Reliability of Hip Strength Assessment in Young Active People with Hip Dysplasia: An Examination in Student Circus Artists.

BACKGROUND: Developmental dysplasia of the hip (DDH) is common in performing artists and other young active individuals and involves abnormalities in bony morphology of the acetabulum and proximal femur that can negatively impact walking biomechanics, muscular strength, quality of life, and sleep. Rehabilitation for hip-related conditions should target known modifiable impairments such as hip muscle strength, though a reliable method of assessment in this population remains unclear. OBJECTIVE: To determine the inter- and intra-rater reliability of hip muscle strength assessments using handheld dynamometry (HHD) in young active circus artists with DDH. METHODS: Reliability of hip strength in all planes was assessed using HHD in 21 adult performing circus arts students (mean age 21.3 yrs [3.2]; 13 M, 5 F, 3 NB) with symptomatic radiologically and clinically diagnosed hip dysplasia. The reliability of average peak force and absolute peak force were expressed for each position tested. Reliability was assessed using intraclass correlation coefficients (ICC) with standard error of measurement (SEM) and minimal detectable change (MDC) values calculated to improve clinical interpretability. RESULTS: Good to excellent inter-rater reliability resulted for all hip muscle strength testing positions, ICC=0.88 (95%CI 0.70 to 0.95) to ICC=0.97 (0.92 to 0.99), except average peak hip flexion strength, ICC=0.71 (0.28 to 0.88). Absolute peak hip abduction, ICC=0.77 (0.16 to 0.94), and adduction strength, ICC=0.72 (-0.55 to 0.92), demonstrated the lowest intra-rater reliability. Transverse plane strength measures (rotation) produced the lowest SEM and MDC values followed by the frontal plane (abduction/adduction) and sagittal plane (flexion/extension). CONCLUSION: HHD is an appropriate and reliable method to assess hip muscle strength in circus artists with DDH.

Association between hip muscle strength/function and hip cartilage defects in sub-elite football players with hip/groin pain.

OBJECTIVE: To explore associations between hip muscle strength and cartilage defects (presence and severity) on magnetic resonance imaging (MRI) in young adults with hip/groin pain participating in sub-elite football. DESIGN: Sub-elite football players with hip/groin pain (>6 months) completed assessments of isometric hip strength and functional task performance. Hip cartilage defects were assessed using the Scoring Hip Osteoarthritis with MRI tool. This exploratory, cross-sectional study used logistic and negative binomial models to assess the relationships between hip muscle strength or functional task performance and hip cartilage defects, controlling for body mass index, age, testing site and cam morphology, incorporating sex-specific interaction terms. RESULTS: One hundred and eighty-two (37 women) sub-elite (soccer or Australian football) players with hip/groin pain (age 26 ± 7 years) were included. Greater hip extension strength was associated with higher cartilage total score (adjusted incidence rate ratio [aIRR] 1.01, 95%CI: 1.0 to 1.02, p = 0.013) and superolateral cartilage score (adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI): 1.01 to 1.06, p < 0.01). In female sub-elite football players, greater hip external rotation strength was associated with lateral cartilage defects (aOR 1.61, 95%CI: 1.05 to 2.48, p = 0.03) and higher cartilage total score (aIRR 1.25, 95%CI: 1.01 to 1.66, p = 0.042). A one-repetition increase in one-leg rise performance was related to lower odds of superomedial cartilage defects (aOR 0.96, 95%CI: 0.94 to 0.99, p < 0.01). CONCLUSIONS: Overall, there were few associations between peak isometric hip muscle strength and overall hip cartilage defects. It is possible that other factors may have relevance in sub-elite football players. Additional studies are needed to support or refute our findings that higher one leg rise performance was associated with reduced superomedial cartilage defect severity and greater hip extension strength was related to higher cartilage defect severity scores.

The association between hip/groin pain and hip strength in football players: An exploratory analysis of the FORCe cohort.

OBJECTIVES: Explore associations between peak hip strength in football players with hip/groin pain and healthy controls. DESIGN: Cross-sectional study. METHODS: Male and female sub-elite football players (soccer and Australian football) with hip/groin pain >6-month duration and players without hip/groin pain were recruited across Melbourne and Brisbane, Australia. Demographic information and two questionnaires; the Copenhagen Hip and Groin Outcome Score and the International Hip Outcome Tool 33 were collected. Hand-held dynamometry was used to measure isometric hip strength for flexion, extension, abduction, adduction, internal rotation, and external rotation. Linear mixed effects models were used to compare strength measures between groups. RESULTS: 190 football players with hip/groin pain (mean ±â€¯standard deviation age, 27.8 ±â€¯6.3 years) and 64 controls (age, 27.3 ±â€¯5.6 years) were included in this study. Of these, 291 symptomatic limbs and 128 control limbs were used for analyses. Symptomatic players had lower peak hip adduction (adjusted mean difference = -0.18: 95 % confidence interval -0.27 to -0.08, P : 0.001), external rotation (-0.06: 95 % confidence interval -0.09 to -0.02, P : 0.003), and internal rotation strength (-0.06: 95 % confidence interval -0.10 to -0.03, P : 0.001) compared to controls. A sport-specific interaction was observed for hip abduction strength. When separated by football code, abduction strength was lower in symptomatic Australian football players compared to their same sport peers (-0.20: 95 % confidence interval -0.33 to -0.06, P : 0.004), but not in symptomatic soccer players (-0.05: 95 % confidence interval -0.15 to 0.06, P : 0.382). CONCLUSIONS: Hip adduction, internal rotation, and external rotation strength appears lower in football players with hip/groin pain independent of sex and football code. Hip abduction strength was lower in symptomatic Australian football players but not in soccer players.

The association between statistical shape modeling-defined hip morphology and features of early hip osteoarthritis in young adult football players: Data from the femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study.

Objective: To explore the relationship between radiographic hip shape and features of early hip osteoarthritis (OA) on magnetic resonance imaging (MRI) in young male and female football players without radiographic hip OA. Design: We used baseline data from a cohort of symptomatic and asymptomatic football players aged 18-50 years. Hip shape was assessed on anteroposterior radiographs with statistical shape modeling (SSM) for men and women separately. Cartilage defects and labral tears were graded using the Scoring Hip Osteoarthritis with MRI (SHOMRI) system. We used logistic regression with generalized estimating equations to estimate associations between each hip shape variant, called shape modes, and cartilage defects or labral tears. Results: We included 229 participants (446 hips, 77.4% male). For each sex, 15 shape modes were analyzed. In men, three shape modes were associated with cartilage defects: adjusted odds ratios (aOR) 0.75 (95%CI 0.58-0.97) per standard deviation (SD) for mode 1; 1.34 (95%CI 1.05-1.69) per SD for mode 12; and 0.61 (95%CI 0.48-0.78) per SD for mode 15; and one also with labral tears: aOR 1.30 (95%CI 1.01-1.69) per SD for mode 12. These modes generally represented variations in the femoral neck and subtypes of cam morphology, with and without pincer morphology. For women, there was no evidence for associations with the outcomes. Conclusions: Several hip shape variants were associated with cartilage defects on MRI in young male football players. Specifically, one subtype of cam morphology was associated with both cartilage defects and labral tears. Hip shape was not associated with early OA features in women.

Many physiotherapists lack preparedness to prescribe physical activity and exercise to people with musculoskeletal pain: A multi-national survey.

OBJECTIVES: Determine physiotherapists' (i) awareness of physical activity, and exercise prescription guidelines; (ii) perceived role, knowledge, confidence, skills and training in prescribing and progressing aerobic exercise and resistance training to people with musculoskeletal pain; (iii) professional development preferences; and (iv) perceived influences of external factors on exercise prescription for people with musculoskeletal pain. DESIGN: Multi-national cross-sectional survey. METHODS: An open online survey was developed specifically for this study. RESULTS: 1,352 physiotherapists from 56 countries participated. The majority of respondents correctly stated physical activity guidelines for adults (60%) and children (53%), but only 37% correctly stated guidelines for older adults. Eleven percent and 16% could name an accepted guideline for aerobic exercise and resistance training, respectively. Most agreed their role included prescribing aerobic exercise (75%) and resistance training (89%). Fewer reported they had the confidence, training or skills to prescribe aerobic exercise (38-50%) and resistance training (49-70%). Workshops were the most preferred (44%) professional development option. Most respondents believed appointment scheduling and access to equipment and professional development (62-79%) affected their ability to prescribe effective exercise. CONCLUSION: Many physiotherapists lack knowledge and training to provide physical activity advice, and to prescribe aerobic exercise and resistance training to people with musculoskeletal pain.

Prevalence of early hip OA features on MRI in high-impact athletes. The femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study.

OBJECTIVE: To compare early hip osteoarthritis (OA) features on magnetic resonance imaging (MRI) in high-impact athletes with and without hip and/or groin pain, and to evaluate associations between early hip OA features, the International Hip Outcome Tool (iHOT33) and Copenhagen Hip and Groin Outcome Score (HAGOS). DESIGN: This case-control study evaluated data of the femoroacetabular impingement and hip osteoarthritis cohort (FORCe). One hundred and eighty-two symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 pain-free high-impact athletes (soccer or Australian football (AF)) without definite radiographic hip OA underwent hip MRI. The Scoring Hip Osteoarthritis with MRI (SHOMRI) method quantified and graded the severity of OA features. Each participant completed the iHOT33 and HAGOS. RESULTS: Hip and/or groin pain was associated with higher total SHOMRI (0-96) (mean difference 1.4, 95% CI: 0.7-2.2), labral score (adjusted incidence rate ratio (aIRR) 1.33, 95% CI: 1.1-1.6). Differences in prevalence of cartilage defects, labral tears and paralabral cysts between symptomatic and pain-free participants were inconclusive. There was a lower prevalence of effusion-synovitis in symptomatic participants when compared to pain-free participants (adjusted odds ratio (aOR) 0.46 (95% CI: 0.3-0.8). Early hip OA features were not associated with iHOT33 or HAGOS. CONCLUSIONS: A complex and poorly understood relationship exists between hip and/or groin pain and early hip OA features present on MRI in high-impact athletes without radiographic OA. Hip and/or groin pain was associated with higher SHOMRI and labral scores.

Muscle size and composition in people with articular hip pathology: a systematic review with meta-analysis.

OBJECTIVE: To synthesise and evaluate the current evidence investigating muscle size and composition in non-inflammatory articular hip pathology. METHODS: A systematic review of five electronic databases, using three concepts; articular hip pathology (e.g., osteoarthritis (OA)); hip muscles; and outcomes (e.g., muscle size and adiposity) was undertaken. Studies addressing non-inflammatory or non-traumatic articular hip pain, using measures of muscle size and adiposity were included and appraised for risk of bias. Data was extracted to calculate standardised mean differences (SMD) and pooled where possible for meta-analysis. RESULTS: Thirteen cross-sectional studies were included; all studies measured muscle size and 5/13 measured adiposity. In OA, there was low to very low quality evidence of no difference in hip muscle size, compared with matched controls. In unilateral OA, there was low to very low quality evidence of smaller size in gluteus minimus (SMD -0.38; 95% confidence interval (CI) -0.74, -0.01), gluteus medius (-0.44; 95% CI: -0.83, -0.05) and gluteus maximus (-0.39; 95% CI: -0.75, -0.02) muscles in the symptomatic limb. Individual studies demonstrated non-uniform changes in muscle size in OA. No significant difference was observed in muscle size in other pathologies or in adiposity for any group. CONCLUSION: There is some low quality evidence that specific hip muscles are smaller in unilateral hip OA. Variation in the magnitude of differences indicate changes in size are not uniform across all muscles or stage of pathology. Studies in larger cohorts investigating muscle size and composition across the spectrum of articular pathologies are required to clarify these findings.

Rorschach missing responses--is this more than nothing?

The Rorschach has been demonstrated as a suitable tool for investigating otherwise hidden psychological aspects of sex offenders: sex-related responses are more common. The present paper looks at the established tendency of some clients to minimise their overall Rorschach responding, the linking of this response restraint to particular Rorschach profiles, and the sparse but consistent literature which casts doubt on the proposition that Examiner enthusiasm will cause the minimising client to provide more responses which divulge additional information. In the case of sex offenders, with so much to hide, it is proposed that there may be extensive filtering of responses even among those giving more than "normal" sex-related responses. "What the client did not say", and the corresponding "missing" Rorschach responses in the case of sex offenders is discussed in the light of an individual case: (a sex offender with undue interest in young boys' penii) where "sex-like" images were specifically targeted, but never named as such. The exciting prospect of inferring what the client could have said and thus generating the content of missing responses, whether or not response filtering produced numerical minimisation, must be balanced against the risk of naked men and women (and their genitalia) representing nothing more than an artefact of the clinician's own making--"ce qui n' est pas le cas".

Conditioning rhinitis in allergic humans.

A classical Pavlovian paradigm pairing an olfactory cue with allergen challenge for a single training trial was used to produce conditioned histamine release and conditioned nasal airflow decrease in seasonal allergic rhinitis sufferers. There was no conditioned increase in subjective symptoms. Histamine release and airflow decrease showed evidence of extinction by a second test trial. A second study comparing the effects of the number of training trials showed that three training trials produced greater histamine release and airflow decrease than a single training trial, suggesting stronger effects with additional training.

"God brought all these churches together": issues in developing religion-health partnerships in an Appalachian community.

This study explored health-related and organizational religious activities in an Appalachian community and identified cultural issues in the development of religion-health partnerships. Partnerships between religious groups and health providers are a channel for health promotion efforts to vulnerable populations and must be approached from the culture of the community. An ethnographic, exploratory study of health-related and organizational activities in nonmainline religious groups yielded the use of prayer requests, anointing, testimonial, and denominational links as potential health resources. Organizational decisions were by congregational consensus and theological interpretation. The communal setting of worship as an informal resource to a community of believers, especially the vulnerable, was a viable model for religion-health partnerships in central Appalachia. Implications for nursing practice, education, and research also are addressed.

The effects of lipopolysaccharide (LPS) on the fever response in rats at different ambient temperatures.

There is a complex interplay between the immune system, nervous system, and sleep. When an organism is challenged with lipopolysacchride (LPS), the immune system is stimulated, producing a fever response that is independent of ambient temperature, and an increase in slow-wave sleep (SWS). The study investigated sleep patterns of immune-challenged rats during the light phase cycle to determine the effects of various ambient temperatures. It was hypothesised that fever response would occur independently of ambient temperatures. Also, the febrile response would be monophasic, and there would be an increase in slow-wave sleep (SWS) and a decrease in rapid-eye-movement (REM) sleep. Thirty Wistar rats were randomly placed in 3 different ambient temperature groups, 22 degrees C, 15 degrees C, and 30 degrees C. Within each of these conditions, the same subjects served as control and experimental groups. Four animals were placed in 4 subsections of 2 standard boxes that were placed in the ambient-temperature box. The electrodes were connected to the analog to digital computer board, where all the data was processed and stored on a hard drive. The animals were injected I.P. with saline and recorded for a period of 6 h to establish a baseline. On Day 2, the same animals were injected I.P. with LPS and recorded for 6 h to determine the febrile effects of LPS on the immune system; the same procedure was repeated in the other ambient temperatures. The results have shown that animals experienced a monophasic fever response in low and normal temperatures, but not in the high temperatures. Although there was no increase in SWS, there was a significant decrease in REM sleep in 3 groups.

Paradoxical conditioning of the plasma copper and corticosterone responses to bacterial endotoxin.

The cascade of physiologic mechanisms in response to infection, the acute phase response, is recognized as having a major role in host defense. Two such responses are an increase in plasma copper and activation of the hypothalamic-pituitary-adrenal axis, which are consistently reported to occur during bacterial infection. We aimed to determine whether the alterations in plasma copper and corticosterone were conditionable using the conditioned taste aversion paradigm. The regime involved the pairing of a novel-tasting saccharine solution (the conditioned stimulus) with lipopolysaccharide (the unconditioned stimulus). Seven days after the initial pairing of these stimuli (the test day), the saccharine solution was represented. Animals exposed to this condition displayed a significant decrease in plasma copper levels. In addition, these rats experienced a reduction in plasma corticosterone that was time dependent. Paradoxically, the conditioned response of both these variables were in a direction contrary to that reported during bacterial infection. These results suggest that some acute phase responses may condition as a rebound response, or in an opposing trend to that occurring as the initial reaction.

Behaviorally conditioned anorexia: role of gastric emptying and prostaglandins.

The reduction of food intake in response to bacteria is posited to be a favourable host reaction. This report attempted to examine whether gastric emptying is involved in the known conditionability of this response. Additionally, this study investigated the role of prostaglandins in the conditioned anorexic response. To investigate this phenomenon, lipopolysaccharide (LPS) (100 micrograms/kg) was used as the unconditioned stimulus, and paired with a novel 1% saccharin solution (conditioned stimulus). Upon conditioned stimulus (CS) representation, experimental animals displayed a marked reduction in food consumption (experiment 1) and emptying of gastric contents (experiment 2). Additionally, treatment with indomethacin upon CS reexposition blocked both the conditioned anorexia and suppression of gastric emptying. These results indicate that conditioned anorexia is possibly the result of a conditioned inhibition of gastric emptying, and this process is mediated by conditioned alterations in PG levels.

Is oral levamisole immunostimulation in rats mediated by reduced levels of free plasma corticosterone?

A brief review of the immunostimulative and anti-inflammatory properties of levamisole is followed by a research report which indicates that in rats under antigenic challenge by ovalbumin, oral levamisole (18 mg/kg) decreases corticosterone levels. This previously unreported finding may belie the immunostimulative effect of levamisole.

Muramyl peptides and the functions of sleep.

Muramyl peptides (MPs) are bacterially derived sleep factors which stimulate slow wave sleep. In the neonate, MPs are capable of inducing quiet sleep and suppressing active sleep. Given that active sleep is thought to be important for brain development during this period, the possibility that changes in the availability of MPs in the neonate may affect brain development was examined. Rat pups were given muramyl dipeptide (MDP) twice daily for the first 14 days post partum. It was hypothesised that MDP would stimulate quiet sleep at the expense of active sleep as has been shown in the young rabbit. There was no effect on neonatal levels of quiet sleep or active sleep. There was, however, a variety of effects, apparently unrelated to the sleep functions of MDP. These effects were changes in adult learning, serotonin metabolism and brain anatomy. The function of sleep in the mediation of the sleep-independent effects of MPs was examined, in particular the opposite effects of MDP on host immunity depending on the sleepiness of the host. In this light sleep does indeed serve to mediate the effects of MPs and it is speculated that many of the effects observed here may change in response to sleep levels in individuals. The notion that autonomic signalling between brain and spleen is more efficient during sleep is presented as an example of a function of sleep that may modulate the immunological effects of MPs.

Behavioral conditioning of endotoxin-induced plasma iron alterations.

The cascade of physiologic mechanisms in response to infection, the acute-phase response, is recognized as playing a major role in host defence. One such response is the hypoferremia that is consistently reported to occur during bacterial infection. This study aimed to determine whether the alterations in plasma iron were conditionable using the conditioned taste aversion (CTA) paradigm. The regime involved the pairing of a novel-tasting saccharin solution with bacterial endotoxin. Seven days after the initial pairing of these stimuli (the test day), the saccharin solution was represented. Animals exposed to this condition displayed a significant reduction in the level of plasma iron. Animals treated with an intraperitoneal dose of 400 micrograms/Kg lipopolysaccharide (LPS) displayed lower conditioned iron levels than rats infused with 100 micrograms/Kg LPS; however, this difference was not significant. These results showed that in addition to other acute-phase responses (fever and anorexia), plasma iron alterations are able to be manipulated through behavioral manipulations.

Modification of body temperature and sleep state using behavioral conditioning.

Previous research has demonstrated the conditionability of events within the acute-phase response. This study examined whether two such responses, fever and sleep alterations, were conditionable in the rat during the dark photoperiod. The experimental animals were administered a novel saccharin solution as the conditioned stimulus (CS) in conjunction with lipopolysaccharide as the unconditioned stimulus (UCS). This group displayed significantly higher body temperatures than controls upon saccharin representation, 7 days after the original CS-UCS pairing. The experimental animals additionally displayed a conditioned increase in slow wave sleep (SWS); however, the LPS-induced reduction in rapid eye movement (REM) sleep was unable to be reenlisted. Similar to the acute-response, the conditioned alteration in SWS appeared to be due to an increase in episode frequency, rather than duration. These results suggest that the multiple acute-phase events may be simultaneously conditionable, producing an optimum environment for pathogen elimination.

Behavioral conditioning of lipopolysaccharide-induced anorexia.

One manifestation of the acute phase response, sickness behavior, is now considered an important response in the organism's overall attempt to reinstate homeostasis. This report aimed to determine whether the sickness behavior of anorexia was conditionable using the conditioned taste aversion paradigm. To investigate this phenomenon, lipopolysaccharide (LPS) (100 micrograms/kg) was used as the unconditioned stimulus, and was paired with a novel 1% saccharin solution (conditioned stimulus). Upon conditioned stimulus representation, the anorectic effects of LPS were observed. These data are consistent with recent literature showing acute phase events to be conditionable.

Pavlovian conditioning of nasal tryptase release in human subjects with allergic rhinitis.

The role of Pavlovian conditioning in humans with perennial allergic rhinitis was investigated using release of tryptase from sensitised mast cells as an indicator of allergic responsiveness. Challenge with house dust mite allergen (unconditioned stimulus) was paired with a drink of novel taste and appearance (conditioned stimulus) in a single conditioning trial. Upon reexposure to the conditioned stimulus alone, levels of mast cell tryptase released in subjects who had received both the novel drink and allergen challenge on the conditioning trial was significantly greater than subjects who had received either the drink or the allergen alone. The results support the involvement of the central nervous system in mast cell degranulation in allergic rhinitis in humans.