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Background: Persistent wearing of an ill-fitting bra is a global female health issue. High incidences of poor bra fit have been partially attributed to a lack of knowledge. Bra fit knowledge has not previously been measured through the ability of women to identify bra fit issues. Objectives: The objective was to determine whether women can identify the presence/absence of bra fit issues as a measure of bra fit knowledge. Design Twenty-four women participated in this cross-sectional cohort study. Methods: Participants self-reported bra fit issues subjectively and researchers carried out an objective bra fit assessment based on professional bra fitting criteria. Results were presented descriptively and binary logistic regression statistics were adopted to determine whether subjective responses predicted objective analyses. Results: All participants failed the objective bra fit assessment, with 77 bra fit issues identified in total. Common bra fit issues were cups that were too large (63%, n=15), the front band not in contact with the sternum (58%, n=14) and straps that were too loose (50%, n=12). Participants subjectively reported the absence / presence of bra fit issues accurately in 51% of instances. Of the 77 bra fit issues that were identified in the bra fit assessment, 62% (n=48) were reported subjectively. Of the 67 (47%) bra fit components that were considered a correct fit in objectively, only 26 (39%) were reported by participants. This indicates an over-reporting of bra fit issues by participants. Conclusion: Participants were unable to consistently distinguish between the absence/presence of bra fit issues. In support of previous suggestions, a lack of bra fit knowledge may be a barrier to achieving correct bra fit. Further work is required to improve bra fit knowledge to enable selection of the correct size bra. Potential benefits of improving knowledge include improving bra fit, reducing pain, and improving psychological wellbeing.

Background: Non-surgical guidelines recommend implementing a correctly fitted bra when managing back pain amongst larger breasted women. Achieving this is challenging with current bra solutions, sizing principles and fitting approaches. Persistent wearing of an ill-fitting bra can cause negative health implications, including Non-Specific Back Pain (NSBP). Objectives: This study investigated immediate and short-term biomechanical and pain responses to changing breast support garment amongst larger breasted women with NSBP. Methods: Participants (n=24) performed a standing task, drop jumps and seated typing tasks whilst bra and spinal kinematic data were recorded. Five breast support conditions were assessed: participants’ usual bra (Control), a professionally fitted bra in the immediate term (Standard), and after four weeks wear (Standard28), and a bra with an alternative design, measurement, and fitting approach in both the immediate term (Alternative) and after four weeks wear (Alternative28). A bra fit assessment and clinical pain / disability questionnaires were included. Results: All participants failed the bra fit assessment in the control bra, compared to 87.5% (n=21) in the standard and 4.2% (n=1) in the alternative bras. The standard28 and alternative28 bras provided symptomatic relief, with the alternative28 bra improving a greater number of outcome measures. Reduced nipple-sternal-notch distance was observed only in the alternative28 bra condition. Conclusions: Symptomatic relief may be associated with the resting position of the breast tissue on the anterior chest wall. The alternative bra may provide potential clinical benefit if implemented as part of a non-surgical, or conservative pain management strategy. Alternative breast support garments should be considered to provide solutions to the problems associated with traditional bras.

Background. External cues are effective in improving gait in people with Parkinson’s disease (PD). However, the most effective cueing method has yet to be determined. Objective. The aim of this study was to compare the immediate effects of using visual, auditory, or somatosensory cues on their own or in combination during walking compared to no cues in people with PD. Methods. This was a single blinded, randomly selected, controlled study. Twenty people with PD with an age range of 46–79 years and Hoehn and Yahr scores of 1–3 were recruited. Participants were studied under 4 cueing conditions; no cue, visual, auditory, or somatosensory cues, which were randomly selected individually or in a combination. Results. A repeated measures ANOVA with pairwise comparisons using Bonferroni correction showed that any single or combination of the cues resulted in an improvement in gait velocity and stride length compared to no cue. Some significant differences were also seen when comparing different combinations of cues, specifically stride length showed significant improvements when additional cues were added to the light cue. The statistically significant difference was set at p<0.05. Conclusions. Walking using visual, auditory, or somatosensory cues can immediately improve gait mobility in people with PD. Any or a combination of the cues tested could be chosen depending on the ability of the individual to use that cue.

Purpose: E-bikes have the potential to overcome some of the barriers that stroke survivors face with regards to physical activity. This study aims to explore the factors that affect e-bike usage by stroke survivors. Methods: A mixed methods multiple case studies design, using semi-structured interviews and GPS data. Subject to GP approval, participants loaned an e-bike or e-trike for up to three months. Interviews were undertaken pre and post intervention. The COM-B behaviour change model acted as a framework for analysis. GPS data relating to journey duration and distance travelled was collected fortnightly. Results: Six participants were recruited; only three loaned an e-bike/e-trike (with adaptations as required). Storage, being unable to get GP approval, and safety were withdrawal reasons. Level of impairment was a factor influencing the type of e-bike used, level of support required and the motivation of the participants. Conclusion: Stroke survivors can use e-bikes although barriers exist. Electrical assistance was a positive factor in enabling some of the participants to cycle outdoors. Due to the small sample size and the number of participants who were able to loan an e-bike, further research is required to determine whether e-bikes are a feasible and effective intervention to increase physical activity for stroke survivors.IMPLICATIONS FOR REHABILITATION The assistance provided by the e-bike/e-trike could provide stroke survivors the opportunity to cycle outdoors. E-bikes/e-trikes could facilitate participation of activities of everyday living such as shopping, hobbies and increase levels of physical activity. Rehabilitation could focus on physical impairment, its effects on self-confidence, and knowledge surrounding the e-bike to overcome barriers to cycling. Social support, the belief that e-bike was an enjoyable mode of physical activity that was good for their health were reported by the participants as important factors for using the e-bike/e-trike.

BACKGROUND It is well known that due to current measurement, sizing and fitting approaches, poor bra fit is prevalent amongst larger breasted women. It is proposed to be a causal factor in the development of negative health outcomes including non-specific back pain (NSBP). Correcting poor bra fit may provide significant symptomatic relief, although this hasn’t yet been explored As a self-management strategy, this conservative approach may provide women with independence, empowerment and active involvement in the long-term management of their pain. AIM To determine the potential effectiveness of an alternative approach for managing chronic NSBP amongst larger breasted women, this study aimed to explore immediate and short-term biomechanical, psychosocial and pain responses to changing breast support garment amongst symptomatic and non-symptomatic participants. METHOD Asymptomatic participants (n=24) performed a static standing task, drop jumps and seated typing whilst kinematic data from the breasts and spine were recorded. Three breast support conditions were assessed: Usual, professionally fitted bra in the immediate term (PFB), and after four weeks wear (PFB28). Bra fit assessments were included for both bras. Measures of conscious motor processing were made using the Movement Specific Reinvestment Scale. Symptomatic participants followed the same data collection protocol (n=24) however, five breast support conditions were included: Usual, PFB, PFB28,and an Alternative Bra in the immediate term (AB) and after four weeks wear (AB28) (Optifit, Saddleworth, UK). A combination of clinical pain questionnaires measured symptomatic change. RESULTS All asymptomatic participants failed the bra fit assessment in the Usual bra and 67% (n=16) in the PFB. Less bra fit issues were present in the PFB compared to the usual bra, resulting in biomechanical changes relating to breast support and posture. These changes were not maintained over time (PFB28). All symptomatic participan

Background/Aims An ongoing discussion about direct access to physiotherapy for patients with musculoskeletal pain disorders in Austria requires the development of a curriculum that educates physiotherapy students to make autonomous decisions to treat the patient without the need for medical referral (keep), to treat the patient with additional medical check-up (keep and refer) or to send the patient for medical evaluation without physiotherapeutic management (refer), and to recognise the presence of serious pathologies. The aim of this study was to examine the feasibility, acceptability and potential effectiveness of an educational intervention that was provided to Austrian physiotherapy students in their final semester of the 3-year undergraduate (bachelor) degree. Methods An educational intervention was given to Austrian physiotherapy students in their final semester of the 3-year undergraduate (bachelor) degree, which consisted of a single, 1-hour face-to-face case-based lecture on the principles of differential diagnosis, screening for possible red flag pathologies and review of the body systems. A control group did not receive the intervention, but both groups completed 11 validated vignettes. Results Half of Austrian universities (n=6/12) and 116 final year Austrian undergraduate physiotherapy students took part in the study. All students from the intervention group were satisfied with the intervention and 77.6% found the intervention beneficial for making keep/refer decisions based on clinical vignettes. Overall, 89.7% did not find the intervention too time consuming. A potential effectiveness of the intervention could not be demonstrated. Conclusions Future similar studies need to investigate if more teaching hours and/or if different educational methods are capable of improving the keep/refer decision-making abilities of Austrian undergraduate physiotherapy students.

Background: Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain. Hypothesis: Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment. Study Design: Prospective crossover intervention. Level of Evidence: Level 3. Methods: Patients with patellofemoral pain (PFP; n = 61; mean age, 27 ± 9 years) were enrolled. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot) using 6 simple clinical tests. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Visual analog scale (VAS), perception of recovery scale (PRS), 5-Level European Quality 5 Dimensions (EQ- 5D-5L), and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (S-LANSS) were used to assess pain, knee function, and quality of life before and after the interventions. Results: In total, 34% (n = 21) of patients demonstrated recovery after multimodal treatment. However, over 70% (n = 29/40) of nonresponders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared with after multimodal treatment (P < 0.001). The VAS score at rest was significantly lower in the “weak and pronated foot” and the “weak and tight” subgroups (P = 0.011 and P = 0.008, respectively). Posttreatment pain intensity on activity was significantly lower in the “strong” subgroup (P = 0.006). Conclusion: Targeted treatment designed according to subgroup characteristics improves clinical outcomes in patients unresponsive to multimodal treatment. Clinical Relevance: Targeted intervention could be easily implemented after 6 simple clinical assessment tests to subgroup patient

Introduction: Patellar mobility is often routinely assessed in people with patellofemoral pain (PFP) in clinical practice. This study assessed the stability of the data when measuring patellar mobility using the total medial-lateral patellar glide test across multiple repetitions. It also compared patellar mobility of people with healthy knees to people with PFP and within subgroups of PFP. Methods: Twenty-two people without knee problems underwent five repetitions of the total medial-lateral patellar glide test. Differences in mean value for each repetition and the intra-class correlations (ICC) between the first assessment and the average values of additional repetitions were calculated. Mean patellar mobility was compared with 127 participants with PFP who took part in a previously published subgrouping study. Differences between the healthy knee group and PFP subgroups were also explored using a one-way ANOVA with pairwise comparisons. Results: The mean patellar mobility in healthy individuals was 16.4 mm (SD 5.3), difference in mean patellar mobility across repetitions was minimal and the ICC ranged between 0.93 and 0.95. People with PFP had significantly lower patellar mobility than the healthy knee group. Two of three PFP subgroups had statistically significantly lower mean patellar mobility (difference in mean -5.6mm and -6.5mm; P<0.001). Discussion: A single medial-lateral patellar glide test appears as informative as repeated tests in practice. One off measures of patellar mobility using the total medial-lateral patellar glide test may identify subgroups of PFP to help guide treatment in clinical practice. Further work is needed to assess other reliability parameters for this measure.

Identification of subgroups within the patellofemoral pain (PFP) population has gained a lot of interest and attention from the research community in recent years due to the recognition of the relatively poor patient outcomes associated with the multimodal approach and following the success of subgrouping approaches used in the management of Low Back Pain. This paper reviews early attempts at PFP subgrouping and introduces readers to some of the modern methodological approaches employed to derive subgroups. Summaries of the results of two research projects illustrating the use of these more robust methods to derive subgroups in the PFP population are provided. In conclusion it appears there are probably 3 or 4 discrete subgroups within the PFP population that may require a more personalised approach to treatment. However, to date no definitive RCTs have been conducted to evaluate the potential benefits of targeted interventions for PFP subgroups in terms of improved patient outcomes so this warrants further research.

Background Community-based studies of patellofemoral pain (PFP) need a questionnaire tool that discriminates between those with and those without the condition. To overcome these issues, we have designed a self-report questionnaire which aims to identify people with PFP in the community. Methods Study designs: comparative study and cross-sectional study. Study population: comparative study: PFP patients, soft-tissue injury patients and adults without knee problems. Crosssectional study: adults attending a science festival. Intervention: comparative study participants completed the questionnaire at baseline and two weeks later. Crosssectional study participants completed the questionnaire once. The optimal scoring system and threshold was explored using receiver operating characteristic curves, test-retest reliability using Cohen’s kappa and measurement error using Bland-Altman plots and standard error of measurement. Knowngroup validity was explored by comparing PFP prevalence between genders and age groups. Results Eighty-four participants were recruited to the comparative study. The receiver operating characteristic curves suggested limiting the questionnaire to the clinical features and knee pain map sections (AUC 0.97 95 % CI 0.94 to 1.00). This combination had high sensitivity and specificity (over 90 %). Measurement error was less than the mean difference between the groups. Test–retest reliability 3 / 7 estimates suggest good agreement (N = 51, k = 0.74, 95 % CI 0.52–0.91). The cross-sectional study (N = 110) showed expected differences between genders and age groups but these were not statistically significant. Conclusion A shortened version of the questionnaire, based on clinical features and a knee pain map, has good measurement properties. Further work is needed to validate the questionnaire in community samples.

Background Keep/refer decision as the ability to independently determine whether a patient’s condition is suitable for physiotherapy management (keep) or not (refer), is regarded as an core element in the World Confederation of Physical Therapists‘ (WCPT) Guideline for Standards of Physical Therapy Practice. However, it is currently unknown how individual European countries have implemented this in their national guidelines. Objectives To determine if keep/refer decision making abilities are an integral part of national guidelines for the physiotherapy profession of member countries of the European Network of Physiotherapy in Higher Education (ENPHE). Data Sources A review was performed including medical databases, the grey literature and personal correspondence with professional ENPHE member associations. To gain the information of interest, all eligible documents were reviewed. Results 11 national guidelines for the physiotherapy profession could be obtained. Two additional member associations use European guidelines as their national ones. Despite the fact that in the WCPT guidelines keep/refer decision making abilities are clearly described as a core element, there exists huge inconsistency as to how various European (with direct and non direct access systems) countries have included them in their national guidelines. Conclusion Despite the fact that most ENPHE member countries deem a close collaboration between health care professionals important and that physiotherapists should know the limitation of their expertise, keep/refer decision making abilities as explicitly stated in the WCPT guidelines were not included in the majority of guidelines that were reviewed.

Patellofemoral Pain (PFP) is a musculoskeletal disorder causing significant pain and dysfunction around the knee, commonly leading to long term limitations. People with PFP are commonly referred for physiotherapy, although current multimodal physiotherapy approaches tend to be rather ad-hoc and are failing in the long term. Identification of patient strata (or subgroups) who may respond differentially to interventions has been recognised as an international priority. It has been proposed that there are PFP patient strata, classified based on clinical tests, who would respond to modes of interventions targeted at the individual's stratum.