Ankle sprains: patient perceptions of function and performance of physical tasks. A mixed methods approach.

PURPOSE: To investigate patient's perceptions of function and performance of physical tasks after discharge from treatment for an ankle sprain. METHODS: Using a mixed methods approach, 40 participants who presented with an acute sprained ankle and their treating clinicians completed two questionnaires related to function at the start and end of a rehabilitation programme. Additionally, participants completed the questionnaires at 6 weeks following discharge at which time they also performed physical tasks that were still perceived as difficult. Ten participants also completed a semi-structured interview. RESULTS: There were no significant differences (p > 0.05) in the participant's and clinician's initial assessment of function. However, at discharge participants scored their function significantly (p < 0.05) lower than clinicians. This difference was not apparent 6 weeks later (p > 0.05). However, there was a significant difference (p  < 0.05) following actual performance of tasks with an effect size of 1.58. Participant interviews confirmed that patients had a fear of re-injury until they actually performed tasks that were perceived as difficult. CONCLUSIONS: Clinicians and participants do not have a similar perception of the recovery of an ankle sprain at discharge. Performing tasks which were perceived as difficult were valuable in assisting participants gain an improved appreciation of their function.

Interexaminer reliability of orthopaedic special tests used in the assessment of shoulder pain.

Orthopaedic special tests (OST) are commonly used in the assessment of the painful shoulder to assist to rule-in or rule-out specific pathology. A small number of tests with high levels of diagnostic accuracy have been identified but interexaminer reliability data is variable or lacking. The aim of this study was to determine the interexaminer reliability of a group of OST with demonstrated diagnostic accuracy at primary care level. Forty consecutive subjects with shoulder pain were recruited. Six tests were performed by two examiners (physiotherapists) on the same day. Tests included the active compression test, Hawkins-Kennedy test, drop-arm test, crank test, Kim test and belly-press test. 'Fair' reliability (kappa 0.36-0.38) was observed for the active compression test (labral pathology), Hawkins-Kennedy test and crank test. Prevalence of positive agreements was low for the active compression test (acromioclavicular joint), drop-arm test, Kim test and belly-press test. Prevalence and bias adjusted kappa (PABAK) values indicated 'substantial' reliability (0.65-0.78) for these tests. The active compression test (acromioclavicular joint), belly-press tests (observation and weakness), Kim test and drop-arm test demonstrate acceptable levels of interexaminer reliability in a group of patients with sub-acute and chronic shoulder conditions.

Reliability of a new hand-held dynamometer in measuring shoulder range of motion and strength.

Acceptable reliability is a prerequisite for inclusion of physical examination tests in clinical examinations of the painful shoulder. The aim of this study was to establish the intraexaminer and interexaminer reliability of measures of shoulder range of motion (ROM) and muscle force using a new hand-held dynamometer with the ability to standardize overpressure force during passive ROM tests. Forty consecutive subjects with shoulder pain were recruited, and tests were performed by two physiotherapists. Tests included active ROM elevation, passive ROM glenohumeral abduction and external rotation and resisted abduction and external rotation. All tests demonstrated high levels of intraexaminer reliability (ICC 0.85-0.99; LOA 6-24° and 1.1-7.0 kg). Highest levels of interexaminer reliability reliability were observed for measures of active ROM flexion (ICC 0.88-0.95; LOA 14-22°). Passive ROM tests demonstrated 'moderate - substantial' interexaminer reliability (ICC 0.45-0.62; LOA 25-34°). The ICCs for resisted tests ranged from 0.68 to 0.84, and LOA ranged from 3.2 to 8.5 kg. Active ROM flexion demonstrated high levels of both intra- and interexaminer reliability. Measures of passive ROM and peak isometric force demonstrated acceptable levels of intraexaminer reliability.

Child discipline and nurturing practices among a cohort of Pacific mothers living in New Zealand.

UNLABELLED: The Pacific Islands Families (PIF) study is a longitudinal investigation of a cohort (N=1376) of Pacific infants born in New Zealand (NZ), and their mothers and fathers. OBJECTIVES: The PIF study aimed to determine: (1) the prevalence of disciplinary and nurturing parenting practices used with children at 12 months of age, and (2) the demographic, maternal and lifestyle factors associated with parenting practices. METHODS: At the 12-month measurement point, mothers (N=1207) were interviewed about their parenting practices using a modified version of the Parent Behaviour Checklist. RESULTS: High nurturance was significantly associated with Samoan ethnicity and post school qualifications, and low nurturance was significantly associated with post-natal depression, alcohol consumption and gambling. At the univariate level, high discipline scores were significantly associated with gambling, postnatal depression and lack of alignment to either Pacific or to European traditions. However the strongest association with discipline was the ethnicity variable with Tongan mothers reporting significantly higher disciplinary behaviours that all other ethnicities. CONCLUSIONS: It is clear that there are a number of common underlying lifestyle issues that need to be considered when dealing with parenting problems in families with young children. However specific to Pacific families, is Tongan ethnicity accounting for a strong cultural effect on parenting style, in particular high discipline scores relative to other Pacific groups. This important finding may be used to guide social policy and prevention programmes that are focused on the wellbeing of Pacific mothers and their children.

Two years on: gambling amongst Pacific mothers living in New Zealand.

Research investigating the prevalence and correlates of Pacific peoples gambling within a New Zealand context is limited. This paper provides data about gambling activity from the two-year data collection point for a cohort of mothers within the longitudinal Pacific Islands Families study. The results indicate a number of consistencies and discrepancies between data collected at this time point and two years previously (six-week baseline data collection point). For example, at baseline, Samoans were the least likely to gamble and spent less money on gambling activities. Two years later, Samoans remained the least likely to gamble, but those who did gamble, were more likely to spend more money than other ethnicities. This article highlights the importance of this type of prospective study in examining the development of the risk and protective factors in relation to the development of problem gambling.

Do perceptions of neighbourhood problems contribute to maternal health?: findings from the Pacific Islands Families study.

Research suggests that physical and social aspects of the neighbourhood have a bearing on our well-being. As part of the Pacific Islands Families Study, this study examined maternal perceptions and socio-demographic determinants of neighbourhood problems and their association with mental health. The main problems reported centred on noise, pollution and safety matters. Ethnicity, deprivation and alcohol consumption were the best predictors of greater perceived neighbourhood problems. Adjusted analyses showed that those reporting greater neighbourhood problems were almost twice as likely as those reporting fewer problems to have psychological morbidity. Mothers with high deprivation scores were 7.3 times more likely to have psychological morbidity. Findings suggest that neighbourhood quality and socio-economic position are important contributors to mental health. Negative effects on health are likely to derive from exposure to pollutants and from problem features in the neighbourhood acting as sources of psychosocial stress and barriers to health promoting activities. Improvements to services and regulations may contribute to health gains.

Pacific Islands Families Study: maternal factors associated with cigarette smoking amongst a cohort of Pacific mothers with infants.

AIM: To describe the association between cigarette smoking and maternal factors amongst a cohort of Pacific mothers. METHOD: Mothers of a cohort of 1398 Pacific infants born in Middlemore Hospital, Auckland, New Zealand during 2000 were interviewed when their infants were 6 weeks old (n=1376) and followed up at 12 months (n=1219). This paper is based on all mothers who were interviewed at both data points. Mothers participated in a 1-hour interview that included questions about the number of cigarettes smoked yesterday, and the number of other people living in the same home who currently smoke cigarettes. Cross tabulations and logistic regression models were applied to investigate the association between maternal smoking and health, demographic, social, cultural, and educational factors. RESULTS: At the 6 weeks data point, 24.5% of mothers reported smoking, and at the 12-month follow-up, 29.8% of mothers smoked. From the 6 weeks measurement point more mothers started smoking (9.6%) than stopped (4.4%). Variables associated with smoking at 12 months after birth were: age (less than 20 years), non-Tongan ethnicity, non-partnered or de facto marital status, New Zealand-born, low income, full-time parenting, English fluency, non-separationalism, living with other smokers, size of house is too small, and overcrowding. After controlling for confounding variables, English fluency and cultural alignment to mainstream New Zealand culture remained statistically significant. Formal education qualifications, parity, and type of house they lived in were not significantly associated with smoking. CONCLUSION: Many Pacific mothers in this cohort were smoking around the time of birth and continued to smoke a year after giving birth. These findings demonstrate the need to explore acculturation issues surrounding smoking behaviour and smoking cessation for Pacific women in New Zealand. A qualitative research design may assist in advancing a more effective response to cigarette smoking amongst Pacific mothers.

Intimate partner violence within a cohort of Pacific mothers living in New Zealand.

Maternal reports of intimate partner violence (IPV) were obtained from a cohort of Pacific mothers living in New Zealand. The Conflict Tactics Scale was completed by 1,095 women who had given birth in the past 12 months, and who were married or living with a partner as married. The 12-month prevalence of "victimization" through verbal aggression was 77%, 21% for "minor" physical violence, and 11% for "severe" physical violence. The 12-month prevalence of "perpetration" of verbal aggression against a partner was 90%, 35% for "minor" physical violence, and 19% for "severe" violence towards their partner. The experience of social inequality and acculturation are associated with IPV, albeit differentially across the experience of victimization and perpetration. Factors significantly associated with victimization are ethnicity, maternal education, social marital status and household income. Factors significantly associated with perpetration are ethnicity, cultural alignment, maternal birthplace and alcohol consumption since the birth of the child.

Maternal smoking: risks related to maternal asthma and reduced birth weight in a Pacific Island birth cohort in New Zealand.

AIMS: This study investigated associations between smoking and maternal asthma and two indicators of pregnancy outcome: birth weight and preterm delivery. METHODS: Data were gathered as part of the Pacific Islands Families (PIF) Study. Mothers of a cohort of 1398 Pacific infants born in South Auckland, New Zealand during 2000 were interviewed when their infants were 6 weeks old. Mothers were questioned regarding maternal health and lifestyle behaviours such as cigarette smoking. Additional data were obtained from hospital records. Analyses focused on 1368 biological mothers. RESULTS: Approximately 20% of mothers reported smoking during their last trimester of pregnancy. Logistic regression analyses showed that smokers had over twice the risk of having maternal asthma as well as a low birth weight (LBW) or small for gestational age (SGA) infant than non-smokers. Smoking significantly reduced mean birth weight from between 149.2 grams (1-9 cigarettes) to 204.3 grams (10+ cigarettes). No significant association was found between smoking and preterm birth. CONCLUSIONS: Smoking is preventable, yet continues to have negative consequences for mothers and their offspring. Findings can inform public health policy and smoking cessation programmes for Pacific families.

Health problems among six-week old Pacific infants living in New Zealand.

BACKGROUND: The purpose of this paper is to describe maternal reports of various health problems experienced by their Pacific infants in the first six weeks of their lives and to examine the infant, maternal and socio-demographic factors associated with infant health problems. MATERIAL/METHODS: The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which mothers in the cohort (n=1376) were interviewed about the health problems experienced by their infants (n=1398) in the first six weeks of life. RESULTS: Fifty-five percent of mothers reported that their infant had experienced minor health problems, and 15.6% reported moderate to severe infant health problems. Most mothers (98%) reported that they had a regular family doctor or health clinic to go to if their infant had a health problem. We found no meaningful associations between infant, maternal, or socio-demograhic variables and general infant health problems, possibly because of the wide range of infant illnesses reported. Since 43% of the infant health problems reported were related to breathing difficulties we carried out univariate and multivariate analyses on this specific health problem. Factors significantly associated (p<0.05) with infant breathing problems were maternal cigarette smoking during the last trimester, cold housing, and residing in New Zealand for over 10 years. CONCLUSIONS: The high rate of infant health problems, in particular infant breathing problems, among Pacific infants in this cohort and the significant links with modifiable factors warrant priority action by housing and health agencies to minimise the consequences of these risk factors.

Postnatal depressive symptoms among Pacific mothers in Auckland: prevalence and risk factors.

OBJECTIVE: To assess the prevalence of and risk factors for postnatal depressive symptoms in a cohort of mothers of Pacific Island infants in Auckland, New Zealand. METHOD: The data were gathered as part of the Pacific Island Families Study, in which 1376 mothers were interviewed when their babies were 6 weeks old. The interview included the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: 16.4% of mothers were assessed as probably experiencing depression. Prevalence rates varied from 7.6% for Samoans to 30.9% for Tongans. In addition to ethnicity, risk factors identified by stepwise multiple logistic regression included low Pacific Island acculturation, first birth, stress due to insufficient food, household income less than dollar 40,000, difficulty with transport, dissatisfaction with pregnancy, birth experience, baby's sleep patterns, partner relationship and home. A large prevalence difference between Tongans and other groups remained when the effects of other risk factors were controlled statistically. CONCLUSIONS: The prevalence of depressive symptoms among Pacific mothers is at the upper end of the range typically reported. Focus on the overall rate, however, obscures substantial variation between groups. Risk factors are generally similar to those identified in previous research. IMPLICATIONS: The findings have implications for prevention and treatment and caution against assuming homogeneity within ethnic categories. Further research is required to explain differences in prevalence between Tongan and other Pacific Island groups.

Pacific Islands Families: First Two Years of Life Study--design and methodology.

AIMS: Knowledge about the health, psychosocial, and behavioural characteristics of Pacific peoples with young children resident in New Zealand is limited. The Pacific Islands Families: First Two Years of Life (PIF) Study was designed to redress this knowledge gap. This paper describes the design and methodology of the PIF Study. METHODS: Mothers of Pacific infants born at Middlemore Hospital between 15 March and 17 December 2000 were recruited. Maternal home interviews covering sociodemographic, cultural, environmental, child development, family and household dynamics, childcare, lifestyle, and health issues were undertaken at approximately 6-weeks, 12-months, and 24-months postpartum. Paternal home interviews and child development assessments were conducted at approximately 12-months and 24-months postpartum. Information from Middlemore's Hospital Discharge Summary records and Plunket's 6-week and 6-month assessments was also captured. RESULTS: 1708 mothers were identified, 1657 were invited to participate, 1590 (96%) consented to a home visit; and, of these, 1,477 (93%) were eligible for the PIF study. Of those eligible, 1,376 (93%) participated at 6-weeks, 1224 (83%) participated at 12-months, and 1144 (77%) participated at 24-months. No important differential attrition was observed. Paternal interviews and child assessments were conducted on 825 fathers and 1241 infants at 12-months and on 757 fathers and 1064 children at 24-months. CONCLUSIONS: The PIF study is a large, scientifically and culturally robust longitudinal study that has achieved respectable participation rates in a historically hard-to-reach population. We believe that results from this study will inform future policy development within New Zealand.

Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts.

BACKGROUND AND PURPOSE: Symphysis pubis pain is a significant problem for some pregnant women. The purpose of this study was to investigate the effects of exercise, advice, and pelvic support belts on the management of symphysis pubis dysfunction during pregnancy. SUBJECTS: Ninety pregnant women with symphysis pubis dysfunction were randomly assigned to 3 treatment groups. METHODS: A randomized masked prospective experimental clinical trial was conducted. Specific muscle strengthening exercises and advice concerning appropriate methods for performing activities of daily living were given to the 3 groups, and 2 of the groups were given either a rigid pelvic support belt or a nonrigid pelvic support belt. The dependent variables, which were measured before and after the intervention, were a Roland-Morris Questionnaire score, a Patient-Specific Functional Scale score, and a pain score (101-point numerical rating score). RESULTS: After the intervention, there was a significant reduction in the Roland-Morris Questionnaire score, the Patient-Specific Functional Scale score, and the average and worst pain scores in all groups. With the exception of average pain, there were no significant differences between groups for the other measures. DISCUSSION AND CONCLUSION: The findings indicate that the use of either a rigid or a nonrigid pelvic support belt did not add to the effects provided by exercise and advice.

Head and neck position sense in whiplash patients and healthy individuals and the effect of the cranio-cervical flexion action.

BACKGROUND: Whiplash may damage structures within the neck that can affect position sense. Deep neck flexor muscle retraining may improve position sense. The current study compared range of motion and position sense in whiplash and control subjects and investigated the effects of a muscle training session on position sense. METHODS: Twenty-three subjects with whiplash were compared with a matched control group. Range of motion and neck position sense measures were recorded using the 3-Space Fastrak. Measures of function were also assessed in the whiplash group. Subjects were then randomised into experimental and control groups and the former group received a training session to activate the deep neck flexor and scapular stabilising muscles (the cranio-cervical flexion action) during head and neck movements. After training, position sense measures were re-evaluated. FINDINGS: Results showed significant reductions (P < 0.05) in active range of motion in the whiplash group when compared to the healthy group. No significant differences (P > 0.05) between whiplash and healthy groups in position matching accuracy were observed. Functional outcome scores indicated the whiplash group to be mildly disabled. No effect on error scores was observed when position-matching tasks were performed with and without the cranio-cervical flexion action. Correlations between functional measures or range of motion, and position sense were not significant. INTERPRETATION: There was no evidence of position sense impairment in the mildly disabled whiplash subjects. The performance of the cranio-cervical flexion action had no effect on position sense, and hence clinical improvements observed from using this action may be more associated with mechanical stabilisation.

Factors affecting antenatal care attendance by mothers of Pacific infants living in New Zealand.

AIMS: To describe antenatal care attendance by mothers of Pacific infants recently delivered at Middlemore Hospital, South Auckland and to examine the demographic and psychosocial factors associated with late initiation of care and inadequate attendance. METHODS: The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which 1365 birth mothers in the cohort (n=1376) were interviewed when their infants were six weeks old about their antenatal care attendance. RESULTS: Almost all (99.1%) mothers attended antenatal care at least once. Over a quarter (26.6%) initiated their antenatal care late, and 10.7% attended fewer than the recommended number of times. Maternal factors significantly associated with late initiation of antenatal care were high parity, first pregnancy, not being employed prior to pregnancy and Cook Island Maori ethnicity. Factors associated with inadequate attendance were reaction to the pregnancy and being employed prior to pregnancy. CONCLUSIONS: A significant proportion of mothers of Pacific infants reported initiating antenatal care later than the first trimester and attending fewer antenatal visits than recommended. These findings indicate that the importance of antenatal care needs to be promoted among Pacific communities.

Smoking among mothers of a Pacific Island birth cohort in New Zealand: associated factors.

AIMS: The present study investigated (among mothers of a Pacific Island birth cohort) the rates of smoking before, during, and after pregnancy as well as factors predictive of smoking during pregnancy. METHODS: Data were gathered as part of the Pacific Islands Families (PIF) Study. In this study, mothers of a cohort of 1398 Pacific infants born in Middlemore Hospital, Auckland during 2000 were interviewed when their infants were 6 weeks old. Mothers were questioned about their maternal health, and lifestyle behaviours such as cigarette smoking. Additional data were obtained from hospital records. Analyses focused on 1365 biological mothers. RESULTS: Overall, 339 (approximately one-quarter) of the mothers reported smoking during pregnancy. 331 (76.1%) of the 435 smokers (before pregnancy) continued to smoke during pregnancy, and eight mothers commenced smoking once pregnant. Smoking rates for each trimester were 23.7% in the first, 21.0% in the second, and 20.4% in the third trimester of pregnancy, respectively. Multivariate analyses showed that smoking was significantly associated with several factors, including indicators of disadvantage and degree of westernisation. CONCLUSIONS: Greater efforts are needed to reduce smoking during pregnancy among Pacific women. Findings can be used to inform public health policy and smoking cessation programmes for Pacific families.

Maternal and demographic factors associated with non-immunisation of Pacific infants living in New Zealand.

AIM: To identify the proportion of infants who had not received their first dose of the primary immunisation series at approximately 6 weeks of age, and to identify the maternal and demographic factors associated with non-immunisation. METHOD: The data were gathered as part of the Pacific Islands Families (PIF): First Two Years of Life Study in which 1376 mothers were interviewed about the immunisation status of their infant. Mothers responded to questions about whether their child had been immunised, who administered the vaccines, and how satisfied they were with the care and treatment of their child in that context. RESULTS: Twenty-seven percent of the mothers reported that they had not had their infant immunised at approximately six-weeks of age. Factors significantly associated (p<0.05) with non-immunisation were ethnic group, maternal birth place, parity, difficulty with transport, and age of the baby at the time of the interview. CONCLUSIONS: These findings demonstrate the need for education about the importance of the primary immunisation series and the current schedules, together with community resources to support mothers in the context of this infant health care initiative. Improving immunisation uptake through education may not be sufficient with the more widespread issues of deprivation and social equity needing to be addressed.

Effects of a stress-management program on injury and stress of competitive gymnasts.

20 competitive gymnasts (17 girls, 3 boys; mean age, 14.4 +/- 3.4 yr.) were recruited from two clubs in Auckland, New Zealand. Gymnasts, who had competed at a national or international level, were divided into two groups to examine the effects of a longitudinal stress-management program on injury and stress. Those in the stress-management group took part in 12 1-hr. sessions over 24 weeks, while the control group took part in a placebo program of anthropometric measurements and lectures on nutrition. All participants completed the Life Experiences Survey and Athletic Experiences Survey at baseline, 3 mo., 6 mo. (end of intervention), and 9 mo. (3 mo. after completion of intervention). Injury data were collected prospectively by weekly self-report over the 9-mo. study. Repeated-measures analyses of covariance with age and, where applicable, the baseline measure of the dependent variable entered as covariates, indicated no significant group or group by time effects for the scores on the two surveys, or injury scores. However, given the small sample, the statistical power of the study to detect even large effects was low. Therefore, rather than concluding that the stress-management program had no effect on training hours lost to injury or on stress, upper limits were placed on the magnitude of any effects that might exist. Further research using larger samples is recommended.

Factors associated with not breastfeeding exclusively among mothers of a cohort of Pacific infants in New Zealand.

AIMS: This study investigated the association between not breastfeeding exclusively (among mothers of a cohort of Pacific infants in New Zealand) and several maternal, sociodemographic, and infant care factors. METHODS: The data were gathered as part of the Pacific Islands Families (PIF) Study. Infant feeding information was obtained through interviews with mothers (6 weeks post-birth) and from hospital records for 1247 of the 1365 biological mothers. RESULTS: Factors significantly associated with not exclusively breastfeeding at hospital discharge included smoking, unemployment prior to pregnancy, years in New Zealand, not seeing a midwife during pregnancy, caesarean delivery, and twin birth status. Factors significantly associated with cessation (before 6 weeks post-birth) of exclusive breastfeeding (for mothers who initially breastfed exclusively) included smoking, employment prior to pregnancy, being in current employment, high parity, dummy use, not receiving a visit from Plunket, infant not discharged at the same time as the mother, infant not sharing the same room as the parent(s) at night, regular childcare, and having a home visit for the infant from a traditional healer. CONCLUSIONS: Aside from smoking, different factors were associated with initiation and maintenance of exclusive breastfeeding. Identification of risk factors should assist targeting women who are at heightened risk of not breastfeeding exclusively.

A prospective study of problem and regular nonproblem gamblers living in the community.

Little is known about the life course of gambling problems and there have been no prospective studies of problem gambling. This article describes a study of 77 problem gamblers and 66 nonproblem gamblers recruited from a national prevalence survey in New Zealand in 1991 and reassessed in 1998. While most 1991 problem gamblers were nonproblematic at follow-up, a significant minority had developed more serious problems. Multiple logistic regression analysis identified more severe gambling problems, hazardous drinking, and a preference for track betting as the strongest independent predictors of subsequent problem gambling. These findings contradict conventional notions that pathological gambling is invariably a chronic or chronically relapsing disorder. The findings have implications for the interpretation of previous research, conduct of future research, and problem gambling policy and treatment.