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Coppack RJ, Ladlow P, Cassidy RP, Egginton N, Barker-Davies R, Houston A, Lunt KM, O'Sullivan O, Bennett AN. Academic Department of Military Rehabilitation (ADMR): avoiding the pitfalls of ' the Walker Dip'. BMJ Mil Health 2024; 170:4-8. [PMID: 37495378 DOI: 10.1136/military-2023-002469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
A key research theme identified during the 2021 Strategic Delivery Plan (SDP) for Defence Medical Services (DMS) Research was preventing and treating musculoskeletal injury (MSKI). MSKI is a significant burden to military populations globally, reducing both operational strength and force readiness. It is therefore essential that research is conducted to gain a greater understanding of the epidemiology, aetiology and risk factors associated with MSKI to develop targeted prevention strategies and rehabilitation interventions. The Academic Department of Military Rehabilitation (ADMR) and the recently established MSKI research-theme working group must use a combination of balance and flexibility when coordinating research priorities to ensure they align and reflect both higher level DMS and UK Defence Rehabilitation practitioner-driven priorities. This article describes the response ADMR have taken to meet and align with the requirements of the 2021 SDP.
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Affiliation(s)
- Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - N Egginton
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - K M Lunt
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - O O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
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Estberger A, Kemp JL, Thorborg K, Pålsson A, Ageberg E. Are Exercise Therapy Protocols For The Treatment of Hip-Related Pain Adequately Described? A Systematic Review of Intervention Descriptions. Int J Sports Phys Ther 2023; 18:38-54. [PMID: 36793572 PMCID: PMC9897011 DOI: 10.26603/001c.68069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background Hip-related pain is an umbrella term encompassing pain from non-arthritic hip joint pathologies, such as femoroacetabular impingement syndrome, hip dysplasia, and labral tears. Exercise therapy is commonly recommended for these conditions, but the reporting completeness of these interventions is currently unclear. Purpose The aim of this systematic review was to assess the reporting completeness of exercise therapy protocols for people with hip-related pain. Study design Systematic review according to PRISMA guidelines. Materials and Methods A systematic search was conducted, searching the MEDLINE, CINAHL, and Cochrane databases. The search results were independently screened by two researchers. Inclusion criteria were studies using exercise therapy in people with non-arthritic hip-related pain. Two independent researchers used the Cochrane risk of bias tool version 2 to analyze risk of bias, and the Consensus on Exercise Reporting Template (CERT) checklist and score (1-19) to synthesize reporting completeness. Results Fifty-two studies used exercise therapy for hip-related pain, but only 23 were included in the synthesis as 29 studies had no description of the intervention. CERT scores ranged from 1 to 17 (median 12, IQR 5-15). The most well-described items were tailoring (87%), and the least well-described items were motivation strategies (9%) and starting level (13%). Studies used exercise therapy alone (n=13), or in combination with hip arthroscopy (n=10). Conclusion Only 23 of 52 eligible studies reported sufficient details to be included in the CERT synthesis. The median CERT score was 12 (IQR 5-15), with no study reaching the maximum score of 19. Lack of reporting makes it difficult to replicate interventions in future research, and to draw conclusions on efficacy and dose-response to exercise therapy for hip-related pain. Level of evidence Level 1, systematic review.
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Affiliation(s)
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport La Trobe University
| | - Kristian Thorborg
- Department of Health Sciences Lund University, Lund, Sweden
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Departement of Orthopedic Surgery, Amager-Hvidovre Hospital, Institute for Clinical Medicine Copenhagen University, Copenhagen, Denmark
| | - Anders Pålsson
- Department of Health Sciences Lund University, Lund, Sweden
| | - Eva Ageberg
- Department of Health Sciences Lund University, Lund, Sweden
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Walters V, Coppack RJ, Cassidy RP, Suffield C, Papadopoulou T, Bilzon J, Ladlow P. Use of an isometric mid-thigh pull test during musculoskeletal rehabilitation: can the criterion values from the updated British Army physical employment standards be used to inform UK Defence Rehabilitation practice? BMJ Mil Health 2021; 168:279-285. [PMID: 34417340 DOI: 10.1136/bmjmilitary-2021-001950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/08/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Objective outcome measures that can quantify the force generating capacity of the lower limb are required to allow clinicians to accurately measure functional status and treatment adaptations over time. The aim of this prospective observational cohort study is to: (1) evaluate the acceptability of the isometric mid-thigh pull (IMTP) test as a measure of functional strength with military personnel undergoing residential hip pain rehabilitation; (2) compare the peak force values recorded against the updated Army physical employment standards (PES) assessment criteria and (3) assess if the minimum PES required of military personnel has the potential to inform clinical decision making and return to duty criteria within UK Defence Rehabilitation. METHODS Acceptability was assessed against patient's adherence to the testing procedures and test burden. Clinician acceptability was assessed against ease of administration and safety of test procedure. Hip pain was recorded before, immediately following and 1 hour after testing. Net peak force was recorded using portable force plates. RESULTS Full patient and clinician acceptability to IMTP testing procedures were demonstrated. Minimal changes in visual analogue scale (VAS) pain scores were demonstrated between baseline values at rest and follow-up. Despite being medically downgraded and functionally compromised due to chronic hip pain, 100% of patients met the PES expected on entry to the British Army and 79% met the PES expected at the end of basic training. CONCLUSION The IMTP provides rehabilitation clinicians with an objective quantifiable measure of maximum muscle strength that can be used early in the rehabilitation care pathway. Based on our finding, it is unclear if the current British Army PES can be used as a criterion standard in Defence Rehabilitation. Therefore, further research focused on generating clinically relevant patient-specific IMTP score criteria, with a larger sample of diverse diagnostic sub-groups is required.
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Affiliation(s)
- Vanessa Walters
- Department for Health, University of Bath, Bath, UK.,Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - C Suffield
- Headquarters, Royal Army Physical Training Corps, Aldershot, UK
| | - T Papadopoulou
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,British Association of Sport and Exercise Medicine, Doncaster, UK
| | - J Bilzon
- Department for Health, University of Bath, Bath, UK.,Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
| | - P Ladlow
- Department for Health, University of Bath, Bath, UK .,Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
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Centemero A, Rigatti L, Giraudo D, Mantica G, De Marchi D, Chiarulli EF, Gaboardi F. The role of the multi-disciplinary team and multi-disciplinary therapeutic protocol in the management of the chronic pelvic pain: There is strenght in numbers! Arch Ital Urol Androl 2021; 93:211-214. [PMID: 34286558 DOI: 10.4081/aiua.2021.2.211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/15/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim of the study is to evaluate the effectiveness of a Multi-disciplinary team (MDT) and multi-disciplinary approach in the treatment of Chronic Pelvic Pain (CPP). METHODS The data of all consecutive patients referred for a CPP from 11/2016 to 2/2019 has been prospectively collected. The sample was divided in two groups: Group A, made by patients managed after the institution of our MDT, and Group B, made of patients managed before this date. The MDT is composed by three urogynecologists, a psychologist and a physiotherapist. All Group A patients underwent a weekly bladder instillation with dimethyl sulfoxide (DMSO), kinesiotherapy for trigger points and Percutaneous Tibial Nerve Stimulation for 10 consecutive weeks. Patients were asked to perform a self-treatment following the Stanford Protocol and to adhere to a specific diet. All Group B patients were managed only with DMSO instillations and a strict diet. RESULTS The Group A was made of 41 females and 6 males while the Group B was made of 38 females and 5 males. The Group A patients showed a statistically significant improvement in the Pelvic Pain Urgency Frequency, in the frequency times reported at the 6 months voiding diary, and a better Patient Global Impression of Improvement. CONCLUSIONS Our data support the efficacy of the MDT in the management of CPP. The multimodal approach might represent an effective and reproducible non-invasive option to manage successfully CPP.
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Affiliation(s)
| | | | | | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa.
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Allan R, Cassidy RP, Coppack RJ, Papadopoulou T, Bennett AN. Biomechanical and clinical outcomes in response to inpatient multidisciplinary hip and groin rehabilitation in UK military personnel. BMJ Mil Health 2021; 168:266-272. [PMID: 33619232 DOI: 10.1136/bmjmilitary-2020-001588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hip and groin related pain is a common complaint among the military population across UK Defence Rehabilitation and addressing associated biomechanical dysfunction is a key treatment goal. Personnel are exposed to complex occupational loads, therefore assessing movement during demanding tasks may expose biomechanical deficits. Observing biomechanical and clinical outcomes in response to treatment is therefore an important consideration. The aims were to examine clinical and biomechanical outcomes prior to (T1) and 12 weeks post (T2) inpatient rehabilitation and explore the influence of pathological subgroup. METHODS Prospective cohort study as part of a clinical service evaluation of 25 patients undergoing treatment for hip and groin related pain. Three-dimensional motion capture (3DM) during a single-leg squat, hip strength and patient-reported outcome measures were collected at T1 and T2. RESULTS Increased abductor and external rotator strength with reductions in contralateral pelvic drop (1.9°; p=0.041) at T2 on the injured side. Pain reduced by 9.6 mm (p=0.017) but no differences were found for Non-Arthritic Hip Score (NAHS). No statistically significant differences were found between pathological subgroups. Kinematic profiles display variation between diagnostic subgroups and response to treatment. CONCLUSION Strength and pain improved with treatment in this service evaluation although biomechanical adaptation and NAHS remain inconclusive. Small and uneven sample size prevents a firm conclusion regarding the effect of pathological subgroupings, however, the data can be considered hypothesis generating for future, larger studies to integrate 3DM for monitoring response to rehabilitation in pathological subgroups to support clinical decision making.
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Affiliation(s)
- Richard Allan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK
| | - T Papadopoulou
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,British Association of Sport and Exercise Medicine, Doncaster, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Stanford Hall, Stanford-on-Soar, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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6
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Wright AA, Tarara DT, Gisselman AS, Dischiavi SL. Do currently prescribed exercises reflect contributing pathomechanics associated with femoroacetabular impingement syndrome? A scoping review. Phys Ther Sport 2020; 47:127-133. [PMID: 33276232 DOI: 10.1016/j.ptsp.2020.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Research reports limited, mixed evidence on the effectiveness of physiotherapy management in the treatment of femoroacetabular impingement (FAI) syndrome. The purpose of this review was to (1) identify what therapeutic exercises are being utilized in the non-surgical management of patients with FAI syndrome; (2) map the extent to which reported exercises reflect contributory pathomechanics associated with FAI syndrome. DESIGN Scoping Review. METHODS MEDLINE, PubMed, CINAHL, SPORTDiscus, and PEDRO electronic databases were searched for studies that implemented a non-surgical, exercise-based treatment approach in patients with FAI syndrome. Exercises were extracted and analyzed according to elements recognized as contributing to the pathomechanics associated with FAI syndrome. RESULTS 24 studies fulfilled the inclusion criteria. 453 exercises were extracted. Uniplanar exercises accounted for 338/453 or 74.6% of all reported exercises whereas triplanar exercises accounted for 21/453 or 4.6% of all exercises. Non-weight bearing exercises accounted for 220/453 or 48.6% of all exercises. CONCLUSION The majority of therapeutic exercises were classified as sagittal, uniplanar exercises, utilizing a concentric exercise approach. These findings highlight that exercises utilizing triplanar, eccentric hip control, in a single limb weightbearing position are considerably underrepresented.
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Affiliation(s)
- Alexis A Wright
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, 136 Harrison Ave, Boston, MA, 02111, USA.
| | - Daniel T Tarara
- Department of Exercise Science, High Point University, One University Pkwy. High Point, NC, 27268, USA
| | | | - Steven L Dischiavi
- Department of Physical Therapy, High Point University, One University Pkwy. High Point, NC, 27268, USA
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7
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Coppack RJ, Ladlow P, Bennett AN. Developing UK Defence Rehabilitation research priorities: a 2020 clinical practitioner engagement exercise. BMJ Mil Health 2020; 168:256-259. [PMID: 33243765 DOI: 10.1136/bmjmilitary-2020-001676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Establishing research priorities help to address knowledge gaps and exploit emerging opportunities to develop a clinical evidence base. The previous clinical engagement exercise to determine UK Defence Rehabilitation practitioner-based research priorities was conducted in 2014. The aim of this article is to (1) describe how research priorities are established for UK Defence Rehabilitation; (2) review, reassess and rate the priorities highlighted and set by rehabilitation practitioners following the 2014 survey and (3) identify new rehabilitation research themes and topics reflecting 2020 priorities. METHODS Stage 1: delegates (n=72) at the October 2019 Defence Medical Services Rehabilitation Conference participated in a series of focus group workshops. Stage 2: an online survey circulated through the military chain of command to all Defence Primary Health Care clinical rehabilitation staff. Stage 3: a thematic analysis of all survey submissions yielding a ranked order of priority by topic. RESULTS 165 clinical rehabilitation staff completed an online survey. 'Rehabilitation outcomes', 'Psychological factors in rehabilitation' and 'Residential/Inpatient treatment paradigm' emerged as three clear research priorities across all three tiers of UK Defence Rehabilitation. New research priorities emerging from the 2020 survey were 'lifestyle factors during rehabilitation', 'management of pain during rehabilitation' and 'anterior knee pain'. CONCLUSION It is essential that funding directed to musculoskeletal rehabilitation focuses on the highest research priorities in the field to ensure optimum health return on investment. The results of this survey will assist in guiding the clinical research being conducted within UK Defence Rehabilitation over the next five years.
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Affiliation(s)
- Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Department for Health, University of Bath, Bath, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK.,Department for Health, University of Bath, Bath, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK .,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Ladlow P, Conway D, Hayhurst D, Suffield C, Cassidy RP, Coppack RJ. Integration of strength training into UK Defence Rehabilitation practice: current trends and future challenges. BMJ Mil Health 2020; 168:314-319. [PMID: 33087537 PMCID: PMC9340023 DOI: 10.1136/bmjmilitary-2020-001590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 11/19/2022]
Abstract
The use of strength and conditioning (S&C) in musculoskeletal rehabilitation has gained wide acceptance among the rehabilitation community. However, there is an absence of evidence demonstrating how to best integrate the principles of S&C into rehabilitation practice. This article discusses four broad themes: (1) an overview of the UK Defence Rehabilitation care pathway, (2) the historical and current approaches to physical training to support operational readiness of the British Armed Forces, (3) the current and future challenges of integrating S&C into Defence Rehabilitation practice and (4) research priorities relating to the use of S&C in Defence Rehabilitation. We detail the importance of strength/power-based physical attributes within our military population. We recommend that consideration be given to the benefits of an alternative education/coaching-based model to be used during the current 3-week residential care pathway, which aims to ensure effective implementation of therapeutic S&C over a longer period of care.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
- Department for Health, University of Bath, Bath, UK
| | - D Conway
- Complex Trauma Department, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - D Hayhurst
- Primary Care Rehabilitation Facility (PCRF) Credenhill, Credinhill, UK
| | - C Suffield
- Physical and Recreational Training Centre, Army Training Centre Pirbright, Pirbright, UK
| | - R P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
- Centre for Lower Limb Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
- Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK
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Barker-Davies RM, O'Sullivan O, Senaratne KPP, Baker P, Cranley M, Dharm-Datta S, Ellis H, Goodall D, Gough M, Lewis S, Norman J, Papadopoulou T, Roscoe D, Sherwood D, Turner P, Walker T, Mistlin A, Phillip R, Nicol AM, Bennett AN, Bahadur S. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med 2020; 54:949-959. [PMID: 32475821 PMCID: PMC7418628 DOI: 10.1136/bjsports-2020-102596] [Citation(s) in RCA: 346] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 02/06/2023]
Abstract
The highly infectious and pathogenic novel coronavirus (CoV), severe acute respiratory syndrome (SARS)-CoV-2, has emerged causing a global pandemic. Although COVID-19 predominantly affects the respiratory system, evidence indicates a multisystem disease which is frequently severe and often results in death. Long-term sequelae of COVID-19 are unknown, but evidence from previous CoV outbreaks demonstrates impaired pulmonary and physical function, reduced quality of life and emotional distress. Many COVID-19 survivors who require critical care may develop psychological, physical and cognitive impairments. There is a clear need for guidance on the rehabilitation of COVID-19 survivors. This consensus statement was developed by an expert panel in the fields of rehabilitation, sport and exercise medicine (SEM), rheumatology, psychiatry, general practice, psychology and specialist pain, working at the Defence Medical Rehabilitation Centre, Stanford Hall, UK. Seven teams appraised evidence for the following domains relating to COVID-19 rehabilitation requirements: pulmonary, cardiac, SEM, psychological, musculoskeletal, neurorehabilitation and general medical. A chair combined recommendations generated within teams. A writing committee prepared the consensus statement in accordance with the appraisal of guidelines research and evaluation criteria, grading all recommendations with levels of evidence. Authors scored their level of agreement with each recommendation on a scale of 0-10. Substantial agreement (range 7.5-10) was reached for 36 recommendations following a chaired agreement meeting that was attended by all authors. This consensus statement provides an overarching framework assimilating evidence and likely requirements of multidisciplinary rehabilitation post COVID-19 illness, for a target population of active individuals, including military personnel and athletes.
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Affiliation(s)
- Robert M Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Oliver O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK oliver.o'
- Headquarters Army Medical Directorate, Camberley, UK
| | - Kahawalage Pumi Prathima Senaratne
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
- Department of Sport and Exercise Medicine, Queen's Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK
| | - Polly Baker
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- University of Brighton, Brighton, East Sussex, UK
| | - Mark Cranley
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Shreshth Dharm-Datta
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Henrietta Ellis
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Duncan Goodall
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
- Medical Department, Nottinghamshire County Cricket Club, Nottingham, UK
| | - Michael Gough
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Sarah Lewis
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Jonathan Norman
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Theodora Papadopoulou
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
- British Association of Sport and Exercise Medicine, Doncaster, UK
| | - David Roscoe
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Daniel Sherwood
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Philippa Turner
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
- Medical School, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Tammy Walker
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Alan Mistlin
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Rhodri Phillip
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
| | - Alastair M Nicol
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
- FASIC Sport and Exercise Medicine Clinic, University of Edinburgh, Edinburgh, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, London, UK
| | - Sardar Bahadur
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, United Kingdom
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10
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McGovern RP, Martin RL, Kivlan BR, Christoforetti JJ. NON-OPERATIVE MANAGEMENT OF INDIVIDUALS WITH NON-ARTHRITIC HIP PAIN: A LITERATURE REVIEW. Int J Sports Phys Ther 2019; 14:135-147. [PMID: 30746300 PMCID: PMC6350663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Non-arthritic hip pain is defined as being related to pathologies of the intra-articular structures of the hip that can be symptomatic. A trial of non-operative management is commonly recommended before consideration of surgery for individuals with non-arthritic hip conditions. There is a need to describe a non-operative or conservative treatment plan for individuals with non-arthritic hip pain. PURPOSE The purpose of this literature review was to systematically examine the literature in order to identify and provide evidence for non-operative or conservative management of individuals with non-arthritic hip pain. A proposed home exercise program will be provided for individuals with non-arthritic hip pain. STUDY DESIGN Review of the Literature. MATERIALS/METHODS A literature search of PubMed, Medline, SPORTSDiscus, and CINAHL was conducted. Keywords included: "hip" AND "femoroacetabular impingement" OR "labral tear." Studies were included if they described non-operative management for individuals with non-arthritic hip pain. Studies were excluded if they recommended a trial of conservative treatment without specific management or interventions and/or activity modification without specific details for intervention. RESULTS A total of 49 studies met the eligibility criteria and were included in the review. Rehabilitation recommendations were identified from manuscripts including clinical trials, case series, discussion articles, or systematic reviews related to the non-operative or conservative management of non-arthritic hip pain. Rehabilitation interventions focused on patient education, activity modification, limitation of aggravating factors, an individualized physical therapy protocol, and use of a home exercise program. CONCLUSIONS Rehabilitation should address biomechanical deficiencies with neuromuscular training of the hip and lumbopelvic regions. While the current literature on non-operative management is limited, future randomized control trials will establish the effectiveness of specific physical therapy protocols for individuals with non-arthritic hip pain. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
| | | | - Benjamin R. Kivlan
- Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
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Yoo JI, Lee TH, Kim JY, Kim JH, Ha YC. Outcomes of Hip Arthroscopy in a Military Population Are Similar to Those in the Civilian Population: Matched Paired Analysis at 2 Years. Arthroscopy 2018; 34:2096-101. [PMID: 29685837 DOI: 10.1016/j.arthro.2018.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical outcomes, including the visual analog pain score, University of California Los Angeles activity, modified Harris hip score, and radiologic outcomes after hip arthroscopy in male patients whose symptoms developed during military services with those in a matched-pair control group of active young, nonmilitary patients at a minimum postoperative follow-up of 2 years. METHODS From September 2009 to December 2014, 28 male patients with mechanical symptoms that developed during military service underwent hip arthroscopic surgery. The control group included 28 professional male athletes who were matched with gender, Tönnis grade 0 or 1, crossover percentage, and labral procedure. At the minimum 2-year follow-up, radiographic and clinical outcomes were assessed using serial radiography. Statistical analysis was performed to confirm the differences between the preoperative and postoperative outcome measures. RESULTS Most common arthroscopic procedures in the study and control groups were femoroplasty (64.4% vs 53.6%) and labral repair (64.3% vs 53.6%). All improvements in both groups were statistically significant at the last postoperative follow-up (P < .001). In the study group, 89.3% of soldiers were able to return to their preoperative military branch. Although radiologic and clinical outcomes in both groups were not significantly different, hospitalization time in soldiers was significantly longer than that in the control group (79.4 ± 27.0 vs 4.0 ± 1.3 days, P < .001). Time of return to their preoperative military branch in the study group was similar to sports activity in the control group (5.9 ± 4.3 vs 6.3 ± 3.7 months, P = .258). CONCLUSIONS Male patients with symptoms that developed during military services achieved similar levels of benefit from hip arthroscopy as those in the control group of active young patients. Although hospitalization time in the military population was significantly longer than that in the control group, time to return to activity was similar in both groups. LEVEL OF EVIDENCE Level III, comparative trial.
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Ladlow P, Coppack RJ, Dharm-Datta S, Conway D, Sellon E, Patterson SD, Bennett AN. The effects of low-intensity blood flow restricted exercise compared with conventional resistance training on the clinical outcomes of active UK military personnel following a 3-week in-patient rehabilitation programme: protocol for a randomized controlled feasibility study. Pilot Feasibility Stud 2017; 3:71. [PMID: 29234504 PMCID: PMC5723055 DOI: 10.1186/s40814-017-0216-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/01/2017] [Indexed: 01/08/2023] Open
Abstract
Background A challenge for rehabilitation practitioners lies in designing optimal exercise programmes that facilitate musculoskeletal (MSK) adaptations whilst simultaneously accommodating biological healing and the safe loading of an injured limb. A growing body of evidence supports the use of resistance training at a reduced load in combination with blood flow restriction (BFR) to enhance hypertrophic and strength responses in skeletal muscle. In-patient rehabilitation has a long tradition in the UK Military, however, the efficacy of low intensity (LI) BFR training has not been tested in this rehabilitation setting. The aims of this study are to determine (1) the feasibility of a randomised controlled trial (RCT) investigating LI-BFR training in a residential, multidisciplinary treatment programme and (2) provide preliminary data describing the within and between-group treatment effects of a LI-BFR intervention and a conventional resistance training group in military personnel. Methods This is a single-blind randomised controlled feasibility study. A minimum of 28 lower-limb injured UK military personnel, aged 18 to 50 years, attending rehabilitation at the UK Defence Medical Rehabilitation Centre (DMRC) will be recruited into the study. After completion of baseline measurements, participants will be randomised in a 1:1 ratio to receive 3 weeks (15 days) of intensive multidisciplinary team (MDT) in-patient rehabilitation. Group 1 will receive conventional resistance training 3 days per week. Group 2 will perform twice daily LI-BFR training. Both groups will also undertake the same common elements of the existing MDT programme. Repeat follow-up assessments will be undertaken upon completion of treatment. Group 2 participants will be asked to rate their pain response to LI-BFR training every five sessions. Discussion The results will provide information on the feasibility of a full-scale RCT. Recommendations for an adequately powered study to determine the efficacy of LI-BFR training during in-patient rehabilitation can then be made. The study may also provide insights into the potential effectiveness of LI-BFR training as a novel exercise modality to induce muscle adaptations in the absence of high mechanical loading of the lower-limb. Trial registration ISRCTN Reference: ISRCTN 63585315 dated 25 April 2017.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom, Surrey UK.,Department for Health, University of Bath, Bath, UK
| | - Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom, Surrey UK.,Department for Health, University of Bath, Bath, UK
| | - Shreshth Dharm-Datta
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom, Surrey UK
| | - Dean Conway
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom, Surrey UK
| | - Edward Sellon
- Imaging Department, Oxford University Hospitals, Oxford, UK
| | - Stephen D Patterson
- School of Sport, Health and Applied Science, St Mary's University, London, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom, Surrey UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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