Long-term outcome collection after hip fracture in Ireland: a systematic review of traditional and grey literature.

This review aimed to describe the methods and results from recent Irish research about post-acute hip fracture outcomes. Meta-analyses estimate the 30-day and 1-year mortality rate at 5% and 24% respectively. There is a need for standardised recommendations about which data should be recorded to aid national and international comparisons. PURPOSE: Over 3700 older adults experience hip fracture in Ireland annually. The Irish Hip Fracture Database national audit records acute hospital data but lacks longer-term outcomes. This systematic review aimed to summarise and appraise recent Irish studies that collected long-term hip fracture outcomes and to generate pooled estimates where appropriate. METHODS: Electronic databases and grey literature were searched in April 2022 for articles, abstracts, and theses published from 2005 to 2022. Eligible studies were appraised by two authors and outcome collection details summarised. Meta-analyses of studies with common outcomes were conducted where the sample was generalisable to the broad hip fracture population. RESULTS: In total, 84 studies were identified from 20 clinical sites. Outcomes commonly recorded were mortality (n = 48 studies; 57%), function (n = 24; 29%), residence (n = 20; 24%), bone-related outcomes (n = 20; 24%), and mobility (n = 17; 20%). One year post-fracture was the most frequent time point, and patient telephone contact was the most common collection method used. Most studies did not report follow-up rates. Two meta-analyses were performed. The pooled estimate for one-year mortality was 24.2% (95% CI = 19.1-29.8%, I2 = 93.8%, n = 12 studies, n = 4220 patients), and for 30-day mortality was 4.7% (95% CI = 3.6-5.9%, I2 = 31.3%, n = 7 studies, n = 2092 patients). Reports of non-mortality outcomes were deemed inappropriate for meta-analysis. CONCLUSION: Hip fracture long-term outcomes collected in Irish research are broadly in line with international recommendations. Heterogeneity of measures and poor reporting of methods and findings limits collation of results. Recommendations for standard outcome definitions nationally are warranted. Further research should explore the feasibility of recording long-term outcomes during routine hip fracture care in Ireland to enhance national audit.

Clinical pathways for the management of low back pain from primary to specialised care: a systematic review.

PURPOSE: Clinical pathways for low back pain (LBP) have potential to improve clinical outcomes and health service efficiency. This systematic review aimed to synthesise the evidence for clinical pathways for LBP and/or radicular leg pain from primary to specialised care and to describe key pathway components. METHODS: Electronic database searches (CINAHL, MEDLINE, Cochrane Library, EMBASE) from 2006 onwards were conducted with further manual and citation searching. Two independent reviewers conducted eligibility assessment, data extraction and quality appraisal. A narrative synthesis of findings is presented. RESULTS: From 18,443 identified studies, 28 papers met inclusion criteria. Pathways were developed primarily to address over-burdened secondary care services in high-income countries and almost universally used interface services with a triage remit at the primary-secondary care boundary. Accordingly, evaluation of healthcare resource use and patient flow predominated, with interface services associated with enhanced service efficiency through decreased wait times and appropriate use of consultant appointments. Low quality study designs, heterogeneous outcomes and insufficient comparative data precluded definitive conclusions regarding clinical- and cost-effectiveness. Pathways demonstrated basic levels of care integration across the primary-secondary care boundary. CONCLUSIONS: The limited volume of research evaluating clinical pathways for LBP/radicular leg pain and spanning primary and specialised care predominantly used interface services to ensure appropriate specialised care referrals with associated increased efficiency of care delivery. Pathways demonstrated basic levels of care integration across healthcare boundaries. Well-designed randomised controlled trials to explore the potential of clinical pathways to improve clinical outcomes, deliver cost-effective, guideline-concordant care and enhance care integration are required.

Detecting subtle mobility changes among older adults: the Quantitative Timed Up and Go test.

BACKGROUND: The Quantitative Timed Up and Go (QTUG) test uses wearable sensors, containing a triaxial accelerometer and an add-on triaxial gyroscope, to quantify performance during the TUG test with potential to capture more minor changes in mobility. AIMS: To examine the responsiveness, minimum detectable change (MDC) and observed effect size of QTUG in a cohort of socially active adults aged 50 years and over participating in a structured community exercise program. METHODS: 54 participants (91% females, mean age 63.6 ± 6.5 years) completed repeated QTUG testing under single- and dual-task conditions. Responsiveness of the QTUG was assessed by correlation of change in standard TUG with QTUG change (Pearson's correlation coefficient). MDC and effect sizes (standardized mean difference and Cohen's d) were also calculated for QTUG. RESULTS: There was a strong positive correlation between change in the standard TUG and change in QTUG (single task r = 0.91, p < 0.001). MDC in QTUG was calculated as 0.77 (Sd, 1.39; ICC 0.96) seconds (single task) and 2.33 (Sd 2.18; ICC 0.85) seconds (dual task). Several QTUG parameters showed improvements in mean values with small effect sizes (sit -to-stand transition time d = 0.418; walk time d = 0.398; cadence d = 0.306, swing time d = 0.314; step time d = 0.479; gait velocity d = 0.365; time to reach turn d = 0.322) under single-task conditions and with a moderate effect size (d = 0.549) in time taken to turn under the dual-task condition. CONCLUSION: Initial evidence of QTUG's responsiveness to change in mobility in active middle to older age adults has been demonstrated with small to moderate effect sizes observed in specific QTUG parameters.

Development of real world learning opportunities in community exercise prescription for healthcare professional programmes - 'Physio Hub'.

BACKGROUND: Given the challenge of chronic lifestyle diseases, the shift in healthcare focus to primary care and recognised importance of a preventive approach to health, including exercise prescription, the embedding of related learning in healthcare professional programmes is critical. METHODS: In response to these contemporary demands, a complex curriculum development project was undertaken at University College Dublin, employing a four dimensional curriculum framework for the development of health professional curricula, that focused on (1) future orientation of healthcare practices (the why?), (2) defining capabilities of graduates (the what?), (3) teaching, learning and assessment (the how?) and (4) organisation/institution delivery (the where)? The process was informed by latest exercise, health promotion, educational and health policy literature, alongside engagement with multiple internal university and external community stakeholders. RESULTS: Having sufficient clinical education opportunity for translating exercise theory into practice was identified as a key need (the Why?). Development of strategies for health promotion and design and delivery of evidence based exercise programmes with inter-professional and inter-sectoral network building were some of the graduate capabilities identified as being critically important. (the what?) The resultant UCD Physio Hub model of clinical education combines 'on campus' and 'community outreach' activity to facilitate inter-sectoral 'real world' experiential student learning in health promotion and exercise prescription for both healthy and clinical populations. Underpinned by social constructivist educational theory, students are encouraged to be creative and to collaborate in responding to identified health needs of specific community groups by designing and delivering community services. (the how?) In developing new student learning opportunities to enhance curriculum, a supportive organisational culture and context was critical with UCD having excellent exercise infrastructure and the Physio Hub project aligning with a community engagement ethos articulated in the university's strategy. (the where?) CONCLUSION: This paper provides an overview of Physio Hub, its services, educational practices and translational research ethos, all of which are combined to deliver a rich exercise and health promotion learning experience. Although developed for physiotherapy in this instance, the curriculum process and resultant education model could be applied across medical and other health professional programmes and to facilitate interdisciplinary learning.

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

BACKGROUND: Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services. METHOD: Throughout 2014, APPs (n = 22) entered clinical data on a national database. Analysis of these data using descriptive statistics determined patient wait times, Consultant Doctor involvement in clinical decisions, and patient clinical outcomes. Chi square tests were used to compare patient clinical outcomes across orthopaedic and rheumatology clinics. A pilot study at one site identified re-referral rates to orthopaedic/rheumatology services of patients managed by the APPs. RESULTS: In one year, 13,981 new patients accessed specialist orthopaedic and rheumatology consultations via the APP. Median wait time for an appointment was 5.6 months. Patients most commonly presented with knee (23%), lower back (22%) and shoulder (15%) disorders. APPs made autonomous clinical decisions regarding patient management at 77% of appointments, and managed patient care pathways without onward referral to Consultant Doctors in more than 80% of cases. Other onward clinical pathways recommended by APPs were: physiotherapy referrals (42%); clinical investigations (29%); injections administered (4%); and surgical listing (2%). Of those managed by the APP, the pilot study identified that only 6.5% of patients were re-referred within one year. CONCLUSION: This national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment. Therefore, patients gained earlier access to orthopaedic and rheumatology consultations in secondary care, with most patients conservatively managed.

The Influence of a Cognitive Dual Task on the Gait Parameters of Healthy Older Adults: A Systematic Review and Meta-Analysis.

This review examines the effect of a dual task on the gait parameters of older adults with a mean gait speed of 1.0 m/s or greater, and the effect of type and complexity of task. A systematic review of Web of Science, PubMed, SCOPUS, Embase, and PsycINFO was performed in July 2016. Twenty-three studies (28 data sets) were reviewed and pooled for meta-analysis. The effect size on seven gait parameters was measured as the raw mean difference between single- and dual-task performance. Gait speed significantly reduced with the addition of a dual task, with increasing complexity showing greater decrements. Cadence, stride time, and measures of gait variability were all negatively affected under the dual-task condition. In older adults, the addition of a dual task significantly reduces gait speed and cadence, with possible implications for the assessment of older people, as the addition of a dual task may expose deficits not observed under single-task assessment.

'Look up from the waiting list and see the bigger picture': a qualitative analysis of clinical specialist physiotherapist perspectives on low back pain care in Ireland.

INTRODUCTION: Healthcare systems are struggling to deliver high-quality low back pain (LBP) care. In 2012 specialist physiotherapist-led musculoskeletal (MSK) triage services were introduced in Irish hospitals to expedite patient care and alleviate pressure on elective orthopaedic/ rheumatology consultant clinics. Specialist physiotherapists have expertise to inform health service improvement and reform, but their perspectives of LBP healthcare delivery have received scant attention. OBJECTIVES: To explore specialist physiotherapists' perspectives on LBP care in Ireland, the barriers and facilitators to quality LBP care and the development of MSK interface services in primary care settings. DESIGN: Cross-sectional observational study using an anonymous electronic survey with thematic framework analysis of response data from open-ended questions. PARTICIPANTS: Thirty-four clinical specialist physiotherapists in Irish MSK triage services. RESULTS: Thematic analysis resulted in six overarching themes, grouped into two categories. One category pertained to LBP healthcare in Ireland with the following three themes: 1) Inadequate health services for patients with LBP; 2) Need for defined LBP clinical pathways; 3) Need for a multisectoral approach to spine health. Themes in the second category, pertaining to the development of community-based MSK interface services, were: 4) Concern regarding isolation from secondary care services; 5) Unrealistic expectations of MSK triage; 6) Improved communication and collaboration with primary care services. CONCLUSION: Specialist physiotherapists have concerns regarding LBP health services and persistence of a biomedical, secondary care-led approach. They advocate for investment in primary care multi-disciplinary teams, enhanced integration across primary and secondary care, development of a national clinical pathway and a multisectoral approach. CONTRIBUTION OF PAPER.

Informing low back pain care from the ground up: Survey of national musculoskeletal triage physiotherapists in Ireland.

BACKGROUND: Healthcare is changing to meet the challenge of a rising musculoskeletal burden associated with the expanding, aging population. Clinicians, important stakeholders in healthcare provision, have crucial insights into service improvement, but clinician consultation is a shortcoming in healthcare development. In Ireland, specialist physiotherapist-led musculoskeletal (MSK) triage services operate at the primary-secondary care interface to expedite patient care. OBJECTIVES: To inform future development of low back pain (LBP) care in Ireland through profiling the operationalisation of the national MSK triage service for LBP, including access, referral management, clinical investigations, onward referral options, access to multidisciplinary team (MDT) services and integration with primary healthcare services. DESIGN: Cross-sectional observational study using a bespoke, anonymous electronic survey. PARTICIPANTS: Thirty-eight clinical specialist physiotherapists working in national programme Irish MSK triage services. RESULTS: Thirty-eight MSK Triage physiotherapists submitted responses (response rate 72%). There was considerable site-dependent variation in LBP service provision, with discrepancies in access to triage services, wait times, referral processing and prioritisation, access to clinical investigations and onward referral options. Most respondents (81%) reported wait times exceeding the three-month target; 75% reported that the level of clinical autonomy associated with their role limited service efficiency; 75% were dissatisfied with primary-secondary care service integration. Respondents identified insufficient availability of primary care multidisciplinary services. CONCLUSION: Lack of standardisation of LBP services exists in Ireland. Services would benefit from improved standardisation, reduced wait times, national accreditation and a defined scope of advanced physiotherapy practice and the development of nationwide community multidisciplinary infrastructure with enhanced interservice communication.

Exploring the acceptability of three time-matched exercise interventions for increasing fitness in women living with obesity: A mixed-methods evaluation of the EXOFFIT study.

Background: The EXOFFIT study compared the effectiveness of three time-matched exercise interventions in women with obesity for improving cardiorespiratory fitness. To best inform future research, evaluation of the interventions' acceptability is needed. Previous research has been inconsistent with methods and reporting of acceptability. Thus, the theoretical framework of acceptability (TFA) can be utilized to ensure that all aspects of acceptability are evaluated. No study to date in women with obesity has utilized the TFA in conjunction with quantitative data (i.e., frequencies of themes) to highlight the aspects of interventions that may be most important for participants. Objective: This study aimed to examine the acceptability of the EXOFFIT program and gain insight into the participants' experience of participation, their perspective on the acceptability of trial procedures and interventions and gather their feedback on program changes. Methods: A mixed-methods approach was employed. Thirty-eight participants who completed the exercise interventions were interviewed and completed a self-reported exit questionnaire. Interviews were transcribed verbatim and analyzed in three phases: emergent themes were agreed upon, then mapped to the TFA constructs and the frequencies of each construct and theme were presented as counts. Data collected from the exit questionnaire were collated and reported using descriptive statistics. Results: All seven TFA constructs were identified in the analysis. The EXOFFIT program was found to have a high level of acceptability, with affective attitude, perceived effectiveness and self-efficacy being the most reported constructs. The burden and opportunity costs associated with the program were mainly related to family commitments and support needed to participate. Any negative impact of participation was noted to be outweighed by the perceived benefits. Conclusions: The results of this study will inform the development of future programs with women with obesity and support the consideration of the TFA constructs from the outset of study design.Clinical Trial Registration Number: ISRCTN13517067.

Developing an international competency and capability framework for advanced practice physiotherapy: a scoping review with narrative synthesis.

INTRODUCTION: The need to address increasing numbers of people seeking care, insufficient numbers of physicians, and providing high-value and sustainable care has contributed to changing physiotherapy practice across the world, often referred to as advanced practice physiotherapy. Currently, there is no internationally standardized competency and capability framework to support advanced practice physiotherapy. OBJECTIVES: This scoping review has two aims; 1) To identify and map out the competencies of advanced practice physiotherapy available in the literature. 2) To develop a competency and capability framework by mapping the competencies identified from the review. DESIGN: The Arksey and O'Malley framework and the PRISMA Scoping review methodology were used. Databases searched included CINAHL Plus, MEDLINE Ovid, PubMed, and Scopus. The competency and capability framework was developed through a narrative synthesis approach. RESULTS: Nineteen documents were included in the final review, with 13 grey literature (government reports, policy documents, thesis) and six research papers. Included publications came from the United Kingdom, Ireland, Australia, New Zealand, and Canada. The included documents covered predominantly musculoskeletal practice (n = 17). The others focused on cardiorespiratory care, incontinence and pelvic health. Through narrative synthesis, 27 competencies and capabilities were identified and grouped under seven domains. CONCLUSION: The synthesis of this scoping review provides the first competency and capability framework for advanced practice physiotherapy that integrates competencies and capabilities from five different countries. With the expansion of advanced practice physiotherapy, the framework developed from this review is the first step towards international recognition, standardization and consistency of education and training of practitioners. CONTRIBUTION OF THE PAPER.

Evaluating the importance of a core competency and capability framework for advanced practice physiotherapy: A cross-sectional survey.

INTRODUCTION: The need for a global core competency and capability framework for advanced practice physiotherapy is important due to the rapidly changing nature of health care delivery internationally and the need to standardize advanced practice physiotherapy. OBJECTIVE: To determine the importance of a proposed international core competency and capability framework for advanced practice physiotherapy. METHODS: We conducted a cross-sectional online survey of advanced practice physiotherapists across seven countries. The importance of each competency and capability was rated on a five-point agreement Likert scale. Participants were from the United Kingdom, Ireland, Australia, New Zealand, Canada, Switzerland and Argentina. RESULTS: A total of 99 participants completed the survey, comprising 63% (57/90) females and 33% (30/90) males. Sixty percent, 60% (54/90), had over 20 years of experience. The survey participants represented a diverse geographic distribution, with 25% (23/90) from Australia, 25% (23/90) from Canada, 18% (6/90) from New Zealand, and 18% (6/90) from the United Kingdom. Four percent 4% (4/90) from Ireland, and 4% (4/90) from other countries (Switzerland and Argentina). The survey revealed a strong consensus among participants, with all competencies and capabilities ranked as high and considered important to advanced practice. CONCLUSION: This study demonstrates a consensus among advanced practice physiotherapists across seven countries on the importance of a proposed competency and capability framework. The findings highlight the need for a global standard in advanced practice physiotherapy, particularly in light of the rapidly changing healthcare landscape.

Physical activity should be the primary intervention for individuals living with chronic pain A position paper from the European Pain Federation (EFIC) 'On the Move' Task Force.

BACKGROUND: There is clear evidence demonstrating the benefits of physical activity (PA) on pain and overall health, however, PA is challenging for many individuals living with chronic pain. Even non-exercise specialists can (cost) effectively promote PA, but many health professionals report a number of barriers in providing guidance on PA, suggesting that it is not consistently promoted. This expert position paper summarizes the evidence and provides five recommendations for health professionals to assess, advise and support individuals living with any chronic pain condition with a long life expectancy in adopting and sustaining physically active lifestyles. METHODS: This position paper was prepared by the 'On The Move' Task Force of the European Pain Federation EFIC. Final recommendations were endorsed by the European Pain Forum, Pain Alliance Europe and the Executive Board of EFIC. RESULTS: We recommend that all health professionals (1) Take a history of the persons' PA levels, and put PA on the agenda, (2) Advise that PA is important and safe for individuals living with chronic pain, (3) Deliver a brief PA intervention and support individuals living with chronic pain in becoming physically active, (4) Discuss acceptable levels of PA-related soreness and pain and (5) Provide ongoing support in staying physically active. SIGNIFICANCE: Physical activity is safe and offers several advantages, including general health benefits, low risk of side effects, low cost and not requiring access to healthcare. Adoption of these recommendations can improve the quality of care and life of individuals living with chronic pain and reduce their overall health risks.

Work-related musculoskeletal disorders among Irish farm operators.

BACKGROUND: To establish prevalence, risk factors, and impact of work-related musculoskeletal disorders (WMSDs) among farmers in Ireland. METHODS: In summer 2009, a questionnaire was appended to the Teagasc (Irish Agricultural and Food Development Authority) National Farm Survey (n = 1,110) to obtain data on the prevalence, risk factors and impact of WMSDs amongst farm operators in Ireland. Data were collected by trained recorders and analyzed using chi-square tests, t-tests, Mann-Whitney's U-tests and logistic regression models. RESULTS: The prevalence of WMSDs in the previous year was 9.4% (n = 103), with the most commonly affected body region being the low back 31% (n = 32). Nearly 60% (n = 57) of farmers reported missing at least a full day's work as a consequence of their WMSD. Personal factors evaluated using binary regression analysis, were found not to influence whether or not a farmer experienced a WMSD. However, work-related factors such as larger European Size Units (ESUs, OR: 1.007, CI: 1.002-1.012), greater number of hectares farmed (OR: 2.501, CI: 1.208-4.920), higher income (OR: 1.859, CI: 1.088-3.177), dairy enterprise (OR: 1.734, CI: 1.081-2.781), and working on a full-time farm (OR: 2.156, CI: 1.399-3.321) increased the likelihood of experiencing a WMSD. Working on a full-time farm was the only factor found to independently predict WMSDs in the multiple regression analyses. CONCLUSIONS: This study suggests that the prevalence of WMSDs can be reduced by the application of improved farm management practices. A more detailed examination of the risk factors associated with WMSDs is required to establish causality and develop effective interventions.

Developing a core competency and capability framework for advanced practice physiotherapy: A qualitative study.

INTRODUCTION: There is an urgent need to develop an international competency and capability framework to support standardization of education and roles in advanced practice physiotherapy (APP). This need arose due to the rapid growth of the APP model of care, implemented out of necessity in the absence of agreement as to the competencies and capabilities or formal education required for the roles. This study explores the views and perceptions of practitioners and key stakeholders on a draft competency and capability framework for advanced practice physiotherapists. OBJECTIVES: The purpose of this study was to: 1) gather feedback from key stakeholders (advanced practice physiotherapists, researchers, and leaders) on a draft competency and capability framework and 2) use that feedback to revise and improve the draft framework. DESIGN: Qualitative study using a series of four multi-national online focus groups. Thematic analysis was conducted according to Braun and Clarke. RESULTS: Sixteen participants from the United Kingdom, Ireland, Canada, Australia, and New Zealand participated in the study. Five themes were generated after data analysis: clinical expert, experienced communicator, strong leader, collaborator, and knowledge creator). A modified competency and capability framework was developed based on feedback from the focus groups and input from subject matter experts (SMEs). CONCLUSION: This study provides a modified core competency and capability framework comprising 24 competencies grouped under six domains. This study is a step toward international standardization of advanced practice physiotherapy based on a commonly agreed framework for the education and training of advanced practice physiotherapists.

Gym staff perspectives on disability inclusion: a qualitative study.

PURPOSE: To explore gym staff perspectives on the inclusion of people with disability in the gym setting. MATERIALS AND METHODS: Semi-structured interviews were conducted with 16 staff at four urban gym facilities, exploring perspectives on disability inclusion. An interpretive descriptive approach was adopted with reflexive thematic analysis of interview data and subsequent mapping of themes to the socioecological model. RESULTS: Consistent with the socioecological model, the themes identified were "people with disability benefit from participation in gym settings" (personal); "positive interactions with people with disability" (interpersonal); "managing expectations of other gym users" (interpersonal); "inclusion is supported by a positive ethos, staff training and accessible facilities" (organisational); "people with disability lack awareness of inclusive exercise opportunities" (community); "desire to increase collaboration with healthcare professionals" (community); "access to transport can facilitate gym attendance" (community) and "local gym policy" (policy). CONCLUSION: Although an overall ethos of inclusion was apparent, areas identified for enhancement were: awareness of gym services in the community; inter-sectoral collaboration with healthcare and disability organisations; comprehensive disability inclusion training; transport systems and accessibility; engaging people with disability in gym service planning. Implications for rehabilitationGym staff value collaboration with healthcare and rehab professionals to support inclusion of people with disability in exercise.Standardised disability inclusion training for gym staff is recommended.Individuals with disability should be empowered to contribute to the development of inclusive gym facilities and services.Rehab professionals have a role to play in raising awareness and advocating for inclusive exercise opportunities.

Prevalence of musculoskeletal disorders among farmers: A systematic review.

OBJECTIVE: To determine the prevalence of musculoskeletal disorders (MSDs) among farmers and to establish the most common regional MSDs reported. METHODS: Comprehensive electronic searches of Pubmed, Web of Science, CINAHL, SCOPUS, EMBASE, Agris Database, and Cochrane Library were carried out using keywords for MSDs and farmers. Pooled estimates of prevalence with 95% confidence intervals were calculated for overall MSD prevalence and the most common regional MSDs reported. RESULTS: Twenty-four studies fulfilled the inclusion criteria and were incorporated into this review. From these studies, life-time prevalence of any form of MSD among farmers was 90.6% while 1-year MSD prevalence was 76.9% (95% CI 69.8-82.7). The majority of studies focused on spinal MSDs with low back pain (LBP) the most frequently investigated. Life-time LBP prevalence was 75% (95% CI 67-81.5) while 1-year LBP prevalence was 47.8% (95% CI 40.2-55.5). The next most common regional MSDs reported were upper (range 3.6-71.4%) and lower extremities (range 10.4-41%). CONCLUSIONS: The systematic review identified the prevalence of MSDs by body region in farmers and established that LBP was the most common MSD, followed by upper and then lower extremity MSDs. Reported trends suggest that the prevalence of MSDs in farmers is greater than in non-farmer populations. Case-definition uniformity among MSD researchers is warranted. More studies are needed regarding upper and lower extremity MSDs, gender, workplace, and task context of MSDs.

Risk factors for musculoskeletal disorders among farm owners and farm workers: a systematic review.

BACKGROUND: A systematic review was undertaken to establish risk factors for the development of musculoskeletal disorders (MSDs) among farmers. METHODS: Comprehensive electronic searches of Pubmed, Web of Science, CINAHL, SCOPUS, EMBASE, Agris Database, and Cochrane Library were carried out using a battery of key words for MSDs and farmers. The studies methods quality was assessed using a standardized checklist. RESULTS: Thirty-three studies fulfilled the inclusion criteria. The median method score was 65% of the maximum attainable score, resulting in 15 studies of higher methodological. Risks were categorized into: Work characteristics (n = 11), personal characteristics (n = 5), and psychosocial factors (n = 5). Spinal MSD risk factors include exposure to working in tree crops, vibration, postural load, being an owner operator, age, education beyond high school, suffering from asthma or depression, having <8 hr nightly sleep, bad quality sleep, and geographic location. Upper extremity MSD risk factors include being an owner operator, dust with pig workers, numbness and coldness in younger milkers and numbness in milkers >43 years, age, and body height in dairy farmers. Lower extremity MSD risk factors include, duration of farming ≥10 years, working >5 hr daily in animal barns, milking >40 cows, years as a dairy farmer, farm work, age, body mass, and female gender. CONCLUSIONS: In exploring risk factors the spine was the most researched body region, followed by lower and upper extremity. Given the variance between studies, it is recommended that future studies focus on specific types of farmers and should explore specific exposures for specific body parts using standardized case definitions.

Comparison of time-matched aerobic, resistance or combined exercise training in women living with obesity: a protocol for a pilot randomised controlled trial-the EXOFFIT (Exercise for Obesity in Females to increase Fitness) study.

INTRODUCTION: Obesity in women has more than doubled in the past thirty years. Increasing research suggests that increased cardiorespiratory fitness (CRF) can largely attenuate the negative health risks associated with obesity. Though previous literature suggests that combined training may be the most effective for improving CRF in adults with obesity, there is minimal research investigating the efficacy of combined and resistance programmes in women with obesity. This article outlines a protocol for a parallel pilot study which aims to evaluate the feasibility and efficacy of three exercise modalities in women with obesity for increasing CRF and strength and improving body composition and other health outcomes (i.e. quality of life). METHODS AND ANALYSIS: Sixty women (aged 18-50) with obesity (body mass index [BMI] ≥ 30 and/or waist circumference ≥ 88 cm) who are physically inactive, have no unstable health conditions and are safe to exercise will be recruited from September 2021 to December 2022. The main outcome will be feasibility and acceptability of the intervention and procedures. Trial feasibility outcomes will be evaluated to determine if a definitive trial should be undertaken. Trial acceptability will be explored through follow-up qualitative interviews with participants. Secondary outcomes will include CRF (predicted VO2 max), anthropometrics (i.e. BMI), strength (5RM bench press, leg dynamometry, grip strength) and other health outcomes (i.e., pain). Participants will be block randomised into one of four trial arms (aerobic exercise, resistance training and combined training groups, non-active control group) and measurements will be completed pre- and post-intervention. The exercise groups will receive an individualised supervised exercise programme for 3× sessions/week for 12 weeks. The change in mean values before and after intervention will be calculated for primary and secondary outcomes. ANOVA and t-tests will be applied to evaluate within-group and between-group differences. If sufficient participants are recruited, the data will be analysed using ANCOVA with the age and BMI as covariates. DISCUSSION: This pilot will provide data on the feasibility and acceptability of trial procedures and of the programmes' three progressive time-matched exercise interventions (aerobic, resistance and combined) for women living with obesity, which will help inform future research and the potential development of a full-scale randomised clinical trial. TRIAL REGISTRATION: ISRCTN, ISRCTN13517067 . Registered 16 November 2021-retrospectively registered.

Impact of training modes on fitness and body composition in women with obesity: A systematic review and meta-analysis.

OBJECTIVE: This study aimed to assess the effectiveness of different exercise modalities and determine the optimal exercise prescription for improving cardiorespiratory fitness, body composition, and metabolic health of women with obesity. METHODS: A systematic review of randomized controlled trials (RCTs) published between January 1988 and October 2020 was conducted. The RCTs were screened using the following inclusion criteria: 1) participants: women aged 18 to 65 years with BMI > 30 kg/m2 and without comorbidities; 2) intervention: exercise; 3) comparison: non-intervention control; and 4) outcomes measures: cardiorespiratory fitness (maximal oxygen consumption), body composition (i.e., body weight, percentage body fat), and/or metabolic measures (i.e., blood pressure, cholesterol). RESULTS: A total of 20 RCTs with a total of 2,062 participants were included. Although the results showed that any form of exercise was more effective than control, improvements in fitness and body composition were modest. Aerobic exercise (vigorous and moderate intensity) appeared most promising for improving fitness and body weight, whereas low-load resistance training resulted in the largest improvements in body fatness. CONCLUSIONS: In women living with obesity, aerobic exercise was consistently effective in improving fitness and body composition. Although both resistance training and combined exercise interventions appear promising, more research is needed to evaluate their efficacy and determine an optimal exercise prescription for this population.

Mobilisation and physiotherapy intervention following hip fracture: snapshot survey across six countries from the Fragility Fracture Network Physiotherapy Group.

PURPOSE: Hip fracture guidelines recommend early mobilisation, multidisciplinary care, physiotherapy and fall prevention interventions. This study documents mobilisation practices and physiotherapy interventions provided post-hip fracture in six countries. MATERIALS AND METHODS: Physiotherapists from orthopaedic wards in Denmark, Australia, Spain, Brazil, Norway and Ireland provided information regarding mobilisation and physiotherapy for 10 consecutive hip fracture patients (>60 years), between 2014 and 2018. RESULTS: Physiotherapists (n = 107) entered data on 426 patients. Two-thirds of patients (283, 66%) attempted standing 0-1 days after surgery (range: 0% of patients in Spain to 92% in Norway). Fewer patients (199, 47%) attempted walking on day 0-1 (range: 0% Spain/Brazil to 69% Norway). Physiotherapy to mobilise every weekday was provided to 356 patients (84%, range: 60% Ireland to 100% Spain). On weekends, physiotherapy to mobilise was limited (175, 40%, range: 0% Spain to 81% Brazil) but 298 patients (70%) mobilised with non-physiotherapy staff (range: 0% Spain to 96% Denmark/Ireland). Physiotherapy treatments included mobility, gait training, and range-of-motion exercises. Referral to fall prevention interventions was low (93, 22%, range: 0% Spain to 76% Ireland). CONCLUSION: Stronger compliance with guideline recommendations on early mobilising, weekend mobilising and referral to fall prevention interventions post hip-fracture is needed in some countries.Implications for rehabilitation This study provides a snapshot of mobilisation and physiotherapy practice for hip fracture patients in six countries. The results suggest a need to improve systems and approaches in some countries to enhance compliance with recommendations specifically relating to: • early attempts at standing and walking post-surgery. • opportunities to mobilise on weekends (with physiotherapist and/or other staff). • broader range of multidisciplinary care e.g., geriatric review, occupational therapy and nutrition advice. • use of standardised tests by physiotherapists post-surgery. • referral to fall prevention interventions.