Search

Refereed/Peer-reviewed Objectives: The aim of this systematic review was to critically review and synthesise the findings from primary studies on pitching mechanics and performance of healthy adult baseball pitchers. Design: Systematic review with meta-analysis. Methods: Eight English- and Japanese-language databases were systematically searched from inception to 22nd July 2022. Results: In total, 29 descriptive biomechanical studies were included. Overall study quality was moderate. In subgroup analyses, professional pitchers showed significantly higher stride length, peak shoulder internal rotation velocity, peak shoulder proximal force and ball velocity compared to collegiate pitchers. Conversely, collegiate pitchers were found to have significantly higher peak pelvis rotation velocity. Conclusions: Available normative data suggested potentially heterogeneous pitching mechanics and performance between professional and collegiate pitchers. However, the findings in this review should be interpreted cautiously. Since statistical heterogeneity was significant within most data sets, more detailed subgroup analyses are required. Additionally, more high-quality studies utilising measurement systems with established reliability are required to obtain accurate data in baseball pitching mechanics and performance.

Purpose: Determine the impact of preseason and between-seasons changes in individual physical performance on injury risk in elite junior Australian football players and if injuries sustained during a season impact subsequent-season performance improvement. Methods: This prospective cohort study assessed individual performance measures (sprint speed, jump, agility, and aerobic endurance) during preseason over 4 consecutive seasons. Injury status (injured/not injured) was tracked weekly to determine the relationship between individual performance and in-season injury occurrence. Mixed models were used to determine the relationship between physical performance and injury, and the effect of injury on physical performance improvement. Results: A total of 206 players played 2 consecutive seasons and were included (17.6 y, 181.9 cm, 75.7 kg). Faster players during preseason experienced higher injury incidence (injuries/season) during that playing season (incidence rate ratio = 0.127; P = .034). Injury incidence was not influenced by between-seasons change in any performance measure. Players injured during their first season maintained their aerobic fitness, which declined in noninjured players (d = 0.39; P = .013). Players who sustained a lower-limb injury during their first season saw smaller improvements in sprint speed than players who did not get injured (d = 0.39; P = .035). Conclusion: Faster players experience higher injury incidence than slower players and may require specific prevention interventions. Players who experience a lower-limb injury during the playing season do not improve sprint speed between seasons to the same extent as players who do not get injured, highlighting the need for targeted high-speed running ability development as part of rehabilitation.

Introduction: Increases in demand for therapeutic ultrasound-guided musculoskeletal injections have led to longer waiting times for appointments. With the right training, sonographers are well placed to perform these low-risk procedures. This study evaluated the effect of musculoskeletal injections administered by trained sonographers with respect to patient safety and satisfaction. Methods: Patients were recruited from three radiology clinics staffed with appropriately trained sonographers. Patients who agreed to have their injection completed by a sonographer completed satisfaction surveys immediately after their appointment, with adverse reactions also recorded. Longer-term outcomes were recorded 7–10 days later. Results: 97% of 804 participating patients were completely satisfied with the service they received. Reported adverse events were low, with

This study aimed to identify whether a revised lower Functional Movement Screen (FMS) composite score threshold would be associated with a greater injury risk for junior athletes than the common threshold of

Purpose This study analysed data from a national survey of people living in Australian Residential Aged Care Facilities (RACFs) reporting on what is the best thing about where they live and suggestions for improvement. Data from prior to the Covid-19 pandemic were compared with data during the Covid-19 pandemic. Methods Qualitative data from the Happy Life Index Survey were analysed using summative content analysis to code the responses in the data sets and then organise them into categories. Once categorised, the pre-Covid-19 and mid-Covid-19 data sets were compared using descriptive statistics. Results A total of 4745 residents, from over 100 RACFs, provided 8512 open-text responses to at least one of the two survey questions. Pre-Covid-19 responses were compared with mid-Covid-19 responses and those trending towards relevance (5–10% change) were identified. There were both positive and negative relevant percent changes for staff number, food (general comments), and friendliness. A trending positive percentage change was observed for staff quality and the internal environment. There was a trending negative relevant percentage change for lifestyle activities, staff generally, level of contentedness, the general environment, general choice, and general views about the service. Conclusion People living in RACFs notice the changes in staffing levels and visitors during restrictions imposed during infectious outbreaks. During these times, they appreciate the quality of the staff attending to their needs and the quality of their food. Further exploration is needed of the value of lifestyle activities and strategies to promote feelings of contentedness and general wellbeing during times of restriction.

Objectives: The objectives of this study were to identify the entry-level health profession students’ perception and readiness to adopt online learning as a component of blended learning (BL). Methods: A cross sectional survey using a structured questionnaire was administered using Google forms. Entry level Health professionals’ education (HPE) graduate students of a higher education institute in India completed the survey (N= 628). The questionnaire was developed from the literature and content validated by experts. Ethics clearance was obtained from the Institutional ethics committee. Results: Out of 628 responses, 603 fully completed questionnaires were included for analysis. Of the participants, 98 % owned a smartphone, whereas 67% possessed either a laptop or a stationary computer. 60 % of the respondents reported at least one hour of internet access per day for learning purposes. Most of the participants were comfortable in accessing online learning materials and interacting with peers. The majority of the participants (77.4%) were willing to spend 10 to 20 hours per week on online learning. Conclusion: Entry Level HPE graduate students were ready to adopt online learning as a component of BL. Providing necessary infrastructure and creating online learning materials needs to be considered.

Refereed/Peer-reviewed Background: To compare intrinsic foot muscle size between people with and without symptomatic midfoot osteoarthritis, and examine the association between muscle size and strength, pain and foot-related disability. Methods: Twenty-three participants with symptomatic midfoot osteoarthritis and 23 age, sex and BMI matched controls were included. Intrinsic foot muscle cross-sectional area was measured using MRI. Hand-held dynamometry was used to assess foot and ankle muscle strength, and foot-related pain and disability was measured using Manchester Foot Pain & Disability Index. Findings: Small and non-statistically significant differences were found in intrinsic foot muscle cross-sectional area between the two groups (effect sizes 0.15–0.26, p > 0.05). Muscle strength was reduced in the midfoot osteoarthritis group, with differences of 12–33% (effect sizes 0.47–1.2). In the control group, moderate positive associations) existed between foot muscle cross-sectional area and lesser digits flexor strength (r = 0.5 to 0.7, p < 0.05). Conversely, in the midfoot osteoarthritis group, negligible positive associations were found (r < 0.3, p > 0.05). Associations between foot muscle cross-sectional with and pain and disability scores in the midfoot osteoarthritis group were negligible (r < −0.3, p > 0.05). Interpretation: Despite reductions in maximal isometric muscle strength, midfoot osteoarthritis does not appear to be associated with reduced intrinsic foot muscle cross-sectional area measured by MRI. Muscle compositional or neural factors may explain the reductions in muscle strength and variation in symptoms in people with midfoot osteoarthritis and should be investigated.

Purpose Residents living in residential aged care facilities (RACF) are a vulnerable sector of the community during the Covid-19 pandemic, both from the disease and the resultant control measures, such as lockdowns, quarantines, and social distancing. In a patient centred health system, it is important that the views of residents and their relatives, ie. the ‘consumers’, are included to help understand the effect of these control measures. The Happy Life Index (HLI) is a consumer completed survey tool that measures modifiable quality of life indicators including food, environment and cleanliness, activities and lifestyle, staff friendliness, staff presence, management and care quality. This study explored the effect of Covid-19 related lockdowns on HLI scores from residents and their relatives. Methods This study is a secondary analysis using HLI data obtained from Australian RACF residents and relatives. The seven HLI components were rated on a 5-point scale (1 = Very bad; 5 = Excellent). The likelihood of residents and relatives giving a rating of “Excellent” was estimated using logistic regression comparing those who responded before the Covid-19 related restrictions to those who responded during the Covid-19 related restrictions. Results A total of 9,790 residents responded to at least one of the HLI questions. Fewer residents reported satisfaction associated with staff in their RACF, both in terms of friendliness and presence, during the Covid-19 restrictions compared to pre-Covid-19 lockdowns, whilst amongst relatives, fewer reported satisfaction with management during the restrictions. RACF residents were more likely to report satisfaction with their meals during the Covid-19 related restrictions than prior to the restrictions. Conclusion This study suggests that during Covid-19 related restrictions a greater emphasis on staff wellbeing and staffing numbers may help to maintain resident’s satisfaction with the service quality.

Objectives Deficits in strength of lower limb musculature have been associated with increased injury risk in a variety of athletic populations. As medical and performance staff seek to better understand the association between hip and knee strength measures and injury risk, measurement tools with high reliability and utility are required to profile and manage athletes effectively. The purpose of this study was to investigate the test-retest reliability of a portable fixed frame dynamometry system used to assess hip and knee strength of an elite Australian Football League team. Design Case series. Methods Maximum voluntary isometric strength of the hip abductors, hip adductors and knee flexors of 41 elite male Australian Football League footballers (mean age = 23.7 ± 4.1 years, height = 189.2 ± 7.0 cm, weight = 88.6 ± 8.4 kg) were tested during preseason training. Tests were performed one week apart on the same training day of a standard preseason week. Results Test-retest reliability was very high for left hip adduction (ICC 0.958), right hip adduction (ICC 0.955), left hip abduction (ICC 0.957), right hip abduction (ICC 0.945), left knee flexion (ICC 0.927) and right knee flexion (ICC 0.923). Furthermore, standard errors of measurement in per cent (SEM%) ranged from 3.21 to 5.03%, and minimal detectable change (MDC) from 3.93 to 6.65 kg for the different hip and thigh strength measures, making it possible to determine small changes in strength at the individual level. Conclusions This study demonstrated very high reliability when testing maximal voluntary isometric hip and knee strength using a portable fixed dynamometry system (KangaTech) in an elite male Australian Football League setting.

Aim and Background: Clinical Education opportunities for undergraduate Physiotherapy students are now increasingly occurring internationally. The clinical educator (CE) plays a significant role in the clinical education process particularly when a student undertakes a clinical placement in a different country as the CE often takes on a surrogate caretaker role. This study explores the self-reported perceptions of Physiotherapy students from three countries representing different global society clusters – South Africa (Sub-Saharan Africa), India (Southern Asia) and Australia (Anglo), regarding the roles and attributes of a CE that they value in the clinical education process. Method: Data was collected from undergraduate Physiotherapy students in a university in India (n=23) and Australia (n=154) and compared with data from a similar student cohort in South Africa (n=70). Students were asked roles and attributes of a clinical educator were of most value in the clinical education setting. Results: The relative values placed on CE roles/attributes across the three cohorts was similar, however specific differences between cohorts suggest that clinical educators should be aware of differences when supervising international students.

The Functional Movement Screen (FMS) and physical performance testing are often suggested to be related to sports injury risk. This study explored if the combination of FMS and physical performance testing improved identification of non‐contact injury risk over FMS testing alone in an elite junior Australian football cohort. Over a three‐year period, 573 players completed pre‐season injury history questionnaires, FMS, physical performance testing (20‐m sprint, vertical jump, planned agility testing, and shuttle run test), and subsequent in‐season injury surveillance. Results: Neither previous injury or FMS score

This paper discusses the use of retrospective clinical audits in complex Allied Health interventions, specifically based on our experience of designing and trialling a clinical audit in one service delivery area of occupational therapy (i.e., occupational therapy for sensory needs of children with autism spectrum disorder). Covered in our discussion is the application considerations of conducting an audit as external auditors to service organisations, however, lessons learnt can be applied to other Allied Health service delivery contexts as well. We encourage Allied Health professionals and researchers to utilise clinical audits as foundation of decision-making and especially for further research in areas with limited efficacy- and effectiveness-based research.

The diagnosis of acute appendicitis remains challenging. This review determined the current diagnostic accuracy of CT and ultrasound for suspected acute appendicitis in adults.This systematic review adhered to the PRISMA for diagnostic test accuracy guidelines. A systematic search was undertaken in appropriate databases. Screening of potential titles and abstracts, full-text retrieval, methodological quality assessment using QUADAS, and data extraction was performed. Meta-analyses were performed for relevant subgroups, and sensitivity analysis was completed to account for outliers. GRADE was utilized to assess the certainty of findings.31 studies evaluating CT, 10 evaluating US, and six evaluating both were included. Pooled sensitivity and specificity for CT was 0.972 [0.958, 0.981] and 0.956 [0.941, 0.967] respectively, and 0.821 [0.738, 0.882] and 0.859 [0.727, 0.933] for US, respectively. When analyzing subgroups based on the use of contrast enhancement, sensitivity and specificity was highest for CT with intravenous and oral contrast (0.992 [0.965, 0.998], 0.974 [0.936, 0.99]), compared to CT with intravenous contrast (0.955 [0.922, 0.974], 0.942 [0.916, 0.960]). Low-Dose CT produced comparable values (0.934 [0.885,0.963], 0.937 [0.911, 0.955]) relative to these subgroups and standard dose non-contrast CT (0.877 [0.774,0.937], 0.914 [0.827, 0.959]). US studies which excluded equivocal findings demonstrated significantly greater values than the remainder of US studies (p 0.0001).The updated diagnostic test accuracies of CT, US and relevant subgroups should be implemented in light of factors such as dose, cost, and timing.For diagnosis of adult acute appendicitis: • CT with intravenous plus oral contrast enhancement yields statistically significantly greater diagnostic accuracy than CT with intravenous contrast alone. • Low-dose CT yields comparable sensitivity and specificity to standard-dose CT. • Ultrasound studies which exclude equivocal results may overinflate sensitivity and specificity.

Aims and Background Hypermobility is a common presentation in the community and is reported related to higher rates of injury and musculoskeletal pain, however the mechanism underpinning this relationship remains unclear. Poor proprioception in hypermobile joints has been proposed as a potential mechanism. This study aims to determine if there is a difference in proprioceptive acuity, as measured by joint position reproduction, in adults with generalised joint hypermobility. Design and methods A convenience sample of 26 university students and staff (mean age 29.23 years, range 18-47) were recruited, of which 12 participants displayed generalised joint hypermobility, and 14 did not. A laser light, mounted to the dominant thumb, was used to test joint position reproduction sense by pointing to targets using a unilateral active-active position reproduction protocol. Results/Findings Test reliability across a range of targets was poor to good (intraclass correlation coefficients ranged from 0.1163 to 0.7256), indicating significant variability between participants. No significant differences was found in absolute angle of error between generalised joint hypermobility and non-generalised joint hypermobility participants. For direction of error in relation to the proprioceptive targets, only 30° thumb extension above horizontal was found to be significantly different between the hypermobile and non-hypermobile groups, with hypermobile participants tending to underestimate distance to target. Age and sex were not correlated to thumb proprioception. Application and Conclusion The difference found in direction of error and tendency to underestimate angular distance may be protective against straying into possibly injurious end-ranges; however, larger studies are recommended to confirm this.

Nordic hamstring exercises (NHE) are promoted as an evidence-based strategy for reducing the prevalence of hamstring injuries in football, with a number of studies showing a significant reduction in hamstring injury rates following implementation of a NHE-based program. However, most of the research to date has been undertaken in soccer with less research carried out in other football codes. Despite this lack of relevant evidence, NHE has recently become popular as a preventative measure in Australian Rules football (ARF) teams; however, hamstring injuries remain high. This paper reviews the literature associated with the use of NHE for ARF players and questions the appropriateness of this exercise approach as a preventative measure for hamstring injuries in this sport. When considering the use of a preventative exercise program, such as the NHE, the specific risks associated with the sporting activity should be considered and the evidence reviewed in light of this. Whilst NHE provides an easy way to do eccentric exercises, the movement does not replicate what is needed in the real world for ARF and should therefore be included in a hamstring injury prevention program in this code with caution.

Objectives Identify how modified Lower-Quarter Y-Balance Test (mYBT-LQ) and Upper-Quarter Balance Test (mYBT-UQ) scores relate to injury risk and measures of physical performance in elite adolescent Australian Football (AF) athletes. Design Prospective cohort study. Methods Pre-season mYBT-LQ, mYBT-UQ, and physical performance measures (speed, jump height, and agility) were obtained in 257 elite adolescent male AF athletes. Injury status was tracked across the 18-game season to determine the relationship between mYBT scores and injury risk based on time-to-event analysis. Cross-sectional analysis of mYBT-LQ scores and performance measures determined the relationships between these variables. Results There were no significant associations between injury risk and any single mYBT parameter. However, athletes with high posteromedial asymmetry and good agility performance (top 25% of the cohort) had moderately increased injury risk with and tended to without a previous injury history (Hazard Ratio = 3.26 [95% Confidence Interval: 1.01, 10.54; p = 0.048] and 2.69 [95% Confidence Interval = 0.92, 7.82; p = 0.069], respectively). There were significant correlations between faster agility times and higher composite limb-length normalised mYBT-LQ (r = -0.210; CI = -0.324, -0.090), limb-length normalised average posteromedial reach score (r = -0.227; CI = -0.340, -0.108), and limb-length normalised average posterolateral reach score (r = -0.250: CI = -0.361, -0.132). Conclusion In isolation, the mYBT is not useful for identifying injury risk in junior AF athletes, and only small correlations between mYBT-LQ and physical performance variables were identified. However, high mYBT-LQ posteromedial asymmetry is associated with increased injury risk for athletes with good agility performance. This should be considered within athlete preparation programs.

Bennett, H, Fuller, J, Milanese, S, Jones, S, Moore, E, and Chalmers, S. The relationship between movement quality and physical performance in elite adolescent Australian football players. J Strength Cond Res XX(X): 000-000, 2020-The assessment of movement quality is commonplace in competitive sport to profile injury risk and guide exercise prescription. However, the relationship between movement quality scores and physical performance measures is unclear. Moreover, whether improvements in these measures are associated remain unknown. Over a 4-year period, 918 individual elite adolescent Australian Rules Footballers completed the Functional Movement Screen (FMS) and physical performance testing (5- and 20-m sprint, vertical jump, planned agility, and 20-m shuttle run test), allowing the analysis of relationships between FMS parameters and performance measures. In addition, 235 athletes completed testing over 2 consecutive years, allowing the analysis of relationships between changes in these outcomes. Small associations were observed between FMS composite score, hurdle step performance, in-line lunge performance, trunk stability push-up performance, rotary stability, and measures of speed, power, agility, and aerobic fitness (ρ = 0.071-0.238). Across consecutive seasons, significant improvements were observed in the deep squat subtest (d = 0.21), FMS composite score (d = 0.17), and 5- (d = 0.16) and 20-m sprint times (d = 0.39). A negative association between change in rotary stability and change in jump height (ρ = -0.236) from one season to the next was detected. Results suggest FMS scores have limited relationships with measures of performance in footballers. To optimize athletic performance, once acceptable movement capabilities have been established, training should not prioritize improving movement quality over improvements in strength, power, and change of direction ability.

Background: Shoulder and elbow overuse injuries are the most common problems in baseball players. No scoping review has compared the findings from different types of evidence. Purpose: To map the broad evidence from 3 types of evidence (epidemiological, biomechanical, and narrative) on potential risk factors for shoulder and elbow injuries in baseball and identify gaps in the existing literature to guide future research. Study Design: Scoping review. Methods: Eight electronic databases were searched from inception to May 14, 2020. Any peer-reviewed papers that investigated or discussed potential risk factors for shoulder and elbow injuries in baseball were included. Results: A total of 302 studies (107 epidemiological studies, 85 biomechanical studies, and 110 narrative reviews) were included. Risk factors were categorized into 9 domains: sports profiles, physical characteristics/functions, pitching mechanics, performance, behavioral, psychosocial, biological and developmental, injury/sports profiles, and environmental factors. Studies were consistent in supporting limited shoulder range of motion (ROM) and player positions (pitchers or catchers) as risk factors for shoulder injuries. For elbow injuries, the majority of the included studies suggested that being pitchers or catchers and working with higher ball velocity can be risk factors. Conclusion: Findings were consistent in some risk factors, such as limited shoulder ROM and positions. However, findings were inconsistent or limited for most factors, and substantial research gaps were identified. Research assessing those factors with inconsistent or limited evidence in the current literature were recognized to be priorities for future studies.

BACKGROUND: Blended learning (BL), the integration of online with face to face teaching, is established as a teaching method in higher education. Understanding the learner's readiness toward online component of BL is important in designing and delivering BL. Nursing students require proficiency in interpersonal relationship and social interaction apart from knowledge and skills. BL may provide an opportunity to acquire the professional skills better than the traditional face to face sessions. The objectives of this study were to identify the nursing student's readiness toward BL and perceptions about the online learning component of BL. MATERIALS AND METHODS: First- and second-year entry level graduate nursing students of Sri Ramachandra Institute of Higher Education, Chennai, India, were the participants of the study. This study used a mixed method approach. An online questionnaire, developed based on the literature and expert consensus, was used in the first phase. A focus group discussion (FGD) with ten random participants of the survey was conducted to understand the perceptions and readiness to adopt the online component of BL. The present study was conducted from December 2019 to January 2020. Survey results were analyzed through descriptively. Content analysis was carried to summarize FGD results. RESULTS: A total 158 students of entry level nursing graduate programme participated in the survey. 53.8% of felt BL will have positive effect on their learning and 70% of the respondents were ready to adopt BL. The FGD identified two themes: (I) Readiness to adopt online learning as a component of BL and (II) perceived barriers and challenges in adopting online contents. CONCLUSION: Entry level nursing graduate students had a positive perception about the online components. Majority of them are confident in accessing the online contents. Willingness to learn through online, previous experience with online learning, and perceived advantages of online component might influence the learner's readiness. Availability of internet and absence of teachers were perceived as the barriers to online learning by the participants.

Objectives This study examines the acute morphological changes (up to three days) in the normal, asymptomatic Achilles tendon (AT) in response to a single bout of exercise in relation to tendon dimensions and vascularity. Design Within-subject pre-post design. Methods Participants conducted a 7.7 km pack march on a sealed road in a time of 1 h 16 min (approximately 6 km h−1). The longitudinal image of the sagittal diameter, transverse image of the area and vascularity at 20 mm proximal to the superior aspect of the calcaneus and longitudinal image of the sagittal diameter at the insertion was measured the day before the pack march, immediately afterwards and then three days later. Results The tendon showed no significant change in sagittal diameter and cross-sectional area at 20 mm proximal to the calcaneus and at the insertion immediately post-exercise. Tendon vascularity increased significantly in 91% of the left ATs and 87% of the right ATs in response to the pack march. Three days after the pack march an increase in sagittal diameter at the insertion and 20 mm proximal to the calcaneus was observed and increased vascularity was still present in 22% of the ATs. Conclusions This study highlighted the tendon’s response to exercise and has shown that at three days post-exercise that the tendon had not recovered to pre-exercise levels with respect to tendon dimensions and vascularity.

Introduction. Student engagement with both face-to-face and online sessions is becoming increasingly important as a metric of teaching success. Understanding engagement needs to move beyond positioning the student as a generic learner and explore the variations in person and context that will enable a transformative approach to blended learning arrangements. This article investigates physical therapy students' perceptions regarding resources they choose to engage with to support their learning. Methods. One hundred and fifteen (59% female); average age 21.7 years; 7.8% international students in the Bachelor of Physiotherapy and Master of Physiotherapy programs at the University of South Australia. A questionnaire with open-ended questions was administered in class and provided data on students' preferences and perceptions regarding resources that support their learning. Students' attendance, online resource usage, and grade point average were collected and used to explore themes emerging from the data. Results. Students with higher grades described their own behaviors that assisted their learning while students with lower grades focused on external barriers that limited their learning. Participants chose to attend class because this enabled them to ask questions, access explanations and demonstrations, increase concentration, pick up nonverbal communication, and access teacher support. Participants chose to use online activities because this supported them to work at their own pace, or at an optimal time, or concentrate more. Discussion. Participants reported making choices based on perceptions that a particular behavior would contribute to the immediate process of learning or assessment outcomes, rather than long-term goals such as being able to provide the best patient care. Classroom delivery is successful for students who attribute social interaction as a key aspect to their effective learning while online delivery formats meet the needs of students who engage better in private contexts. Conclusion. Engagement success may increase if face-to-face sessions have flexible access, while online activities include opportunities for interaction and support. Refereed/Peer-reviewed

Physical comfort is a key ergonomic consideration when evaluating combat helmets because discomfort, which can exhibit as pressure spots, headaches, and migraines, can lead to distraction and have a detrimental effect on operational performance. Debate exists as to whether comfort and discomfort are two separate states or whether they are two points on the same scale. The aim of this study was to identify which distinction was relevant for the assessment of a combat helmet and to use this as a basis for selecting an outcome measure from a wide group of measures reported in literature. However, no existing measure was deemed suitable by users (dismounted soldiers) and a new outcome measure for the assessment of physical discomfort of combat helmets was developed with the users. Refereed/Peer-reviewed

When designing Human Factors and Ergonomics evaluations, in addition to considering validity and reliability, it is important to ensure that measures and methodologies have utility for the chosen application. Ensuring utility requires consideration of domain specific aspects including practicality, feasibility, and access to users. The intention of this paper is to describe the process and outcome of deriving a series of considerations that can be used by Human Factors/Ergonomics practitioners when designing an evaluation of soldier clothing and equipment to help ensure that it is useful and practical for the dismounted domain. The aim is to help with dissemination of knowledge that is obtained by practitioners during their careers and forms a foundation that other practitioners can augment with their own experience Refereed/Peer-reviewed

Background: The current English language research evidence does not support the clinical use of Kinesio tape (KT).Objectives: This systematic review aimed to collect and synthesise unexplored Japan...

Refereed/Peer-reviewed

Background: Conservative management is often the first-choice treatment for baseball players with disabled throwing shoulder (DTS). Considering the high popularity of baseball in Japan, we suspected that there might be some evidence regarding this topic in the Japanese-language literature. Objective: This study aimed to systematically review Japanese-language primary studies investigating the effectiveness of conservative management for DTS in baseball. Methods: Eight databases were systematically searched from inception to 7 April 2016. Data on authors, publication years, sample characteristics, types of interventions, outcome measures and results were extracted. Data were synthesised qualitatively. Results: Seven studies with low evidence level and low-to-moderate study quality were included. Interventions examined in the included studies were downward throwing, combined physiotherapy interventions and joint distension. Forming correction, stretching for posterior shoulder muscles and strengthening exercises to improve scapular/trunk stability were commonly used in combined physiotherapy interventions. Downward throwing and combined physiotherapy interventions corresponded with expert opinions described in the English-language literature. Due to the lack of studies with high level of evidence, however, it was difficult to determine the genuine effects of these interventions. Conclusion: Our systematic review found limited evidence about the effectiveness of any conservative management for baseball players with DTS. Although downward throwing and combined physiotherapy interventions might be appropriate management in some cases, further studies of higher level of evidence and greater methodological rigour are required. Refereed/Peer-reviewed

Background: A recent advancement in physiotherapy in Australia has been the development of Extended Scope Physiotherapy Practitioner (ESPP) roles. However, compared to the UK, ESPP roles in Australia have generally been introduced in a piecemeal fashion. To assist with defining ESPP roles and credentialing requirements for ESPP in Australia, we felt it was important to engage with context-specific key stakeholders. This study sought to understand the perceptions of a range of key stakeholders on the ESPP role in Australia, using qualitative interview techniques. Methodology: Semi-structured interviews were held with medical, nursing and allied health professional staff employed within an Australian health directorate who had reported experience with ESPPs. Findings: There was general consensus of the value of ESPP in improving the efficacy and efficiency of health service delivery, achieving positive patient outcomes and offering opportunities for interdisciplinary learning among colleagues. Participants agreed that physiotherapists were well placed to practice in an ESPP role in musculoskeletal clinical practice (orthopaedic clinics/ emergency departments), and that future opportunities may exist in the areas of women’s health, cardiopulmonary, and neurology physiotherapy. There was consistency that postgraduate courses should be accredited and tailored to the scope of ESP trainees. Core knowledge and skills required by ESPPs included ordering/interpretation of radiology, working with and educating staff from other disciplines, and triage, screening and early identification of musculoskeletal conditions. Finally, common barriers to the ESPP role in Australia were characterised as either ‘hard’ (legislative) or ‘soft’ (jurisdictional, professionally/culturally based). Refereed/Peer-reviewed

Introduction: Mechanical Neck Pain (MNP) is any type of pain caused by placing abnormal stress and strain on the structures that constitute the vertebral column. Elevated first rib dysfunction is one potential somatic lesion that could lead to neck pain. Little information is available regarding this somatic lesion and its management. Aim: To assess the impact of treating first rib dysfunction with Mulligan’s Sustained Natural Apophyseal Glide (SNAG) among subjects with mechanical neck dysfunction. Materials and Methods: A quasi-experimental-study with 40 patients with elevated first rib and neck pain were included in this study. After baseline evaluation comprising of history, pain intensity, Pressure Pain Threshold (PPT), Cervical Range of Motion (CROM) and Neck Disability Index (NDI), the subjects were divided into two groups (n=20). The Experimental group was treated with SNAG with neck isometrics and the control group was treated with interferential therapy with neck isometrics. After six sessions of treatment the PPT, CROM and NDI were measured. The results were tested using Paired t-test and Mann-Whitney U-tests with a statistical significance level set at p

ObjectivesThe current understanding of hypermobility and its diagnostic criteria is still insufficient to create a complete and systematic clinical presentation of the disorder. The objective of this study was to assess the prevalence of joint hypermobility syndrome (JHS) amongst a cohort of jazz dancers, by analyzing its presence in accordance with a number of diagnostic criteria, and to verify potential risk factors for joint hypermobility in jazz dancers.Methods77 jazz dancers from the Polish Dance Theater were examined (58 female and 19 male). The prevalence of JHS was assessed using the following diagnostic tools: a structured interview, Beighton score, Grahame & Hakim questionnaire, and Sachse's criteria, in the modified version proposed by Kapandji.ResultsThe prevalence of JHS in this cohort of jazz dancers differed significantly, depending on which criteria were adopted (p = 0.001) with Beighton score, Grahame & Hakim questionnaire, and Sachse's criteria identifying 64.9%, 74% and 59.7% of the sample as JHS respectively. Hypermobility was significantly more prevalent in women than men (p < 0.05).ConclusionsThis study demonstrated a significant prevalence of joint hypermobility in jazz dancers and corroborates the findings of other researchers, indicating the need for unified diagnostic criteria for JHS in dancers.

Background: The evidence-to-practice gap, where clinical practice does not reflect the findings from research evidence, has been identified as a concern in allied health disciplines such as physiotherapy. Failure to provide care according to current (research) evidence raises the potential that patients are receiving care that is either not needed, is ineffective, less effective than current research indicates, or potentially harmful. For research evidence to be translatable to clinical practice, the research should be seen to be applicable, i.e. the clinician should be able to recognise that the research study sample reflects their patient population. Method: This study presents a pragmatic clinical review of patient sampling from high level primary research trials investigating physical therapy for low back pain. Only studies where full text copies were freely accessible to clinicians were reviewed. The review collated the characteristics of the study subjects and explored how they related to standard clinical practice. Results: A total of 63 full text randomised controlled trials papers were identified and reviewed. Across the studies reviewed, the clinical presentations of included subjects were variably described, with inconsistencies in the diagnostic labels used, the characteristics of the symptoms reported and the nature of the exclusion criteria applied. Of concern was the lack of reporting of patient’s clinical presentation according to standard clinical assessment findings to allow the clinician to gauge the applicability of the study. Conclusion: A core principle of clinical physiotherapy practice is the clinical assessment of the patient to identify the patient’s specific presentation to individualise rehabilitation and exclude serious pathology. To close the evidence-practice gap, we either need to revisit standard clinical practice or focus on the reporting of the research evidence to ensure its applicability.

Background Studies investigating the association between the Functional Movement Screen (FMS) and sports injury risk have reported mixed results across a range of athlete populations. Objectives The purpose of this systematic review was to identify whether athlete age, sex, sport type, injury definition and mechanism contribute to the variable findings Study design Systematic review and meta-analysis Methods A systematic search was conducted in October 2018 using PubMed, EBSCO host, Scopus, EmBase and Web of Science databases. Studies were included if they were peer reviewed and published in English language, included athletes from any competition level, performed the FMS at baseline to determine risk groups based on FMS composite score, asymmetry or pain, and prospectively observed injury incidence during training and competition. Study eligibility assessment and data extraction was performed by two reviewers. Random effects meta-analyses were used to determine odds ratio (OR),sensitivity and specifcity with 95% confidence intervals. Sub-group analyses were based on athlete age, sex, sport type,injury definition, and injury mechanism Results Twenty-nine studies were included in the FMS composite score meta-analysis. There was a smaller efect for junior(OR=1.03 [0.67–1.59]; p=0.881) compared to senior athletes (OR=1.80 [1.17–2.78]; p=0.008) and for male (OR=1.79[1.08–2.96]; p=0.024) compared to female (OR=1.92 [0.43–8.56]; p=0.392) athletes. FMS composite scores were most likely to be associated with increased injury risk in rugby (OR=5.92 [1.67–20.92]; p=0.006), and to a lesser extent American football (OR=4.41 [0.94–20.61]; p=0.059) and ice hockey (OR=3.70 [0.89–15.42]; p=0.072), compared to other sports. Specifcity values were higher than sensitivity values for FMS composite score. Eleven studies were included in the FMS asymmetry meta-analysis with insufficient study numbers to generate sport type subgroups. There was a larger effect for senior (OR=1.78 [1.16–2.73]; p=0.008) compared to junior athletes (OR=1.21 [0.75–1.96]; p=0.432). Sensitivity values were higher than specifcity values for FMS asymmetry. For all FMS outcomes, there were minimal differences across injury definitions and mechanisms. Only four studies provided information about FMS pain and injury risk. There was a smaller effect for senior athletes (OR=1.28 [0.33–4.96]; p=0.723) compared to junior athletes (OR=1.71 [1.16–2.50]; p=0.006). Specifcity values were higher than sensitivity values for FMS pain Conclusion Athlete age, sex and sport type explained some of the variable findings of FMS prospective injury-risk studies.FMS composite scores and asymmetry were more useful for estimating injury risk in senior compared to junior athletes.Effect sizes tended to be small except for FMS composite scores in rugby, ice hockey and American football athletes. Refereed/Peer-reviewed

Background There is no consensus in the English-language literature regarding the best types or dosages of stretching to maximise muscle strength and functional performance. It is possible that primary research published in non-English languages provides different insights, and could add to the body of international knowledge. Purpose This systematic review aimed to identify and evaluate Japanese-language randomised controlled trials (RCTs) investigating acute effects of stretching on maximal strength and functional performance. Methods Three Japanese databases and five English databases were searched from inception to 24 March 2015. Only Japanese-language RCTs examining acute effects of stretching on maximal strength and/or functional performance were included. Risk of bias in included studies was assessed using Physiotherapy Evidence Database scale. GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach was applied to evaluate the quality of evidence. Descriptive synthesis was attempted. Results Seven RCTs with variable methodological quality were included. No two studies were the same, thus meta-analysis was not possible. Descriptively, because of heterogeneity of interventions and outcome measures, it was not possible to identify consensus on the benefits of stretching. GRADE approach indicated low to very low quality evidence for this topic. Conclusion This review of Japanese-language RCTs provided no additional information to strengthen or challenge the current English-language evidence base on acute effects of stretching on maximal strength and performance. Future Japanese-language studies should address methodological flaws exposed in this review and incorporate functional outcome measures to strengthen the international evidence base.

Background: Delayed onset muscle soreness (DOMS) is a common problem experienced after exercise. The use of heat has been proposed to relieve symptoms. Microwave diathermy (MWD) is a physical modality that produces deep heat in the tissues. Although its use in the Western world has become less common since the 1980s, it is still frequently used in Japan. Objective: The purpose of this systematic review was to collect and assess Japanese language experimental research regarding the effect of MWD on signs and symptoms of DOMS. Methods: Three Japanese databases (CiNii, Ichushi and Medical*Online) and five English databases (CINAHL, Embase, MEDLINE, Scopus and Web of Science) were searched until 2 March 2015. Only Japanese-language experimental studies were included. Two Japanese native speakers independently assessed the methodological quality of included studies using the McMaster Critical Review Form. Data were synthesised qualitatively. Results: Three non-randomised experimental trials investigating the effects of MWD at 2450 MHz on DOMS in elbow flexors were included. All studies had moderate methodological qualities. Two studies reported significant positive effects on active range of motion (ROM) after eccentric exercises. No significant effect was identified in pain, circumference, maximal isometric strength and biochemical markers. Conclusion: Our systematic review found limited formal evidence about the effect of MWD to improve active elbow ROM for subjects with DOMS. Real effects were difficult to assess due to the potential lack of statistical precision in data derived from small sample sizes. Future research should address the methodological flaws identified in this review, to provide more conclusive evidence.

Background: Musculoskeletal symptoms are reportedly common among musicians. Flautists may be at high risk of symptoms, due to their asymmetrical playing posture. Aims: To determine the prevalence and incidence of musculoskeletal symptoms among flautists.Methods: A systematic search of four databases, with reference and citation lists of included studies, screened for additional studies. Included studies were assigned to the Oxford Centre for Evidence-based Medicine levels of evidence and critical appraisal was performed using a previously published tool. Data extracted included the country, sample size, data collection methods, response rates, sample demographics and data pertaining to the prevalence or incidence of musculoskeletal symptoms among flautists. Results: Seven studies (evidence levels 1 and 3) were included. These were at moderate to high risk of bias. There was wide variation in the populations and the types of musculoskeletal symptoms investigated. Lifetime prevalence of any musculoskeletal symptoms of any duration varied from 15 to 95% depending on the populations and symptoms investigated. In schoolchildren, this was as high as 79%, and 95% in university students. The upper extremities were most commonly affected, with minimal differences in the prevalence of symptoms between right and left sides. Due to the differences in the types of data collected, different groups of flautists could not be directly compared. Conclusions: The lack of studies with high evidence levels and low risk of bias in this area precludes a clear understanding of the prevalence and location of musculoskeletal symptoms in flautists, although current evidence suggests that the prevalence is high. Refereed/Peer-reviewed

Rationale, aims and objectives Declining capacity to function safely and independently in the community is a manifestation of ageing. Multiple measures are used to define and predict functional decline. This paper explores the use of partial least squares (PLS) analysis to understand the interaction between overtime measures of functional decline. Methods Comprehensive information was captured on individuals aged 65+ who presented at a large metropolitan Australian hospital Emergency Department (ED) for a complaint, which did not result in a hospital admission. They were followed-up by telephone 1 and 3 months, post-ED discharge. Information was collected each time on home situations (living alone, using community services, using a gait aid and having a formal carer), recent falls, hospitalizations and instrumental activities of daily living (IADLs). PLS analysis was applied to identify overtime relationships between measures. Results Valid information was provided by 147 individuals at all three time points. The eight individual IADL items clustered clearly around physical, mental or combined mental and physical IADLs. These clusters were strongly related to increased use of community supports, gait aid and carer, and living alone. The relationship was less convincingly for hospitalizations, and falls were not explained well. Conclusion PLS analysis offers a novel and comprehensive way of analysing complex health data, which allows sense to be made of relationships over a 3-month period. This analysis provides a better understanding of declining function over time, than could be provided by current health modelling methods.

Background: An increase in demand for professional development activities amongst the allied health workforce has seen the emergence of new technology-based training delivery methods. Blended learning, involving a combination of the traditional face-to-face teaching with the use of e-learning, is one emerging approach to the provision of professional development activities in allied health. Conclusions: Whilst blended learning has advantages in terms of flexibility of learning, and economies of scale, there is no 'one size fits all' approach to optimizing the learning outcomes, no matter what the teaching and learning environment. A range of strategies for the effective provision of blended learning activities from the literature is provided. Methods: Eighteen databases were searched from inception. Only English language publications describing quantitative research (systematic reviews or primary quantitative studies) were included. All studies were appraised using the CASP critical appraisal tool (CAT) for Systematic Reviews and the McMaster CAT for Quantitative studies. Objectives: This systematic review investigated the questions: 'What is the effect on learning of a blended learning model of training delivery method for allied health clinicians?' and, 'From the perspective of stakeholders, what are the advantages, disadvantages and recommendations for successful implementation of a blended learning model of training delivery method for allied health clinicians?' Results: Four Systematic Reviews and 14 primary studies describing quantitative data were included. The literature indicates that there was weak evidence regarding improved outcomes from blended learning interventions, compared with other educational models. Refereed/Peer-reviewed

Clinical education presents a unique learning experience in contrast to the classroom-based teaching approach. Clinical education represents a less controlled learning environment than the classroom, making it difficult for educationalists to plan a stable and equitable clinical education experience for all students. Given the issues associated with clinical education understanding the experience from the perspective of the student may help identify strategies to improve the learning process, and facilitate engagement. This study surveyed a cohort of final year physiotherapy students from James Cook University, Townsville, Australia, about their perceptions of teaching and learning activities during clinical placements. Students reported that the most valuable activities involved individual patient-centred learning activities with adequate discussion and immediate feedback which included information about the student’s limitations, skills, knowledge, and attitude. The least valuable learning opportunities in clinical education were those which were not directly related to patient care and which involved being tutored by, observing or being examined by other students. The results of this study indicate that clinical educators may need to reframe teaching activities to ensure that the students see the value of them as learning opportunities within the clinical education experience. Refereed/Peer-reviewed

Objectives This study investigated the preferred learning styles, related to clinical education of a cohort of final year physiotherapy students. Design A cross sectional observation study using a questionnaire survey. Setting Undergraduate physiotherapy program at James Cook University, Townsville, Queensland. Participants 48 final year physiotherapy students representing 89% of the total cohort (48/54). Interventions Survey questionnaire using Kolb's Learning Style Inventory (Version 3.1). Results The preferred learning styles were spread uniformly across the three learning styles of Converging, Assimilating and Accommodating, with the least preferred method of learning style the Diverging style. This suggests that in the clinical environment this student cohort are least likely to prefer to develop their learning from actually experiencing the scenario i.e. in front of a real life patient (concrete experience), and were more likely prefer this learning to come from a theoretical perspective, allowing them to consider the problem/scenario before experiencing it. When transforming this experience into knowledge, they prefer to use it on a ‘real life’ patient (active experimentation). Conclusion Whilst understanding learning styles have been promoted as a means of improving the learning process, there remains a lack of high level evidence. The findings of this study reinforce those of other studies into the learning styles of physiotherapy students suggesting that physiotherapy students share common learning style profiles.