identified in relation to experiences working with lower limb OA. Themes were as follows: weight-bearing physical demands are challenging; lower limb OA can affect work performance; emotional consequences of pain; concerns about work in the future; positive experiences of supportive colleagues and managers; and minimal effects on sedentary work. Three themes were identified relating to strategies to manage at work: adjustments at work help manage pain and avoid exacerbations; regular strategies to manage pain; and healthcare professionals are consulted, but usually not specifically for work. CONCLUSIONS: Workers with lower limb OA experience physical and emotional difficulties at work that can impact work performance. Workers are concerned about longevity and job security and use a range of strategies to manage symptoms and remain at work. Employers, employees, and healthcare professionals may need to work together to create workplace accommodations to help workers with lower limb OA confidently remain in work.

Content and Quality of Mobile Apps for the Monitoring of Musculoskeletal or Neuropathic Pain in Australia: Systematic Evaluation.

Background: Mobile apps offer a potential mechanism for people with persistent pain to monitor pain levels conveniently within their own environment and for clinicians to remotely monitor their patients' pain. However, the quality of currently available apps and the usefulness of included features from a clinical perspective are not known. Objective: The aim of this study was to examine the content and quality of currently available smartphone apps designed for monitoring the intensity or presence of musculoskeletal or neuropathic pain. Methods: A systematic search was performed in the Australian Apple and Google Play stores. Apps were included if they were designed to monitor the intensity or presence of musculoskeletal or neuropathic pain and were available in the English language within the Australian app stores. Data pertaining to the intended use of the app and clinical population were extracted by using a custom-designed data extraction form, and app quality was assessed by using the 23-item Mobile App Rating Scale. Results: Of the 2190 apps screened, 49 met the inclusion criteria. Apps were primarily designed for adult users (36/49, 73%) with nonspecific musculoskeletal or neuropathic pain conditions, arthritis, and joint pain. All apps monitored pain intensity, with almost half (23/49, 47%) also specifying pain location. Overall, the mean quality scores from the Mobile App Rating Scale ranged from 1.5 to 4.4 (out of 5.0). Between 20% (10/49) and 22% (11/49) of apps involved clinicians, consumers, or both in their development, and 20% (10/49) had published literature related to the development or use of the app in clinical scenarios. Although 71% (35/49) had data sharing features, only 5 apps enabled client-clinician communication through the app. Conclusions: The overall quality of mobile apps that are currently available for monitoring pain intensity is acceptable. Presently, mobile apps for remote pain monitoring lack functionality for clinicians to view data between consults. Both users and clinicians should be aware of the limitations of these apps and make informed choices in using or recommending apps that best suit the clinical need.

A Menthol-Enhanced "Cooling" Energy Gel Does Not Influence Laboratory Time Trial Performance in Trained Runners.

l-menthol (menthol) is an organic compound derived from peppermint which imparts a refreshing mint flavor and aroma to oral hygiene products, chewing gum, and topical analgesics. Menthol has been identified as a non-thermal sensory cooling strategy for athletes when ingested or mouth-rinsed during exercise in hot environments. Therefore, sports nutrition products delivering a controlled concentration of menthol could be beneficial for athletes exercising in the heat. We sought to test the performance and perceptual outcomes of a novel menthol energy gel during treadmill running in the heat (33 °C, 49% RH). Fourteen trained runners (mean ± SD; age: 31 ± 6 years, VO2max: 56.5 ± 10.1 mL·kg-1·min-1, BMI: 23.2 ± 2.4 kg/m2; six female) participated in a randomized, crossover, double-blind, and placebo-controlled study. A menthol-enhanced energy gel (0.5% concentration; MEN) or flavor-matched placebo (PLA) was ingested 5 min before and again at 20 and 40 min of a 40 min treadmill exercise preload at 60% VO2max, followed by a 20 min self-paced time trial. The total distance, vertical distance, perceptual measures (thermal comfort, thermal sensation, rating of perceived exertion, and affect), and cognitive performance via computerized neurocognitive assessment were measured. No difference between 20 min self-paced time trial total distance (MEN: 4.22 ± 0.54 km, PLA: 4.22 ± 0.55 km, p = 0.867), vertical distance (MEN: 49.2 ± 24.6 m, PLA: 44.4 ± 11.4 m, p = 0.516), or any perceptual measures was observed (all p > 0.05). Cognitive performance was not different between the trials (all p > 0.05). These results suggest that a menthol energy gel is not superior to a non-menthol gel in terms of performance or perception during treadmill running in the heat. More research is needed to confirm whether these findings translate to ecologically valid settings, including outdoor exercise in ambient heat and during competition.

The Impact of a Short-Term Ketogenic Low-Carbohydrate High-Fat Diet on Biomarkers of Intestinal Epithelial Integrity and Gastrointestinal Symptoms.

Endurance exercise can disturb intestinal epithelial integrity, leading to increased systemic indicators of cell injury, hyperpermeability, and pathogenic translocation. However, the interaction between exercise, diet, and gastrointestinal disturbance still warrants exploration. This study examined whether a 6-day dietary intervention influenced perturbations to intestinal epithelial disruption in response to a 25-km race walk. Twenty-eight male race walkers adhered to a high carbohydrate (CHO)/energy diet (65% CHO, energy availability = 40 kcal·kg FFM-1·day-1) for 6 days prior to a Baseline 25-km race walk. Athletes were then split into three subgroups: high CHO/energy diet (n = 10); low-CHO, high-fat diet (LCHF: n = 8; <50 g/day CHO, energy availability = 40 kcal·kg FFM-1·day-1); and low energy availability (n = 10; 65% CHO, energy availability = 15 kcal·kg FFM-1·day-1) for a further 6-day dietary intervention period prior to a second 25-km race walk (Adaptation). During both trials, venous blood was collected pre-, post-, and 1 hr postexercise and analyzed for markers of intestinal epithelial disruption. Intestinal fatty acid-binding protein concentration was significantly higher (twofold increase) in response to exercise during Adaptation compared to Baseline in the LCHF group (p = .001). Similar findings were observed for soluble CD14 (p < .001) and lipopolysaccharide-binding protein (p = .003), where postexercise concentrations were higher (53% and 36%, respectively) during Adaptation than Baseline in LCHF. No differences in high CHO/energy diet or low energy availability were apparent for any blood markers assessed (p > .05). A short-term LCHF diet increased intestinal epithelial cell injury in response to a 25-km race walk. No effect of low energy availability on gastrointestinal injury or symptoms was observed.

"It's just as remarkable as being left-handed, isn't it?": exploring normativity through Australian physiotherapists' perspectives of working with LGBTQIA+ patients.

INTRODUCTION: Individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex, asexual and other related identities (LGBTQIA+) experience challenges with healthcare, including physiotherapy. To understand potential contributions to poor experiences, this study explored physiotherapists' experiences and perspectives about working with members of LGBTQIA+ communities. METHODS: This study employed a qualitative research design, suitable for exploring the experiences and perspectives of individuals within the physiotherapy context. The sample consisted of physiotherapists working in Australia who participated in a larger survey study. Data were collected via semi-structured interviews which were audio-recorded and transcribed verbatim. Data analysis was conducted using a relativistic and queer theoretical framework with a reflexive thematic approach. RESULTS: Eighteen physiotherapists with diverse sexual orientations participated in the interviews. While all participants identified as women or men, not all used binary gender pronouns. Five key themes were developed: 1) "anti-discrimination" regarding choice of language and providing safe environments; 2) "current and historical discrimination" against LGBTQIA+ individuals; 3) "taking an equality approach" when working with LGBTQIA+ patients; 4) "knowledge of LGBTQIA+ health" in a broad sense and specifically with transgender and gender-diverse people; and 5) "managing own reactions" with respect to individual biases and discomfort. CONCLUSION: Underpinning all themes was the overarching concept of cis/hetero/endonormativity. Assuming normativity when working with LGBTQIA+ patients, is likely to have negative effects on patients' mental health, the therapeutic relationship and quality of care. In order to improve diversity, safety, inclusion and equity of care for LGBTQIA+ individuals, it is vital that normativity within physiotherapy is challenged.

The Effect of Pre-Exercise Hyperhydration on Exercise Performance, Physiological Outcomes and Gastrointestinal Symptoms: A Systematic Review.

BACKGROUND: Fluid loss during prolonged exercise in hot conditions poses thermoregulatory and cardiovascular challenges for athletes that can lead to impaired performance. Pre-exercise hyperhydration using nutritional aids is a strategy that may prevent or delay the adverse effects of dehydration and attenuate the impact of heat stress on exercise performance. OBJECTIVES: The aim of this systematic review was to examine the current literature to determine the effect of pre-exercise hyperhydration on performance, key physiological responses and gastrointestinal symptoms. METHODS: English language, full-text articles that compared the intervention with a baseline or placebo condition were included. An electronic search of Medline Complete, SPORTDiscus and Embase were used to identify articles with the final search conducted on 11 October 2022. Studies were assessed using the American Dietetic Association Quality Criteria Checklist. RESULTS: Thirty-eight studies involving 403 participants (n = 361 males) were included in this review (n = 22 assessed exercise performance or capacity). Two studies reported an improvement in time-trial performance (range 5.7-11.4%), three studies reported an improvement in total work completed (kJ) (range 4-5%) and five studies reported an increase in exercise capacity (range 14.3-26.2%). During constant work rate exercise, nine studies observed a reduced mean heart rate (range 3-11 beats min-1), and eight studies reported a reduced mean core temperature (range 0.1-0.8 °C). Ten studies reported an increase in plasma volume (range 3.5-12.6%) compared with a control. Gastrointestinal symptoms were reported in 26 studies, with differences in severity potentially associated with factors within the ingestion protocol of each study (e.g. treatment, dose, ingestion rate). CONCLUSIONS: Pre-exercise hyperhydration may improve exercise capacity during constant work rate exercise due to a reduced heart rate and core temperature, stemming from an acute increase in plasma volume. The combination of different osmotic aids (e.g. glycerol and sodium) may enhance fluid retention and this area should continue to be explored. Future research should utilise valid and reliable methods of assessing gastrointestinal symptoms. Furthermore, studies should investigate the effect of hyperhydration on different exercise modalities whilst implementing a strong level of blinding. Finally, females are vastly underrepresented, and this remains a key area of interest in this area.

Adherence to a Ketogenic Low-Carbohydrate, High-Fat Diet Is Associated With Diminished Training Quality in Elite Racewalkers.

PURPOSE: To examine the effects of a high-carbohydrate diet (HCHO), periodized-carbohydrate (CHO) diet (PCHO), and ketogenic low-CHO high-fat diet (LCHF) on training capacity. METHODS: Elite male racewalkers completed 3 weeks of periodic training while adhering to their dietary intervention. Twenty-nine data sets were collected from 21 athletes. Each week, 6 mandatory training sessions were completed, with additional sessions performed at the athlete's discretion. Mandatory sessions included an interval session (10 × 1-km efforts on a 6-min cycle), tempo session (14 km with a 450-m elevation gain), 2 long walks (25-40 km), and 2 easy walks (8-12 km) where "sleep-low" and "train-low" dietary strategies were employed for PCHO. Racewalking speed, heart rate, rating of perceived exhaustion, and blood metabolites were collected around key sessions. RESULTS: LCHF covered less total distance than HCHO and PCHO (P < .001); however, no differences in training load between groups were evident (P = .285). During the interval sessions, walking speed was slower in LCHF (P = .001), equating to a 2.8% and 5.6% faster speed in HCHO and PCHO, respectively. LCHF was also 3.2% slower in completing the tempo session than HCHO and PCHO (P = .001). Heart rate was higher (P = .002) and lactate concentrations were lower (P < .001) in LCHF compared to other groups, despite slower walking speeds during the interval session. No between-groups differences in rating of perceived exhaustion were evident (P = .077). CONCLUSION: Athletes adhering to an LCHF diet showed impaired training capacity relative to their high-CHO-supported counterparts, completing lower training volumes at slower speeds, with higher heart rates.

Technical issues occur but are infrequent and have little impact on physiotherapist-delivered videoconferencing consultations for knee osteoarthritis: A descriptive study.

INTRODUCTION: Clinicians often report technical issues as a barrier to adopting videoconferencing service models. This descriptive study nested within a randomised controlled trial investigated the frequency, nature and impact of technical issues during video consultations. METHODS: Physiotherapists (n = 15) underwent training to deliver knee osteoarthritis care focussed on education, strengthening and physical activity. In the randomised controlled trial, participants received five physiotherapy consultations either in-person or via videoconferencing (via Zoom) over 3-months; consultations were recorded and physiotherapists documented technical difficulties. In this study, available notes were audited (n = 169 initial and n = 147 final consultations) and nature and frequency of technical issues coded. Based on whether the clinician reported technical difficulties, three subgroups were created for analysis 1) in-person, 2) videoconferencing without technical issues, 3) videoconferencing with technical issues. Forty participants were randomly selected for each subgroup (n = 120). Duration of consultation components (set-up and introduction, assessment, exercise, physical activity, education and wrap-up), total consultation duration and duration of technical issues were compared across subgroups using one-way multivariate analyses of variance with mean differences (MD) and 95% confidence intervals (CIs). RESULTS: Technical issues were documented in 37% (initial) and 19% (final) of video consultations. Problems with audio/video were most frequent, occurring in 36-21% (initial) and 18-24% (final) consultations. Audio/video problems were predominantly experienced during set-up, but did not significantly increase videoconferencing consultation duration compared to in-person consultation duration (MD (95% CI) 0.72 (-3.57 to 5.01) minutes). DISCUSSION: While technical issues with videoconferencing consultations frequently occur, they are typically minor, transient and resolved quickly.

Short Severe Energy Restriction with Refueling Reduces Body Mass without Altering Training-Associated Performance Improvement.

PURPOSE: We investigated short-term (9 d) exposure to low energy availability (LEA) in elite endurance athletes during a block of intensified training on self-reported well-being, body composition, and performance. METHODS: Twenty-three highly trained race walkers undertook an ~3-wk research-embedded training camp during which they undertook baseline testing and 6 d of high energy/carbohydrate (HCHO) availability (40 kcal·kg FFM -1 ·d -1 ) before being allocated to 9 d continuation of this diet ( n = 10 M, 2 F) or a significant decrease in energy availability to 15 kcal·kg FFM -1 ·d -1 (LEA: n = 10 M, 1 F). A real-world 10,000-m race walking event was undertaken before (baseline) and after (adaptation) these phases, with races being preceded by standardized carbohydrate fueling (8 g·kg body mass [BM] -1 for 24 h and 2 g·kg BM -1 prerace meal). RESULTS: Dual-energy x-ray absorptiometry-assessed body composition showed BM loss (2.0 kg, P < 0.001), primarily due to a 1.6-kg fat mass reduction ( P < 0.001) in LEA, with smaller losses (BM = 0.9 kg, P = 0.008; fat mass = 0.9 kg, P < 0.001) in HCHO. The 76-item Recovery-Stress Questionnaire for Athletes, undertaken at the end of each dietary phase, showed significant diet-trial effects for overall stress ( P = 0.021), overall recovery ( P = 0.024), sport-specific stress ( P = 0.003), and sport-specific recovery ( P = 0.012). However, improvements in race performance were similar: 4.5% ± 4.1% and 3.5% ± 1.8% for HCHO and LEA, respectively ( P < 0.001). The relationship between changes in performance and prerace BM was not significant ( r = -0.08 [-0.49 to 0.35], P = 0.717). CONCLUSIONS: A series of strategically timed but brief phases of substantially restricted energy availability might achieve ideal race weight as part of a long-term periodization of physique by high-performance athletes, but the relationship between BM, training quality, and performance in weight-dependent endurance sports is complicated.

Physiotherapists vary in their knowledge of and approach to working with patients who are LGBTQIA+: a qualitative study.

QUESTION: What are the attitudes, beliefs and knowledge gaps of physiotherapists in Australia regarding working with patients who identify as LGBTQIA+? DESIGN: Qualitative design using a custom online survey. PARTICIPANTS: Physiotherapists currently practising in Australia. METHODS: Data were analysed using reflexive thematic analysis. RESULTS: A total of 273 participants met the eligibility criteria. Participating physiotherapists were predominantly female (73%), aged between 22 and 67 years, residing in a large Australian city (77%) and working in musculoskeletal physiotherapy (57%), in private practice (50%) and hospital (33%) settings. Almost 6% self-identified as part of the LGBTQIA+ community. Only 4% of the participants had received training related to healthcare interactions or cultural safety for working with patients who identify as LGBTQIA+ in the context of physiotherapy. Three main themes regarding approaches to physiotherapy management were identified: treating the whole person in context, treating everyone the same, and treating the body part. Gaps in knowledge were primarily related to understandings of the relevance of sexual orientation and gender identity to physiotherapy and health issues specific to LGBTQIA+ patients. CONCLUSION: Physiotherapists can be considered to approach gender identity and sexual orientation in three distinct ways and suggest a range of knowledge and attitudes about working with patients who identify as LGBTQIA+. Physiotherapists who consider gender identity and sexual orientation to be relevant to physiotherapy consultations appear to have higher levels of knowledge and understanding of this topic and may also understand physiotherapy as multifactorial and not only biomedical.

Characterising tibialis posterior tendinopathy using the International Classification of Functioning, Disability and Health: a cross sectional study.

BACKGROUND: Tibialis posterior tendinopathy (TPT) is characterised by pain around the medial foot/ankle and difficulties weightbearing. OBJECTIVE: Compare individuals who have TPT with asymptomatic controls across the International Classification of Functioning, Disability and Health (ICF) domains of body structure and function, activity, participation and personal factors. METHODS: Twenty-two individuals meeting the selection criteria for TPT (86% female, mean ± SD age:43 ± 13 years; body mass index [BMI]:28 ± 7 kg/m2) were compared to 27 controls (93% female, age:44 ± 16 years, BMI:23 ± 5 kg/m2). Standardised differences (and 95% confidence intervals [CIs]) between groups were estimated for outcomes under each ICF domain using Cliff's delta to allow for comparison of the magnitude of deficits across outcomes (>0.47 considered large). RESULTS: Impairments in body structure and function in individuals with TPT were accompanied by activity limitations including difficulties due to foot problems (-1.0 (-1.0, -1.0)) and with independent living (-0.8 (-1.0, -0.3)) and greater time to complete stair descent/ascent (-0.6 (-0.8, -0.3)). Considering participation, overall foot-related function (-1.0 (-1.0, -1.0)), ability to participate in activities (-0.7 (-0.08, -0.3)), social restrictions (-0.8 (-1.0, -0.4)) and quality of life (-0.7 (-0.9, -0.5)) were poorer in individuals with TPT. CONCLUSION: Individuals with TPT have large impairments in body structure and function, activity limitations and participation restrictions, particularly relating to independent living, mental health and pain. Personal factors appear to contribute to a lesser extent to the TPT presentation. Treatment plans should consider activity and participation limitations in addition to body structure and function.

Exploring Rhenium Arene Piano-Stool Chemistry with [Re(η6-C6H6)(NCCH3)3]+: A Powerful Semi-Solvated Precursor.

Thermal treatment of the ReIII hydride complex [ReH(η5-C6H7)(η6-C6H6)]+ in CH3CN results in the formation of [Re(η6-C6H6)(NCCH3)3]+. This semi-solvated complex is remarkably stable under an ambient atmosphere and exhibits a fast CH3CN self-exchange, which facilitates substitution reactions. The CH3CN ligands are replaced by σ-donating phosphines such as trimethyl phosphine (PMe3), triphenyl phosphine (PPh3), or the bidentate 1,2-bis(diphenylphosphino)ethane (dppe) to afford [Re(η6-C6H6)(NCCH3)3-x(PR3)x]+ (if R = Me, then x = 2; if R = Ph, then x = 1 or 2) or [Re(η6-C6H6)(dppe)(NCCH3)]+, respectively. [Re(η6-C6H6)(NCCH3)3]+ also reacts with π-acceptors such as 2,2'-bipyridine (bipy), 1,10-phenanthroline (phen), or CO (1 atm) to give [Re(η6-C6H6)(L)(NCCH3)]+ (L = bipy or phen) and [Re(η6-C6H6)(CO)(NCCH3)2]+, respectively. The latter does not show any signs of decomposition after being exposed to an ambient atmosphere for multiple days. Additionally, [Re(η6-C6H6)(NCCH3)3]+ reacts with π-donors such as the dienes 2,3-dimethyl-1,3-butadiene (DMBD), norbornadiene (NBD), or 1,5-cyclooctadiene (COD) to give [Re(η6-C6H6)(η4-diene)(NCCH3)]+ (diene = DMBD, NBD, and COD). All three complexes are extremely stable and do not decompose during purification by preparative high-performance liquid chromatography (aqueous acidic gradient). In the presence of 18-crown-6, [Re(η6-C6H6)(NCCH3)3]+ reacts with lithium cyclopentadienyl to give the sandwich complex [Re(η5-C5H5)(η6-C6H6)]. Loss of the coordinated benzene was observed when treating [Re(η6-C6H6)(NCCH3)3]+ with diphenylacetylene (PhC≡CPh), yielding the tetra-coordinated [Re(NCCH3)(η2-PhC≡CPh)3]+.

Horse Housing on Prince Edward Island, Canada: Attitudes and Experiences Related to Keeping Horses Outdoors and in Groups.

Limited research has assessed the "human dimension" of horse care. The aims of this study were to (1) understand horse owner attitudes toward horse welfare when kept outdoors versus indoors and in groups versus individually, (2) compare horse owner attitudes toward horse welfare with the ways in which they house their horses, and (3) explore horse owner reasons for and challenges with their horses' housing. Seventy-six horse owners in Prince Edward Island, Canada completed a questionnaire. Non-parametric tests and quantitative content analysis were used for data analysis. Consistent with the way horses were kept, most (82-96%) owners agreed that horses' physical health, mental well-being, and natural living were better when kept outdoors and in groups. Fewer (64-68%) participants agreed that the horses' standard of care was better when kept outdoors or in groups. Results show associations between owners whose attitudes suggest indoor and/or individual housing is better for horse welfare and keeping their horses indoors part-time and/or individually. Two overarching themes were developed from owners' responses regarding their reasons and challenges related to the ways in which horses were housed: horse-centered and owner-centered care. The results indicate that horse owners' choices about their horses' housing correspond to beliefs about improved horse welfare.

The Impact of Acute Calcium Intake on Bone Turnover Markers during a Training Day in Elite Male Rowers.

INTRODUCTION: Although an acute exercise session typically increases bone turnover markers (BTM), the impact of subsequent sessions and the interaction with preexercise calcium intake remain unclear despite the application to the "real-life" training of many competitive athletes. METHODS: Using a randomized crossover design, elite male rowers ( n = 16) completed two trials, a week apart, consisting of two 90-min rowing ergometer sessions (EX1, EX2) separated by 150 min. Before each trial, participants consumed a high (CAL; ~1000 mg) or isocaloric low (CON; <10 mg) calcium meal. Biochemical markers including parathyroid hormone (PTH), serum ionized calcium (iCa) and BTMs (C-terminal telopeptide of type I collagen, osteocalcin) were monitored from baseline to 3 h after EX2. RESULTS: Although each session caused perturbances of serum iCa, CAL maintained calcium concentrations above those of CON for most time points, 4.5% and 2.4% higher after EX1 and EX2, respectively. The decrease in iCa in CON was associated with an elevation of blood PTH ( P < 0.05) and C-terminal telopeptide of type I collagen ( P < 0.0001) over this period of repeated training sessions and their recovery, particularly during and after EX2. Preexercise intake of calcium-rich foods lowered BTM over the course of a day with several training sessions. CONCLUSIONS: Preexercise intake of a calcium-rich meal before training sessions undertaken within the same day had a cumulative and prolonged effect on the stabilization of blood iCa during exercise. In turn, this reduced the postexercise PTH response, potentially attenuating the increase in markers of bone resorption. Such practical strategies may be integrated into the athlete's overall sports nutrition plan, with the potential to safeguard long-term bone health and reduce the risk of bone stress injuries.

Inclusion of Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Related Identities Content in Australian Physical Therapy Curricula: Perceived Barriers and Priorities for Inclusive Education.

INTRODUCTION: Providing culturally responsive, patient-centered care is crucial for ensuring safe and positive health care experiences for individuals with diverse gender identities and sexual orientations. Doing so requires adequate training and knowledge of the health professionals involved in those health care experiences. REVIEW OF LITERATURE: Individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other related identities (LGBTQIA+) experience significant barriers to health and positive health care experiences. In physical therapy, research has identified that individuals who identify as LGBTQIA+ experience discrimination, discomfort, and lack of practitioner knowledge about health needs. The aim of this study was to determine how, and to what extent, content related to LGBTQIA+ individuals is included in Australian physical therapy curricula as well as perceived barriers to inclusion. SUBJECTS: Physical therapy program directors (PDs) as of January 2022 for all Australian universities that deliver physical therapy programs (n = 24). METHODS: A Qualtrics survey was emailed to PDs to collect quantitative and qualitative data regarding the inclusion and mode of delivery of LGBTQIA+ content, as well as the perceived importance, and barriers to inclusion, of LGBTQIA+ curricula. RESULTS: Twenty-four (100%) universities (PD or proxy) responded to the survey. More than 62% (15/24) of PDs reported that their programs included LGBTQIA+ content with 88% (21/24), indicating that LGBTQIA+ content is relevant to the physical therapy curriculum. Time devoted to LGBTQIA+ content ranged from 0 to 6 (median 2-4) hours across any year, delivered primarily in general or foundational courses (37%). Perceived lack of trained faculty (14/22; 64%) and time (13/22; 59%) were barriers to the integration of LGBTQIA+ specific content into the curriculum. DISCUSSION: Our results indicate that the physical therapy curriculum may be contributing to ongoing negative experiences of individuals identifying as LGBTQIA+ with physical therapy encounters. Although most (87%) physical therapy program leaders in Australia believe that LGBTQIA+ specific content is relevant to the training of new graduates, content is included in only 62% of curricula. Perceived barriers to inclusion of LGBTQIA+ specific curriculum were a lack of time and appropriately trained faculty. Externally developed content is available to address limited expertise within programs, but faculty may require guidance on how to overcome perceived lack of time (ie, space in the curriculum). CONCLUSION: Most Australian physical therapy programs include LGBTQIA+ content to a limited extent in their curricula, indicating a lack of perceived importance relative to other topics. In this way, Australian universities are maintaining the pervasive heteronormativity of the physical therapy profession and are complicit in the ongoing health disparities between the LGBTQIA+ and heteronormative communities.

Athlete perceptions of flavored, menthol-enhanced energy gels ingested prior to endurance exercise in the heat.

Background: L-menthol evokes a cooling sensation by activating cold sensing cation channels. Menthol-enhanced fluids can be ergogenic during exercise in the heat by improving thermal perception; hence, the addition of menthol to energy gels may benefit athletes. Previously, unflavored menthol gels were deemed acceptable at 0.1% concentration, but no research has been undertaken on menthol gels with additional flavoring. Therefore, we determined athlete perceptions of flavored energy gels with different menthol concentrations. Methods: With a randomized, crossover, double-blind, placebo-controlled design, 27 athletes (34.8 ± 6.7 y, 9 females) ingested an energy gel with either 0.1%, 0.3%, 0.5%, or 0.7% menthol concentration, or a non-menthol, flavor-matched placebo (CON), on separate occasions before outdoor exercise. Gels were rated for cooling sensation, irritation, flavor, and overall experience on 100-point sensory and hedonic labeled magnitude scales. The duration of any cooling sensation was also reported. Results: All menthol gels delivered a greater cooling sensation compared to CON (7.4 ± 8.1 AU) with a significantly greater response for 0.7% (59.9 ± 20.5 AU) and 0.5% (57.7 ± 21.8 AU), compared to all others. Irritation was higher for all menthol gels compared to CON (3.4 ± 7.2 AU) and for 0.7% compared to 0.1% (31.1 ± 31.0 vs. 16.3 ± 21.0 AU, p = 0.041), with none rated above a 'mild-moderate' intensity. The menthol gels delivered a significantly longer cooling sensation duration (12.3-19.6 min) versus CON (2.2 ± 4.8 min) with no difference between menthol gels. Conclusion: A flavored menthol energy gel at 0.1-0.7% concentration provides a cooling sensation for athletes when ingested before exercise. The 0.5% concentration is recommended to maximize the cooling sensation whilst minimizing irritation.

Staff perspectives on the key elements to successful rapid uptake of telerehabilitation in medium-sized public hospital physiotherapy departments.

BACKGROUND AND PURPOSE: During the COVID-19 pandemic, hospital physiotherapy departments transitioned to telerehabilitation to ensure continuity of care for patients. The purpose of this study is to determine the key elements to successful, rapid uptake of telerehabilitation in medium-sized public hospital physiotherapy departments in response to COVID-19. METHODS: This study used a qualitative design. Physiotherapists who delivered telerehabilitation consultations during the COVID-19 restriction period in two Brisbane public hospital physiotherapy departments were eligible to participate in semi-structured interviews. Data were analysed thematically. RESULTS: Twenty-five physiotherapists (22-60 years of age; 68% female) with 1-40 years of clinical experience provided insights into their perceptions of the rapid uptake of telerehabilitation in the provision of clinical care. Physiotherapists worked across musculoskeletal outpatient (72%), inpatient, community, paediatrics and pelvic health departments. Qualitative analyses in relation to the physiotherapist perceptions of the key elements of rapid transition to telerehabilitation, revealed four key themes underpinning success: (1) 'it requires a whole team approach', (2) 'technology issues will be encountered and can be overcome', (3) 'optimise the situation while understanding the differences' and (4) 'modifying your approach doesn't imply inferior quality of care'. CONCLUSION: Rapid implementation of telerehabilitation in a hospital setting is possible, and is facilitated by organisational, administrative and management support, willingness of physiotherapists to adopt, shared learning experience, quality software and connection, availability of equipment and space and optimised systems and processes. Key factors facilitating successful telerehabilitation consultations include effective communication, demonstration, involving a third party to help, and clients who are well prepared and willing to engage.