Epidemiology, etiology and prevention of injuries in competitive ice speed skating-limited current evidence, multiple future priorities: A scoping review.

Long-track and short-track ice speed skating are integral to the Winter Olympics. The state of evidence-based injury prevention in these sports is unclear. Our goals were to summarize the current scientific knowledge, to determine the state of research, and to highlight future research areas for injury prevention in ice speed skating. We conducted a scoping review, searching all injury and injury prevention studies in competitive ice speed skaters. The six-stage Translating Research into Injury Prevention Practice (TRIPP) framework summarized the findings. The systematic search yielded 1109 citations. Nineteen studies were included, and additional searches yielded another 13 studies, but few had high-quality design. TRIPP stage 1 studies (n = 24) found competition injury rates from 2% to 18% of participants with various injury locations and types. Seasonal prevalence of physical complaints was up to 84% (for back pain) in long- and short-track. Ten studies covered information on TRIPP stage 2, with two small etiological studies linking injuries to functional strength deficits (short-track) and training load (long-track). Questionnaire studies identified various perceived risk factors for injuries but lacked further scientific evidence. Most TRIPP stage 3 studies (five out of eight) focused on developing protective measures, while two studies found short-track helmets performed poorly compared to helmets used in other sports. No study evaluated the efficacy, the intervention context, or the effectiveness (TRIPP stages 4-6) of the measures. Scientific knowledge on injury prevention in ice speed skating is limited. Future research should prioritize high-quality studies on injury epidemiology and etiology in the sports.

Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women - A systematic review and meta-analysis.

BACKGROUND: Diastasis of the rectus abdominis muscle (DRAM) commonly occurs in pregnancy and postnatally. Physiotherapists routinely guide women in its management, although the effectiveness of these treatments is unknown. OBJECTIVES: To determine the effectiveness of conservative interventions to reduce the presence and width of DRAM in pregnant and postnatal women. DATA SOURCES: EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro searched until August 2021. STUDY SELECTION/ELIGIBILITY: Randomised control trials examining any conservative interventions to manage DRAM during the ante- and postnatal periods were included. STUDY APPRAISAL AND SYNTHESIS METHODS: Methodological quality was assessed using the Cochrane Risk of Bias 2 tool. Meta-analyses were performed using a random effects model to calculate mean differences (MD) and odds ratios (OR). A GRADE approach determined the certainty of evidence for each meta-analysis. RESULTS: Sixteen trials with 698 women during the postnatal period were included. No trials evaluated interventions during the antenatal period. All interventions included some form of abdominal exercise. Other interventions included abdominal binding, kinesiotape and electrical stimulation. There was moderate certainty evidence from six trials (n = 161) that abdominal exercise led to a small reduction in inter-recti distance (MD -0.43 cm, 95% CI -0.82 to -0.05) in postnatal women compared to usual care. LIMITATIONS: Three of the 16 trials had a low risk of bias. CONCLUSION AND IMPLICATIONS: Conservative interventions do not lead to clinically significant reductions in inter-recti distance in women postnatally but abdominal exercises may have other physical and psychosocial benefits in the management of DRAM. Systematic Review Registration Number PROSPERO (CRD42020172529).

Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review.

BACKGROUND: Diastasis of the rectus abdominis muscle (DRAM) is common during and after pregnancy. OBJECTIVES: To determine the association between: the presence of DRAM and low back pain, lumbo-pelvic pain, incontinence, pelvic organ prolapse, abdominal muscle performance or health-related quality of life; and between DRAM width and severity of these outcomes. DATA SOURCES: Six electronic databases (EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro). STUDY SELECTION: Included studies of all designs with adults with DRAM that assessed low back pain, lumbo-pelvic pain incontinence, pelvic organ prolapse, abdominal performance or health-related quality of life. STUDY APPRAISAL & SYNTHESIS METHODS: Methodological quality was assessed using the Effective Public Health Practice Project tool. A narrative summary was completed for DRAM presence and presence of the various musculoskeletal dysfunctions, and DRAM width and the severity of these dysfunctions. RESULTS: Twelve studies involving 2242 participants were included. There was no significant association between the presence of DRAM and lumbo-pelvic pain or incontinence. There was a small association between the presence of DRAM and pelvic organ prolapse. DRAM width may be associated with health-related quality of life, abdominal muscle strength and severity of low back pain. LIMITATIONS: Quality of studies was weak. There was variability in the methods used to assess DRAM. CONCLUSION: There is weak evidence that DRAM presence may be associated with pelvic organ prolapse, and DRAM severity with impaired health-related quality of life, impaired abdominal muscle strength and low back pain severity. Systematic Review Registration Number: PROSPERO CRD42017058089.

Musculoskeletal pain and associated factors among Ethiopian elementary school children.

BACKGROUND: Ethiopian school children often carry school supplies in heavy school bags and encounter limited school facilities. This stresses their vulnerable musculoskeletal system and may result in experiencing musculoskeletal pain. High prevalence of musculoskeletal pain has been documented, but data on musculoskeletal pain among elementary school children in Ethiopia is lacking. To determine the prevalence of musculoskeletal pain and associated factors among elementary school children in Gondar, Ethiopia. METHODS: Cross-sectional study was conducted among children from six randomly selected elementary schools. Sample size was determined proportionally across school grades and governmental and private schools to ensure variety within the sample. Data collection consisted of physical measurements including height, weight and schoolbag weight, and a structured questionnaire on musculoskeletal pain, mode of transport, walking time and school facilities. Data were analysed descriptively and through uni- and multivariate logistic regression model. RESULTS: In total 723 children participated. The overall prevalence of self-reported musculoskeletal pain was 62%, with a significant difference between school types (governmental 68% versus private 51%). Shoulder, neck and lower leg/knee were most commonly reported. Walking to and from school for ≥20 min (OR = 2.94, 95% CI 2.05 to 4.21) and relative school bag weight (OR = 2.57, 95% CI 1.48 to 4.47) were found significantly associated with self-report musculoskeletal pain. Children with carrying heavy school supplies and also walking long duration have a 3.5 (95% CI = 1.80-6.95) times greater chance of reporting pain as compared to those who carry lesser weighed bags and reported shorter walking duration at the same time. CONCLUSIONS: Prevalence of self-reported musculoskeletal pain was high among children attending public schools and also those who walked a long way to and from school. Long walking duration and relative school bag weight were significantly associated with musculoskeletal pain. These findings can inform policymakers to provide transportation services and other facilities at elementary schools. The findings of this study should be interpreted with caution due to possible social desirability bias with higher prevalence of self-reported pain and more so in children population.

Validity and reliability of an activity monitor to quantify arm movements and activity in adults following distal radius fracture.

PURPOSE: To examine the validity and reliability of an activity monitor to estimate upper limb activity. METHODS: Thirty-two adults after distal radial fracture were recruited. 15 adults performed five upper limb activities during two testing sessions, one week apart to investigate criterion validity against the criterion reference of three-dimensional motion analysis, convergent validity, and test-retest reliability. 17 adults in two therapy groups wore monitors for three consecutive days at baseline and six weeks post-intervention. Hypothesis testing (noninferiority) assessed comparison of group differences. RESULTS: There were large, significant positive correlations between monitor counts and motion analysis for affected/unaffected wrists during the grocery shelving [r = 0.82, r = 0.73, respectively] and floor sweeping activities [r = 0.54, r = 0.59, respectively]. Large confidence intervals relative to means suggests the monitor could not accurately predict motion analysis distance or acceleration. Relative reliability was excellent in affected/unaffected wrists for crank ergometer [ICC(2,1) = 0.91, ICC(2,1) = 0.88, respectively], grocery shelving [ICC(2,1) = 0.83, ICC(2,1) = 0.89, respectively], and table dusting activities [ICC(2,1) = 0.77, ICC(2,1) = 0.83, respectively]. Correlations and reliability for typing were poor; hypothesis testing of group equivalence was not confirmed. CONCLUSIONS: There is preliminary evidence that an activity monitor is a valid and reliable tool to measure gross arm activity after distal radial fracture. Implications for Rehabilitation Distal radius fractures are one of the most common upper limb fractures that cause activity limitations and participation restrictions. After a distal radius fracture patients are often referred to therapy (physiotherapy, occupational therapy, hand therapy) for rehabilitation to return to pre-injury function and activity levels. Activity monitors may be a valid and reliable measurement tool that therapists can use with their patients to quantify gross arm activity to enable monitoring of injury recovery and rehabilitation adherence. Activity monitors may not be sufficiently reliable and valid to monitor fine movements of the wrist and hand after distal radius fracture.

The Shoulder Function Index (SFInX): evaluation of its measurement properties in people recovering from a proximal humeral fracture.

BACKGROUND: Concerns about test administration, reliability estimations, content and internal structure (dimensionality) of available shoulder measures for people with proximal humeral facture led to the development of a new clinician-observed outcome measure: the Shoulder Function Index (SFInX). The SFInX measures shoulder function by judgement of actual ability to perform daily tasks in which the shoulder is involved. Patients and health professionals had input into the instrument development, and Rasch analysis was used to create a unidimensional, interval-level scale. This study comprehensively evaluated the measurement properties of the SFInX in people recovering from a proximal humeral fracture. METHODS: Data were collected on 92 people [79 women, mean age 63.5 years (SD13.9)] who sustained a proximal humeral fracture within the previous year on three occasions to allow for evaluation of the following measurement properties: construct validity (convergent, discriminant and known-groups validity), longitudinal validity (responsiveness), intra-rater reliability (one week retest interval), and inter-rater reliability (n = 20 subgroup; two independent raters). Comparative measures were Constant Score and Disabilities of the Arm Shoulder and Hand (DASH) and discriminative measure was a mental status questionnaire. Minimal clinically important difference, floor and ceiling effects and feasibility of the SFInX were also evaluated. A priori hypotheses were formulated where applicable. RESULTS: Results for construct validity testing supported hypothesised relationships (convergent validity r = 0.75-0.89 (Constant Score and DASH); discriminant validity r = -0.08 (mental status); known-groups validity r = 0.50). For longitudinal validity, lower correlations (r = 0.40-0.49) than hypothesised (r = 0.50-0.70) were found. The SFInX scores changed more (10.3 points) than other scales, which could indicate that the SFInX is more responsive than the comparative measures. Intra-rater and inter-rater reliability found ICCs of 0.96 (95 % CI 0.94-0.97) and 0.91 (95 % CI 0.63-0.97) respectively, with low measurement error (SEM = 3.9-5.8/100). A change of 11-12 points (out of 100) was indicative of a clinically important difference. CONCLUSIONS: The SFInX is a feasible outcome measure which clinicians can use to reliably measure and detect clinically important changes in the construct of 'shoulder function', the ability to perform activities in which the shoulder is involved, in people recovering from a proximal humeral fracture.

The Shoulder Function Index (SFInX): a clinician-observed outcome measure for people with a proximal humeral fracture.

BACKGROUND: Proximal humeral fractures are amongst the most common fractures. Functional recovery is often slow and many people have ongoing disability during activities of daily life. Unidimensional measurement of activity limitations is required to monitor functional progress during rehabilitation. However, current shoulder measures are multidimensional incorporating constructs such as activities, range of motion and pain into a single scale. Psychometric information of these measures is scarce in this population, and indicate measurement issues with reliability. Therefore, the aim was to develop the clinician-observed Shoulder Function Index (SFInX), a unidimensional, interval-level measure of 'shoulder function' based on actual performance of activities, reflecting activity limitations following a proximal humeral fracture. METHODS: An outcome measure development study was performed including item generation (existing shoulder measures, focus groups) and item selection (selection criteria, importance and feasibility ratings, pilot testing, Rasch analysis). Clinicians (n=15) and people with a proximal humeral fracture (n=13) participated in focus groups. Items were pilot tested (n=12 patients) and validated in a Rasch study. The validation study sample (n=92, 86% female) were recruited between 5 and 52 weeks post-fracture and had a mean age of 63.5 years (SD13.9). Measurements at recruitment and 6 and 7 weeks later were taken in three public metropolitan hospitals or during home visits. Raw SFInX data were analysed with WINSTEPS v3.74 using polytomous Rasch models. RESULTS: From 282 generated items, 42 items were selected to be rated by clinicians and patients; 34 items were pilot tested and 16 items were included for Rasch analysis. The final SFInX, developed with the Partial Credit Model, contains 13 items and has the response categories: 'unable', 'partially able' and 'able'. It is unidimensional measuring 'shoulder function', and can measure from early functional use (drinking from a cup) to independence around the house (lifting items above head, carrying heavy items). CONCLUSIONS: The SFInX is a promising outcome measure of shoulder function for people with a proximal humeral fracture. It has content relevant to patients and clinicians, is unidimensional and feasible for use in clinical and home settings. In its current form, the SFInX is ready for further psychometric evaluation, and for subsequent use in clinical settings and research.

Reliability and validity of shoulder function outcome measures in people with a proximal humeral fracture.

PURPOSE: Investigate test--retest reliability and validity of five shoulder outcome measures in people during their active rehabilitation after a shoulder fracture. METHOD: This prospective longitudinal study assessed shoulder function in 20 people (16 women, mean age 68.1 years) with surgical or conservative management at 6, 12 and 13 weeks post proximal humeral fracture using three patient-reported (Disabilities of Arm, Shoulder and Hand; Oxford Shoulder Score; Subjective Shoulder Value) and two clinician-administered (Constant Score; UCLA Shoulder score) outcome measures. RESULTS: Content analysis categorised items into multiple domains of functioning for each outcome measure. Construct validity testing between measures found moderate to strong correlations (r=0.43-0.92). Longitudinal validity (responsiveness), represented by correlations between change scores, was moderate to strong (r=0.44-0.83). Although ICCs2,1 for test-retest reliability ranged from 0.75 to 0.93, Limits of Agreement between measurements were relatively wide (10-23% of available range of scores). Minimal clinically important difference estimates varied between anchor- and distribution-based methods. CONCLUSIONS: The five outcome measures assessing shoulder function provided values for reliability and validity that meet measurement requirements for use in groups of people after a proximal humeral fracture. However, the use of these outcome measures might be limited by low absolute agreement between measurements and their content covering multiple domains of functioning. Implications for Rehabilitation Linking the International Classification of Functioning, Disability and Health (ICF) to the content of common shoulder function outcome measures showed that multiple domains of functioning are combined into a single score. This might not be preferred for measurement of the single construct of "shoulder function". Currently available shoulder function outcome measures may not be sufficiently reliable to monitor change in an individual after a proximal humeral fracture during the rehabilitation phase.

Walking tests for stroke survivors: a systematic review of their measurement properties.

PURPOSE: To provide an overview of walking tests including their measurement properties that have been used in stroke survivors. METHOD: Electronic databases were searched using specific search strategies. Retrieved studies were selected by using specified inclusion criteria. A modified consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was applied for methodological quality assessment of the included studies. A quality assessment for statistical outcomes was used to assess measurement properties of the walking tests. Tests that were included were categorized according to the framework of the international classification of functioning, disability and health (ICF). RESULTS: Thirty-two studies, evaluating 23 walking tests, were included. The tests assessed walking using the outcome measures of walking speed, walking distance, functional ambulation and walking on different surfaces. The methodological design and statistical methods of most studies evaluating reliability and criterion validity were sufficient, and found the outcome measures to be reliable and valid. However, data on measurement error, minimal important difference and minimal important change were lacking and responsiveness was correctly evaluated in one study only. CONCLUSIONS: Many walking tests have been clinimetrically evaluated in stroke survivors. Most walking tests were found to be reliable and valid.

Investigation of sleep disturbance in chronic low back pain: an age- and gender-matched case-control study over a 7-night period.

Sleep disturbance is frequently reported by people with chronic low back pain (>12 weeks; CLBP), but few studies have comprehensively investigated sleep in this population. This study investigated differences in subjectively and objectively measured sleep patterns of people with CLBP, and compared this to age- and gender matched controls. Thirty-two consenting participants (n = 16 with CLBP, n = 16 matched controls), aged 24-65 years (43.8% male) underwent an interview regarding sleep influencing variables, completed the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Pittsburgh Sleep Diary, SF36-v2, Hospital Anxiety and Depression Scale, Oswestry Disability Index, Numerical Pain Rating Scales, and underwent seven consecutive nights of actigraphic measurement in the home environment. Compared to controls, people with CLBP had, on self-report measures, significantly poorer sleep quality [Pittsburgh Sleep Quality Index (range 0-21) mean (SD) 10.9 (4.2)], clinical insomnia [Insomnia Severity Index mean (range 0-28) 13.7 (7.6)], lower sleep efficiency, longer sleep onset latency, more time awake after sleep onset, and more awakenings during sleep (p < 0.05). However, no significant differences between groups were found on objective actigraphy (p > 0.05). The findings provide some evidence to support self-reported sleep assessment as an outcome measure in CLBP research, while further research is needed to determine the validity of objective sleep measurement in this population.

Objective measurements of sleep for non-laboratory settings as alternatives to polysomnography--a systematic review.

Sleep disturbance influences human health. To examine sleep patterns, it is advisable to utilize valid subjective and objective measures. Laboratory-based polysomnography (PSG) is deemed the gold standard to measure sleep objectively, but is impractical for long-term and home utilization (e.g. resource-demanding, difficult to use). Hence, alternative devices have been developed. This study aimed to review the literature systematically, providing an overview of available objective sleep measures in non-laboratory settings as an alternative to PSG. To identify relevant articles, a specific search strategy was run in EMBASE, PubMed, CINAHL, PsycInfo and Compendex (Engineering Village 2). In addition, reference lists of retrieved articles were screened and experts within this research field were contacted. Two researchers, using specified in/exclusion criteria, screened identified citations independently in three stages: on title, abstract and full text. Data from included articles were extracted and inserted into summarizing tables outlining the results. Of the 2217 electronically identified citations, 35 studies met the inclusion criteria. Additional searches revealed eight papers. Psychometric characteristics of nine different objective measures of sleep pattern alternatives to PSG [(bed) actigraphy, observation, bed sensors, eyelid movement- and non-invasive arm sensors, a sleep switch and a remote device] were evaluated. Actigraphy is used widely and has been validated in several populations. Alternative devices to measure sleep patterns are becoming available, but most remain at prototype stage and are validated insufficiently. Future research should concentrate on the development and further validation of non-invasive, inexpensive and user-friendly sleep measures for non-laboratory settings.

Efficacy of taping for the treatment of plantar fasciosis: a systematic review of controlled trials.

BACKGROUND: The proximal insertional disorder of the plantar fascia is plantar fasciosis. Although plantar fasciosis is frequently seen by different health-care providers, indistinctness of etiology and pathogenesis is still present. A variety of interventions are seen in clinical practice. Taping constructions are frequently used for the treatment of plantar fasciosis. However, a systematic review assessing the efficacy of this therapy modality is not available. METHODS: To assess the efficacy of a taping construction as an intervention or as part of an intervention in patients with plantar fasciosis on pain and disability, controlled trials were searched for in CINAHL, EMBASE, MEDLINE, Cochrane CENTRAL, and PEDro using a specific search strategy. The Physiotherapy Evidence Database scale was used to judge methodological quality. Clinical relevance was assessed with five specific questions. A best-evidence synthesis consisting of five levels of evidence was applied for qualitative analysis. RESULTS: Five controlled trials met the inclusion criteria. Three trials with high methodological quality and of clinical relevance contributed to the best-evidence synthesis. The findings were strong evidence of pain improvement at 1-week follow-up, inconclusive results for change in level of disability in the short term, and indicative findings that the addition of taping on stretching exercises has a surplus value. CONCLUSIONS: There is limited evidence that taping can reduce pain in the short term in patients with plantar fasciosis. The effect on disability is inconclusive.