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Muscle volume must increase substantially during childhood growth to generate the power required to propel the growing body. One unresolved but fundamental question about childhood muscle growth is whether muscles grow at equal rates; that is, if muscles grow in synchrony with each other. In this study, we used magnetic resonance imaging (MRI) and advances in artificial intelligence methods (deep learning) for medical image segmentation to investigate whether human lower leg muscles grow in synchrony. Muscle volumes were measured in 10 lower leg muscles in 208 typically developing children (eight infants aged less than 3 months and 200 children aged 5 to 15 years). We tested the hypothesis that human lower leg muscles grow synchronously by investigating whether the volume of individual lower leg muscles, expressed as a proportion of total lower leg muscle volume, remains constant with age. There were substantial age‐related changes in the relative volume of most muscles in both boys and girls (p < 0.001). This was most evident between birth and five years of age but was still evident after five years. The medial gastrocnemius and soleus muscles, the largest muscles in infancy, grew faster than other muscles in the first five years. The findings demonstrate that muscles in the human lower leg grow asynchronously. This finding may assist early detection of atypical growth and allow targeted muscle‐specific interventions to improve the quality of life, particularly for children with neuromotor conditions such as cerebral palsy. [ABSTRACT FROM AUTHOR]

Cerebral palsy is a neurological condition that is known to affect muscle growth. Detailed investigations of muscle growth require segmentation of muscles from MRI scans, which is typically done manually. In this study, we evaluated the performance of 2D, 3D, and hybrid deep learning models for automatic segmentation of 11 lower leg muscles and two bones from MRI scans of children with and without cerebral palsy. All six models were trained and evaluated on manually segmented T1‐weighted MRI scans of the lower legs of 20 children, six of whom had cerebral palsy. The segmentation results were assessed using the median Dice similarity coefficient (DSC), average symmetric surface distance (ASSD), and volume error (VError) of all 13 labels of every scan. The best performance was achieved by H‐DenseUNet, a hybrid model (DSC 0.90, ASSD 0.5 mm, and VError 2.6 cm3). The performance was equivalent to the inter‐rater performance of manual segmentation (DSC 0.89, ASSD 0.6 mm, and VError 3.3 cm3). Models trained with the Dice loss function outperformed models trained with the cross‐entropy loss function. Near‐optimal performance could be attained using only 11 scans for training. Segmentation performance was similar for scans of typically developing children (DSC 0.90, ASSD 0.5 mm, and VError 2.8 cm3) and children with cerebral palsy (DSC 0.85, ASSD 0.6 mm, and VError 2.4 cm3). These findings demonstrate the feasibility of fully automatic segmentation of individual muscles and bones from MRI scans of children with and without cerebral palsy. [ABSTRACT FROM AUTHOR]

Introduction: Low back pain, and especially non-specific low back pain, is a common cause of presentation to the emergency department (ED). Although these patients typically report relatively high pain intensity, the clinical course of their pain and disability remains unclear. Our objective was to review the literature and describe the clinical course of non-specific low back pain after an ED visit.Methods: Electronic searches were conducted using MEDLINE, CINAHL and EMBASE from inception to March 2019. We screened for cohort studies or randomised trials investigating pain or disability in patients with non-specific low back pain presenting to EDs. We excluded studies that enrolled participants with minimal pain or disability scores at baseline. Two reviewers independently screened the full texts, extracted the data and assessed risk of bias and quality of evidence. Estimates of pain and disability were converted to a common 0-100 scale. We estimated pooled means and 95% CIs of pain and disability as a function of time since ED presentation.Results: Eight studies (nine publications) with a total of 1994 patients provided moderate overall quality evidence of the expected clinical course of low back pain after an ED visit. Seven of the eight studies were assessed to have a low risk of bias. At the time of the ED presentation, the pooled estimate of the mean pain score on a 0-100 scale was 71.0 (95% CI 64.2-77.9). This reduced to 46.1 (95% CI 37.2-55.0) after 1 day, 41.8 (95% CI 34.7 to 49.0) after 1 week and 13.5 (95% CI 5.8-21.3) after 26 weeks. The course of disability followed a similar pattern.Conclusions: Patients presenting to EDs with non-specific low back pain experience rapid reductions in pain intensity, but on average symptoms persisted 6 months later. This review can be used to educate patients so they can have realistic expectations of their recovery. [ABSTRACT FROM AUTHOR]

AbstractBackgroundObjectivesMethodsResultsConclusionsSystematic reviews are potentially less biased and provide more precise estimates than primary studies of diagnostic test accuracy. Their use to inform evidence-based diagnosis is rapidly expanding. However, the extent, scope and methodologies of systematic reviews of studies of the accuracy of diagnostic tests relevant to physical therapy have not yet been described. Information about methods used in these systematic reviews could inform future reviews and subsequently improve evidence-based diagnosis in physical therapy.  To describe the systematic review methodology of diagnostic test accuracy studies relevant to physical therapy.All systematic reviews indexed on DiTA (Diagnostic Test Accuracy database) were included. Data on methodology, reporting characteristics, and review topics were extracted. A random sample was assessed for risk of bias using the Risk Of Bias In Systematic Reviews (ROBIS) tool.  The review included 241 reviews published between 1995 and 2022, covering all 10 major physical therapy subdisciplines, although 90% related to musculoskeletal physical therapy. In 72% of reviews, QUADAS and QUADAS-2 were used to assess the risk of bias. In a random sample of included reviews, 47% of reviews displayed a ‘high’ risk of bias.  Systematic reviews of diagnostic test accuracy studies relevant to physical therapists are becoming more prevalent. There is a relatively large number of these reviews however a large proportion use methods that expose them to bias. This makes the interpretation of their results more difficult. Future research could focus on publishing methodology guidelines for physical therapy-relevant diagnostic test accuracy reviews. [ABSTRACT FROM AUTHOR]

Introduction: Low back pain, and especially non-specific low back pain, is a common cause of presentation to the emergency department (ED). Although these patients typically report relatively high pain intensity, the clinical course of their pain and disability remains unclear. Our objective was to review the literature and describe the clinical course of non-specific low back pain after an ED visit., Methods: Electronic searches were conducted using MEDLINE, CINAHL and EMBASE from inception to March 2019. We screened for cohort studies or randomised trials investigating pain or disability in patients with non-specific low back pain presenting to EDs. We excluded studies that enrolled participants with minimal pain or disability scores at baseline. Two reviewers independently screened the full texts, extracted the data and assessed risk of bias and quality of evidence. Estimates of pain and disability were converted to a common 0-100 scale. We estimated pooled means and 95% CIs of pain and disability as a function of time since ED presentation., Results: Eight studies (nine publications) with a total of 1994 patients provided moderate overall quality evidence of the expected clinical course of low back pain after an ED visit. Seven of the eight studies were assessed to have a low risk of bias. At the time of the ED presentation, the pooled estimate of the mean pain score on a 0-100 scale was 71.0 (95% CI 64.2-77.9). This reduced to 46.1 (95% CI 37.2-55.0) after 1 day, 41.8 (95% CI 34.7 to 49.0) after 1 week and 13.5 (95% CI 5.8-21.3) after 26 weeks. The course of disability followed a similar pattern., Conclusions: Patients presenting to EDs with non-specific low back pain experience rapid reductions in pain intensity, but on average symptoms persisted 6 months later. This review can be used to educate patients so they can have realistic expectations of their recovery., Competing Interests: Competing interests: CGM is supported by a Principal Research Fellowship from Australia’s National Health and Medical Research Council (APP1103022) as well as a Program grant (APP1113532) and two Centre for Research Excellence grants (APP1134856, APP1171459). He has received research grants from various government and not for profit agencies. His expenses have been covered by professional associations hosting conferences he has spoken at. GCM is supported by an Early Career Fellowship from Australia’s National Health and Medical Research Council (APP1141272). FlexEze provided heat wraps at no cost for the SHaPED trial that DMC, GCM, BR and CGM are investigators on., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)