The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study).

BACKGROUND: This study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations. METHODS: Sixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified. A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators. RESULTS: Care received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators. CONCLUSIONS: This is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts.

Designing clinical indicators for common residential aged care conditions and processes of care: the CareTrack Aged development and validation study.

BACKGROUND: People who live in aged care homes have high rates of illness and frailty. Providing evidence-based care to this population is vital to ensure the highest possible quality of life. OBJECTIVE: In this study (CareTrack Aged, CT Aged), we aimed to develop a comprehensive set of clinical indicators for guideline-adherent, appropriate care of commonly managed conditions and processes in aged care. METHODS: Indicators were formulated from recommendations found through systematic searches of Australian and international clinical practice guidelines (CPGs). Experts reviewed the indicators using a multiround modified Delphi process to develop a consensus on what constitutes appropriate care. RESULTS: From 139 CPGs, 5609 recommendations were used to draft 630 indicators. Clinical experts (n = 41) reviewed the indicators over two rounds. A final set of 236 indicators resulted, mapped to 16 conditions and processes of care. The conditions and processes were admission assessment; bladder and bowel problems; cognitive impairment; depression; dysphagia and aspiration; end of life/palliative care; hearing and vision; infection; medication; mobility and falls; nutrition and hydration; oral and dental care; pain; restraint use; skin integrity and sleep. CONCLUSIONS: The suite of CT Aged clinical indicators can be used for research and assessment of the quality of care in individual facilities and across organizations to guide improvement and to supplement regulation or accreditation of the aged care sector. They are a step forward for Australian and international aged care sectors, helping to improve transparency so that the level of care delivered to aged care consumers can be rigorously monitored and continuously improved.

Inertial Sensor Reliability and Validity for Static and Dynamic Balance in Healthy Adults: A Systematic Review.

Compared to laboratory equipment inertial sensors are inexpensive and portable, permitting the measurement of postural sway and balance to be conducted in any setting. This systematic review investigated the inter-sensor and test-retest reliability, and concurrent and discriminant validity to measure static and dynamic balance in healthy adults. Medline, PubMed, Embase, Scopus, CINAHL, and Web of Science were searched to January 2021. Nineteen studies met the inclusion criteria. Meta-analysis was possible for reliability studies only and it was found that inertial sensors are reliable to measure static standing eyes open. A synthesis of the included studies shows moderate to good reliability for dynamic balance. Concurrent validity is moderate for both static and dynamic balance. Sensors discriminate old from young adults by amplitude of mediolateral sway, gait velocity, step length, and turn speed. Fallers are discriminated from non-fallers by sensor measures during walking, stepping, and sit to stand. The accuracy of discrimination is unable to be determined conclusively. Using inertial sensors to measure postural sway in healthy adults provides real-time data collected in the natural environment and enables discrimination between fallers and non-fallers. The ability of inertial sensors to identify differences in postural sway components related to altered performance in clinical tests can inform targeted interventions for the prevention of falls and near falls.

Older Adults' Experiences of Goals in Health: A Systematic Review and Metasynthesis.

Objective: To synthesize older adults' experiences and perceptions of goal setting and pursuit within health systems. Methods: Six databases were searched to May 2019 using a combination of MeSH and free text terms. Included papers were written in English and reported original qualitative research for participants aged 65 years and older. Participant quotes from the results sections of included studies were gathered for thematic analysis and synthesis. Results: Initial search yielded 9,845 articles, and 134 were identified for full-text review. Fifteen papers were included in the final synthesis. Two main themes were identified: enablers (intrinsic and extrinsic) and barriers (personal and system). Conclusion: Older adults' self-belief is the strongest enabler for goal activities, enhanced by a personalized coaching approach from health staff. Conversely, inconsistent goal terminology confuses patients and reduces engagement. Likewise, fatigue has profound physical and cognitive impact on patients' ability to engage and participate in goals.

Dermal thickness and echogenicity using DermaScan C high frequency ultrasound: Methodology and reliability testing in people with and without primary lymphoedema.

BACKGROUND: DermaScan C high frequency ultrasound was investigated for image capture and analysis of dermal measures in people with and without primary lymphoedema. METHOD: Three repeated images were taken at six sites in people without lymphoedema (NLO). Intra-rater reliability was assessed by taking three sets of measures on images from 10 people and inter-session reliability by capturing three images, lifting the probe from the skin in between. Methods were adjusted, and repeated images from four sites were taken in people with primary lymphoedema (PLO) and reliability re-assessed. RESULTS: Intra-rater reliability in NLO and PLO for echogenicity measures were excellent (NLO ICC(3,1) : .989; PLO .997) across all sites and specific to each site (calf: ICC(3,1) : .989; and foot: ICC(3,1) : .999, respectively). Inter-session reliability was moderate for NLO (ICC(3,1) : .727), improving after method modifications for PLO (ICC(3,1) : .916). When investigated by site, inter-session reliability was good in the foot (ICC(3,1) : .811) and moderate in the calf (ICC(3,1) : .616). Mean thickness analysed by site resulted in good inter-session reliability only in the foot (ICC(3,1) .838). CONCLUSION: Intra-rater reliability was excellent using the DermaScan C for dermal measures in people with primary lymphoedema. Inter-session reliability required particular attention to method and gain settings.

Health Literacy Among Canadian Men Experiencing Prostate Cancer.

The objective was to describe the health literacy of a sample of Canadian men with prostate cancer and explore whether sociodemographic and health factors were related to men's health literacy scores. A sample of 213 Canadian men (M age = 68.71 years, SD = 7.44) diagnosed with prostate cancer were recruited from an online prostate cancer support website. The men completed the Health Literacy Questionnaire along with demographic, comorbidity, and prostate cancer treatment-related questions online. Of the 5-point scales, men's health literacy scores were highest for "Understanding health information enough to know what to do" (M = 4.04, SD = 0.48) and lowest for "Navigating the health care system" (M = 3.80, SD = 0.58). Of the 4-point scales, men's scores were highest for "Feeling understood and supported by health care professionals" (M = 3.20, SD = 0.52) and lowest for "Having sufficient information to manage my health" (M = 2.97, SD = 0.46). Regression analyses indicated that level of education was positively associated with health literacy scores, and men without comorbidities had higher health literacy scores. Age and years since diagnosis were unrelated to health literacy. Support in health system navigation and self-management of health may be important targets for intervention.

Pillow preferences of people with neck pain and known spinal degeneration: a pilot randomized controlled trial.

BACKGROUND: In people without cervical pathologies, changing to a latex or polyester pillow is reported to decrease waking cervical symptoms. Whether this also occurs for people with spinal degeneration in the neck is unknown. AIM: This pilot study tested recruitment strategies for people with cervical spine degeneration, and the effect of different pillows on cervical waking symptoms, sleep quality, cervical range of motion, neck disability index and quality of life. DESIGN: A randomized sequential-block double-blind controlled trial. SETTING: A community-based study. POPULATION: Adult volunteers (18+ years) with regular waking cervical symptoms (headache, cervical pain and/or stiffness, scapular pain), confirmed radiologic evidence of cervical spine degeneration, side sleeper and "usual" use of one pillow. METHODS: Participants were recruited, through community advertising at medical and physiotherapy practices, local community groups, and via newspaper, radio and websites. After screening for eligibility, they tested latex and polyester pillows for 28 days each, interspersed with 28 days on "usual" pillow for washout, and comparison. Subjects ceased using a trial pillow if it affected sleep quality or waking symptoms. Cervical range of motion, neck disability index and quality of life were measured pre-post each pillow trial, whilst waking symptoms and sleep quality were assessed daily. RESULTS: Of 117 local volunteers, 92 had radiologically-confirmed cervical spondylosis, and a further 45 (48.9%) were excluded for medical conditions, sleep position and/or pillow use. Approximately 70% "usual" pillows were polyester. Overall no pillow significantly altered any outcome measure. Considering trends however, the polyester pillow significantly increased side flexion range of movement on waking and showed some effect on nocturnal-waking cervical pain. The latex pillow did not perform well on any outcome measure. Significantly more subjects completed the polyester pillow trial than the latex pillow trial (post-hoc power 80% vs. 55%). CONCLUSIONS: Well-powered studies to truly detect pillow impact on waking symptoms and sleep quality require 400+ symptomatic subjects. CLINICAL REHABILITATION IMPACT: It has previously been reported that using a latex or polyester pillow significantly improves waking cervical symptoms in the general population. This pilot study did not replicate these results in people with known cervical spine degeneration.

CareTrack Aged: the appropriateness of care delivered to Australians living in residential aged care facilities: a study protocol.

INTRODUCTION: The aged population is increasing rapidly across the world and this is expected to continue. People living in residential aged care facilities (RACFs) represent amongst the sickest and frailest cohort of the aged population, with a high prevalence of chronic conditions and complex comorbidities. Given the vulnerability of RACF residents and the demands on the system, there is a need to determine the extent that care is delivered in line with best practice ('appropriate care') in RACFs. There is also a recognition that systems should provide care that optimises quality of life (QoL), which includes support for physical and psychological well-being, independence, social relationships, personal beliefs and a caring external environment. The aims of CareTrack Aged are to develop sets of indicators for appropriate care and processes of care for commonly managed conditions, and then assess the appropriateness of care delivered and QoL of residents in RACFs in Australia. METHODS AND ANALYSIS: We will extract recommendations from clinical practice guidelines and, using expert review, convert these into sets of indicators for 15 common conditions and processes of care for people living in RACFs. We will recruit RACFs in three Australian states, and residents within these RACFs, using a stratified multistage sampling method. Experienced nurses, trained in the CareTrack Aged methods ('surveyors'), will review care records of recruited residents within a 1-month period in 2019 and 2020, and assess the care documented against the indicators of appropriate care. Surveyors will concurrently assess residents' QoL using validated questionnaires. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Human Research Ethics Committee of Macquarie University (5201800386). The research findings will be published in international and national journals and disseminated through conferences and presentations to interested stakeholder groups, including consumers, national agencies, healthcare professionals, policymakers and researchers.

LIMPRINT in Australia.

Background and Study Objective: Australia was one of nine participating countries in the epidemiology Phase II Lymphoedema Impact and Prevalence - International (LIMPRINT) project to determine the number of people with chronic edema (CO) in local health services. Methods and Results: Data collection occurred through questionnaire-based interviews and clinical assessment with provided LIMPRINT tools. Four different types of services across three states in Australia participated. A total of 222 adults participated with an age range from 22 to 102 years, and 60% were female. Site 1 included three residential care facilities (54% of participants had swelling), site 2 was community-delivered aged care services (24% of participants had swelling), site 3 was a hospital setting (facility-based prevalence study; 28% of participants had swelling), and site 4 was a wound treatment center (specific patient population; 100% of participants had swelling). Of those with CO or secondary lymphedema, 93% were not related to cancer, the lower limbs were affected in 51% of cases, and 18% of participants with swelling reported one or more episodes of cellulitis in the previous year. Wounds were identified in 47% (n = 105) of all participants with more than half of those with wounds coming from the dedicated wound clinic. Leg/foot ulcer was the most common type of wound (65%, n = 68). Conclusions: Distances between services, lack of specialized services, and various state funding models contribute to inequities in CO treatment. Understanding the high number of noncancer-related CO presentations will assist health services to provide timely effective care and improve referral pathways.

Measurement of transversus abdominis activation in chronic low back pain patients using a novel standardized real-time ultrasound imaging method.

Real-time ultrasound imaging (US) to measure abdominal muscle dimensions has aided low back pain rehabilitation and research. Notwithstanding, ultrasound imaging measurement of transversus abdominis muscle activation in chronic low back pain populations has been characterized by variable and generally suboptimal intra-observer reliability. Methodological deficiencies of 'freehand' ultrasound imaging are uncontrolled probe-skin pressure, inclination and roll of the probe. Despite previous attempts to standardize these parameters, intra-observer reliability in chronic low back pain was poor to moderate (0.32-0.62). Therefore, a standardized method that controls and records probe force, inclination and roll during ultrasound imaging may optimize measurement reliability in chronic low back pain. This pilot study investigated utility, standardization and intra-observer reliability of ultrasound imaging transversus abdominis thickness measurement in chronic low back pain patients (n = 17). Transversus abdominis imaging over two separate measurement sessions was conducted using a novel method to standardize probe parameters. Resting and contracted transversus abdominis thickness, and transversus abdominis activation measurements were obtained from duplicate paired images (n = 68). Intra-class correlation coefficients were reported with 95% confidence intervals. Transversus abdominis thickness at rest (intra-class correlation coefficient = 0.97 confidence interval: 0.93, 0.99), when contracted (intra-class correlation coefficient = 0.99 confidence interval: 0.97, 0.99) and transversus abdominis activation (intra-class correlation coefficient = 0.93 confidence interval: 0.81, 0.97) measurements were highly reliable. Ultrasound imaging of transversus abdominis using the novel standardized ultrasound imaging method produced highly reliable intra-observer transversus abdominis measurements, superior to 'freehand' ultrasound imaging, despite the physical limitations typically associated with a chronic low back pain population. Unique standardizing ranges for 'probe force device' probe parameters were obtained. This novel standardized ultrasound imaging method may optimize transversus abdominis activation assessment in chronic low back pain and other populations, aiding future research.

Feasibility of population screening tests to establish a healthy ageing trajectory.

OBJECTIVES: There are no agreed comprehensive tests for age-related changes to physical, emotional, mental and social functioning. Research into declining function focuses on those 75 years and older and little is known about age-related changes in younger people. The aims of this project were (1) to ascertain a comprehensive test battery that could underpin community-based health screening programmes for people aged 40-75 years and pilot both (2) community-based recruitment and (3) the utility, acceptability, response burden and logistics. METHODS: A total of 11 databases were searched using a broad range of relevant terms. An identified comprehensive, recent, high-quality systematic review of screening instruments for detection of early functional decline for community-dwelling older people identified many relevant tools; however, not all body systems were addressed. Therefore, lower hierarchy papers identified in the rapid review were included and expert panel consultation was conducted before the final test battery was agreed. Broad networks were developed in one Australian city to aid pilot recruitment of community-dwellers 40-75 years. Recruitment and testing processes were validated using feasibility testing with 12 volunteers. RESULTS: The test battery captured (1) online self-reports of demographics, health status, sleep quality, distress, diet, physical activity, oral health, frailty and continence; and (2) objective tests of anthropometry; mobility; lung function; dexterity; flexibility, strength and stability; hearing; balance; cognition and memory; foot sensation; and reaction time. Recruitment and testing processes were found to be feasible. CONCLUSION: This screening approach may provide new knowledge on healthy ageing in younger people.

Intermittent Pneumatic Compression Dosage for Adults and Children with Lymphedema: A Systematic Review.

BACKGROUND: Pneumatic compression has been used for more than 40 years in the management of lymphedema (LE). Modes of application have evolved with little consensus regarding optimal treatment parameters or dosage. The aim of this systematic review was to report the evidence for dosage of intermittent pneumatic compression (IPC) for people with LE and, particularly, that for upper versus lower limbs or child versus adult dosage. METHODS: Medline, Embase, CINAHL, PubMed, and Scopus were searched with terms, including LE and IPC devices, with no restriction on time. Other materials searched included reference lists of included articles. STUDY SELECTIONS: Systematic review registration: PROSPERO ID: CRD42017054338. Studies were assessed according to PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines and were excluded if they were not in English, not human, had physiological outcomes, or studied IPC in combination with other therapies. Quality appraisal, using the McMaster University Critical Review Tool, was undertaken by two researchers with differences resolved by a third. One hundred twenty-two full-text studies were screened for eligibility. RESULTS: Sixteen met inclusion criteria for final analysis. Of these, four were reported separately due to concurrent use of compression garments during the study period. One randomized controlled trial met the requirements for a level II (National Health and Medical Research Council) rating; the remainder were level III-2 and below. Devices applying compression via multichamber sleeves were more commonly used in the past 20 years, with a trend toward lower pressures and shorter treatment times compared with earlier studies. Little evidence exists for application of specific dosage of IPC for children or a particular limb. New devices utilizing lower pressures support home use and self-management of LE. CONCLUSION: Low-level evidence of moderate quality shows significant outcomes achieved with dosage times of 45-60 minutes, applying pressures between 30 and 60 mmHg in sequential IPC programs. Methodological limitations in most studies suggest caution in drawing conclusions.

Stigma in Male Depression and Suicide: A Canadian Sex Comparison Study.

Stigma in men's depression and suicide can restrict help-seeking, reduce treatment compliance and deter individuals from confiding in friends and family. In this article we report sex comparison findings from a national survey of English-speaking adult Canadians about stigmatized beliefs concerning male depression and suicide. Among respondents without direct experience of depression or suicide (n = 541) more than a third endorsed the view that men with depression are unpredictable. Overall, a greater proportion of males endorsed stigmatizing views about male depression compared to female respondents. A greater proportion of female respondents endorsed items indicating that men who suicide are disconnected, lost and lonely. Male and female respondents with direct personal experience of depression or suicide (n = 360) strongly endorsed stigmatizing attitudes toward themselves and a greater proportion of male respondents indicated that they would be embarrassed about seeking help for depression.

Conservative management of lymphoedema in children: a systematic review.

PURPOSE: A systematic literature review was conducted to determine best practice conservative management of pediatric lymphoedema. METHOD: The PRISMA protocol was followed; a search of Ovid Medline, Cinahl and Scopus was conducted using the search terms children OR pediatric OR adolescent AND lymphoedema OR lymphedema. Studies about management or treatment of lymphoedema in children were included while studies about filariasis, imaging, pathology, secondary lymphoedema, surgical techniques, central lymphoedema and those with participants with a median age greater than 18 years were excluded. RESULTS: Of 738 possible studies identified, eight studies were eligible for inclusion in the review: four case reports, two retrospective service reviews and two prospective studies investigating different interventions. All studies were rated using the NHMRC hierarchy of evidence and appraised by both authors using the McMaster University Critical Review Form. Studies were of low quality with poor descriptions of management, small sample size, unclear and inconsistent methodology and irreproducible outcome measures. CONCLUSION: This review identified low level evidence to support the use of pneumatic compression in the management of pediatric lymphoedema. Further research is required to identify optimal parameters for application of pneumatic compression and to investigate the use of other interventions for conservative management of pediatric lymphoedema.

Mechanisms for triceps surae injury in high performance front row rugby union players: a kinematic analysis of scrummaging drills.

The front row of a rugby union scrum consists of three players. The loose head prop, hooker and tight head prop. The objective of this study was to determine if known biomechanical risk factors for triceps surae muscle injury are exhibited in the lower limb of front row players during contested scrummaging. Eleven high performance front row rugby union players were landmarked bilaterally at the posterior superior iliac spine (PSIS), greater trochanter, lateral femoral epicondyle, midline of the calcaneus above the plantar aspect of the heel, midline lower leg 5cm and 20cm proximal to the lateral malleolus, at the axis of subtalar joint, lateral malleolus, and head of the fifth metatarsal. Players were video recorded during a series of 2 on 1 live scrummaging drills. Biomechanical three dimensional analysis identified large angular displacements, and increased peak velocities and accelerations at the ankle joint during attacking scrummaging drill techniques when in the stance phase of gait. This places the triceps surae as increased risk of injury and provides valuable information for training staff regarding injury prevention and scrum training practices for front row players. Key pointsFront rowers exhibited patterns of single leg weight bearing, in a position of greater ankle plantar flexion and knee extension at toe off during scrummaging, which is a risk position for TS injury.Front rowers also exhibited greater acceleration at the ankle, knee, and hip joints, and greater changes in ankle ROM from toe strike to toe off during attacking scrum drills.These reported accelerations and joint displacements may be risk factors for TS injury, as the ankle is accelerating into plantar flexion at final push off and the muscle is shortening from an elongated state.

Time to stabilisation of the cervical spine when supported by a pillow in side lying.

Currently, there is little information to guide consumers, retailers and health professionals about the length of time it takes for the cervical spine to stabilise when resting on a pillow. The aim of this study was to determine the time required to achieve stabilisation of the cervical spine when supported by a polyester pillow and innerspring mattress in side lying. Twenty-four asymptomatic females rested in a standardised side lying position during the capture of 3D data from markers placed over cervical landmarks. Time to stabilisation was assessed for each axis, each landmark and globally for each participant. A large variation in global stabilisation times was identified between participants; however, 70.8% of participants had stabilised by 15 min or earlier. Fifteen minutes is the best estimate of the time to stabilisation of the cervical spine for young females in a side lying position when resting on a polyester pillow. PRACTITIONER SUMMARY: This study aimed to determine the time required to achieve stabilisation of the cervical spine when supported by a polyester pillow and innerspring mattress in side lying. Through a laboratory study using 3D VICON® motion analysis technology, we identified that 70.8% of participants had stabilised by 15 min.

Extracorporeal Shock Wave Therapy (ESWT) as a treatment for recurrent Neurogenic Heterotopic Ossification (NHO).

PRIMARY OBJECTIVE: To describe the effects of extracorporeal shock wave therapy (ESWT) on neurogenic heterotopic ossification (NHO). RESEARCH DESIGN: A single case study was considered the most appropriate methodology in this situation. METHODS AND PROCEDURES: The subject was a 43 year old female 10 years post-traumatic brain injury with recurring NHO around the hip joint. Baseline assessments of pain using a 10-point VAS, range of motion of the hip using a goniometer and walking ability (number of steps over a standard distance) were conducted. Four applications of ESWT using a Minispec™ Extracorporeal Shock Wave Lithotripsy machine (Medispec Int. USA) administered over 6 weeks to the anterolateral aspect of the right hip. Follow-up assessments were conducted weekly over the period of intervention and then monthly for 5 months. MAIN OUTCOMES AND RESULTS: Immediately following treatment, pain was reduced to 0 on the VAS scale; hip range of motion increased and the number of steps over a standard distance reduced, indicating increased step length. At 5-month follow-up, without further ESWT intervention, these results were maintained. CONCLUSION: This case study suggests that ESWT may be a non-invasive, low risk intervention for the management of NHO.

A randomized, comparative trial: does pillow type alter cervico-thoracic spinal posture when side lying?

BACKGROUND: Many patients ask for advice about choosing a pillow. This research was undertaken to determine if pillow type alters cervico-thoracic spine position when resting in the side-lying position. AIM: To investigate the effect of different pillow shape and content on the slope of cervico-thoracic spine segments when side lying. MATERIALS AND METHODS: The study was a randomized blinded comparative trial set in a laboratory that replicated a bedroom. The subjects were side sleepers aged over 18 years. Exclusion criteria were history of surgery to the cervico-thoracic spine, an injury or accident to the cervico-thoracic spine in the preceding year, or currently receiving treatment for neck symptoms. Each participant rested in a standardized side-lying position for 10 minutes on each of the trial pillows: regular shaped polyester, foam, feather, and latex pillows, and a contour shaped foam pillow. Reflective markers were placed on external occipital protuberance (EOP), C2, C4, C7, and T3, and digital images were recorded of subjects at 0 and 10 minutes on each pillow. Images were digitized using each reflective marker and the slope of each spinal segment calculated. Univariate analysis of variance models were used to investigate slope differences between pillows at 0 and 10 minutes. Significance was established at P < 0.01 to take account of chance effects from repeated measures and multiple comparisons. RESULTS: At 0 and 10 minutes, the EOP-C2, C2-C4, and C4-C7 segmental slopes were significantly different across all pillows. Significant differences were identified when comparing the feather pillow with the latex, regular and contour foam pillows, and when comparing the polyester and foam contour pillows. The regular and contour foam pillows produced similar slopes at all spinal segments. CONCLUSION: Cervico-thoracic spinal segment slope alters significantly when people change from a foam, latex, or polyester pillow to a feather pillow and vice versa. The shape of a foam pillow (contour versus regular shape) does not significantly alter cervico-thoracic spinal segment slope.

Your Pillow May Not Guarantee a Good Night's Sleep or Symptom-Free Waking.

PURPOSE: To describe the performance of the pillow that participants usually slept on with respect to retiring and waking cervico-thoracic symptoms, pillow comfort, and sleep quality. METHODS: Participants (n=106) were systematically recruited for a field trial comparing their own pillow and five trial pillows. Participants provided daily retiring and waking symptom reports and sleep-quality and pillow-comfort ratings prospectively for 1 week on each pillow. Linear and logistic regression models were used to investigate the relationship between pillow use, age, gender, sleep quality, pillow comfort, and waking and temporal (overnight) symptom reports. RESULTS: No waking symptoms were reported by 42.5% of participants on their own pillow. Regular waking symptoms, failure to relieve retiring symptoms, uncomfortable pillows, and/or poor-quality sleep were reported by over 50% of participants. All participants who reported poor sleep quality also reported poor pillow comfort. Pillow-comfort reports were not related to any waking symptom report; however, reports of poor sleep quality were significantly related to waking cervical stiffness (adjusted odds ratio [AOR]=4.3 [Confidence Interval (CI): 1.3-15.6]) and scapula pain (AOR=6.1 [CI: 1.1-31.6]). Feather pillow users provided consistently low reports of pillow comfort and sleep quality. CONCLUSION: Many participants appear to have made poor pillow choices, as poor sleep quality, low pillow comfort, and waking symptoms were common. Further research is required to understand why people choose particular pillows to sleep on, as well as to identify the best fit between person and pillow to optimize sleep quality and reduce waking symptoms.

Recreational cyclists: The relationship between low back pain and training characteristics.

This study investigated the relationship between low back pain (LBP) and training characteristics in recreational cyclists. Purposive sampling was used to recruit sixty-six recreational cyclists from nine cycling clubs. Participants completed a survey reporting training characteristics and LBP behaviour during a usual week of cycling. This included percent of time spent cycling in three common riding positions, cycling terrain, average cycling pace, number of gears, days per week cycled and number of cycling events per year. Fifty percent reported LBP during or after cycling or smoking and LBP. Cyclists who reported LBP cycled significantly further in a usual week of cycling than cyclists who did not report LBP (p=0.022). An odds ratio indicated that people who cycle 160 km or more per week are 3.6 times as likely to experience LBP compared with people who cycle less than 160 km per week (OR=3.6, CI=1.29-10.15). Preference for riding with the hands on the brakes approached significance with respect to LBP reports (P=0.06). No other significant relationship between LBP and training characteristics was identified. In order to reduce the risk of LBP recreational cyclists who report LBP should consider decreasing cycling distance to less than 160 km per week.