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Context: Long-term conditioning programs for enhanced sensorimotor performance have been causally linked to reduced risk of serious ligamentous injury. However, the efficacy of brief, short-term conditioning interventions has not been established. Objective: To assess the effects of short-term sensorimotor conditioning on the knee flexors. Design: Randomized controlled trial. Setting: University research laboratory. Participants: 23 males randomly assigned to conditioning (n = 12; age: 20.5 ±1.8 y; height: 1.80 ± 0.05 m; body mass: 74.3 ±6.0 kg [mean±SD]) and no-conditioning control (n = 11; age: 20.6 ±1.9 y; height: 1.79 ±0.05 m; body mass: 73.6 ±6.3 kg) groups. Intervention: Sensorimotor conditioning of the nondominant leg (4 sessions/wk; 3 wk). Main Outcome Measures: Sensorimotor (blind force and limb-position-replication errors) and neuromuscular (peak force, electromechanical delay [volitional and magnetically evoked]) performance of the knee flexors of both legs were assessed. The contralateral limb and an antecedent period of no conditioning were controls. Results: The conditioned leg showed decreased force error to 3.8% (3.8 ± 6.9% vs 6.3 ± 3.7% [mean ± SD], post- vs preconditioning, respectively; F1,21 = 5.4; P = .04) and a trend toward decreased positional error to 2.0% (2.0 ± 6.9% vs 4.7 ± 7.7%, post- vs preconditioning; F1,21 = 2.7; P = .06). Performances were not altered in the control conditions. Modest improvements were noted for volitional electromechanical delay following conditioning (39.8 ± 4.3 ms vs 42.3 ± 5.2 ms [F1,21 = 7.2; P = .01]), but peak force (overall, 202 ± 78 N) and magnetically evoked electromechanical delay (24.7 ± 4.2 ms) were not influenced. Conclusion: Short-term conditioning offered improved sensorimotor performance and positively affected neuromuscular determinants of knee flexor performance in men. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of early self-managed focal sensorimotor training compared to functional exercise training after total knee replacement on functional mobility and sensorimotor function. Design: A single-blind controlled clinical trial. Setting: University Hospital of Rion, Greece. Subjects: A total of 52 participants following total knee replacement. Outcome measures: The primary outcome was the Timed Up and Go Test and the secondary outcomes were balance, joint position error, the Knee Outcome Survey Activities of Daily Living Scale, and pain. Patients were assessed on three separate occasions (presurgery, 8 weeks post surgery, and 14 weeks post surgery). Intervention: Participants were randomized to either focal sensorimotor exercise training (experimental group) or functional exercise training (control group). Both groups received a 12-week home-based programme prescribed for 3–5 sessions/week (35–45 minutes). Results: Consistently greater improvements (F2,98 = 4.3 to 24.8; P < 0.05) in group mean scores favour the experimental group compared to the control group: Timed Up and Go (7.8 ± 2.9 seconds vs. 4.6 ± 2.6 seconds); balance (2.1 ± 0.9° vs. 0.7 ± 1.2°); joint position error (13.8 ± 7.3° vs. 6.2 ± 9.1°); Knee Outcome Survey Activities of Daily Living Scale (44.2 ± 11.3 vs. 26.1 ± 11.4); and pain (5.9 ± 1.3 cm vs. 4.6 ± 1.1 cm). Patterns of improvement for the experimental group over time were represented by a relative effect size range of 1.3–6.5. Conclusions: Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement. [ABSTRACT FROM AUTHOR]

Background and Purpose In Greece, as in many countries, there is a scarcity of evidence in the type of physiotherapy services offered for the rehabilitation of total knee replacement (TKR). Despite the number of TKRs annually performed in Greece (over 10,000), there are no available clinical guidelines as to the content of best physiotherapy practice. The aim of this nationwide survey undertaken by physiotherapists treating TKR patients post-operatively was to record standard practice and services available in Greece. Methods Design: cross-country survey Ten per cent of all registered physiotherapists working in public/private sectors were recruited. The developed survey comprised of questions regarding therapists' profile, protocols implemented at different stages of rehabilitation and the aims and modalities used. Results A 58.7% response rate was achieved, where 36% (47/132) of respondents were treating patients in the inpatient phase and 64% (85/132) after hospital discharge. Patients in Greece are discharged with a home-based exercise program (56.7%) and, to a lesser extent, are referred to rehabilitation centres (13.3%). Strengthening, range of movement and functionality seemed to be the primary goals especially in the inpatient phase, whereas in the outpatient phase, apart from the larger differences identified, functionality and balance training were more frequently reported. Conclusions No significant variations in practice were found during inpatient rehabilitation, whilst there seemed to be diversity across outpatient physiotherapy programs. The current survey suggests that patient's general health and psychological and behavioural issues are the criteria by which physiotherapists select the volume of implemented exercise and progression. However, no specific guidelines were followed. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Alongside its role in athletic conditioning, stretching has commonly been integrated in warm-up routines prior to athletic performance. Numerous studies have reported detrimental acute effects on strength following stretching. Consequently, athletes have been recommended to discontinue stretching as part of warm-ups. In contrast, studies indicate that chronic stretching performed as a separate bout from training or competition may enhance performance. However, the influence of stretching on complex performances has received relatively little attention. Objective: The purpose of this study was to review both the acute and chronic effects of stretching on performances involving the stretch-shortening cycle (SSC). Methods: A systematic search for literature was undertaken (January 2006-December 2012) in which only randomized controlled trials (RCTs) or studies with repeated measures designs were included. The Physiotherapy Evidence Database (PEDro) rating scale was used for quality assessment of the evidence. Results: The review included 43 studies, from which conflicting evidence emerged. Approximately half of the studies assessing the acute effect of static stretching reported a detrimental effect on performance, while the remainder found no effect. In contrast, dynamic stretching showed no negative effects and improved performance in half of the trials. The effect size associated with static and dynamic stretching interventions was commonly low to moderate, indicating that the effect on performance might be limited in practice. Factors were identified that might have contributed to the conflicting results reported across studies, such as type of SSC performance and carrying out dynamic activity between the stretching bout and performance. Few studies since 2006 have addressed the chronic effect of stretching on functional and sports performance. Although negative effects were not reported, robust evidence of the overall beneficial effects within current bibliographic databases remains elusive. Plausible mechanisms for the observed effects from stretching are discussed, as well as possible factors that may have contributed to contradictory findings between studies. Limitations: Considerable heterogeneity in study design and methods makes comparison between studies challenging. No regression analysis of the contribution of different predictors to variation between trials had previously been performed. Hence, predictors had to be selected on the basis of a qualitative analysis of the predictors that seemed most influential, as well as being identified in previous narrative reviews. Conclusion: Different types of stretching have differential acute effects on SSC performances. The recommended volume of static stretching required to increase flexibility might induce a negative acute effect on performances involving rapid SSCs, but the effect sizes of these decrements are commonly low, indicating that the acute effect on performance might be limited in practice. No negative acute effects of dynamic stretching were reported. For athletes that require great range of motion (ROM) and speed in their sport, long-term stretching successfully enhances flexibility without negatively affecting performance. Acute dynamic stretching may also be effective in inducing smaller gains in ROM prior to performance without any negative effects being observed. [ABSTRACT FROM AUTHOR]

The aims of this study were (1) to investigate the relationship between self-perception of effort and task duration in an intermittent isometric fatigue trial (IIF) and (2) to evaluate the capability of two assessment paradigms (perceived exertion; perceived task duration) to reflect changes in IIF intensity. Fifteen participants performed two IIF tasks of the knee extensors at intensities of 60 and 70 % of daily peak force, each separated by 48-72 h. Ordering of the tasks was counter-balanced and participants were blinded to the precise intensity of each IIF. A category-ratio scale (CR-10) and visual analogue scale were used during each IIF task to record measures of perceived exertion and perceived task duration, respectively. Measures were recorded at 10 % intervals across the relative duration of each IIF task. Pearson product-moment correlation coefficients revealed strong positive correlations ( r > 0.99; p < 0.01) between completed task duration and both perceptual scales at the two IIF intensities. Separate two-way repeated measures ANOVAs of CR-10 and perceived task duration responses revealed significant main effects for time only ( F = 126.8; p < 0.001; F = 117.2; p < 0.001, CR-10 and perceived task duration, respectively). The results suggest that perceived exertion and perceived task duration are equally effective predictors of IIF end-point. However, neither measure was sufficiently responsive to discriminate between 10 % changes in exercise intensity. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the effects of plyometric exercise on unilateral balance performance. Nine healthy adults performed baseline measurements on the dominant limb that consisted of: a 20-s unilateral stability test on a tilt balance board, where a higher stability index represented deterioration in balance performance; isokinetic plantar flexion torque at 0.52 and 3.14 rad · s-1; muscle soreness in the calf region; and resting plantar flexion angle. Plyometric exercise consisted of 200 counter-movement jumps designed to elicit symptoms of muscle damage, after which baseline measurements were repeated at 30 min, 24, 48, and 72 h. Perceived muscle soreness of the calf region increased significantly following the plyometric exercise protocol (F4,32 = 17.24, P < 0.01). Peak torque was significantly reduced after the plyometric exercise protocol (F4,32 = 7.49, P < 0.05), with greater loss of force at the lower angular velocity (F4,32 = 3.46, P < 0.05), while resting plantar flexion angle was not significantly altered compared with baseline values (P > 0.05). The stability index was significantly increased (F4,32 = 3.10, P < 0.05) above baseline (mean 2.3, s = 0.3) at 24 h (3.3, s = 0.4), after which values recovered. These results indicate that there is a latent impairment of balance performance following a bout of plyometric exercise, which has implications for both the use of skill-based activities and for increased injury risk following high-intensity plyometric training. [ABSTRACT FROM AUTHOR]

Neuromuscular performance capabilities, including those measured by evoked responses, may be adversely affected by fatigue; however, the capability of the neuromuscular system to initiate muscle force rapidly under these circumstances is yet to be established. Sex-differences in the acute responses of neuromuscular performance to exercise stress may be linked to evidence that females are much more vulnerable to anterior cruciate ligament injury than males. Optimal functioning of the knee flexors is paramount to the dynamic stabilisation of the knee joint, therefore the aim of this investigation was to examine the effects of acute maximal intensity fatiguing exercise on the voluntary and magnetically-evoked electromechanical delay in the knee flexors of males and females. Knee flexor volitional and magnetically-evoked neuromuscular performance was assessed in seven male and nine females prior to and immediately after: (1) an intervention condition comprising a fatigue trial of 30-s maximal static exercise of the knee flexors, (2) a control condition consisting of no exercise. The results showed that the fatigue intervention was associated with a substantive reduction in volitional peak force that was greater in males compared to females (15.0, 10.2%, respectively, P < 0.01) and impairment to volitional electromechanical delay in females exclusively (19.3%, P < 0.05). Similar improvements in magnetically-evoked electromechanical delay in males and females following fatigue (21%, P < 0.001), however, may suggest a vital facilitatory mechanism to overcome the effects of impaired voluntary capabilities, and a faster neuromuscular response that can be deployed during critical times to protect the joint system. [ABSTRACT FROM AUTHOR]

This study investigated the effect of an acute, prolonged, intermittent, high-intensity single-leg pedalling exercise task (PIHIET) on the isokinetic leg strength of the knee flexors in six male and seven female collegiate soccer players. Following determination of single-leg VO2peak, subjects completed a PIHIET designed to simulate the energetics of soccer match play (~90 min in total; ~70% single-leg VO2peak). Pre-, mid- and post-PIHIET gravity-corrected indices of knee flexion peak torque (PT) and range of motion-relativised torque at 15% of knee flexion (RRT15%; 0% = full knee extension) were assessed at a lever-arm angular velocity of 1.05 rad·s-1 for intervention and control limbs using an isokinetic dynamometer. Repeated measures ANOVAs revealed significant condition (PIHIET, control) × time (pre-, mid-, post-PIHIET) interactions for knee flexion PT (F[2,22]=26.2; P<0.001) and RRT15% (F[2,22]=20.1; P<0.001). Flexion PT and RRT15% were observed to decrease, pre- to post-intervention, from 92.8 (28.7) N·m to 72.1 (28.0) N·m and from 63.8 (17.5) N·m to 47.9 (18.4) N·m respectively, for the intervention limb alone. These data corresponded to 22.3% and 24.9% mean reductions pre–post intervention in PT and RRT15%. Exploratory post hoc analysis of the pattern of the relative deterioration (%) of PT and RRT15%, for the intervention limb alone, revealed a three-way interaction [group (male, female) x parameter (PT, RRT15%) x assessment phase (pre- to mid-PIHIET, mid- to post-PIHIET)] (F1,11=5.2; P<0.05). This interaction characterised a greater deterioration of strength performance during the mid- to post-PIHIET assessment phase, at the extremes of range of motion (RRT15%) for the female group. The greater percentage of mid–post phase strength loss observed in women near the end-range extension may potentially be implicated in the higher incidence of knee injury reported in female soccer players. [ABSTRACT FROM AUTHOR]

Patient-reported outcome measures (PROMs) provide clinicians a greater understanding of patients' perceived ability in their physical performance. Existing PROMs on falls efficacy provide meaningful information about the perceived ability in older people to perform common activities of daily living without falling. However, the perceived ability to recover balance from a slip, a trip, or volitional movements has been inadequately assessed. Balance recovery confidence relates to the judgment of self-reactive ability. The scale of balance recovery confidence (BRC) is a new PROM that measures perceived balance recovery self-efficacy. The purpose of the study protocol is to describe the first psychometric evaluation of BRC's measurement properties. This study is a validation phase of a newly developed PROM conducted in Singapore. Two hundred community-dwelling older adults, aged 65 years and older, will complete five self-reported instruments (BRC, Activities-specific Balance Confidence Scale, Falls Efficacy Scale-International, Late-Life Function and Disability Instrument-Function and Global Perceived Effect) and three performance measures (Hand strength dynamometer, 30-second Chair Stand, Mini BESTest). Classical test theory methods will assess acceptability, data completeness, targeting of the items, scaling assumptions, internal consistency reliability and construct validity. Factor analysis will establish unidimensionality. Rasch analysis will evaluate item fit, differential item functioning, response scale ordering, targeting of persons and items and the reliability. The findings from this study will be published in peer-reviewed journals and presented at national and international conferences in rehabilitation-specific context. This is the first validation study of BRC. The study will give confidence among clinicians and researchers to use the BRC in fall management research and clinical practice. [ABSTRACT FROM AUTHOR]

Falls efficacy posits an understanding of the perceived ability to prevent and manage falls. There have been no validated self-reported instruments to measure the perceived ability to recover balance in response to destabilizing perturbations. To develop a scale of balance recovery confidence. Stage one had candidate items generated by 12 community-dwelling adults aged 65 and older using the nominal group technique. Stage two had the scale's name, instructions, response options, recall period and the items validated for appropriateness with 28 healthcare professionals and 10 older adults using an e-Delphi technique. Stage three had the scale's psychometric properties evaluated with 84 older adults who had completed self-reported and performance measures. Factor analysis was applied to confirm unidimensionality. The internal structure, reliability and validity of the scale were evaluated using the classical test theory and Rasch measurement theory. The 19-item scale was developed and validated with experts' consensus. The scale is unidimensional with excellent internal structure (Cronbach's α = 0.975) and test-retest reliability with Intraclass Correlation Coefficient (ICC3,1) = 0.944. Construct validity of the scale was supported by its relationships with the other measures (Activities-specific Balance Confidence scale, Falls Efficacy Scale-International, Late-Life Function and Disability International-Function, handgrip strength dynamometry, 30-second chair stand test, and mini-BESTest). The balance recovery confidence scale is a distinct instrument that measures perceived reactive balance recovery. The scale has good psychometric properties and can be used to complement other measurement instruments to help older adults cope with challenges to balance. [ABSTRACT FROM AUTHOR]

Aim: To generate, test and refine programme theories that emerged from a rapid realist review investigating practising UK Nurses' and Midwives' experiences of effective leadership strategies during the COVID‐19 pandemic. Background: The realist review of literature generated six tentative theories of healthful leadership practices reflecting, working with people's beliefs and values; being facilitative; multiple means of communication and; practical support. The review yielded little insight into the actual impact of the leadership approaches advocated. Methods: A realist study, informed by person‐centredness using mixed‐methods. Online survey (n = 328) and semi‐structured interviews (n = 14) of nurses and midwives across the UK in different career positions/specialities. Quantitative data analysed using descriptive statistics and exploratory factor analysis. Framework analysis for qualitative data using context (C), mechanism (M), outcome (O) configurations of the tentative theories. Results: Three refined theories were identified concerning: Visibility and availability; embodying values and; knowing self. Healthful leadership practices are only achievable within organisational cultures that privilege well‐being. Conclusions: Leaders should intentionally adopt practices that promote well‐being. 'Knowing self' as a leader, coaching and mentoring practice development is important for leadership development. Implications for Clinical Practice: Nurses who feel valued, heard, cared for and safe are more likely to remain in clinical practice. Job satisfaction and being motivated to practice with confidence and competence will impact positively on patient outcomes. Impact: The study addresses the role of leadership in developing healthful workplace cultures. The main findings were six leadership practices that promote healthful cultures. The research will have an impact on strategic and clinical leaders, nurses and midwives. Reporting Method: This study used EQUATOR checklist, RAMASES II as reporting standards for realist evaluations. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

This study is aimed at the determination of the measurement properties of the shoulder function B-B Score measured with a smartphone. This score measures the symmetry between sides of a power-related metric for two selected movements, with 100% representing perfect symmetry. Twenty healthy participants, 20 patients with rotator cuff conditions, 23 with fractures, 22 with capsulitis, and 23 with shoulder instabilities were measured twice across a six-month interval using the B-B Score and shoulder function questionnaires. The discriminative power, responsiveness, diagnostic power, concurrent validity, minimal detectable change (MDC), minimal clinically important improvement (MCII), and patient acceptable symptom state (PASS) were evaluated. Significant differences with the control group and significant baseline-six-month differences were found for the rotator cuff condition, fracture, and capsulitis patient groups. The B-B Score was responsive and demonstrated excellent diagnostic power, except for shoulder instability. The correlations with clinical scores were generally moderate to high, but lower for instability. The MDC was 18.1%, the MCII was 25.2%, and the PASS was 77.6. No floor effect was observed. The B-B Score demonstrated excellent measurement properties in populations with rotator cuff conditions, proximal humerus fractures, and capsulitis, and can thus be used as a routine test to evaluate those patients. [ABSTRACT FROM AUTHOR]

Background: Contemporary strategies for prehabilitation and rehabilitation associated with total knee arthroplasty (TKA) surgery have focused on improving joint range-of-motion and function with less emphasis on neuromuscular performance beneficially affecting joint stability. Furthermore, prehabilitation protocols have been found to be too long and generic-in-effect to be considered suitable for routine clinical practice.Methods: A pragmatic exploratory controlled trial was designed to investigate the efficacy of a novel, acute prehabilitative neuromuscular exercise-conditioning (APNEC) in patients electing TKA. Adults electing unilateral TKA were assessed and randomly allocated to exercise-conditioning (APNEC, n = 15) and usual care (Control, n = 14) from a specialised orthopaedic hospital, in the United Kingdom. APNEC prescribed nine stressful exercise-conditioning sessions for the knee extensors of the surgery leg, accrued over one week (3 sessions·week-1; 36 exercise repetitions in total; machine, gravity-loaded) and directly compared with usual care (no exercise). Prescribed exercise stress ranged between 60%-100% of participant's daily voluntary strength capacity, encompassing purposefully brief muscular activations (≤ 1.5 s). Baseline and follow-up indices of neuromuscular performance focusing on muscle activation capacity (electromechanical delay [EMD], rate of force development [RFD] and peak force [PF]) were measured ipsilaterally using dynamometry and concomitant surface electromyography (m. rectus femoris[RF] and m. vastus lateralis[VL]).Results: Group mean ipsilateral knee extensor muscular activation capacity (EMDRF [F(3,57) = 53.5; p < 0.001]; EMDVL [F(3,57) = 50.0; p < 0.001]; RFD [F(3,57) = 10.5; p < 0.001]) and strength (PF [F(3,57) = 16.4; p < 0.001]) were significantly increased following APNEC (Cohen's d, 0.5-1.8; 15% to 36% vs. baseline), but unchanged following no exercise control (per protocol, group by time interaction, factorial ANOVA, with repeated measures), with significant retention of gains at 1-week follow-up (p < 0.001).Conclusions: The exploratory APNEC protocol elicited significant and clinically-relevant improvement and its retention in neuromuscular performance in patients awaiting TKA.Trial Registration: (date and number): clinicaltrial.gov: NCT03113032 (4/04/2017) and ISRCTN75779521 (3/5/2017). [ABSTRACT FROM AUTHOR]

Highlights: [•] The Arts Therapies Survey was conducted in the UK in 2011; 395 arts therapists participated. [•] Over 91% of respondents encounter client depression in their practice. [•] Therapists, who work primarily with depression (D+), were compared to those, who do not (D−). [•] Group D+: more psychodynamically oriented, older and experienced, often work with groups, adults and in health settings. [•] Qualitative findings will follow to deepen the already gained understanding. [ABSTRACT FROM AUTHOR]

Background: According to existing literature, musicians experience high rates of musculoskeletal (MSK) disorders involving different anatomical areas. The aim of the study was to identify patterns of pain location in a sample of music students enrolled in different pan-European music institutions. A further goal was to explore the association between the identified pain patterns and students' characteristics.Methods: A total of 340 music students (mean age 23.3 years, 66.2% female) with current MSK pain completed a web-based questionnaire including both background information (i.e. lifestyle and physical activity, practice habits) and clinical features (i.e. pain characteristics, disability, pain self-efficacy, psychological distress, perfectionism and fatigue).Results: Five patterns of pain location were identified by hierarchical cluster analysis: wrist pain (WP) representing 22.6% of the total sample, widespread pain (WSP) (16.9%), right shoulder pain (RSP) (18.5%), both shoulders pain - left concentrated (LSP) (23.2%), neck and back pain (NBP) (18.8%). Amongst the identified patterns of pain location, bivariate analysis identified the WSP cluster as containing the largest number of associated variables. Participants in this cluster reported a higher percentage of women (p < .05), a higher perceived exertion (p < .01) and psychological distress (p < .001), as well as a lower level of self-efficacy (p < .01). Similarly, a higher percentage of participants included in the WSP cluster perceived their musical activity as the main cause of their MSK pain (p < .01). Additionally, a higher level of disability in relation to playing-related activity was reported by participants included in the WP and WSP clusters (p < .001). The RSP cluster was characterised by a higher percentage of participants playing an instrument in a neutral position (p < .001) and lower levels of socially prescribed perfectionism (p < .01). A higher percentage of participants playing an instrument with both arms elevated in the left quadrant position were included in the LSP cluster and a higher percentage of singers were included in the NBP cluster (p < .001).Conclusions: Five distinct patterns of pain location were identified and their associations with the students' characteristics were explored. These findings may be helpful in the exploration of different aetiologies of MSK pain among musicians and in the development of targeted preventive strategies and treatments. [ABSTRACT FROM AUTHOR]

The article discusses the use of autologous chondrocyte implantation (ACI) in clinical practice to restore hyaline cartilage. It highlights the contemporary regenerative procedures for autologous chondrocyte graft implantation of adjacent chondral tissue. It notes that the rehabilitative period after ACI surgery varies on the physical activity of the patients to protect the ACI site and promote healing.

Musculoskeletal (MSK) conditions among professional musicians and music students are frequent and may have significant physical and psychosocial consequences on their lives and/or on their playing abilities. The Risk of Music Students (RISMUS) research project was set up in 2018 to longitudinally identify factors associated with increased risk of playing-related musculoskeletal disorders (PRMDs) in a large sample of music students enrolled in pan-European institutions. The aim of this cross-sectional study was to describe the prevalence of playing-related musculoskeletal disorders (PRMDs) in this novel population at baseline of the RISMUS project. A further goal was to begin to identify variables that might be associated with the self-reported presence of PRMDs among music students. Eight hundred and fifty students from fifty-six conservatories and music universities in Europe completed a web-based questionnaire on lifestyle and physical activity participation levels, musical practice habits, health history and PRMDs, psychological distress, perfectionism and fatigue. A total of 560 (65%) out of 850 participants self-reported a positive history of painful MSK conditions in the last 12 months, 408 (48%) of whom self-reported PRMDs. Results showed that coming from West Europe, being a first- or a second-year Masters student, having more years of experience and higher rates of perceived exertion after 45 minutes of practice without breaks were factors significantly associated with self-reported presence of PRMDs. According to the authors' knowledge, a large-scale multicentre study investigating prevalence and associated factors for PRMDs among music students at different stages of their education (from Pre-college to Masters levels) has not been conducted before. The high prevalence of PRMDs among music students, especially those studying at university-level, has been confirmed in this study and associated factors have been identified, highlighting the need for relevant targeted interventions as well as effective prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Background: There is accumulating evidence for the advantages of rehabilitation involving sensori-motor training (SMT) following total knee replacement (TKR). However, the best way in which to deliver SMT remains elusive because of potential interference effects amongst concurrent exercise stimuli for optimal neuromuscular and morphological adaptations. The aim of this study was to use additional outcomes (i.e. muscle strength, activation and size) from a published parent study to compare the effects of early-initiated home-based rehabilitative SMT with functional exercise training (usual care) in patients undergoing TKR.Methods: A controlled clinical trial was conducted at the Orthopedic University Hospital of Rion, Greece involving allocation concealment to patients. Fifty-two patients electing to undergo TKR were randomised to either early-initiated SMT [experimental] or functional exercise training [control] in a home-based environment. Groups were prescribed equivalent duration of exercise during 12-weeks, 3-5 sessions of ~ 40 min per week of home-based programmes. Muscle strength and activation (peak force [PF]; peak amplitude [Peak Amp.] and root mean square of integrated electromyography [RMS iEMG]), muscular size (including rectus femoris muscle cross-sectional area [CSARF]), and knee ROM were assessed on three separate occasions (pre-surgery [0 weeks]; 8 weeks post-surgery; 14 weeks post-surgery).Results: Patients undertaking SMT rehabilitation showed significantly greater improvements over the 14 weeks compared to control in outcomes including quadriceps PF (25.1 ± 18.5 N vs 12.4 ± 20.8 N); iPeak Amp. (188 ± 109.5% vs 25 ± 105.8%); CSARF (252.0 ± 101.0 mm2 vs 156.7 ± 76.2 mm2), respectively (p < 0.005); Knee ROM did not offer clinically relevant changes (p: ns) between groups over time. At 14 weeks post-surgery, the SMT group's and control group's performances differed by relative effect sizes (Cohen's d) ranging between 0.64 and 1.06.Conclusion: A prescribed equivalent time spent in SMT compared to usual practice, delivered within a home-based environment, elicited superior restoration of muscle strength, activation and size in patients following TKR.Trial Registration: ISRCTN12101643 , December 2017 (retrospective registration). [ABSTRACT FROM AUTHOR]

Background: The achievement and improvement of skills in musical techniques to reach the highest levels of performance may expose music students to a wide range of playing-related musculoskeletal disorders (PRMDs). In order to establish effective solutions for PRMDs and to develop future preventive measures, it is fundamental to firstly identify the main risk factors that play a significant role in the development of musculoskeletal conditions and symptoms. The aim of the study is to identify those factors associated with increased risk of PRMDs among music students. A further goal is to characterise this population and describe the clinical features of PRMDs, as well as to determine the evolving course of PRMDs in music students during their training.Methods: One hundred and ninety schools have been invited to participate in this study, sixty of which have already confirmed officially their support for the investigation's recruitment procedures, by means of a subsequent distribution of the link to a web-based questionnaire to their student groups (total potential student numbers available: n = 12,000 [based on ~ 200 students per school on average, and 60 volunteering schools]; expected number of students: n = 3000 [based on a 25% response rate from the 12,000 students attending the 60 volunteering schools]). The web-based questionnaire includes questions about any PRMD that students have experienced during their training, and different potential risk factors (i.e. lifestyle and physical activity, practice habits, behaviour toward prevention and health history, level of stress, perfectionism, fatigue and disability). Overall recurrence or new onsets of PRMDs will be assessed at 6 and 12 months after the first data collection to investigate and record the development of new incidents within a period of a year and to enable characterisation of the nature and the evolving course of PRMDs.Discussion: To the best of our knowledge, no other longitudinal studies on risk factors for PRMDs among music students have been conducted so far. Therefore, this study can be considered as an opportunity to begin filling the gaps within current research in this field and to generate new knowledge within musical contexts in education and employment.Trial Registration: ClinicalTrials.gov ( NCT03622190 ), registration date 09/08/2018. [ABSTRACT FROM AUTHOR]

Background: The B-B Score is a straightforward kinematic shoulder function score including only two movements (hand to the Back + lift hand as to change a Bulb) that demonstrated sound measurement properties for patients for various shoulder pathologies. However, the B-B Score results using a smartphone or a reference system have not yet been compared. Provided that the measurement properties are comparable, the use of a smartphone would offer substantial practical advantages. This study investigated the concurrent validity of a smartphone and a reference inertial system for the measurement of the kinematic shoulder function B-B Score. Methods: Sixty-five patients with shoulder conditions (with rotator cuff conditions, adhesive capsulitis and proximal humerus fracture) and 20 healthy participants were evaluated using a smartphone and a reference inertial system. Measurements were performed twice, alternating between two evaluators. The B-B Score differences between groups, differences between devices, relationship between devices, intra- and inter-evaluator reproducibility were analysed. Results: The smartphone mean scores (SD) were 94.1 (11.1) for controls and 54.1 (18.3) for patients (P < 0.01). The difference between devices was non-significant for the control (P = 0.16) and the patient group (P = 0.81). The analysis of the relationship between devices showed 0.97 ICC, −0.6 bias and −13.2 to 12.0 limits of agreement (LOA). The smartphone intra-evaluator ICC was 0.92, the bias 1.5 and the LOA −17.4 to 20.3. The smartphone inter-evaluator ICC was 0.92, the bias 1.5 and the LOA −16.9 to 20.0. Conclusions: The B-B Score results measured with a smartphone were comparable to those of an inertial system. While single measurements diverged in some cases, the intra- and inter-evaluator reproducibility was excellent and was equivalent between devices. The B-B score measured with a smartphone is straightforward and as efficient as a reference inertial system measurement. [ABSTRACT FROM AUTHOR]

Unlabelled: Vitamin D is important for skeletal muscle health and deficiency is associated with clinical neuromuscular symptoms of poor strength and gait. Supplementation can independently increase muscle strength in chronically deficient populations. However, the regulatory role of vitamin D on neuromuscular remodelling and adaptation subsequent to exercise conditioning or injury has not been systematically reviewed.Objective: to systematically review the available evidence of the role of vitamin D on neuromuscular remodelling following exercise conditioning, exercise- or experimentally induced injury. We searched Medline (OVID platform), PubMed, Embase and Web of Science for randomised controlled trials (RCTs) including measures of neuromuscular function, injury and/or inflammation; a physiologically stressful intervention involving exercise conditioning, exercise- or experimentally induced injury and; vitamin D supplementation. Nine RCTs met the inclusion criteria. Significant heterogeneity of methodological approaches and outcomes meant that meta-analysis of data was limited. Qualitative findings indicated that vitamin D may be an effective accelerant of neuromuscular remodelling in animal models (24-140 % improved recovery vs. control); the effects in humans are inconclusive and likely influenced by baseline vitamin D and supplementation strategy. Results of the meta-analyses indicated no effect of vitamin D supplementation on muscle strength adaptation following resistance training [standardised mean difference (SMD): 0.74, P = 0.42] or muscle damage (SMD: -0.03, P = 0.92), although inflammatory markers were elevated in the latter (SMD: 0.56, P = 0.04). Data from animal models offer promising and plausible mechanisms for vitamin D as an agent for neuromuscular adaptation. Further high-quality research is needed to offer clearer insight into the influential role of vitamin D in human populations. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 22-year old patient who was diagnosed with rupture of the anterior cruciate ligament (ACL) of his right knee joint. He undergoes unilateral surgical reconstruction and volunteers for the research project in a contemporary hospital-based rehabilitation programme. The patient was able to return to the sport after the 24-week rehabilitation period of supervised physiotherapy.

An amendment to this paper has been published and can be accessed via the original article. [ABSTRACT FROM AUTHOR]

The effects of flexibility conditioning on neuromuscular and sensorimotor performance were assessed near to full knee extension (25°). Eighteen males who were randomly assigned into two groups underwent eight weeks (three-times per week) of flexibility conditioning (hip region/knee flexor musculature; dominant limb) involving either proprioceptive neuromuscular facilitation (PNF) (n=9) or passive stretching (PASS) (n=9). Both modes of flexibility conditioning are popular within contemporary exercise and clinical settings and have demonstrated efficacy in improving range of motion. The contralateral limb and a prior ‘no exercise’ condition were used as controls. The PNF and PASS modes of conditioning improved passive hip flexibility to a similar extent (mean 19.3% vs. baseline, intervention limb,p<0.01) but did not alter knee flexor strength (overall mean 309.6±81 N) or sensorimotor performance (force and positional errors: 2.3±8.2% and 0.48±7.1%). Voluntary and magnetically evoked electromechanical delays (EMDVand EMDE, respectively) were increased but to a greater extent following PASS compared to PNF (PASS: 10.8% and 16.9% lengthening of EMDVand EMDE, respectively vs. PNF: 3.2% and 6.2%,p<0.01).The attenuated change to electromechanical delay (EMD) performance during PNF conditioning suggests a preserved capability for rapid muscle activation, which is important in the maintenance of dynamic joint stability. That PNF was also equally efficacious in flexibility conditioning would suggest that this mode of flexibility training should be used over passive to help preserve dynamic joint stability capabilities at this extended and vulnerable joint position. [ABSTRACT FROM PUBLISHER]

The effects of flexibility conditioning on neuromuscular and sensorimotor performance were assessed near to full knee extension (25°). Eighteen males who were randomly assigned into two groups underwent eight weeks (three‐times per week) of flexibility conditioning (hip region/knee flexor musculature; dominant limb) involving either proprioceptive neuromuscular facilitation (PNF) (n=9) or passive stretching (PASS) (n=9). Both modes of flexibility conditioning are popular within contemporary exercise and clinical settings and have demonstrated efficacy in improving range of motion. The contralateral limb and a prior 'no exercise' condition were used as controls. The PNF and PASS modes of conditioning improved passive hip flexibility to a similar extent (mean 19.3% vs. baseline, intervention limb, p<0.01) but did not alter knee flexor strength (overall mean 309.6±81 N) or sensorimotor performance (force and positional errors: 2.3±8.2% and 0.48±7.1%). Voluntary and magnetically evoked electromechanical delays (EMDV and EMDE, respectively) were increased but to a greater extent following PASS compared to PNF (PASS: 10.8% and 16.9% lengthening of EMDV and EMDE, respectively vs. PNF: 3.2% and 6.2%, p<0.01).The attenuated change to electromechanical delay (EMD) performance during PNF conditioning suggests a preserved capability for rapid muscle activation, which is important in the maintenance of dynamic joint stability. That PNF was also equally efficacious in flexibility conditioning would suggest that this mode of flexibility training should be used over passive to help preserve dynamic joint stability capabilities at this extended and vulnerable joint position. [ABSTRACT FROM AUTHOR]

This study examined the concurrent effects of exercise-induced muscle damage and superimposed acute fatigue on the neuromuscular activation performance of the knee flexors of nine males (age: 26.7±6.1 years; height 1.81±0.05 m; body mass 81.2±11.7 kg [mean±s]). Measures were obtained during three experimental conditions: (i) ‘fatigue-muscle damage’, involving acute fatiguing exercise performed on each assessment occasion plus a single episode of eccentric exercise performed on the first occasion and after the fatigue trial; (ii) ‘fatigue’, involving the fatiguing exercise only; and (iii) ‘control’ consisting of no exercise. Assessments were performed prior to (pre) and at 1 h, 24 h, 48 h, 72 h, and 168 h relative to the muscle damaging eccentric exercise. Repeated-measures analyses of variance (ANOVAs) showed that muscle damage elicited reductions of up to 38%, 24% and 65% in volitional peak force, electromechanical delay and rate of force development compared to baseline and controls, respectively (F [10, 80] = 2.3 to 4.6; P < 0.05) with further impairments (6.2% to 30.7%) following acute fatigue (F [2, 16] = 4.3 to 9.1; P < 0.05). By contrast, magnetically-evoked electromechanical delay was not influenced by muscle damage and was improved during the superimposed acute fatigue (∼14%; F [2, 16] = 3.9; P < 0.05). The safeguarding of evoked muscle activation capability despite compromised volitional performance might reveal aspects of capabilities for emergency and protective responses during episodes of fatigue and antecedent muscle damaging exercise. [ABSTRACT FROM PUBLISHER]

The effects of serial episodes of fatigue and recovery on volitional and magnetically evoked neuromuscular performance of the knee flexors were assessed in 20 female soccer players during: (i) an intervention comprising 4 × 35 s maximal static exercise, and (ii) a control condition. Volitional peak force was impaired progressively (∼16% vs. baseline: 235.3 ± 54.7 to 198.1 ± 38.5 N) by the fatiguing exercise and recovered to within ∼97 % of baseline values following 6 min of rest. Evoked peak twitch force was diminished subsequent to the fourth episode of exercise (23.3%: 21.4 ± 13.8 vs. 16.4 ± 14.6 N) and remained impaired at this level throughout the recovery. Impairment of volitional electromechanical delay performance following the first episode of exercise (25.5%: 55.3 ± 11.9 vs. 69.5 ± 24.5 ms) contrasted with concurrent improvement (10.0%: 24.5 ± 4.7 vs. 22.1 ± 5.0 ms) in evoked electromechanical delay (P < 0.05), and this increased disparity between evoked and volitional electromechanical delay remained during subsequent periods of intervention and recovery. The fatiguing exercise provoked substantial impairments to volitional strength and volitional electromechanical delay that showed differential patterns of recovery. However, improved evoked electromechanical delay performance might identify a dormant capability for optimal muscle responses during acute stressful exercise and an improved capacity to maintain dynamic joint stabilty during critical episodes of loading. [ABSTRACT FROM PUBLISHER]