Search

Background: The existence of pain-related fear appears to present an obstacle for health promoting behaviour change, particularly among younger adults with obesity. Measures developed and validated for middle-and-older age groups lack validity in younger adults under 45 years of age. This paper reports on the development and psychometric properties of a new instrument, based on a conceptual framework, to measure pain-related fear in younger adults. Methods: A cross sectional survey design was employed. 236 participants aged 18 to 45 years were recruited to participate. Participants completed three existing pain-related fear instruments mapped to a conceptual framework. Exploratory and confirmatory factor analysis identified the dimensions of the new Pain-Related Fear Scale. Construct validity was assessed by comparing scores between physical activity groups; criterion validity by correlation with the Tampa Scale of Kinesiophobia and reliability by Cronbach’s alpha. Differences in scores in the Pain-Related Fear Scale were explored across BMI subgroups. Results: A four-factor model with 12 items met the most acceptability thresholds for a good fitting model (CFI = 0.983; GFI = 0.953; RMSEA = 0.046; SRMR = 0.0301). Higher mean scores on the PainRelated Fear Scale were seen among those reporting low activity compared to high activity levels (F= 4.684; P= 0.01). Modest correlation was observed between the new instrument and Tampa Scale of Kinesiophobia (r= 0.508;95% CI= 0.389-0.612). Cronbach’s alpha was 0.842. Scores were higher in the obese subgroup compared to the healthy bodyweight group (mean difference= -7.42; CI= -12.26 - -2.58; P= 0.001). Conclusion: The Pain-Related Fear Scale is a psychometrically valid measurement of pain-related fear for adults with obesity aged between 18 to 45 years. The instrument can support research relating to barriers to physical activity, and potentially has clinical utility as a screening and outcome measurement.

Obesity continues to be a growing public health problem worldwide. In adults with obesity, physical activity has health benefits beyond those directly attributable to weight loss. However, adults with obesity encounter various barriers to physical activity. Some barriers including fear, have received little academic attention, particularly in adults under 45 years. The aim of this qualitative study was to explore how fears about physical activity are experienced by, and impact on, adults with obesity aged 18 to 45 years. Semi-structured interviews were undertaken in a sample of 10 participants with a body mass index greater than 30 kg/m2. Analysis was conducted using the six phases of thematic analysis from the guidelines of Braun and Clarke. Participants gave detailed accounts of their experiences of fear and how it impacted on physical activity. Three themes were extracted: (1) fear as a barrier to physical activity; (2) threats, concerns and worries about weight underpinning fear(s) of activity; and (3) the consequences of fear(s). The findings suggest that the emotion of fear, particularly pain-related fear(s), were a frequent and important barrier to physical activity among younger adults with obesity. This is an important finding because of the risk it poses to health behaviour change. The findings provide some evidence that younger adults experience fear avoidance beliefs aligned to the conceptual principles of the Fear Avoidance Model. Further research is needed to further explore this relationship in a larger sample of younger adults with obesity, and explore its implications for promoting behaviour change in this group.

Lower-limb running injuries are common. Running shoes have been proposed as one means of reducing injury risk. However, there is uncertainty as to how effective running shoes are for the prevention of injury. It is also unclear how the effects of different characteristics of running shoes prevent injury. To assess the effects (benefits and harms) of running shoes for preventing lower-limb running injuries in adult runners. We searched the following databases: CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus and SPORTDiscus plus trial registers WHO ICTRP and ClinicalTrials.gov. We also searched additional sources for published and unpublished trials. The date of the search was June 2021. We included randomised controlled trials (RCTs) and quasi-RCTs involving runners or military personnel in basic training that either compared a) a running shoe with a non-running shoe; b) different types of running shoes (minimalist, neutral/cushioned, motion control, stability, soft midsole, hard midsole); or c) footwear recommended and selected on foot posture versus footwear not recommended and not selected on foot posture for preventing lower-limb running injuries. Our primary outcomes were number of people sustaining a lower-limb running injury and number of lower-limb running injuries. Our secondary outcomes were number of runners who failed to return to running or their previous level of running, runner satisfaction with footwear, adverse events other than musculoskeletal injuries, and number of runners requiring hospital admission or surgery, or both, for musculoskeletal injury or adverse event. Two review authors independently assessed study eligibility and performed data extraction and risk of bias assessment. The certainty of the included evidence was assessed using GRADE methodology. We included 12 trials in the analysis which included a total of 11,240 participants, in trials that lasted from 6 to 26 weeks and were carried out in North America, Europe, Australia and South Africa. Most of the evidence was low or very low certainty as it was not possible to blind runners to their allocated running shoe, there was variation in the definition of an injury and characteristics of footwear, and there were too few studies for most comparisons. We did not find any trials that compared running shoes with non-running shoes. Neutral/cushioned versus minimalist (5 studies, 766 participants) Neutral/cushioned shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with minimalist shoes (low-certainty evidence) (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.59 to 1.01). One trial reported that 67% and 92% of runners were satisfied with their neutral/cushioned or minimalist running shoes, respectively (RR 0.73, 95% CI 0.47 to 1.12). Another trial reported mean satisfaction scores ranged from 4.0 to 4.3 in the neutral/ cushioned group and 3.6 to 3.9 in the minimalist running shoe group out of a total of 5. Hence neutral/cushioned running shoes may make little or no difference to runner satisfaction with footwear (low-certainty evidence). Motion control versus neutral / cushioned (2 studies, 421 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral / cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.92, 95% CI 0.30 to 2.81). Soft midsole versus hard midsole (2 studies, 1095 participants) Soft midsole shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with hard midsole shoes (low-certainty of evidence) (RR 0.82, 95% CI 0.61 to 1.10). Stability versus neutral / cushioned (1 study, 57 participants) It is uncertain whether or not stability shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral/cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.49, 95% CI 0.18 to 1.31). Motion control versus stability (1 study, 56 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with stability shoes because the quality of the evidence has been assessed as very low certainty (RR 3.47, 95% CI 1.43 to 8.40). Running shoes prescribed and selected on foot posture (3 studies, 7203 participants) There was no evidence that running shoes prescribed based on static foot posture reduced the number of injuries compared with those who received a shoe not prescribed based on foot posture in military recruits (Rate Ratio 1.03, 95% CI 0.94 to 1.13). Subgroup analysis confirmed these findings were consistent between males and females. Therefore, prescribing running shoes and selecting on foot posture probably makes little or no difference to lower-limb running injuries (moderate-certainty evidence). Data were not available for all other review outcomes. Most evidence demonstrates no reduction in lower-limb running injuries in adults when comparing different types of running shoes. Overall, the certainty of the evidence determining whether different types of running shoes influence running injury rates was very low to low, and as such we are uncertain as to the true effects of different types of running shoes upon injury rates. There is no evidence that prescribing footwear based on foot type reduces running-related lower-limb injures in adults. The evidence for this comparison was rated as moderate and as such we can have more certainty when interpreting these findings. However, all three trials included in this comparison used military populations and as such the findings may differ in recreational runners. Future researchers should develop a consensus definition of running shoe design to help standardise classification. The definition of a running injury should also be used consistently and confirmed via health practitioners. More researchers should consider a RCT design to increase the evidence in this area. Lastly, future work should look to explore the influence of different types or running shoes upon injury rates in specific subgroups.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the impact of interventions to improve inhaler technique on performance and clinical outcomes in people with COPD.

Physical activity is a health behavior contributing to successful weight management. Adults with overweight and obesity find it challenging to meet recommended activity guidelines because of a range of barriers, some of which are not yet fully understood. A barrier receiving limited consideration, compared with other literature within this field, is that of fear. The purpose of this scoping review was to establish the extent of literature on fear-related barriers to physical activity in adults with overweight or obesity and to identify gaps in this literature. The review followed the scoping review framework outlined by Arksey and O'Malley and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The findings of the identified papers were charted thematically using a framework of fears and age group. In total, 34 studies were included that identified nine different fears related to barriers to activity in this population. However, only a small number of studies (n = 5) had explicitly intended to explore fear-related barriers. There were notable knowledge gaps including activity-related fear of pain and movement in adults under 45 years of age. There is a strong rationale to further explore these fears because they may restrict health promoting behavior.

This thesis establishes the feasibility and validity of using digital surveys to collect population-based data. Subsequently, the thesis reports on the utilisation of a digital questionnaire determine the prevalence of patellofemoral pain (PFP) at mass-participant running events within the UK. In Chapter 2, to determine the feasibility creating a digital Survey instrument for Natural history, Aetiology and Prevalence of Patellofemoral pain Studies (SNAPPS) questionnaire, a systematic review comparing the response rate and completeness of digital and paper-based epidemiological surveys was conducted. The review found paper-based surveys to have a slightly higher response rate than digital surveys. As digital surveys offer several other benefits including lower costs per response, ease of data collection and automation of results coding, a pragmatic and practical approach was taken and, the paper version of the SNAPPS questionnaire was converted to a digital online version. In Chapter 3, eSNAPPS was developed and then validated against the original paper SNAPPS. Results showed that eSNAPPS was equivalent to paper SNAPPS and was valid against the paper version in determining the presence of PFP. Subsequently, in Chapter 4, eSNAPPS was utilised to evaluate the prevalence of PFP in individuals from the general population who attended mass-participation events in the UK. In this chapter, a cross-sectional study was conducted. There were over 1,080 responses, and with no missing data within the returned surveys. Furthermore, from the largest study in the UK and second largest in the world, the prevalence of PFP of those within the community attending mass-participant events was 17.4%. The results in this chapter highlighted that it was feasible to collect population-based data using eSNAPPS and that the adaptation of SNAPPS questionnaire has a positive outcome on the quality of data whilst also minimising the logistical demand surrounding data entry and data management. The findings from this thesis confirm the role that digital surveys can play in data collections for large scale epidemiology studies and the role of eSNAPPS in establishing the prevalence of PFP in the general population.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects (benefits and harms) of running shoes for preventing lower‐limb running injuries in adult runners.

Multi-day running events are increasingly popular however, research in these events is lacking and fails to consider the dynamic nature of musculoskeletal physiology. Twenty-three athletes completing a ten-day marathon event participated in the study. Proprioception, dynamic balance, knee valgus and flexibility were assessed the day before the event and after one, five and nine consecutive marathons. There were significant reductions in these measurements across the event and reductions were more apparent in the non-dominant side. Each runner suffered on average 4.2 injuries. Runners performed significantly worse in musculoskeletal measurements, particularly on the non-dominant side, as the competition progresses. Therefore, athletic trainers should design appropriate between-day recovery strategies during events based on with-in event data collection.

Background: Following an ACL injury, reconstruction (ACL-R) and rehabilitation, athletes may return to play with a proprioceptive deficit. However, literature is lacking to support this hypothesis in elite athletic groups who have returned to international levels of performance. It is possible the potentially heightened proprioceptive ability evidenced in athletes may negate a deficit following injury. The purpose of this study was to consider the effects of ACL injury, reconstruction and rehabilitation on knee joint position sense (JPS) on a group of elite athletes who had returned to international performance. Methods: Using a cross-sectional design ten elite athletes with ACL-R and ten controls were evaluated. JPS was tested into knee extension and flexion using absolute error scores. Average data with 95% confidence intervals between the reconstructed, contralateral and uninjured control knees were analyzed using t-tests and effect sizes. Results: The reconstructed knee of the injured group demonstrated significantly greater angle of error scores when compared to the contralateral and uninjured control into knee flexion (p = 0.0001, r = 0.98) and knee extension (p = 0.0001, r = 0.91). There were no significant differences between the contralateral uninjured knee of the injured group and the uninjured control group. Conclusions: Elite athletes who have had an ACL injury, reconstruction, rehabilitation and returned to international play demonstrate lower JPS ability compared to control groups. It is unclear if this deficiency affects long-term performance or secondary injury and re-injury problems. In the future physical therapists should monitor athletes longitudinally when they return to play.

The Landing Error Scoring System (LESS) is a relatively new clinical test that assesses landing biomechanics during a drop jump task. Performance measures such as Jump Height (JH), Power (P), Contact time (CT) and Reactive Strength Index (RSI) are common performance measures in an athletic population. Comparing results from the LESS against these performance measures has not previously been reported in an elite rugby union setting. The aim of this study was to compare differences between LESS scores and lower limb performance measures in elite male rugby union players. Thirty two male, elite rugby union players participated in the study. Each participant completed 3 trials of the LESS. Performance data regarding JH, P, CT and RSI were recorded concurrently via the OptoJump system (Microgate, Bolzano, Italy). LESS trials were scored independently by the authors. Statistical analyses were used to confirm inter and intra-rater reliability. Data was tested for normality and one-way factorial MANOVA was used to assess between group differences (p

Background: Dance involves movements of complexity and physical intensity which result in stress on the body. As a consequence, dancers are at risk of injury which can impact on their well-being. Screening tools are used for injury prevention to identify those dancers at risk of injury. The aim of this study was to investigate which screening tools can predict injury in dancers, encompassing all dance genres, levels and ages.\ud \ud Methods: An electronic search of seven databases from their inception to December 2017 was conducted. The databases were the Allied and Complementary Medicine Database (AMED), CINAHL, eBOOK Collection (EBSCOhost), MEDLINE, Cochrane Database of Systematic Reviews, SPORTDiscus and PEDro: the Physiotherapy Evidence Base. The following search terms were used: (i) Dance AND injury AND Screening, (ii) Screening AND dance and (iii) Musculoskeletal AND Screening AND Dance. Studies were assessed using a 20-point scoring tool, and eligible studies were included in a meta-analysis.\ud \ud Results: The mean methodological quality score was 12.2 points. Injured dancers had a significantly higher compensated turnout range of motion than non-injured dancers: pooled mean difference of compensated turnout (23.29°; 95% CI 14.85–31.73; P

Context: Training exposure has been associated with injury epidemiology in elite youth soccer, where lower-limb musculoskeletal screening is commonly used to highlight injury risk. However, there has been little consideration of the relationship between lower-limb screening and the loading response to soccer activities. Objective: To quantify the efficacy of using screening tests to predict the loading elicited in soccer-specific activities and to develop a hierarchical ordering of musculoskeletal screening tests to identify test redundancy and inform practice. Design: Correlational. Setting: Professional soccer club academy. Participants: A total of 21 elite male soccer players aged 15.7 (0.9) years. Intervention: Players completed a battery of 5 screening tests (knee to wall, hip internal rotation, adductor squeeze, single-leg hop, and anterior reach) and a 25-minute standardized soccer session with a Global Positioning System unit placed at C7 to collect multiplanar PlayerLoad data. Main Outcome Measures: Baseline data on each screening test, along with uniaxial PlayerLoad in the mediolateral, anteroposterior, and vertical planes. Results: Stepwise hierarchical modeling of the screening tests revealed that dominant leg knee-to-wall distance was the most prevalent and powerful predictor of multiplanar PlayerLoad, accounting for up to 42% of variation in uniaxial loading. The adductor squeeze test was the least powerful predictor of PlayerLoad. Of note, one player who incurred a knee injury within 3 weeks of testing had shown a 20% reduction in knee-to-wall distance compared with peers, and elicited 23% greater PlayerLoad, supporting the hierarchical model. Conclusions: There was some evidence of redundancy in the screening battery, with implications for clinical choice. Hierarchical ordering and a concurrent case study highlight dominant leg knee-to-wall distance as the primary predictor of multiaxial loading in soccer. This has implications for the design and interpretation of screening data in elite youth soccer.

Background: Bronchiectasis is a chronic respiratory disease characterised by abnormal and irreversible dilatation and distortion of the smaller airways. Bacterial colonisation of the damaged airways leads to chronic cough and sputum production, often with breathlessness and further structural damage to the airways. Long-term macrolide antibiotic therapy may suppress bacterial infection and reduce inflammation, leading to fewer exacerbations, fewer symptoms, improved lung function, and improved quality of life. Further evidence is required on the efficacy of macrolides in terms of specific bacterial eradication and the extent of antibiotic resistance.Objectives: To determine the impact of macrolide antibiotics in the treatment of adults and children with bronchiectasis.Search methods: We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted all searches on 18 January 2018.Selection criteria: We included randomised controlled trials (RCTs) of at least four weeks' duration that compared macrolide antibiotics with placebo or no intervention for the long-term management of stable bronchiectasis in adults or children with a diagnosis of bronchiectasis by bronchography, plain film chest radiograph, or high-resolution computed tomography. We excluded studies in which participants had received continuous or high-dose antibiotics immediately before enrolment or before a diagnosis of cystic fibrosis, sarcoidosis, or allergic bronchopulmonary aspergillosis. Our primary outcomes were exacerbation, hospitalisation, and serious adverse events.Data collection and analysis: Two review authors independently screened the titles and abstracts of 103 records. We independently screened the full text of 40 study reports and included 15 trials from 30 reports. Two review authors independently extracted outcome data and assessed risk of bias for each study. We analysed dichotomous data as odds ratios (ORs) and continuous data as mean differences (MDs) or standardised mean differences (SMDs). We used standard methodological procedures as expected by Cochrane.Main results: We included 14 parallel-group RCTs and one cross-over RCT with interventions lasting from 8 weeks to 24 months. Of 11 adult studies with 690 participants, six used azithromycin, four roxithromycin, and one erythromycin. Four studies with 190 children used either azithromycin, clarithromycin, erythromycin, or roxithromycin.We included nine adult studies in our comparison between macrolides and placebo and two in our comparison with no intervention. We included one study with children in our comparison between macrolides and placebo and one in our comparison with no intervention.In adults, macrolides reduced exacerbation frequency to a greater extent than placebo (OR 0.34, 95% confidence interval (CI) 0.22 to 0.54; 341 participants; three studies; I2 = 65%; moderate-quality evidence). This translates to a number needed to treat for an additional beneficial outcome of 4 (95% CI 3 to 8). Data show no differences in exacerbation frequency between use of macrolides (OR 0.31, 95% CI 0.08 to 1.15; 43 participants; one study; moderate-quality evidence) and no intervention. Macrolides were also associated with a significantly better quality of life compared with placebo (MD -8.90, 95% CI -13.13 to -4.67; 68 participants; one study; moderate-quality evidence). We found no evidence of a reduction in hospitalisations (OR 0.56, 95% CI 0.19 to 1.62; 151 participants; two studies; I2 = 0%; low-quality evidence), in the number of participants with serious adverse events, including pneumonia, respiratory and non-respiratory infections, haemoptysis, and gastroenteritis (OR 0.49, 95% CI 0.20 to 1.23; 326 participants; three studies; I2 = 0%; low-quality evidence), or in the number experiencing adverse events (OR 0.83, 95% CI 0.51 to 1.35; 435 participants; five studies; I2 = 28%) in adults with macrolides compared with placebo.In children, there were no differences in exacerbation frequency (OR 0.40, 95% CI 0.11 to 1.41; 89 children; one study; low-quality evidence); hospitalisations (OR 0.28, 95% CI 0.07 to 1.11; 89 children; one study; low-quality evidence), serious adverse events, defined within the study as exacerbations of bronchiectasis or investigations related to bronchiectasis (OR 0.43, 95% CI 0.17 to 1.05; 89 children; one study; low-quality evidence), or adverse events (OR 0.78, 95% CI 0.33 to 1.83; 89 children; one study), in those receiving macrolides compared to placebo. The same study reported an increase in macrolide-resistant bacteria (OR 7.13, 95% CI 2.13 to 23.79; 89 children; one study), an increase in resistance to Streptococcus pneumoniae (OR 13.20, 95% CI 1.61 to 108.19; 89 children; one study), and an increase in resistance to Staphylococcus aureus (OR 4.16, 95% CI 1.06 to 16.32; 89 children; one study) with macrolides compared with placebo. Quality of life was not reported in the studies with children.Authors' conclusions: Long-term macrolide therapy may reduce the frequency of exacerbations and improve quality of life, although supporting evidence is derived mainly from studies of azithromycin, rather than other macrolides, and predominantly among adults rather than children. However, macrolides should be used with caution, as limited data indicate an associated increase in microbial resistance. Macrolides are associated with increased risk of cardiovascular death and other serious adverse events in other populations, and available data cannot exclude a similar risk among patients with bronchiectasis.

Objective: To describe musculoskeletal injury rates in recreational runners completing ten marathons over ten consecutive days to help event organisers plan future injury preventative advice and strategies.\ud \ud Methods: An observational study involving 27 recreational runners (age 45.1 ± 7.47 yrs, mass 74.5 ± 12.39 kg, years running 11.6 ± 9.42 yrs, average weekly mileage 41.9 ± 12.72 miles). Main outcome measures included total and percentage of musculoskeletal injuries, timing of injury occurrence during 10-day event, and daily individual marathon times.\ud \ud Results: Twenty-six runners sustained 108 injuries, averaging 4 injuries per runner (90.13 per 1000hr). 89% of injuries involved the lower extremity; 24.1% foot, 18.5% hip/buttock, 16.7% ankle and 16.7% lower leg. Common injuries were blisters (15.7%), Achilles tendinitis (11.1%), medial tibial stress syndrome (MTSS) (10.2%), iliotibial band syndrome (ITBS) (9.3%) and low back pain (LBP) (9.3%). 64.3% of injuries were sustained to the left limb. Chisquared analysis revealed more injuries in days 1-3 than days 4-6 (p=0.013) and days 7-10 (p=0.001). Repeated measures ANOVA comparing Days 1-3, 4-6 and 7-10 showed a significant main effect (p=0.039). Post hoc analysis revealed Days 1-3 were significantly quicker time than days 7-10 (p=0.037, difference of 0.276 hrs).\ud \ud Conclusion: Blisters, Achilles tendinitis, MTSS and ITBS are the most common lower extremity injuries in multiday marathons runners performing a repeat course over 10 consecutive days.Runners entering these events should perform appropriate injury prevention programmes. Runners should also be more reserved at the beginning of multiday events to avoid high initial injury risk. However, further investigation of injury rates and risk factors using larger sample sizes is required.

Background: It is suggested the anterior cruciate ligament (ACL) plays a significant role in knee proprioception, however, the effect of ACL injury on knee proprioception is unclear. Studies utilising the two most common measurement techniques, joint position sense and threshold to detect passive motion, have provided evidence both for and against a proprioceptive deficient following ACL injury.\ud \ud Objective: The objective of the study was to undertake a meta-analysis investigating the effects of ACL injury, treated conservatively or by reconstruction, on proprioception of the knee, measured using joint position sense and/or threshold to detect passive movement techniques.\ud \ud Data sources: Seven databases were searched from their inception to September 2013 using the subject headings ‘anterior cruciate ligament, proprioception, postural sway, joint position sense, balance, equilibrium or posture’ to identify relevant studies.\ud \ud Eligibility criteria: PRISMA guidelines were followed as much as possible. Studies that investigated the effect of ACL injury on either knee joint kinaesthesia or position sense were included in this review.\ud \ud Data extraction and synthesis: Two reviewers independently extracted data using a standardised assessment form. Comparisons were made using a fixed effect model with an inverse variance method using Review Manager Software (V5.1).\ud \ud Results: Patients with ACL injury have poorer proprioception than people without such injuries (SMD = 0.35°; P = 0.001 and SMD = 0.38°; P = 0.03) when measured using joint position sense and threshold to detect passive motion techniques respectively. Patients had poorer proprioception in the injured than uninjured leg (SMD = 0.52°; P

Background: Portable and cost-effective accelerometers can yield instantaneous results of force, power, and velocity, with minimum set-up time to assess muscle power. However, such devices must also produce both valid and reliable data.\ud \ud Objective: The current study assessed the validity and reliability of the Myotest Pro wireless accelerometer (ACC). \ud \ud Methods: Thirty physically active males performed two squat jump, on two separate sessions. The jump was recorded simultaneously by a force platform and ACC, which was attached to a barbell resting on the subjects' shoulders. Validity was determined using Pearson correlation coefficient (r) and t-test between the maximum force platform (F_{FP}) and ACC (F_{ACC}) force. Between session reliability of F_{ACC}, power (P_{ACC}) and velocity (V_{ACC}) from the ACC were assessed with t-test, intraclass correlation coefficient (ICC), and coefficient of variation (CV). \ud \ud Results: F_{ACC} correlated highly to F_{FP} (r=0.815, p< 0.05), but there was a proportionate ratio bias of 0.81. There was no difference between sessions (p> 0.05) for any variable. High ICCs were found for all variables (F_{ACC} 0.90; P_{ACC} 0.80; V_{ACC} 0.84). Low CV was found for F_{ACC} (2.1%), P_{ACC} (3.3%) and V_{ACC} (3.2%). \ud \ud Conclusions: ACC is a valid and reliable tool to use for assessing barbell movement, but caution in power data interpretation is needed.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the impact of macrolide antibiotics in the treatment of adults and children with non-cystic fibrosis bronchiectasis.

Proprioception is critical for effective movement patterns. However, methods of proprioceptive measurement in previous research have been inconsistent and lacking in reliability statistics making it applications to clinical practice difficult. Researchers have suggested that damage to the anterior cruciate ligament (ACL) can alter proprioceptive ability due to a loss of functioning mechanoreceptors. The majority of patients opt for reconstructive surgery following this injury. However, some patients chose conservative rehabilitation options rather than surgical intervention.The purpose of this study was to determine the effect of ACL deficiency on knee joint position sense following conservative, non-operative treatment and return to physical activity. A secondary purpose was to report the reliability and measurement error of the technique used to measure joint position sense, (JPS) and comment on the clinical utility of this measurement.Observational study design using a cross-section of ACL deficient patients and matched uninjured controls.Twenty active conservatively treated ACL deficient patients who had returned to physical activity and twenty active matched controls were included in the study. Knee joint position sense was measured using a seated passive-active reproductive angle technique. The average absolute angle of error score, between 10 °-30 ° of knee flexion was determined. This error score was derived from the difference between the target and repositioning angle.The ACL deficient patients had a greater error score (7.9 °±3.6) and hence poorer static proprioception ability that both the contra-lateral leg (2.0 °±1.6; p = 0.0001) and the control group (2.6 °±0.9; p = 0.0001). The standard error of the mean (SEM) of this JPS technique was 0.5 ° and 0.2 ° and the minimum detectable change (MDC) was 1.3 ° and 0.4 ° on asymptomatic and symptomatic subjects respectively.This study confirms a static proprioceptive deficiency exists in the knee joint following ACL injury and rehabilitation, potentially due to a reduction in functioning mechanoreceptors in the ligament over time. The differences between the ACL deficient knee and the control group were above the SEMs and MDCs of the measurement which suggests clinical relevance. Longitudinal studies are needed to evaluate if patients who return to activity with a joint position sense deficiency develop secondary injuries.Individual Cohort Study (2b).

Background Previous research has suggested a decline in knee proprioception with age. Furthermore, regular participation in physical activity may improve proprioceptive ability. However, there is no large scale data on uninjured populations to confirm these theories. The aim of this study was to provide normative knee joint position data (JPS) from healthy participants aged 18–82years to evaluate the effects of age, physical activity and knee direction. Methods A sample of 116 participants across five age groups was used. The main outcome measures were knee JPS absolute error scores into flexion and extension, Tegner activity levels and General Practitioner Physical Activity Questionnaire results. Results Absolute error scores in to knee flexion were 3.6°, 3.9°, 3.5°, 3.7° and 3.1° and knee extension were 2.7°, 2.5°, 2.9°, 3.4° and 3.9° for ages 15–29, 30–44, 45–59, 60–74 and 75 years old respectively. Knee extension and flexion absolute error scores were significantly different when age group data were pooled. There was a significant effect of age and activity level on joint position sense into knee extension. Age and lower Tegner scores were also negatively correlated to joint position sense into knee extension. Conclusions The results provide some evidence for a decline in knee joint position sense with age. Further, active populations may have heightened static proprioception compared to inactive groups. Normative knee joint position sense data is provided and may be used by practitioners to identify patients with reduced proprioceptive ability.

Context: Clinicians require portable, valid, and cost-effective methods to monitor knee joint-position-sense (JPS) ability. Objective: To examine the criterion-related validity of image-capture JPS measures against an isokinetic-dynamometer (IKD) procedure. Design: Random crossover design providing a comparison of knee JPS measures from image capture and IKD procedures. Participants: 10 healthy participants, 5 female, age 28.0 ± 13.29 y, mass 60.3 ± 9.02 kg, height 1.65 ± 0.07 m, and 5 male, 29.6 ± 10.74 y, mass 73.6 ± 5.86 kg, height 1.75 ± 0.07 m. Main Outcome Measures: The dependent variables were absolute error scores (AES) provided by 2 knee directions (flexion and extension). The independent variables were the method (image capture and IKD). Results: There was no significant difference between clinical and IKD AED into knee-extension data (P = .263, r = 0.55). There was a significant difference between clinical and IKD AES into knee-flexion data (P = .016, r =.70). Conclusions: Analysis of photographic images to assess JPS measurements using knee flexion is valid against IKD techniques. However, photo-analysis measurements provided a lower error score using knee-extension data and thus may provide an optimal environment to produce maximal knee JPS acuity. Therefore, clinicians do not need expensive equipment to collect representative JPS ability.

Background Female soccer has only recently become a professional sport within the UK. The need for accurate and reliable screening and profiling of professional female soccer players could assist in the design of injury prevention programmes. Objective To evaluate the clinical joint and limb measures during a preseason screening process in professional female soccer players. Design Cross-sectional, descriptive study. Setting Sports Therapy clinic. Participants 32 professional UK-based female soccer players (aged 23±3.60, mass 62.41±6.37 kg, height 167±6.65 cm) participated in the study. Assessment of Risk Factors Risk factors were assessed during the English Women9s Super League preseason, January 2016. The independent variable was leg dominance. Main Outcome Measurements The outcome measures were leg length, knee to wall distance, knee flexion and extension, hip flexion and extension, hip internal and external rotation ranges of motion (ROM), straight leg raise hip flexion angle from both dominant and non-dominant legs. A qualified and experienced Sports Therapist subjectively assessed and recorded joint ligament laxity at the knee and ankle. Results Paired T-Tests revealed significantly reduced ROM in the dominant side compared to the non-dominant side for both hip flexion (p=0.005) and hip internal rotation (p=0.021). However, all other ROM measurements demonstrated limb symmetry. The most notable findings from the subjective laxity measures was that 35.9% of players had ankle talar inversion laxity. Conclusions Reduced hip ROM in the dominant side of players may increase the risk of lower limb injury. It may be important to include hip flexibility training into pre-season injury prevention programmes for female soccer players to ensure lower limb symmetry. Furthermore, ankle strengthening, proprioception and single leg change of direction exercises may be included in training programmes due to the high prevalence of ankle laxity in this sample. Future studies should monitor these measurements across a season and correlate them with injury incidence.

Background: Multi-day running events are becoming increasingly popular with nonprofessional athletes. However, it is unknown how and when this type of event affects injury risk factors such as proprioception and balance.\ud \ud Objective: To evaluate the effect of running one, five consecutive and nine consecutive marathons on joint position sense (JPS) and dynamic balance.\ud \ud Design: Cross-sectional, observational study.\ud \ud Setting: Sports-injury clinic.\ud \ud Participants: 21 athletes completing the event (age 44.8±8.09 yrs, mass 74.4±13.14 kg, years running 10.4±7.39 yrs, average weekly mileage 44.8±12.09 miles) entered the study. Ten athletes completed the JPS testing and five athletes completed the dynamic balance testing.\ud \ud Assessment of Risk Factors: Risk factors were assessed the day before the event (day zero) and then following completion of one (day one), five (day five) and nine (day nine) consecutive marathons. The independent variable was time.\ud \ud Main Outcome Measurements: JPS error into flexion and extension, star-excursion balance test (SEBT) and number of injuries per runner.\ud \ud Results: Friedman's ANOVAs indicated no effects of time on JPS into extension (p=0.94), dominant-leg anterior (p=0.52) or posterior-lateral (p=0.65) SEBT reach. JPS flexion error significantly decreased by 1.3° from day one to five (p=0.032). Non-dominant leg anterior, posterior-medial and posterior-lateral SEBT reaches significantly decreased from day zero to nine by 0.09% (p=0.043), 0.13% (p=0.043) and 0.17% (p=0.043) of leg length respectively. Dominant leg posterior-medial SEBT reach also significantly decreased by 0.12% of leg length (p=0.043) from day zero to nine. There were 4.2 injuries per runner.\ud \ud Conclusions: The results suggest multi-day running events can cause over four lower limb injuries per runner and reduce dynamic balance ability. Nonprofessional athletes completing these events should be aware of this high injury occurrence and prepare appropriately. Injury prevention programmes incorporating dynamic balance may be recommended. However future studies with additional risk factors and larger sample sizes are needed to substantiate these findings.

Context: Knee joint-position sense (JPS) plays a critical role in controlled and stable joint movement. Poor ability to sense position of the knee can therefore increase risk of injury. There is no agreed consensus on JPS measurement techniques and a lack of reliability statistics on methods. Objective: To identify the most reliable knee JPS measurement technique using image capture. Design: Interexaminer, intraexaminer, and test-retest reliability of knee JPS measurements. Setting: Biomechanics laboratory. Participants: 10 asymptomatic participants. Interventions: None. Main Outcome Measures: Relative and absolute error scores of knee JPS in 3 conditions (sitting, prone, active) through 3 ranges of movement (10-30°, 30-60°, 60-90°), into 2 directions (flexion and extension) using both legs (dominant and nondominant) collected during 15 trials and repeated 7 d after the first data collection. Results: Statistical analysis by intraclass correlations revealed excellent interexaminer reliability between researchers (.98) and intraexaminer reliability within 1 researcher (.96). Test-retest reliability was highest in the sitting condition from a starting angle of 0°, target angle through 60-90° of flexion, using the dominant leg and absolute-error-score variables (ICC = .92). However, it was noted smallest detectable differences were a high percentage of mean values for all measures. Conclusions: The most reliable JPS measurement for asymptomatic participants has been identified. Practitioners should use this protocol when collecting JPS data during prescreening sessions. However, generalizability of findings to a class/group of clients exhibiting knee pathologies should be done with caution.

Assessing strength and power is crucial for evaluating muscular performance and function. As laboratory testing can be time-consuming or inaccessible to many athletes, portable accelerometers have been developed to assess strength and power on the field. Recently, a wireless accelerometer was introduced to allow for even greater flexibility in assessment. Nevertheless, any assessment tool must be valid and reliable. The aim of the current study was to assess the validity and reliability of a commercially available accelerometer. Forty-eight physically active subjects (males, n=32: age 29.2±8.8 yrs, height 1.79±0.12 m, body mass 82.0±14.3 kg; females, n=16: age 27.4±6.3 yrs, height 1.71±0.06 m, body mass 63.8±7.4 kg) completed two countermovement jump squats on a force plate (FP) with at least one minute rest, on two separate occasions. The accelerometer was secured on a lightweight bar, which rested on the subjects’ shoulders whilst jumping. The jump with the highest force generation was selected from each occasion for further analysis. Validity was determined from the Pearson correlation coefficient (r) between the accelerometer and the FP. Bias was also calculated, using a t-test. Reliability was assessed by the intraclass correlation coefficient (ICC) and coefficient of variation (CV), whilst test-retest differences were examined with a t-test. The accelerometer demonstrated significant and high correlation to the force plate (p=0.001, r=0.85), whilst it overestimated force production by 7.8% (p=0.001). Repeatability for both devices was the same (ICC=0.87), with small CV (accelerometer=7.5%, FP=6.1%) and test-retest differences (accelerometer=0.1%, FP=1.1%). The results indicate that the Myotest Pro® accelerometer is a valid and reliable tool for assessing force in the field. However, caution needs to be exercised when the results are compared to data obtained from a force plate, as the Myotest Pro® calculation method overestimates the maximum force produced.

Lower limb strength ratios are important in assessing muscular imbalances. Typically, these ratios are derived from assessment of explosive, maximum effort activities. Such assessment can be functional or isokinetic. The single-effort nature of these assessments does not provide information on imbalance changes following muscular contractions. Any such change could indicate an increased risk of injury after a period of activity, thus raising questions as to the correct procedure of muscle imbalance assessment. Therefore, the aim of the current study was to assess muscle imbalances over maximum effort repeated cycling sprints. Seventeen healthy, physically active young adults (females: n=4, height 1.62±0.03 m, body mass 68.0±6.5 kg; males: n=13, height 1.80±0.06 m, body mass 80.5±13.8 kg) performed five 6-s sprints with 24-s rest interval on a Lode Excalibur bike with torque and power data recorded for each leg. Average, average maximum (average of maximum from each sprint) and peak torque (TAv, TAvM and TP, respectively) and power (PAv, PAvM and PP, respectively) were obtained for each leg. Ratios of these variables were calculated as (((stronger leg-weaker leg) / (average of two legs))*100). Wilcoxon’s test revealed a significantly stronger leg (P