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AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo determine the prevalence of benign paroxysmal positional vertigo without dizziness, a treatable falls risk factor in people attending outpatient falls clinics.Over 6 years, 618 people at risk of falls attending 2 falls clinics were assessed for benign paroxysmal positional vertigo, whether dizzy or non dizzy. Data regarding demographics, canal location of positive tests and comorbidities were collected from medical records.Thirty-nine percent (238) of people with falls risk tested positive for benign paroxysmal positional vertigo; 62 (26%) or 1 in 4 of those testing positive were not dizzy. Thirty-nine of 104 (38%) testing positive for single canal benign paroxysmal positional vertigo and twenty-four of 134 (18%) testing positive for multiple canal benign paroxysmal positional vertigo were not dizzy. Comorbidities were common for all with falls risk but did not differentiate for benign paroxysmal positional vertigo on testing.Benign paroxysmal positional vertigo is common in people attending falls clinics and contributes to falls risk. Dizziness is common in BPPV though 26% or 1 in 4 people testing positive were not dizzy and would be missed without mandatory testing. Testing should also include all semicircular canals as multiple-canal involvement was high.Benign paroxysmal positional vertigo is a common and treatable falls risk factor, however screening for benign paroxysmal positional vertigo in people who fall usually only occurs if they are dizzy.1 in 4 people with falls risk who have benign paroxysmal positional vertigo do not report symptoms of dizzinessScreening for benign paroxysmal positional vertigo in all people who fall whether dizzy or not, is required to comprehensively identify and treat benign paroxysmal positional vertigoAll semicircular canals should be screened for benign paroxysmal positional vertigo as the incidence of multiple-canal involvement is high [ABSTRACT FROM AUTHOR]

OBJECTIVE: We aimed to evaluate the accuracy of clinical tests that are used to diagnose greater trochanteric pain syndrome (GTPS) in clinical practice. DESIGN: Diagnostic test accuracy systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, Embase, CINAHL, AMED, and SPORTDiscus were searched using key words mapped to diagnostic test accuracy for GTPS. STUDY SELECTION CRITERIA: Studies with published or derivable diagnostic accuracy data were included. DATA SYNTHESIS: Risk of bias was assessed using the QUADAS-2 tool, and certainty of evidence, via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. MetaDTA "R" random-effects models were used to summarize individual and pooled data including sensitivity, specificity, likelihood ratios, and pretest/posttest probabilities. RESULTS: From a database yield of 858 studies, 23 full texts were assessed. We included 6 studies for review, involving 15 tests and 272 participants (314 hips). Overall certainty of evidence ranged from very low to moderate. Meta-analysis of 6 tests revealed sequenced test clusters able to significantly shift pretest-posttest probability for or against a GTPS diagnosis. In people reporting lateral hip pain, a negative gluteal tendon (GT) palpation test followed by a negative resisted hip abduction test significantly reduced the posttest probability of GTPS from 59% to 14%. In those with a positive GT palpation test followed by a positive resisted hip abduction test, the posttest probability of GTPS significantly shifted from 59% to 96%. CONCLUSION: The value of magnetic resonance imaging for diagnosing GTPS is debated. We have identified a straightforward, clinically useful diagnostic test cluster to help confirm or refute the presence of GTPS in people reporting lateral hip pain. [ABSTRACT FROM AUTHOR]

Background The frequency and impact of undiagnosed benign paroxysmal positional vertigo (BPPV) in people identified with high falls risk has not been investigated. Objective To determine the frequency and impact on key psychosocial measures of undiagnosed BPPV in adult community rehabilitation outpatients identified with a high falls risk. Design A frequency study with cross-sectional design. Setting A Community Rehabilitation Program in Melbourne, Australia. Subjects Adult community rehabilitation outpatients with a Falls Risk for Older People in the Community Screen score of four or higher. Methods BPPV was assessed in 34 consecutive high falls risk rehabilitation outpatients using the Dix–Hallpike test and supine roll test. Participants were assessed for anxiety, depression, fear of falls, social isolation and loneliness using the Hospital Anxiety and Depression Scale, Falls Efficacy Scale-International and De Jong Gierveld 6-Item Loneliness Scale. Results A total of 18 (53%; 95% confidence interval: 36, 70) participants tested positive for BPPV. There was no significant difference between those who tested positive for BPPV and those who did not for Falls Risk for Older People in the Community Screen scores (P  = 0.555), Hospital Anxiety and Depression Scale (Anxiety) scores (P  = 0.627), Hospital Anxiety and Depression Scale (Depression) scores (P  = 0.368) or Falls Efficacy Scale-International scores (P  = 0.481). Higher scores for the De Jong Gierveld 6-Item Loneliness Scale in participants with BPPV did not reach significance (P  = 0.056). Conclusions Undiagnosed BPPV is very common and associated with a trend towards increased loneliness in adult rehabilitation outpatients identified as having a high falls risk. [ABSTRACT FROM AUTHOR]

Usual care after hip or knee joint replacement does not adequately address the problem of low physical activity levels. We aimed to determine whether exercise delivered in a group setting in the early stage of outpatient rehabilitation influenced self-reported physical activity levels after hip or knee joint replacement. A case series of 79 participants referred to a 6-week outpatient orthopaedic exercise group after total hip or knee replacement were evaluated using the International Physical Activity Questionnaire (IPAQ) short form. Physical function was evaluated using Osteoarthritis Research Society International (OARSI) recommended performance-based tests (30 s Chair Stand Test, 40 m Fast Pace Walk Test, Stair Climb Test, Timed Up and Go Test, 6 Minute Walk Test). Measures were assessed at admission, discharge and 6 weeks after group discharge. Non-parametric analysis was conducted for IPAQ scores. Analysis of functional measures was conducted with linear mixed models with time modelled as a repeated measure. Standard multiple regression and correlation analysis were conducted. Fifty-four participants completed the study. Self-reported activity levels improved significantly at program discharge but not at 6-week follow-up. All performance-based measures improved significantly at program discharge. Fast-paced walking and 6 Minute Walk Test measures continued to improve at 6-week follow-up. Group dynamics present in an outpatient rehabilitation exercise program may increase physical activity levels during group participation but not after group cessation. Performance in all functional measures improved at group discharge. [ABSTRACT FROM AUTHOR]

Purpose : To evaluate the effect of behavioural interventions on levels of physical activity after hip or knee joint replacement. Materials and methods : A systematic review with meta-analysis of randomised controlled trials to determine the effectiveness of behavioural interventions to increase physical activity levels after hip or knee joint replacement. Six databases were searched. Standardised mean differences (SMD) were calculated. The GRADE approach was used to evaluate the level of evidence of each meta-analysis. Results : From a yield of five trials, physical activity was quantified as active minutes per day, daily energy expenditure and daily steps. There was low to moderate-quality evidence from three meta-analyses with observed positive effects that could not conclude whether behavioural interventions increased physical activity in active minutes per day (SMD = 0.18, 95% CI -0.14, 0.51), daily energy expenditure (SMD = 0.31, 95% CI -0.24, 0.87) or daily steps (MD = 844.7, 95% CI -178.6, 1,868.0). Conclusions : The effectiveness of behavioural interventions to address the low levels of physical activity levels observed after hip or knee joint replacement remains uncertain.Implications for rehabilitationPhysical activity levels after hip or knee joint replacements fail to meet recommended daily activity guidelines, increasing the associated risk of cardiovascular disease and early mortality.Rehabilitation interventions that target behaviour change may have an impact in increasing physical activity levels after hip or knee joint replacement surgery.The optimal type and timing of behavioural interventions to effectively increase physical activity levels in this cohort remains unclear.Rehabilitation professionals are advised to highlight the benefits of meeting physical activity recommendations (150 min of moderate-intensity aerobic physical activity or 75 min of vigorous-intensity aerobic physical activity per week) to people who have undergone hip or knee joint replacement, and that behavioural intervention may support patients to meet these recommendations.