Work-related musculoskeletal disorders in oral health professionals: an umbrella review protocol.

OBJECTIVE: The objective of this review is to synthesize the evidence on the prevalence, incidence, risk factors, and preventive and management interventions for work-related musculoskeletal disorders (MSD) in oral health professionals. INTRODUCTION: Oral health professionals face a considerable risk of developing work-related MSD due to the nature of their work. These disorders can lead to loss of employment, reduced job quality, increased occupational injuries, and early retirement. They can also lead to significant financial burdens for employers and society. INCLUSION CRITERIA: This umbrella review will include systematic reviews and meta-analyses that have oral health professionals as a population group and address at least one of the following topics: the prevalence or incidence, risk factors, and the efficiency or effectiveness of interventions for the prevention or management of work-related MSD. METHODS: A systematic search will be conducted across CINAHL Complete (EBSCOhost), Dentistry and Oral Sciences Source (EBSCOhost), MEDLINE (EBSCOhost), Cochrane Library (OVID), Scopus, PsycINFO (Ovid), AMED Allied and Complementary Medicine (Ovid), Epistemonikos, Ergonomics Abstracts Online (EBSCOhost), and Google Scholar (first 200 articles). The search will be limited to articles published in English, with no restrictions on geographical location. Two independent reviewers will screen the titles and abstracts against the inclusion criteria. The studies will be assessed using the JBI critical appraisal instrument for systematic reviews and research syntheses, and data will be extracted from each study using a modified version of the JBI data extraction tool. The GRADE approach will be used to rate the overall quality and strength of the evidence. REVIEW REGISTRATION: PROSPERO CRD42023388779.

Australia and New Zealand Clinical Motion Analysis Group (ANZ-CMAG) clinical practice recommendations.

Clinical motion analysis involves quantitative measurement of gait patterns to identify gait anomalies that currently or have the potential to impact function, activities of daily living and participation. Clinical motion analysis services are equipped with motion capture technology and comprise specialised staff who deliver 3-dimensional motion analysis services to children and adults who present with varying levels of gait impairment. Data is then used to inform intervention recommendations to clinicians with a view to maintaining independent, functional and pain free walking (or appropriate mobility). The ANZ-CMAG (established in 2013) identified a need to establish recommendations to assist in standardising practice guidelines for both current and new clinical motion analysis services within the region. The group serves to promote collaboration between services in quality assurance processes, clinical practices, data sets and research activities. The clinical practice recommendations described in this paper cover: i) requirements for a motion analysis service (including staffing, facilities and equipment), ii) patient assessments (requirements, clinical information and data gathered, reporting and interpretation of patient data), iii) quality assurance processes (including motion capture system / biomechanical models & limitations, marker placement, data storage / record keeping, creation of normative dataset); iv) helpful resources. Better outcomes for children and adults with gait deviations is dependent upon accurate measurement and evaluation of walking and requires input from multidisciplinary clinical teams with specialist knowledge and skills. The ANZ-CMAG hopes these clinical practice recommendations are beneficial to motion analysis services with an aim to improve clinical practices, patient outcomes, and support research collaboration.

A Prospective, Median 15-Year Comparison of Ponseti Casting and Surgical Treatment of Clubfoot.

BACKGROUND: In 2010, 2 authors of this current study reported the results of Ponseti treatment compared with primary posteromedial release (PMR) for congenital talipes equinovarus in a cohort of 51 prospective patients. This current study shows outcomes recorded at a median of 15 years after the original treatment. METHODS: Patient health records were available for all 51 patients at a median of 15 years (range, 13 to 17 years) following treatment of congenital talipes equinovarus with either the Ponseti method (25 patients [38 feet]) or PMR (26 patients [42 feet]). Thirty-eight of 51 patients could be contacted, and 33 patients (65%) participated in the clinical review, comprising patient-reported outcomes, clinical examination, 3-dimensional gait analysis, and plantar pressures. RESULTS: Sixteen (42%) of 38 Ponseti-treated feet and 20 (48%) of 42 PMR-treated feet had undergone a further surgical procedure. The PMR-treated feet were more likely to undergo osteotomies and intra-articular surgical procedures (15 feet) than the Ponseti-treated feet (5 feet) (p < 0.05). Of the 33 patients reviewed with multimodal assessment, the Ponseti group, compared with the PMR group, demonstrated better Dimeglio scores (5.8 compared with 7.0 points; p < 0.05), Disease Specific Instrument (80.7 compared with 65.6 points; p < 0.05), Functional Disability Inventory (1.1 compared with 5.1; p < 0.05), and American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Outcomes Questionnaire scores (52.2 compared with 46.6 points; p < 0.05), as well as improved total sagittal ankle range of motion in gait and ankle plantar flexion range at toe-off. The PMR group with clinical hindfoot varus displayed higher pressures in the lateral midfoot and the forefoot. CONCLUSIONS: Although the numbers of repeat surgical interventions following Ponseti treatment and primary PMR were similar, the PMR-treated feet had greater numbers of osteotomies and intra-articular surgical procedures. Functional outcomes were improved at a median of 15 years for feet treated with the Ponseti method compared with feet treated with PMR, with advantages seen in the Ponseti group over several domains. This study provides the most comprehensive evaluation of outcomes close to skeletal maturity in prospective cohorts, reinforcing the Ponseti method as the initial treatment of choice for idiopathic clubfeet. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Flexed lumbar spine postures are associated with greater strength and efficiency than lordotic postures during a maximal lift in pain-free individuals.

BACKGROUND: Inspite of common lifting advice to maintain a lordotic posture, there is debate regarding optimal lumbar spine posture during lifting. To date, the influence of lumbar posture on trunk muscle recruitment, strength and efficiency during high intensity lifting has not been fully explored. RESEARCH QUESTION: How do differences in lumbar posture influence trunk extensor strength (moment), trunk muscle activity, and neuromuscular efficiency during maximal lifting? METHODS: Twenty-six healthy participants adopted three lumbar postures (maximal extension (lordotic), mid-range (flat-back), and fully flexed) in a free lifting position. Motion analysis and force measurements were used to determine the back extensor, hip and knee moments. Surface electromyography (EMG) of three trunk extensors and the internal obliques were recorded. Neuromuscular efficiency (NME) was expressed as a ratio of normalised extensor moment to normalised EMG. RESULTS: Significantly higher back extensor moments were exerted when moving from an extended to mid-range, and from a mid-range to fully flexed lumbar posture. This was accompanied by a decrease in activity across all three back extensor muscles (P < 0.001) resulting in a higher NME of these muscles in more flexed postures. Change in lumbar posture did not influence hip or knee moments or internal oblique activation. SIGNIFICANCE: A flexed-back posture is associated with increased strength and efficiency of the back muscles compared to a lordotic posture. These findings further question the manual handling advice to lift with a lordotic lumbar spine.

Workplace bullying, psychological hardiness, and accidents and injuries in nursing: A moderated mediation model.

Workplace bullying are prevalent among the nursing workforce. Consequences of workplace bullying include psychological stress and workplace accidents and injuries. Psychological hardiness is proposed as a buffer for workplace bullying and psychological stress on workplace accidents and injuries. This study adopted the Affective Events Theory and Conservation of Resources Theory to develop and test a moderated mediated model in two field studies. Study 1 (N = 286, Australian nurses) found support for the direct negative effect of workplace bullying on workplace accidents and injuries with psychological stress acting as the mediator. The mediation findings from Study 1 were replicated in Study 2 (N = 201, New Zealand nurses). In addition, Study 2 supplemented Study 1 by providing empirical support for using psychological hardiness as the buffer for the association between psychological stress and workplace accidents and injuries. This study offers theoretical and empirical insights into the research and practice on psychological hardiness for improving the psychological well-being of employees who faced workplace mistreatments.

The influence of age on spinal and lower limb muscle activity during repetitive lifting.

This study investigated the effects of age on upper erector spinae (UES), lower erector spinae (LES) and lower body (gluteus maximus; biceps femoris; and vastus lateralis) muscle activity during a repetitive lifting task. Twenty-four participants were assigned to two age groups: 'younger' (n = 12; mean age ± SD = 24.6 ± 3.6 yrs) and 'older' (n = 12; mean age = 46.5 ± 3.0 yrs). Participants lifted and lowered a box (13 kg) repetitively at a frequency of 10 lifts per minute for a maximum of 20 min. EMG signals were collected every minute and normalised to a maximum voluntary isometric contraction. A submaximal endurance test of UES and LES was used to assess fatigue. Older participants showed higher levels of UES and LES muscle activity (approximately 12-13%) throughout the task, but less fatigue compared to the younger group post-task completion. When lifting, lower-limb muscle activity was generally higher in older adults, although temporal changes were similar. While increased paraspinal muscle activity may increase the risk of back injury in older workers when repetitive lifting, younger workers may be more susceptible to fatigue-related effects. Education and training in manual materials handling should consider age-related differences when developing training programmes.

Influencing lumbar posture through real-time biofeedback and its effects on the kinematics and kinetics of a repetitive lifting task.

BACKGROUND: Repetitive, flexed lumbar postures are a risk factor associated with low back injuries. Young, novice workers involved in manual handling also appear at increased risk of injury. The evidence for the effectiveness of postural biofeedback as an intervention approach is lacking, particularly for repetitive, fatiguing tasks. RESEARCH QUESTION: How does real-time lumbosacral (LS) postural biofeedback modify the kinematics and kinetics of repetitive lifting and the risk of low back injury? METHODS: Thirty-four participants were randomly allocated to two groups: biofeedback (BF) and non-biofeedback (NBF). Participants repetitively lifted a 13 kg box at 10 lifts per minute for up to 20 min. Real-time biofeedback of LS posture occurred when flexion exceeded 80% maximum. Three-dimensional motion analysis and ground reaction forces enabled estimates of joint kinematics and kinetics. Rating of perceived exertion (RPE) was measured throughout. RESULTS: The BF group adopted significantly less peak lumbosacral flexion (LSF) over the 20 min when compared to the NBF group, which resulted in a significant reduction in LS passive resistance forces. This was accompanied by increased peak hip and knee joint angular velocities in the BF group. Lower limb moments did not significantly differ between groups. Feedback provided to participants diminished beyond 10 min and subjective perceptions of physical exertion were lower in the BF group. SIGNIFICANCE: Biofeedback of lumbosacral posture enabled participants to make changes in LSF that appear beneficial in reducing the risk of low back injury during repetitive lifting. Accompanying behavioural adaptations did not negatively impact on physical exertion or lower limb joint moments. Biofeedback of LS posture offers a potential preventative and treatment adjunct to educate handlers about their lifting posture. This could be particularly important for young, inexperienced workers employed in repetitive manual handling who appear at increased risk of back injury.

Ankle joint function during walking in tophaceous gout: A biomechanical gait analysis study.

BACKGROUND: The foot and ankle are frequently affected in tophaceous gout, yet kinematic and kinetic changes in this region during gait are unknown. The aim of the study was to evaluate ankle biomechanical characteristics in people with tophaceous gout using three-dimensional gait analysis. METHODS: Twenty-four participants with tophaceous gout were compared with 24 age-and sex-matched control participants. A 9-camera motion analysis system and two floor-mounted force plates were used to calculate kinematic and kinetic parameters. RESULTS: Peak ankle joint angular velocity was significantly decreased in participants with gout (P < 0.01). No differences were found for ankle ROM in either the sagittal (P = 0.43) or frontal planes (P = 0.08). No differences were observed between groups for peak ankle joint power (P = 0.41), peak ankle joint force (P = 0.25), peak ankle joint moment (P = 0.16), timing for peak ankle joint force (P = 0.81), or timing for peak ankle joint moment (P = 0.16). CONCLUSIONS: Three dimensional gait analysis demonstrated that ankle joint function does not change in people with gout. People with gout demonstrated a reduced peak ankle joint angular velocity which may reflect gait-limiting factors and adaptations from the high levels of foot pain, impairment and disability experienced by this population.

Validation of an Inertial Sensor System for Physical Therapists to Quantify Movement Coordination During Functional Tasks.

Physical therapists evaluate patients' movement patterns during functional tasks; yet, their ability to interpret these observations consistently and accurately is unclear. Physical therapists would benefit from a clinic-friendly method for accurately quantifying movement patterns during functional tasks. Inertial sensors, which are inexpensive, portable sensors capable of monitoring multiple body segments simultaneously, are a relatively new rehabilitation technology. We sought to validate an inertial sensor system by comparing lower limb and lumbar spine kinematic data collected simultaneously with a commercial inertial sensor system and a motion camera system while 10 subjects performed functional tasks. Mean and peak segment angular displacement data were calculated and compared between systems. Mean angular displacement root mean square error between the systems across all tasks and segments was <5°. Mean differences in peak displacements were generally acceptable (<5°) for the femur, tibia, and pelvis segments for all tasks; however, the inertial system overestimated lumbar flexion compared to the motion camera system. These data suggest that the inertial system is capable of measuring angular displacements within 5° of a system widely accepted for its accuracy. Standardization of sensor placement, better attachment methods, and improvement of inertial sensor algorithms will further increase the accuracy of the system.

A Comparison of Walking Gait Following Mechanical and Kinematic Alignment in Total Knee Joint Replacement.

BACKGROUND: Although previous studies have compared radiological, pain, and function scores in kinematically aligned (KA) and mechanically aligned (MA) total knee arthroplasty (TKA), no previous studies have undertaken a three-dimensional (3D) gait analysis in these groups. This study compared kinematic and kinetic variables recorded during level walking in patients at least 2 years post-surgery who underwent an MA or KA procedure. METHODS: Utilizing a 9-camera motion analysis system, gait analysis was undertaken on 29 patients (MA = 15, KA = 14). A 9-camera motion analysis system was used to collect 3D kinematic data of the involved and uninvolved limbs during walking at a self-selected speed. Additionally, 3D ground reaction forces and moments during the stance phase were recorded, and an inverse dynamics approach was utilized to analyze these data. RESULTS: There were no significant differences in spatial-temporal variables between MA and KA groups (P > .05). Local minima and maxima for knee joint angles were not significantly different (P > .05) across involved and uninvolved legs and MA/KA groups in any of the 3 planes of motion. Principal component analysis revealed a significant difference (P < .05) in the transverse plane moment in late stance. No other significant differences were observed for knee, hip, or ankle joint moments. CONCLUSION: Differences in gait parameters across the KA and MA groups at 2 years post-surgery were insufficient to support either one of the operative procedures over the other.

Ultrasound Characteristics of the Achilles Tendon in Tophaceous Gout: A Comparison with Age- and Sex-matched Controls.

OBJECTIVE: To investigate the frequency and distribution of characteristics of the Achilles tendon (AT) in people with tophaceous gout using musculoskeletal ultrasound (US). METHODS: Twenty-four participants with tophaceous gout and 24 age- and sex-matched controls without gout or other arthritis were recruited. All participants underwent a greyscale and power Doppler US examination. The AT was divided into 3 anatomical zones (insertion, pre-insertional, and proximal to the mid-section). The following US characteristics were assessed: tophus, tendon echogenicity, tendon vascularity, tendon morphology, entheseal characteristics, bursal morphology, and calcaneal bone profile. RESULTS: The majority of the participants with tophaceous gout were middle-aged men (n = 22, 92%) predominately of European ethnicity (n = 14, 58%). Tophus deposition was observed in 73% (n = 35) of tendons in those with gout and in none of the controls (p < 0.01). Intratendinous hyperechoic spots (p < 0.01) and intratendinous power Doppler signal (p < 0.01) were more frequent in participants with gout compared to controls. High prevalence of entheseal calcifications, calcaneal bone cortex irregularities, and calcaneal enthesophytes were observed in both gout participants and controls, without differences between groups. Intratendinous structural damage was rare. Hyperechoic spots were significantly more common at the insertion compared to the zone proximal to the mid-section (p < 0.01), but between-zone differences were not observed for other features. CONCLUSION: US features of urate deposition, tophus, and vascularization are present throughout the AT in patients with tophaceous gout. Despite crystal deposition, intratendinous structural changes are infrequent. Many characteristics observed in the AT in people with tophaceous gout, particularly at the calcaneal enthesis, are not disease-specific.

Play-based interventions improve physical function for people with adult-acquired brain injury: a systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: To undertake a systematic review and meta-analysis of the effectiveness of play-based interventions compared to traditional therapy in rehabilitation of adults with adult-acquired brain injury. DATA SOURCES: The search was performed using Medline; Cinahl Plus; Health Source (Nursing/Academic Edition); Psychology and behavioural sciences collection; Biomedical reference collection (basic). REVIEW METHODS: Studies included were randomised controlled trials that investigated the effect of play-based interventions on physical function of adults with adult acquired brain injury. Two independent reviewers identified eligible studies and assessed methodological quality using a modified Downs and Black. Meta-analysis compared standardised differences in means, to determine effect sizes for grouped functional outcome measures. The GRADE scoring system was used to determine the level of clinical evidence. RESULTS: Thirty studies met the inclusion criteria, 13 were considered high quality and 17 moderate quality. Studies predominantly involved post-stroke participants, with only three studies including participants with traumatic brain injury. When compared to traditional therapy, dose-matched studies of play-based interventions showed a significant effect on independence (Effect size (ES) = 0.6) and physical performance (ES = 0.43), as measured using the Fugl -Meyer. For non-dose matched studies, play-based interventions showed a significant improvement for balance (ES = 0.76) compared with traditional therapy. In all studies that measured participant enjoyment, play-based therapy was rated as more enjoyable than traditional therapy. CONCLUSION: Play-based interventions for people with adult acquired brain injury are more effective in improving balance and independence, which may be due to them being more enjoyable than traditional therapy.

Contour interpolated radial basis functions with spline boundary correction for fast 3D reconstruction of the human articular cartilage from MR images.

PURPOSE: The aim of this work is to demonstrate a new image processing technique that can provide a "near real-time" 3D reconstruction of the articular cartilage of the human knee from MR images which is user friendly. This would serve as a point-of-care 3D visualization tool which would benefit a consultant radiologist in the visualization of the human articular cartilage. METHODS: The authors introduce a novel fusion of an adaptation of the contour method known as "contour interpolation (CI)" with radial basis functions (RBFs) which they describe as "CI-RBFs." The authors also present a spline boundary correction which further enhances volume estimation of the method. A subject cohort consisting of 17 right nonpathological knees (ten female and seven male) is assessed to validate the quality of the proposed method. The authors demonstrate how the CI-RBF method dramatically reduces the number of data points required for fitting an implicit surface to the entire cartilage, thus, significantly improving the speed of reconstruction over the comparable RBF reconstruction method of Carr. The authors compare the CI-RBF method volume estimation to a typical commercial package (3d doctor), Carr's RBF method, and a benchmark manual method for the reconstruction of the femoral, tibial, and patellar cartilages. RESULTS: The authors demonstrate how the CI-RBF method significantly reduces the number of data points (p-value < 0.0001) required for fitting an implicit surface to the cartilage, by 48%, 31%, and 44% for the patellar, tibial, and femoral cartilages, respectively. Thus, significantly improving the speed of reconstruction (p-value < 0.0001) by 39%, 40%, and 44% for the patellar, tibial, and femoral cartilages over the comparable RBF model of Carr providing a near real-time reconstruction of 6.49, 8.88, and 9.43 min for the patellar, tibial, and femoral cartilages, respectively. In addition, it is demonstrated how the CI-RBF method matches the volume estimation of a typical commercial package (3d doctor), Carr's RBF method, and a benchmark manual method for the reconstruction of the femoral, tibial, and patellar cartilages. Furthermore, the performance of the segmentation method used for the extraction of the femoral, tibial, and patellar cartilages is assessed with a Dice similarity coefficient, sensitivity, and specificity measure providing high agreement to manual segmentation. CONCLUSIONS: The CI-RBF method provides a fast, accurate, and robust 3D model reconstruction that matches Carr's RBF method, 3d doctor, and a manual benchmark method in accuracy and significantly improves upon Carr's RBF method in data requirement and computational speed. In addition, the visualization tool has been designed to quickly segment MR images requiring only four mouse clicks per MR image slice.

Gait characteristics associated with the foot and ankle in inflammatory arthritis: a systematic review and meta-analysis.

BACKGROUND: Gait analysis is increasingly being used to characterise dysfunction of the lower limb and foot in people with inflammatory arthritis (IA). The aim of the systematic review was to evaluate the spatiotemporal, foot and ankle kinematic, kinetic, peak plantar pressure and muscle activity parameters between patients with inflammatory arthritis and healthy controls. METHODS: An electronic literature search was performed on Medline, CINAHL, SportsDiscus and The Cochrane Library. Methodological quality was assessed using a modified Quality Index. Effect sizes with 95% confidence intervals (CI) were calculated as the standardised mean difference (SMD). Meta-analysis was conducted if studies were homogenous. RESULTS: Thirty six studies with quality ranging from high to low met the inclusion criteria. The majority of studies reported gait parameters in Rheumatoid arthritis (RA). The gait pattern in RA was characterised by decreased walking speed (SMD 95% CI -1.57, -2.25 to -0.89), decreased cadence (SMD -0.97, -1.49 to -0.45), decreased stride length (SMD -1.66, -1.84 to -1.49), decreased ankle power (SMD -1.36, -1.70 to -1.02), increased double limb support time (SMD 1.03, 0.84 to 1.22), and peak plantar pressures at the forefoot (SMD 1.11, 0.76 to 1.45). Walking velocity was reduced in psoriatic arthritis and gout with no differences in ankylosing spondylitis. No studies have been conducted in polymyalgia rheumatica, systemic sclerosis or systemic lupus erythematosus. CONCLUSIONS: The review identified the majority of studies reporting gait adaptations in RA, but limited evidence relating to other IA conditions. Poor data reporting, small sample sizes and heterogeneity across IA conditions limit the interpretation of the findings. Future studies may consider a standardised analytical approach to gait analysis that will provide clinicians and researchers with objective evidence of foot function in people with IA.

The assessment of lesions of the Achilles tendon by ultrasound imaging in inflammatory arthritis: A systematic review and meta-analysis.

OBJECTIVE: Ultrasound (US) is a highly sensitive, reliable and non-invasive tool, which allows for the assessment of lesions of tendons and entheseal sites. The aim of this systematic review and meta-analysis is to identify differences in US lesions of the Achilles tendon (AT) between people with inflammatory arthritis (IA) and healthy controls. METHODS: An electronic literature search was performed on Medline, CINAHL, SportDiscus and The Cochrane Library. Methodological quality was assessed using a modified Quality Index. Odds ratios with 95% confidence intervals (CI) were determined. Meta-analysis was conducted on those studies that were considered to be homogenous. RESULTS: A total of 13 high-to-medium quality studies met the inclusion criteria. The majority of studies reported US lesions in spondyloarthropathy (SpA), with limited evidence for other forms of IA. US lesions were not consistently defined with regard to Outcome Measures in Rheumatology Clinical Trials (OMERACT) definitions, and numerous scoring systems were used across the majority of studies. The mean AT thickness at the enthesis in people with SpA was 0.54mm thicker (95% CI: 0.10-0.97mm) with more frequent erosions in people with SpA (odds ratio = 7.43, 95% CI: 1.99-27.77, P = 0.003) and rheumatoid arthritis (RA) (odds ratio = 9.60, 95% CI: 1.23-74.94, P = 0.03), compared to controls. There was no significant difference in the frequency of enthesophyte formation in people with SpA compared to the controls (odds ratio = 2.48, 95% CI: 0.64-9.70, P = 0.19). CONCLUSIONS: The systematic review identified that a majority of studies reporting US lesions were in SpA, but limited evidence relating to other forms of IA. Consistent application of the OMERACT US definitions and scoring of US lesions is required in future studies of AT disease in IA. Further work is also required to distinguish between US lesions reflective of inflammation and structural damage.

Age-related differences do affect postural kinematics and joint kinetics during repetitive lifting.

BACKGROUND: Age is considered a risk factor for manual handling-related injuries and older workers incur higher injury-related costs than younger co-workers. This study investigated the differences between the kinematics and kinetics of repetitive lifting in two groups of handlers of different ages. METHODS: Fourteen younger (mean 24.4 yr) and 14 older (mean 47.2 yr) males participated in the study. Participants repetitively lifted a box weighing 13 kg at a frequency of 10 lifts/min for a maximum of 20 min. Postural kinematics (joint and lumbosacral angles and angular velocities) and kinetics (joint moments) were measured throughout the lifting task using motion analysis and ground reaction forces. Muscle fatigue of the erector spinae was assessed using electromyography. FINDINGS: Peak lumbosacral, trunk, hip and knee flexion angles differed significantly between age groups over the duration of the task, as did lumbosacral and trunk angular velocities. The younger group increased peak lumbar flexion by approximately 18% and approached 99% of maximum lumbosacral flexion after 20 min, whereas the older group increased lumbar flexion by 4% and approached 82% maximum flexion. The younger group had a larger increase in peak lumbosacral and trunk angular velocities during extension, which may be related to the increased back muscle fatigue observed among the younger group. INTERPRETATION: Older participants appeared to control the detrimental effects of fatigue associated with repetitive lifting and limit lumbar spine range of motion. The higher rates of musculoskeletal injury among older workers may stem from a complex interaction of manual handling risk factors.

Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review.

OBJECTIVE: To establish the effectiveness of eccentric exercise as a treatment intervention for lateral epicondylitis. DATA SOURCES: ProQuest, Medline via EBSCO, AMED, Scopus, Web of Science, CINAHL. REVIEW METHODS: A systematic review was undertaken to identify randomized and controlled clinical trials incorporating eccentric exercise as a treatment for patients diagnosed with lateral epicondylitis. Studies were included if: they incorporated eccentric exercise, either in isolation or as part of a multimodal treatment protocol; they assessed at least one functional or disability outcome measure; and the patients had undergone diagnostic testing. The methodological quality of each study was assessed using the Modified Cochrane Musculoskeletal Injuries Group score sheet. RESULTS: Twelve studies met the inclusion criteria. Three were deemed 'high' quality, seven were 'medium' quality, and two were 'low' quality. Eight of the studies were randomized trials investigating a total of 334 subjects. Following treatment, all groups inclusive of eccentric exercise reported decreased pain and improved function and grip strength from baseline. Seven studies reported improvements in pain, function, and/or grip strength for therapy treatments inclusive of eccentric exercise when compared with those excluding eccentric exercise. Only one low-quality study investigated the isolated effects of eccentric exercise for treating lateral epicondylitis and found no significant improvements in pain when compared with other treatments. CONCLUSION: The majority of consistent findings support the inclusion of eccentric exercise as part of a multimodal therapy programme for improved outcomes in patients with lateral epicondylitis.

Fast detection & modelling of the real osteoarthritic holes in the human knee with contour interpolated radial basis functions.

In this article, we propose a novel method for the fast 3D reconstruction of real osteoarthritic (OA) holes in a human femoral cartilage. Initially, semi-automated Region-Based Segmentation (region-growing) and Bounding Box techniques are used to extract femoral cartilage slices from MRI scans of the knee. OA holes were detected and filled automatically by our contour interpolation/RBF (CI-RBF) method and 3D models of both the femoral cartilage and OA holes were reconstructed separately. The method was then applied to a single human knee and results proved it fast, reliable and accurate for reconstructing a 3D model of the femoral cartilage from MRI images with an extremely low root mean square error of 1.67% in the estimated volume of the automatically filled to the manually filled femoral cartilage slices. As per authors' knowledge this is the first time real OA hole has automatically been identified and filled.

Fast identification & modelling of osteoarthritic holes in the human knee with contour interpolated radial basis functions.

In this article, we propose a new method for the fast 3D reconstruction of simulated osteoarthritic holes in a human patella. Initially, clean patella slices were extracted from MRI scans of the knee using Region-Based Segmentation (region-growing) and Bounding Box techniques. Osteoarthritic (OA) holes were then simulated in the patella slices. Our contour interpolation/RBF (CI/RBF) method was then used to detect the hole automatically and reconstruct 3D models of both the patella and OA hole separately. The method presented here proves fast, reliable and efficient for reconstructing a 3D model of the patella from MRI images with an extremely low error of 0.33%.