Pain Education and Virtual Reality Improves Pain, Pain-related Fear of Movement, and Trunk Kinematics in Individuals with Persistent Low Back Pain.

OBJECTIVES: To evaluate the effect of combining pain education and virtual reality exposure therapy using a cognitive behavioural therapy-informed approach (VR-CBT) on pain intensity, fear of movement, and trunk movement, in individuals with persistent low back pain. METHODS: Thirty-seven participants were recruited in a single cohort repeated measures study, attending three sessions one week apart. The VR-CBT intervention included standardised pain education (Session 1), and virtual reality exposure therapy (Session 2) incorporating gameplay with mixed reality video capture and reflective feedback of performance. Outcome measures (Pain intensity, pain-related fear of movement (Tampa Scale of Kinesiophobia), and trunk kinematics during functional movements (maximum amplitude, peak velocity) were collected at baseline (Session1), and one week following education (Session 2) and virtual reality exposure therapy (Session 3). One-way repeated measures ANOVAs evaluated change in outcomes from baseline to completion. Post-hoc contrasts evaluated effect sizes for the education and virtual reality components of VR-CBT. RESULTS: Thirty-four participants completed all sessions. Significant (P<0.001) reductions were observed in Mean(SD) pain (baseline 5.9(1.5); completion 4.3(2.1)) and fear of movement (baseline 42.6(6.4); completion 34.3(7.4)). Large effect sizes (Cohen's d) were observed for education (pain intensity 0.85; fear of movement 1.28) while the addition of virtual reality exposure therapy demonstrated very small insignificant effect sizes, (pain intensity 0.10; fear of movement 0.18). Peak trunk velocity, but not amplitude, increased significantly (P<0.05) across trunk movement tasks. DISCUSSION: A VR-CBT intervention improved pain, pain-related fear of movement, and trunk kinematics. Further research should explore increased VR-CBT dosage and mechanisms underlying improvement.

Effectiveness of Interventions on Work Outcomes After Road Traffic Crash-Related Musculoskeletal Injuries: A Systematic Review and Meta-analysis.

BACKGROUND: Musculoskeletal injuries are common after road traffic crash (RTC) and can lead to poor work-related outcomes. This review evaluated the impact of interventions on work-related (e.g. sick leave), health, and functional outcomes in individuals with a RTC-related musculoskeletal injury, and explored what factors were associated with work-related outcomes. METHODS: Searches of seven databases were conducted up until 9/03/2023. Eligible interventions included adults with RTC-related musculoskeletal injuries, a comparison group, and a work-related outcome, and were in English. Meta-analyses were conducted using RevMan and meta-regressions in Stata. RESULTS: Studies (n = 27) were predominantly conducted in countries with third-party liability schemes (n = 26), by physiotherapists (n = 17), and in participants with whiplash injuries (94%). Pooled effects in favour of the intervention group were seen overall (SMD = - 0.14, 95% CI: - 0.29, 0.00), for time to return to work (- 17.84 days, 95% CI: - 24.94, - 10.74), likelihood of returning to full duties vs. partial duties (RR = 1.17, 95% CI: 1.01, 1.36), decreased pain intensity (- 6.17 units, 95% CI: - 11.96, - 0.39, 100-point scale), and neck disability (- 1.77 units, 95% CI: - 3.24, - 0.30, 50-point scale). DISCUSSION: Interventions after RTC can reduce time to return to work and increase the likelihood of returning to normal duties, but the results for these outcomes were based on a small number of studies with low-quality evidence. Further research is needed to evaluate a broader range of interventions, musculoskeletal injury types, and to include better quality work-related outcomes.

Calibration and validation of physical behaviour cut-points using wrist-worn ActiGraphs for children and adolescents: A systematic review.

OBJECTIVES: To review cut-points calibrated and independently validated from wrist-worn ActiGraph accelerometers to measure moderate to vigorous physical activity (MVPA) and time spent sedentary (SED) in children and adolescents. DESIGN: Systematic literature review. METHODS: Five databases were searched for relevant cut-point calibration and independent validation studies relating to wrist worn ActiGraphs in children and adolescents from inception through 30 April 2022. Extracted data included: country of publication; study name; population; device model; wear location; sampling frequency; epoch length; activity protocol; criterion method and definitions used to classify PA intensity; statistical methods for calibration; statistical methods for validation/cross-validation; and MVPA and SED outcome. RESULTS: Fourteen calibration studies and seven independent validation studies were identified. Calibrated cut-points for MVPA vector magnitude counts ranged from 7065 to 9204 counts per minute (cpm) and 63.5 to 201 milli-gravitational units (mg). For SED, calibrated cut-points ranged from <2556 cpm to 4350 cpm and 30.8 to 48.1 mg. Classification accuracy values determined by independent validation studies varied, with kappa values ranging from 0.31 to 0.60 and area under the curve statistics ranging from 0.51 to 0.84 for MVPA and kappa values ranging from 0.31 to 0.44 and area under the curve statistics ranging from 0.70 to 0.85 for SED. CONCLUSIONS: The results of this systematic literature review support the use of the Crouter and colleagues cut-points for the measurement of MVPA and SED for children and adolescents aged 6-12 years. Further work is required to independently validate cut-points developed in younger children and older adolescents.

Objectively and subjectively measured physical activity levels in individuals with whiplash associated disorder and aged-matched healthy controls.

BACKGROUND: Whiplash associated disorders (WAD) are the most common non-hospitalised injuries resulting from a motor vehicle crash. Half of individuals with WAD experience ongoing pain and disability. Furthermore, individuals with persistent WAD have lower levels of aerobic capacity and isometric strength compared with age-matched controls. It is not known whether these differences are associated with increased levels of pain and disability, or with reduced physical activity (PA) participation. OBJECTIVE: Our primary aim was to compare PA levels in individuals with persistent WAD with healthy controls. Secondary aims were to: compare objective and subjective measurements of PA; explore factors that may influence PA; and describe proportions of these populations meeting World Health Organisation PA guidelines. METHODS: Objective (ActiGraph accelerometer; seven days) and subjective (International Physical Activity Questionnaire (IPAQ)) PA data were collected for n = 53 age-matched participants (WAD n = 28; controls n = 25). RESULTS: Independent sample t-tests showed no significant difference in objectively measured PA (p>0.05) between WAD and controls. For the subjective measure (IPAQ), controls reported more overall weekly PA (t = 0.219, p<0.05), while WAD participants reported more weekly walking minutes (t = -0.712, p<0.05). Linear regression showed mental health quality-of-life predicted objectively measured moderate intensity PA (R2 = 0.225, F (2, 44) = 6.379, p<0.004) and subjectively reported overall PA (R2 = 0.132, F (1, 41) = 6.226, p<0.017). Bland-Altman analyses indicated that subjects over-reported MVPA and under-reported sedentary time using the IPAQ. CONCLUSIONS: Individuals with WAD had levels of physical and mental health quality-of-life significantly lower than controls and below population norms yet participated in similar levels of PA. Given that increased perceptions of mental health quality-of-life were positively associated with objectively measured MVPA and subjectively reported overall PA, strategies to help people with WAD achieve adequate doses of MVPA may be beneficial. ActiGraph-measured and IPAQ-reported PA were discordant. Hence, IPAQ may not be a reliable measure of habitual PA in WAD.

Estimation of human spine orientation with inertial measurement units (IMU) at low sampling rate: How low can we go?

Studying people in their daily life is important for understanding conditions with multi-faceted aetiology such as chronic low back pain. Inertial measurement units can be used to reconstruct the posture and motion of the body outside of laboratories to enable this research. The battery life of these sensors strongly affects the usability of the system, since recharging them frequently is inconvenient and can lead to additional errors. A major determinant of the battery life for these sensors is sampling rate, but the relationship between sampling rate and accuracy in motion reconstruction is not well documented. We measured the spine of 12 participants using inertial measurement units across a variety of tasks such as sitting, standing, walking, and jogging. The orientation of the spine was reconstructed using several filters, including a novel filter developed specifically for high performance at low sampling frequencies. Benchmarking against optical motion capture, we developed a model showing that the error of all tested filters depends exponentially on the sampling frequency, with the optimal filter gains showing a similar exponential relationship. Using this model of error, we developed a criterion for recommending minimum sampling frequencies for accurate motion estimates for each task, finding frequencies ranging from about 13 to 35 Hz sufficient depending on the task. Although we only studied the spine, these models should provide insight into optimizing sampling rate and filter parameters for inertial measurements in general use.

Anterior deltoid muscle reflection using a deltopectoral approach is safe and does not influence outcome of reverse shoulder arthroplasty.

BACKGROUND: The deltopectoral approach is well accepted for shoulder arthroplasty procedures. The extended deltopectoral approach with detachment of the anterior deltoid from the clavicle allows increased joint exposure and can protect the anterior deltoid from traction injury. The efficacy of this extended approach has been demonstrated in anatomic total shoulder replacement surgery. However, this has not been shown in reverse shoulder arthroplasty (RSA). The primary aim of this study was to evaluate the safety of the extended deltopectoral approach in RSA. The secondary aim was to evaluate the performance of the deltoid reflection approach in terms of complications and surgical, functional, and radiologic outcomes up to 24 months after surgery. METHODS: A prospective, nonrandomized comparative study was performed between January 2012 and October 2020 including 77 patients in the deltoid reflection group and 73 patients in the comparative group. The decision for inclusion was based on patient and surgeon factors. Complications were recorded. Patients were followed up for ≥24 months to evaluate their shoulder function and undergo ultrasound evaluation. Functional outcome measures included the Oxford Shoulder Score, Disabilities of the Arm, Shoulder and Hand score, American Shoulder and Elbow Surgeons score, pain intensity (rated on visual analog scale [VAS] from 0 to 100), and range of motion (forward flexion, abduction, and external rotation). A regression analysis was performed to evaluate any factors of influence on the VAS score. RESULTS: There were no significant differences in the complication rate between the 2 groups (14.5% in deltoid reflection group and 13.8% in comparative group, P = .915). Ultrasound evaluation was available in 64 patients (83.1%), and no proximal detachment was observed. In addition, there were no significant differences in functional outcome measures both preoperatively and at 24 months after surgery between the groups assessed based on the mean VAS pain score, Oxford Shoulder Score, Disabilities of the Arm, Shoulder and Hand score, American Shoulder and Elbow Surgeons score, forward flexion, abduction, and external rotation. Adjustment for possible confounders in a regression model indicated that only prior surgery significantly influenced the VAS pain score after surgery (P = .031; 95% confidence interval, 0.574-11.67). Deltoid reflection (P = .068), age (P = .466), sex (P = .936), use of glenoid graft (P = .091), prosthesis manufacturer (P = .382), and preoperative VAS score (P = .362) were not of influence. DISCUSSION: The results of this study show that an extended deltopectoral approach for RSA is safe. Selected reflection of the anterior deltoid muscle improved exposure and prevented anterior deltoid muscle injury followed by reattachment. Patients had similar functional scores preoperatively and at 24 months postoperatively compared with a comparative group. Furthermore, ultrasound evaluation showed intact reattachments.

Are objective measures of sleep and sedentary behaviours related to low back pain flares?

ABSTRACT: Risk factors for low back pain (LBP) flares have been considered about self-reported measures. This case-crossover study aimed to investigate whether (1) objective measures of physical activity and sleep were associated with the risk of experiencing LBP flares and (2) these associations differed for flares defined as pain 2 or more points greater than average pain over the period using an 11-point Numerical rating scale (0-no pain and 10-worst pain imaginable) (pain-defined flare: PDF) and flares identified by participants according to a broader definition that considered emotions or coping (self-reported flare [SRF]). We included 126 participants who had experienced LBP for >3 months. Physical activity and sleep were monitored for 28 days using wearable sensors. Occurrence of flares (PDF or SRF) was assessed daily using a smartphone application. Data on exposure to risk factors 1, 2, and 3 days preceding PDF or SRF were compared with nonflare control periods. Conditional logistic regression determined association between each factor and flares. Data show that day-to-day variation in physical activity and in-bed time are associated with the risk of LBP flares, but associations differ depending on how flare is defined. Longer in-bed time increased the risk of PDF but not SRF. Although physical activity was not associated with the risk of PDF, greater sedentary behaviour increased the risk of SRF and being more physically active decreased the risk for SRF. These results highlight the potential role of targeting sleep and physical activity in interventions to prevent LBP flares and indicate that risk factors differ depending on how LBP flares are defined.

How reliable is measurement of posture during sleep: real-world measurement of body posture and movement during sleep using accelerometers.

Objective. Understanding sleeping behaviours could improve prevention and treatment of sleep problems and associated health conditions. This study aimed to evaluate a method to assess body posture and movement during sleep using trunk-worn accelerometers for 28 nights.Approach. Participants (50 adults with low back pain (66% female); aged 32(±9) years) wore two activPAL-micro sensors (thigh, trunk) during their normal daily life for 28 consecutive days. Parameters related to body posture (e.g. time spent lying supine or prone) and movement (e.g. number of turns) during sleep were calculated for each night. Average values for each parameter were identified for different periods, the Spearman-Brown Prophecy Formula was used to estimate the minimum number of nights required to obtain a reliable estimate of each parameter, and repeatability of measures between different weeks was calculated.Main results. Participants spent 8.1(±0.8) h asleep and most time (44%) was spent in a supine posture. The minimum number of nights required for reliable estimates varied between sleep parameters, range 4-21 nights. The most stable parameters (i.e. requiring less than seven nights) were 'average activity', 'no. of turns', 'time spent prone', and 'posture changes in the first hour'. Some measures differed substantially between weeks.Significance. Most sleep parameters related to body posture and movement require a week or more of monitoring to provide reliable estimates of behaviour over one month. Notably, one week may not reflect behaviour in another week, and the time varying nature of sleep needs to be considered.

Evaluation of a physical activity promotion intervention for adults with whiplash associated disorders: a single-case experimental design study.

PURPOSE: There is considerable variation in the physical and psychological presentations of people with whiplash-associated disorder (WAD). Optimal treatment continues to be a challenge. This research evaluated the efficacy of a community-located, theory-based intervention designed to promote physically active behaviour in people with persistent WAD, and thereby improve perceptions of pain interference and confidence completing activities in the presence of neck pain. MATERIALS AND METHODS: A multiple-baseline, single-case experimental design was used to evaluate the 16-week intervention across six participants. RESULTS: Weighted Tau-U showed significantly increased accelerometer-measured physical activity in three participants with large effect sizes (>0.5), with increased confidence in one participant (ES > 0.5), and reduced pain interference in another participant (ES > 0.7). Changes in other behaviours included clinically important improvements in quality of life for five participants and, in those participants with baseline symptom levels outside threshold levels, improvements in pain catastrophizing and pain self-efficacy. CONCLUSIONS: Participation in a theory-based intervention resulted in significant improvements in physical and psychological health for five of six participants. Providing this type of community-located physical activity promotion strategy, to individuals with persistent WAD, may help address physical impairments and psychological distress commonly experienced in WAD. Trial registration: The trial was registered with the Australia and New Zealand Clinical Trials Registry (ACTRN: ACTRN12617001261303p) and ClinicalTrials.gov (Protocol Number: 2018000349/2017/743).Implications for rehabilitationRehabilitation professionals should consider recommending theory-based physical activity promotion strategies to reduce physical impairments and psychological distress in individuals with persistent WAD.Individually tailored physical activity promotion strategies may help individuals with persistent WAD become more physically active thereby reducing their risk of diseases associated with inactivity which may compound the effects of WADImprovements in physical and psychological health may occur independently of increasing habitual physical activity.Rehabilitation professionals may find that other community-located strategies which aim to promote physically active behaviour confer similar benefits for individuals with persistent WAD.

Expert consensus and perspectives on recovery following road traffic crashes: a Delphi study.

PURPOSE: To reach expert consensus on a definition for recovery following minor and moderate road traffic crash-related injuries and key factors that influence recovery, and to explore expert perspectives on risk identification methods. MATERIALS AND METHODS: A three-round Delphi study was conducted in which 47 experts (insurance representatives, health care professionals and researchers) were consulted. RESULTS: Strong expert agreement (86%) was reached for the definition: "Recovery is multifaceted and includes return to activities of daily living (ADLs), work and social/leisure activities at pre-injury level or at a level deemed acceptable by the individual, with minimal ongoing pain and symptoms, considering physical and mental health and wellbeing". Agreed key factors that influenced recovery included: resilience; coping skills; recovery expectations; pre-existing physical and mental health; workplace support; and, collaboration between the injured individual, treating providers and claim handlers. Expert perspectives on risk identification methods were mixed. CONCLUSIONS: An accepted definition for recovery following minor and moderate road traffic crash-related injury was established, which could facilitate communication and engagement between different rehabilitation stakeholders. Strong consensus was achieved on nine key factors that influenced recovery. Further research is needed to evaluate whether injured persons agree with this definition and on the utility of risk identification methods.Implications for rehabilitationExpert consensus was established for a definition of recovery following minor and moderate road traffic crash-related injuries and nine key influencing factors.An established definition could facilitate communication and engagement between all rehabilitation stakeholders, which could improve the recovery process of the injured person.Rehabilitation professionals need to be familiar with the role of psychosocial factors, such as recovery expectations, resilience and coping skills, in the recovery process.The use of physical and psychological outcome measures at regular intervals could help to identify risk of poor recovery following minor and moderate road traffic crash-related injuries.

The Impact of Musculoskeletal Injuries Sustained in Road Traffic Crashes on Work-Related Outcomes: A Systematic Review.

Musculoskeletal injuries occur frequently after road traffic crashes (RTCs), and the effect on work participation is not fully understood. The primary aim of this review was to determine the impact of sustaining a musculoskeletal injury during an RTC on the rate of return to work (RTW), sick leave, and other work outcomes. The secondary aim was to determine factors associated with these work-related outcomes. An electronic search of relevant databases to identify observational studies related to work and employment, RTC, and musculoskeletal injuries was conducted. Where possible, outcome data were pooled by follow-up period to answer the primary aim. Fifty-three studies were included in this review, of which 28 were included in meta-analyses. The pooled rate of RTW was 70% at 1 month, 67% at 3 months, 76% at 6 months, 83% at 12 months, and 70% at 24 months. Twenty-seven percent of participants took some sick leave by one month follow-up, 13% by 3 months, 23% by 6 months, 36% by 12 months, and 22% by 24 months. Most of the factors identified as associated with work outcomes were health-related, with some evidence also for sociodemographic factors. While 70% of people with RTC-related musculoskeletal injury RTW shortly after accident, many still have not RTW two years later.

Comparative effectiveness of exercise programs for psychological well-being in knee osteoarthritis: A systematic review and network meta-analysis.

OBJECTIVES: The benefits of exercise are well established for psychological well-being, but it is unknown whether one type of exercise can be recommended over another for psychological well-being in knee osteoarthritis (OA). This study aimed to compare the effectiveness of different types of exercise on psychological well-being in people with knee OA. METHODS: Five databases including MEDLINE, EMBASE, Cochrane Register of Controlled Trials, CINAHL and PEDro) were searched from inception until April 2021. Randomised controlled trials comparing the effect of exercise with a non-exercise control or another type of exercise on overall mental health, depressive symptoms or anxiety in people with knee OA. Trial data were extracted independently by two researchers. Network meta-analyses using random-effect models were conducted. The Grading of Recommendations, Assessment, Development and Evaluation framework was used to appraise evidence certainty. RESULTS: Strengthening exercise was more beneficial for overall mental health on the Short Form survey compared to aerobic (mean difference 15.88, 95%CI [6.77, 24.99]), mixed (12.77, 95%CI [5.12, 20.42]) and mind-body (12.51, [4.25, 20.77]) exercise based on 13 trials (n = 796). Strengthening exercise (standardised mean difference 6.81, [5.03, 8.58]), and mixed exercise (6.64, [4.88, 8.40]),) were more beneficial for depressive symptoms than stretching exercise based on 6 trials (n = 627). No differences were observed for anxiety based on 4 trials (n = 557). Certainty of the evidence ranged from very low to low. CONCLUSION: The available evidence supports the recommendation of strengthening exercise as the most beneficial for overall mental health, and strengthening exercise or mixed exercise over stretching exercise for depressive symptoms. No exercise recommendations can be made for anxiety.

Low Back Pain Flares: How do They Differ From an Increase in Pain?

OBJECTIVE: The term flare is commonly used to describe low back pain (LBP) fluctuations, but individuals with LBP consider that it does not always correspond to increased pain. This case cross-over study aimed to: (1) determine the extent to which days with a flare identified according to a multidimensional definition (self-reported flare, SRF) corresponded to days with greater than average pain (pain-defined flare, PDF) and (2) to investigate whether physical and psychosocial features differ between PDF and SRF. MATERIALS AND METHODS: Individuals with LBP for ≥3 months (N=126) provided data on flares, physical, and psychosocial features daily for 28 days using a smartphone application. RESULTS: Most days with SRF (68%) did not have greater than average pain (ie, PDF), but most days with greater than average pain (64%) were reported as an SRF. On days with SRF-only all physical and psychosocial features were worse than nonflare days. SRF+PDF had lower sleep quality and higher pain intensity, fatigue, disability, pain catastrophizing, and fear avoidance than SRF-only. SRF+PDF had higher pain in the afternoon and evening, disability and pain catastrophizing than PDF-only. Self-efficacy at work and during leisure activities was worse on SRF+PDF days than SRF-only and PDF-only days. DISCUSSION: These findings highlight that when individuals with LBP consider they have a flare, they do not always have greater than average pain, but have worse psychosocial features. This emphasizes that flare has broader dimensions than pain alone. Consideration of flare according to broad dimensions is important when investigating symptom fluctuations across different LBP trajectories.

ISSLS PRIZE IN CLINICAL SCIENCE 2021: What are the risk factors for low back pain flares and does this depend on how flare is defined?

PURPOSE: Although risk factors for new low back pain (LBP) episodes and acute-to-chronic transition have been identified, risk factors for flares of LBP remain largely unknown. This case-crossover study aimed to identify: (1) risk factors LBP flares and (2) whether risk factors differed when flare is defined by pain increase (pain-defined flare: PDF) or identified by participants according to a broader flare definition that considered emotions and coping (self-reported flare: SRF). METHODS: One hundred and twenty-six participants with LBP for > 3 months were included. Candidate risk factors and flares (PDF/SRF) were assessed daily using a smartphone application for 28 days. Data on exposure to risk factors one, two and three days preceding PDF/SRF were compared to control periods. Conditional logistic regression estimated associations between risk factors and PDF/SRF. RESULTS: Odds of PDF and SRF were increased by poor sleep quality and morning pain. Good sleep quality reduced odds of flare. Odds for increased pain (PDF), but not SRF, were increased after days with higher afternoon and evening pain, fatigue, fear of physical activity and leisure physical activity. CONCLUSION: LBP flare has been largely ignored but is more reflective of the LBP experience than conventional definitions of acute, sub-acute and chronic LBP. This study highlights risk factors for flare and that these differ depending on whether flare is defined by pain alone (PDF) or a broad multidimensional definition (SRF). Potential targets to reduce the intensity/frequency of LBP flares are identified, with strong indication for the potential role of sleep intervention to mitigate LBP flare risk.

Mobility levels of acute medical patients: Is behavioural mapping comparable to accelerometry?

OBJECTIVE: To (1) determine agreement between behavioural mapping and accelerometry for measuring mobility levels in an acute medical inpatient setting and to (2) explore and compare the required resources and costs for both methods. DESIGN: Observational cross-sectional study. SETTING: Tertiary referral teaching hospital in Brisbane, Australia. SUBJECTS: Adult patients admitted to two acute medical wards. MAIN MEASURES: Mobility levels were recorded by behavioural mapping, and thigh and chest-worn accelerometers (ActivPAL). The level of agreement between the two methods was evaluated using the Intraclass Correlation Coefficients for each mobility level (i.e. lying, sitting, upright, standing and walking). RESULTS: Nineteen patients (10 male (53%); mean(SD) age of 72(14) years) were included in the agreement analysis. The Intraclass Correlation Coefficients were high for 'lying' (ICC = 0.87), 'sitting' (ICC = 0.84) and 'upright' (ICC = 0.93), indicating good to excellent agreement between the two methods. For these mobility levels, mean differences between the two methods were small (<2%), with large standard deviations (up to 18%). Agreement was poor for 'standing' (ICC = 0.00) and 'walking' (ICC = 0.35). Both methods were labour-intensive, with labour costs of A$1,285/€798 (34 hours) for behavioural mapping and A$1,055/€655 (28 hours) for accelerometry. No further costs were involved in behavioural mapping, but clinical backfill was required. Accelerometry involved a financial investment for accelerometers (A$11,100/€6,894 for 22 ActivPAL devices). CONCLUSION: Agreement between behavioural mapping and accelerometry was good for measuring 'lying', 'sitting' and 'upright', but poor for 'standing' and 'walking' in an acute inpatient setting. Both behavioural mapping and accelerometry were labour-intensive, with high costs for the accelerometry equipment.

Impact of interventions on work-related outcomes for individuals with musculoskeletal injuries after road traffic crash: a systematic review protocol.

BACKGROUND: Musculoskeletal injuries are the most common non-fatal injury from road traffic crashes. Even when the injuries are mild, they can cause pain which can affect return to work rates and work ability post-crash. Workplace output losses are the biggest cost from traffic crash-related injuries. There is a need to identify effective interventions that can improve work-related outcomes (e.g. time to return to work, sick leave, and work ability) in this group and a need to understand the intervention components, external factors, and participant characteristics that may be associated with improvement. METHODS: A systematic review will be conducted using seven databases and search terms related to road traffic crash, musculoskeletal injury, work-related outcomes, and study design. Intervention studies will be eligible if they report on at least one work-related outcome, include adults with a traffic crash-related musculoskeletal injury (e.g. fracture or whiplash), include a comparison group, and are written in English. Interventions can be medical, therapeutic, work-based, multicomponent, or other. Two researchers will independently screen titles and abstracts, review full texts for inclusion in the review, and perform the data extraction. The main outcomes of the review will be time until return to work and duration of sick leave. The results will be narratively described, with meta-analyses conducted where possible. DISCUSSION: This review will explore the effectiveness of interventions in individuals with traffic crash-related musculoskeletal injury on work-related outcomes and will act as a useful source for researchers, policy makers, and stakeholders when developing and implementing interventions in this group. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018103746.

Identifying risk of poor physical and mental health recovery following a road traffic crash: An industry-specific screening tool.

This study aimed to develop an industry-specific tool to identify risk of poor physical and mental recovery following minor to moderate injuries sustained in a road traffic crash (RTC). Existing tools are often designed for implementation by health professionals rather than insurer case managers who may not have a background in health. This study is a secondary analysis of a longitudinal cohort study using data collected at 2-6 months and 24 months post-RTC. Participants were claimants (n = 254; Mean age = 50 years; 65% female) with mild-moderate injuries recruited through the common-law 'fault-based' compulsory third party scheme in Queensland, Australia. Sociodemographic, functional and psychological health factors were collected at baseline (2-6 months post RTC) and used as potential predictors for physical and mental health-related quality of life (Short Form 36 v2) at the 2-year follow-up. The LASSO (Least Absolute Shrinkage and Selection Operator) analysis identified six disability items (from the World Health Organization Disability Assessment Schedule 2) to predict poor physical and one item to predict poor mental health-related quality of life. Logistic regressions of these items in addition to age and gender were used to develop a screening tool. Using the tool, 90% of those at risk of poor physical and 80% of those at risk of poor mental health-related quality of life were identified correctly. To conclude, this study presents an 8-item, context-specific tool to help injury managers identify individuals at risk of poor physical and mental health recovery following mild-moderate RTC-related injuries. The tool requires validation in a new cohort and confirmation of acceptability by end-users.

The impact of musculoskeletal injuries sustained in road traffic crashes on work-related outcomes: a protocol for a systematic review.

BACKGROUND: Musculoskeletal injuries (strains/sprains, contusions, dislocations, and fractures) are the most common injury sustained in a road traffic crash. They can have a long-term impact upon the ability to engage in work. Persisting symptoms as well as poor physical and psychological recovery may reduce the ability to return to or remain at work necessitating the use of sick leave or alternate duties to enable a gradual return to full duties. There is also a need to investigate rates of return to work, along with other work-related outcomes in this population so that interventions designed to facilitate return to work can be targeted to this clinical population. In addition, there is a need to explore factors associated with work-related outcomes in people with musculoskeletal injuries subsequent to a road traffic crash. METHODS: A systematic review will be conducted to determine the impact of sustaining a musculoskeletal injury during a road traffic crash on an individual's ability to work. Observational studies will be identified by searching six electronic databases for reports of adults having sustained musculoskeletal injuries during a road traffic crash. Studies featuring paediatric cohorts or those with neurological injuries will be excluded. To be eligible for inclusion, studies must report at least one of the following work-related outcomes: return to work status/rate, sick leave, work ability, work capacity, and health-related work productivity loss. The methodological quality of included studies will be assessed with the National Institutes of Health National Heart, Lung, and Blood Institute Study Quality Assessment Tools for observational cohort and cross-sectional studies, and case-control studies. DISCUSSION: The results of this systematic review may increase our knowledge of work-related outcomes and understanding of the associated factors for people with musculoskeletal injuries following road traffic crashes. Future studies could use the results to plan interventions and influence policy and legislation, and raise awareness of the needs of this clinical population. SYSTEMATIC REVIEW REGISTRATION: Registered on PROSPERO, reference number CRD42018099252 , dated 14 August 2018.

Graphical Tasks to Measure Upper Limb Function in Patients With Parkinson's Disease: Validity and Response to Dopaminergic Medication.

The most widely used method to assess motor functioning in Parkinson's disease (PD) patients is the unified Parkinson's disease rating scale-III (UPDRS-III). The UPDRS-III has limited ability to detect subtle changes in motor symptoms. Alternatively, graphical tasks can be used to provide objective measures of upper limb motor dysfunction. This study investigated the validity of such graphical tasks to assess upper limb function in PD patients and their ability to detect subtle changes in performance. Fourteen PD patients performed graphical tasks before and after taking dopaminergic medication. Graphical tasks included figure tracing, writing, and a modified Fitts' task. The Purdue pegboard test was performed to validate these graphical tasks. Movement time (MT), writing size, and the presence of tremor were assessed. MT on the graphical tasks correlated significantly with performance on the Purdue pegboard test (Spearman's ρ > 0.65; p < 0.05). MT decreased significantly after the intake of dopaminergic medication. Tremor power decreased after taking dopaminergic medication in most PD patients who suffered from tremor. Writing size did not correlate with performance on the Purdue pegboard test, nor did it change after taking medication. Our set of graphical tasks is valid to assess upper limb function in PD patients. MT proved to be the most useful measure for this purpose. The response on dopaminergic medication was optimally reflected by an improved MT on the graphical tasks in combination with a decreased tremor power, whereas writing size did not respond to dopaminergic treatment.

Solvent effects on the thermal isomerization of a rotary molecular motor.

As molecular machines move to exciting applications in various environments, the study of medium effects becomes increasingly relevant. It is difficult to predict how, for example, the large apolar structure of a light-driven rotary molecular motor is affected by a biological setting or surface proximity, while for future nanotechnology precise fine tuning and full understanding of the isomerization process are of the utmost importance. Previous investigations into solvent effects have mainly focused on the relatively large solvent-solute interaction of hydrogen bonding or polarization induced by the isomerization process. We present a detailed study of a key step in the rotary process i.e. the thermal helix inversion of a completely apolar rotary molecular motor in 50 different solvents and solvent mixtures. Due to the relative inertness of this probe, we are able to study the influence of subtle solvent-solvent interactions upon the rate of rotation. Statistical analysis reveals which solvent parameters govern the isomerization process.