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BackgroundPhysical and cognitive impairments are important risk factors for falls in older people. However, no studies have been adequately powered to examine whether cognitive or cognitive-motor training can prevent falls in older people. This is despite good evidence of improvements in fall-related cognitive and physical functions following both intervention types. This manuscript describes the study protocol for a three-arm randomised controlled trial to evaluate the effectiveness of home-based cognitive and cognitive-motor training interventions, compared to a minimal-intervention control group, in preventing falls in older people. This trial was prospectively registered with the Australia New Zealand Clinical Trial Registry, number ACTRN12616001325493.Methods and analysisCommunity-dwelling adults aged 65 years and over, residing in Sydney Australia, will be recruited. Participants (n=750) will be randomly allocated to (1) cognitive-only training, (2) cognitive-motor training or (3) control groups. Both training interventions involve the use of thesmart±step home-based computerised game playing system for a recommended 120 min/week for 12 months. Cognitive training group participants will use a desktop electronic touch pad to play games with thesmart±step system while seated and using both hands. The cognitive-motor training group participants will use a wireless electronic floor step mat that requires accurate stepping using both legs for playing the samesmart±stepgames, hence incorporating balance exercises. All groups will receive an education booklet on fall prevention. The primary outcome will be rate of falls, reported by monthly diaries during the 12-month duration of the study and analysis will be by intention-to-treat. Secondary outcomes include the proportion of fallers, physical and cognitive performance in 300 participants, and brain structure and function in 105 participants who will undertake MRI scans at baseline and 6 months. Cost-effectiveness will be determined using intervention and health service costs.Ethics and disseminationEthical approval was obtained from UNSW Ethics Committee in September 2015 (ref number HC15203). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences.Trial registration numberACTRN12616001325493

Background The current practice of the Swedish Knee Register is not to take into consideration if one or both knees in a patient are subject to surgery when evaluating risk of revision after arthroplasty. Risk calculations are typically done by statistical methods, such as Kaplan-Meier analyses and Cox's proportional hazards models, that are based on the assumption that observed events are independent, and this is rarely appreciated. The purpose of this study was to investigate if ignoring bilateral operations when using these methods biases the results. Methods The bias of not taking bilateral operations into account was investigated by statistically analysing 55 298 prostheses in 44 590 patients, undergoing knee arthroplasty surgery in Sweden during 1985–1999, using traditional proportional hazards analysis, which assumes that all observations are independent, and a shared gamma frailty model, which allows patients to contribute repeated observations. Results The effect of neglecting bilateral prostheses is minute, possibly because bilateral prosthesis failure is a rare event. Conclusion We conclude that the revision risk of knee prostheses in general can be analysed without consideration for subject dependency, at least in study populations with a relatively low proportion of subjects having experienced bilateral revisions.

In systematic reviews statistical pooling is not always possible due to inadequate reporting of the results of original studies. In these reviews, a qualitative analysis using levels of evidence may be performed to summarize the evidence and to formulate conclusions [1]. This is explicit and reproducible, because it explains the exact meaning of labels like strong, moderate, and limited evidence. In the course of time, different sets of levels of evidence have been published [2–5]. All these sets are arbitrary and based on common sense at best. Ferreira et al. [6] show in their article that these different criteria may lead to different conclusions. They advise readers to be cautious when interpreting conclusions of systematic reviews that use levels of evidence. We fully agree, but not merely because different sets of criteria exist. If only one set of levels of evidence would exist this warning would even be more necessary. The use of levels of evidence is essentially an arbitrary and subjective way of summarizing evidence. Typically levels of evidence take into account the quality of the studies and the consistency of the results. In contrast to meta-analysis (statistical pooling), levels of evidence do not include the size of the effect. In the interpretation of both the conclusions of a study and its methodologic quality, there is some subjectivity involved. For example, grading the conclusions is difficult when there is borderline statistical significance, when a positive effect is observed for only part of many outcome measures studied, or when the reviewers do not agree with the authors’ conclusions. A similar example of arbitrary definitions is the interpretation of kappa values. Ferreira et al. [6] use the benchmarks proposed by Landis and Koch [7] to interpret their kappa values. Other often-used benchmarks are the ones proposed by Fleiss [8], which would have changed the conclusions about the disagreements between different sets of levels of evidence in Fereirra’s paper [6] slightly. Existence of different rating systems emphasizes their subjectivity. Kappa

To investigate the role of fatigue in strength training, strength increases produced by a training protocol in which subjects rested between contractions were compared with those produced when subjects did not rest. Forty-two healthy subjects were randomly allocated to either a no-rest group, a rest group, or a control group. Subjects in the two training groups trained their elbow flexor muscles by lifting a 6RM weight 6-10 times on 3 d each week for 6 wk. Subjects in the no-rest group performed repeated lifts without resting, whereas subjects in the rest group rested for 30 s between lifts. Both training groups performed the same number of lifts at the same relative intensity. The control group did not train. Subjects who trained without rests experienced significantly greater mean increases in dynamic strength (56.3% +/- 6.8% (SD)) than subjects who trained with rests (41.2% +/- 6.6%), and both training groups experienced significantly greater mean increases in dynamic strength than the control group (19.7% +/- 6.6%). It was concluded that greater short-term strength increases are achieved when subjects are required to lift training weights without resting. These findings suggest that processes associated with fatigue contribute to the strength training stimulus.

Objetivo Describir el curso evolutivo de los pacientes con lumbalgia aguda y/o ciatica e identificar factores pronosticos Fuentes de datos Busqueda bibliografica en Medline, Embase, Cinahl y Science Citation Index y busqueda manual en las referencias de los originales obtenidos. Estrategia de busqueda: recomendacion de Cochrane Collaboration Back Review Group for Spinal Disorders con filtro metodologico de estudios pronosticos de Medline. Periodo de estudio: desde el inicio de las bases de datos hasta marzo de 2002. Sin limitacion por idioma Seleccion de los estudios Criterios de inclusion: estudios prospectivos, descripcion explicita de la poblacion de estudio, descripcion del metodo de muestreo, pacientes con menos de 3 semanas de evolucion de la lumbalgia antes de su inclusion en la cohorte, periodo minimo de seguimiento de 3 meses, descripcion de sintomas, calidad de vida, discapacidad y reincorporacion laboral. Se excluyeron los estudios que incluyesen pacientes con enfermedades especificas que justificasen la lumbalgia. Se obtuvieron 4.458 de los cuales 15 cumplian los criterios de inclusion (9 ensayos clinicos, 4 estudios de cohortes y un estudio de intervencion en atencion primaria). Se valoro la calidad de los estudios mediante una escala propia de 6 criterios de caracter dicotomico (criterios de inclusion, seleccion aleatoria, perdida de mas del 20% de la cohorte en el momento de evaluar la evolucion, resultados numericos de la evolucion, desconocimiento de los factores pronosticos a priori por parte del evaluador, ajuste estadistico de las variables pronosticas evaluadas). El coeficiente de correlacion intraclase fue de 0,52 (no se da intervalo de confianza) Extraccion de datos Los datos de los estudios fueron obtenidos por 2 de los autores de manera independiente siguiendo un protocolo estandarizado. Las discrepancias fueron resueltas por un tercer miembro del grupo de trabajo Resultados principales El dolor decrece en el primer mes (descenso medio ponderado sobre el inicial del 58%; extremos: 12-84%); lo mismo ocurre con la discapacidad (descenso medio ponderado sobre el inicial del 58%; extremos: 33-83%). La reincorporacion laboral de los inicialmente en baja es del 82% (intervalo de confianza [IC] del 95%: 73-91%). La recurrencia del proceso en el primer ano varia entre el 66 y el 84% (riesgo medio: 73%; IC del 95%: 59-88%). Tres estudios analizan la existencia de factores pronosticos, siendo los resultados obtenidos inconsistentes (las odds ratio varian de 0,04 a 10,4) Conclusiones La mayoria de los pacientes con dolor lumbar agudo presenta una mejoria del dolor y la discapacidad funcional en las primeras 4 semanas, y la reincorporacion a la actividad es la norma. La recurrencia en el ano siguiente se presenta en mas de la mitad de los casos Fuente de financiacion National Health and Medical Research Council and the Australasian Physiotherapy Low Back Pain Trial Consortium Conflicto de Intereses No declarado

People with hemiplegia resulting from cerebrovascular accident commonly demonstrate one or more deviations from the kinematics of normal gait. This paper presents a list of common kinematic deviations for which physiotherapists might look when making clinical observations of hemiplegic gait. A number of likely causes of those kinematic deviations are described, based on a review of the literature, biomechanical considerations and clinical observations. Particularly common and significant stance phase deviations are a decreased peak hip extension in late stance, increased or decreased peak lateral pelvic displacement, increased or decreased knee extension in early or mid stance and decreased plantarflexion at toe-off. The causes of these kinematic deviations lie in the inability to appropriately activate muscles and in the adaptive muscle shortening which commonly occurs following stroke.

This cohort study investigated whether the risk of attrition during Australian Army recruit training was predicted by the fitness, age, date of enlistment, or injury status of recruits. Subjects were 1,317 male Australian Army recruits undertaking 12 weeks of intensive training. Fitness was measured using a 20-m progressive shuttle run test (20 mSRT) in which higher scores reflected higher fitness. A total of 184 subjects failed to complete training. Two hundred seventy-six disabling lower limb training injuries were recorded; 100 were stress fractures or periostitis. Scores on the 20 mSRT ranged between 3.5 and 13.5. Multivariate survival analysis revealed a strong negative association between 20 mSRT score and risk of attrition (p0.001) and a positive association between sustaining a lower limb injury and risk of attrition (p0.001). These effects were additive. Age and enlistment date were not significantly associated with risk of attrition. Fitness and training procedures may be important, modifiable risk factors for attrition.