The benefits of virtual learning abroad programs for higher education students: A phenomenological research study

BACKGROUND

Higher education institutions offer in-country learning abroad programs to provide healthcare students with the opportunity to gain the intercultural and global competencies they need to work in a globally interconnected world. During the Covid-19 pandemic, institutions offered virtual learning abroad programs as an alternative to the in-country programs, however, little is known about whether they provide comparable benefits to students.

OBJECTIVES

The purpose of this study was to investigate, and identify, the benefits gained by higher education healthcare students through their participation in a virtual learning abroad program.

DESIGN/METHODS

This research implemented a qualitative approach, conducting semi-structured interviews with four higher education students enrolled in the final year of their healthcare studies. Data were analyzed using interpretative phenomenological analysis.

RESULTS

The results revealed that virtual programs provide a range of benefits students can use in their future careers. They also provide students with a positive learning experience and an opportunity for personal growth. However, although the benefits students gain from virtual learning abroad programs are similar to those they gain from in-country programs, they are not identical. While virtual learning abroad programs are a viable alternative for in-country programs and offer many benefits, they fail to replicate the intercultural and global competencies that in-country programs offer to students.

CONCLUSION

This study focusses on virtual learning abroad programs and whether the benefits healthcare students gain from them are comparable to the traditional in-country programs. Students gain personal and professional benefits from these programs without the risks and costs associated with international travel. However, the identified lack of increased global awareness has implications for how the benefits of virtual learning abroad programs should be promoted to students.

Development and validation of an assessment tool for higher education learning abroad programs: A qualitative Delphi study

BACKGROUND

Higher education learning abroad programs provide many benefits to healthcare students. However, inadequate preparation prior to their international travel, and misdirected motivations for their participation, can jeopardise the benefits and increase the risks. While it is pivotal to objectively evaluate pre-departure student preparation and the impact the programs have on students, existing assessment questionnaires fail to inform these aspects.

OBJECTIVES

To develop an assessment tool (two surveys) to holistically evaluate learning abroad programs for higher education healthcare students.

DESIGN

A qualitative Delphi technique.

PARTICIPANTS

A total of 24 experts who had designed, managed, participated in, hosted, funded, and/or researched Australian learning abroad programs for higher education students.

METHODS

The study was conducted over a 4-month period. An initial set of pre-departure and post-program questions was developed through a review of the existing literature and from a post-program survey previously used at an Australian higher education institution. Subsequently, experts provided constructive and practical feedback on the questions to be included in the two surveys.

RESULTS

The experts reached consensus on the 26 questions to be included in the pre-departure survey and the 16 questions in the post-program survey after three Delphi rounds. Key areas of interest to the experts were mitigating student risk, improving effectiveness of pre-departure briefings, gaining a better insight into student motivations for participation, and understanding the impact the programs have on students.

CONCLUSIONS

The development of this valid assessment tool (two surveys) will provide higher education institutions and program leaders with the ability to better evaluate the effectiveness of the pre-departure preparation they provide to students, understand the motivations of students who participate, as well as assessing the impact these programs have on students. The insights gathered can be used to improve future program offerings and maximise the benefits to healthcare students while reducing the risks.

The Relationship Between Corticomotor Reorganization and Acute Pain Severity: A Randomized, Controlled Study Using Rapid Transcranial Magnetic Stimulation Mapping

OBJECTIVE

Although acute pain has been shown to reduce corticomotor excitability, it remains unknown whether this response resolves over time or is related to symptom severity. Furthermore, acute pain research has relied upon data acquired from the cranial "hotspot," which do not provide valuable information regarding reorganization, such as changes to the distribution of a painful muscle's representation within M1. Using a novel, rapid transcranial magnetic stimulation (TMS) mapping method, this study aimed to 1) explore the temporal profile and variability of corticomotor reorganization in response to acute pain and 2) determine whether individual patterns of corticomotor reorganization are associated with differences in pain, sensitivity, and somatosensory organization.

METHODS

Corticomotor (TMS maps), pain processing (pain intensity, pressure pain thresholds), and somatosensory (two-point discrimination, two-point estimation) outcomes were taken at baseline, immediately after injection (hypertonic [n = 20] or isotonic saline [n = 20]), and at pain resolution. Follow-up measures were recorded every 15 minutes until 90 minutes after injection.

RESULTS

Corticomotor reorganization persisted at least 90 minutes after pain resolution. Corticomotor depression was associated with lower pain intensity than was corticomotor facilitation (r = 0.47 [P = 0.04]). These effects were not related to somatosensory reorganization or peripheral sensitization mechanisms.

CONCLUSIONS

Individual patterns of corticomotor reorganization during acute pain appear to be related to symptom severity, with early corticomotor depression possibly reflecting a protective response. These findings hold important implications for the management and potential prevention of pain chronicity. However, further research is required to determine whether these adaptations relate to long-term outcomes in clinical populations.

The impact of learning abroad programs in developing countries: A scoping review

OBJECTIVES

An increasing number of higher education healthcare students from developed countries are undertaking short-term learning abroad programs in developing countries. However, sociocultural differences between the students and the communities could lead to unintended, possibly negative consequences for the community. The objective of this review was to explore what is known about the impact of learning abroad programs undertaken by healthcare students on the communities in the developing countries who host them.

DESIGN

The six-step scoping review developed by Arksey and O'Malley (2005) provided a methodological framework for searching the literature and identifying records meeting the inclusion criteria.

DATA SOURCES

A comprehensive range of databases were used to facilitate the literature search (including CINHAHL, EBSCO, ERIC, Google Scholar, MEDLINE, PsycINFO, Scopus and Web of Science).

REVIEW METHODS

A two-stage review process was undertaken. Stage 1 reviewed articles on learning abroad undertaken in developing countries by higher education healthcare students. Stage 2 identified articles that reported the impact on the host community. Articles meeting the stage 2 criteria were further assessed for methodological quality using the Critical Review Form for Qualitative Studies.

RESULTS

The stage 2 review revealed less than one quarter of the included articles (n = 36) reported on the impact of the learning abroad program on the host community and across these eight articles, there was a significant diversity in the methodological rigour and outcomes presented.

CONCLUSIONS

This review identified that most of the published research on learning abroad in developing countries focusses almost exclusively on the impact the programs have on the students, with a paucity of research considering how they impact host communities. Our findings suggest the need to further extend and strengthen the research on the host communities in order to understand the impact higher education healthcare students have on the international communities who host them.

Corticomotor reorganization during short-term visuomotor training in the lower back: A randomized controlled study

INTRODUCTION

Accumulating evidence suggests that motor skill training is associated with structural and functional reorganization of the primary motor cortex. However, previous studies have focussed primarily upon the upper limb, and it is unclear whether comparable reorganization occurs following training of other regions, such as the lower back. Although this holds important implications for rehabilitation, no studies have examined corticomotor adaptations following short-term motor training in the lower back.

METHOD

The aims of this study were to (a) determine whether a short-term lumbopelvic tilt visuomotor task induced reorganization of the corticomotor representations of lower back muscles, (b) quantify the variability of corticomotor responses to motor training, and (c) determine whether any improvements in task performance were correlated with corticomotor reorganization. Participants were allocated randomly to perform a lumbopelvic tilt motor training task (n = 15) or a finger abduction control task involving no lumbopelvic movement (n = 15). Transcranial magnetic stimulation was used to map corticomotor representations of the lumbar erector spinae before, during, and after repeated performance of the allocated task.

RESULTS

No relationship between corticomotor reorganization and improved task performance was identified. Substantial variability was observed in terms of corticomotor responses to motor training, with approximately 50% of participants showing no corticomotor reorganization despite significant improvements in task performance.

CONCLUSION

These findings suggest that short-term improvements in lower back visuomotor task performance may be driven by changes in remote subcortical and/or spinal networks rather than adaptations in corticomotor pathways. However, further research using tasks of varying complexities and durations is required to confirm this hypothesis.

The effect of implicit theories of pain on pain and disability in people with chronic low back pain

BACKGROUND

Implicit theories of pain represent a socio-cognitive mechanism linked to important coping, emotional, and expressive reactions to chronic pain. Evidence suggests that chronic low back pain (CLBP) patients who hold an incremental theory of pain (i.e., view pain as a malleable) use more active coping strategies, display less pain behavior, and report lower levels of depression than those with an entity theory of pain (i.e., view pain as a fixed). However, a link between implicit theories of pain and symptoms of pain and disability in people with CLBP has not been established.

OBJECTIVES

This study investigated the relationship between implicit theories of pain and the level of pain and disability reported by people with CLBP.

DESIGN

Cross-sectional observational study.

METHODS

One hundred and two participants with CLBP completed an online survey distributed through social media channels. The online survey assessed pain intensity and pain-related disability (Chronic Pain Grade Scale), implicit theories of pain (Implicit Theory of Pain Scale), and perceived control over pain (Survey of Pain Attitudes control scale).

RESULTS

Participants with an incremental theory of pain reported significantly less pain and disability compared to those with an entity theory of pain (p < 0.001).

CONCLUSIONS

These findings suggest that implicit theories of pain may guide self-reported symptoms of pain and disability in a CLBP population. Prospective studies are required to confirm the relevance of these findings for risk of future low back pain, and to confirm whether this relationship changes with and without treatment.

The influence of kinesiology tape colour on performance and corticomotor activity in healthy adults: a randomised crossover controlled trial

Background

There exists conflicting evidence regarding the impact of kinesiology tape on performance and muscle function. One variable that may account for disparities in the findings of previous studies is the colour of the tape applied. Colour is hypothesised to influence sporting performance through modulation of arousal and aggression. However, few studies have investigated the influence of colour on products designed specifically to enhance athletic performance. Further, no studies have investigated the potential influence of colour on other drivers of performance, such as corticomotor activity and neuromuscular function. Thus, the aim of this study was to investigate the influence of kinesiology tape colour on athletic performance, knee extensor torque, and quadriceps neuromuscular function.

Methods

Thirty two healthy participants were assessed under five conditions, applied in random order: (1) no kinesiology tape (control), (2) beige-coloured kinesiology tape applied with tension (sham A), (3) beige-coloured kinesiology tape applied with no tension (sham B), (4) red-coloured kinesiology tape applied with tension, and (5) blue-coloured kinesiology tape applied with tension. Athletic performance was assessed using a previously validated hop test, knee extensor torque was measured using an isokinetic dynamometer, and transcranial magnetic stimulation was utilised to provide insight into the neuromuscular functioning of the quadriceps musculature.

Results

Kinesiology tape had no beneficial impact on lower limb performance or muscle strength in healthy adults. The colour of the tape did not influence athletic performance (F (4, 120) = 0.593, p = 0.669), quadriceps strength (F (4, 120) = 0.787, p = 0.536), or neuromuscular function (rectus femoris: F (2.661, 79.827) = 1.237, p = 0.301).

Conclusion

This study found that kinesiology tape does not alter lower limb performance or muscle function in healthy adults, irrespective of the colour of the tape applied. Future research should seek to confirm these findings beyond the research setting, across a range of sports, and at a range of skill levels.

Trial registration

Australian New Zealand Clinical Trials Registry. ACTRN12616001506482. Prospectively registered on 01/11/2016.

Anticipatory and compensatory postural adjustments in people with low back pain: a systematic review and meta-analysis

BACKGROUND CONTEXT

Despite altered anticipatory (APAs) and compensatory postural adjustments (CPAs) being hypothesized to contribute to the onset and persistence of low back pain (LBP), results from studies comparing people with and without LBP are conflicting.

PURPOSE

This systematic review aimed to determine whether APAs or CPAs are altered in the presence of acute and chronic LBP.

STUDY DESIGN

A systematic review of studies was carried out.

PATIENT SAMPLE

No patient sample was required.

OUTCOME MEASURES

Between group standardized mean differences and 95% confidence intervals for APAs ad CPAs METHODS: A comprehensive search was conducted for articles comparing people with LBP (acute or chronic) to healthy controls for the onset or amplitude of muscle activity, center of pressure (COP), or kinematic responses to expected or unexpected perturbations. Two independent reviewers extracted data and assessed the methodological quality of relevant studies. Differences between people with and without LBP were calculated as standardized mean differences, and included in a meta-analysis if outcomes were homogeneous. Otherwise, a narrative synthesis was conducted.

RESULTS

Twenty-seven studies were included, of which the majority examined muscle onsets in response to expected and unexpected perturbations. Only two studies compared people with and without acute LBP, and results for these studies were conflicting. The results show delayed muscle onsets in response to expected and unexpected perturbations for people with chronic LBP when compared with healthy controls. No conclusive evidence for differences between people with and without chronic LBP for COP or kinematic responses.

CONCLUSIONS

There is currently no convincing evidence of differences between people with and without acute LBP for APAs or CPAs. Conversely, delayed muscle onsets in people with chronic LBP suggest APAs and CPAs are altered in this population. However, the functional relevance of these delayed muscle onsets (eg, COP and kinematics) is unknown.

Shoulder Taping and Neuromuscular Control

CONTEXT

  Scapular taping can offer clinical benefit to some patients with shoulder pain; however, the underlying mechanisms are unclear. Understanding these mechanisms may guide the development of treatment strategies for managing neuromusculoskeletal shoulder conditions.

OBJECTIVE

  To examine the mechanisms underpinning the benefits of scapular taping.

DESIGN

  Descriptive laboratory study.

SETTING

  University laboratory.

PATIENTS OR OTHER PARTICIPANTS

  A total of 15 individuals (8 men, 7 women; age = 31.0 ± 12.4 years, height = 170.9 ± 7.6 cm, mass = 73.8 ± 14.4 kg) with no history of shoulder pain.

INTERVENTION(S)

  Scapular taping.

MAIN OUTCOME MEASURE(S)

  Surface electromyography (EMG) was used to assess the (1) magnitude and onset of contraction of the upper trapezius (UT), lower trapezius (LT), and serratus anterior relative to the contraction of the middle deltoid during active shoulder flexion and abduction and (2) corticomotor excitability (amplitude of motor-evoked potentials from transcranial magnetic stimulation) of these muscles at rest and during isometric abduction. Active shoulder-flexion and shoulder-abduction range of motion were also evaluated. All outcomes were measured before taping, immediately after taping, 24 hours after taping with the original tape on, and 24 hours after taping with the tape removed.

RESULTS

  Onset of contractions occurred earlier immediately after taping than before taping during abduction for the UT (34.18 ± 118.91 milliseconds and 93.95 ± 106.33 milliseconds, respectively, after middle deltoid contraction; P = .02) and during flexion for the LT (110.02 ± 109.83 milliseconds and 5.94 ± 92.35 milliseconds, respectively, before middle deltoid contraction; P = .06). These changes were not maintained 24 hours after taping. Mean motor-evoked potential onset of the middle deltoid was earlier at 24 hours after taping (tape on = 7.20 ± 4.33 milliseconds) than before taping (8.71 ± 5.24 milliseconds, P = .008). We observed no differences in peak root mean square EMG activity or corticomotor excitability of the scapular muscles among any time frames.

CONCLUSIONS

  Scapular taping was associated with the earlier onset of UT and LT contractions during shoulder abduction and flexion, respectively. Altered corticomotor excitability did not underpin earlier EMG onsets of activity after taping in this sample. Our findings suggested that the optimal time to engage in rehabilitative exercises to facilitate onset of trapezius contractions during shoulder movements may be immediately after tape application.

Improved compensatory postural adjustments of the deep abdominals following exercise in people with chronic low back pain

The purpose of this study was to determine if 8 weeks of exercise affects motor control in people with chronic low back pain (CLBP), measured by anticipatory (APAs) and compensatory postural adjustments (CPAs). APAs and CPAs were measured prior to and following 8 weeks in two groups of people with CLBP: an exercise group (n=12) who attended three exercise sessions per week for 8 weeks; and a non-exercise control group (n=12) who were advised to continue their usual activities for the duration of the study. APAs and CPAs were recorded during unilateral arm flexion, bilaterally from rectus abdominis (RA), transverse abdominis/internal oblique (TA/IO), and erector spinae (ES) via surface electromyography. Analysis of muscle onsets and APA amplitudes suggests APAs did not change for either group. Ipsi-lateral TA/IO CPAs increased for the exercise group and ipsi-lateral TA/IO CPAs decreased for the control group. Only exercise promoted a pattern of TA/IO activity during CPAs similar to healthy individuals, suggesting improved control of rotational torques. These results show motor control improvement following exercise in people with CLBP, highlighted by improved side specific control of TA/IO.

The number of stimuli required to reliably assess corticomotor excitability and primary motor cortical representations using transcranial magnetic stimulation (TMS): a systematic review and meta-analysis

BACKGROUND

Transcranial magnetic stimulation (TMS) is a non-invasive means by which to assess the structure and function of the central nervous system. Current practices involve the administration of multiple stimuli over target areas of a participant's scalp. Decreasing the number of stimuli delivered during TMS assessments would improve time efficiency and decrease participant demand. However, doing so may also compromise the within- or between-session reliability of the technique. The aim of this review was therefore to determine the minimum number of TMS stimuli required to reliably measure (i) corticomotor excitability of a target muscle at a single cranial site and (ii) topography of the primary motor cortical representation of a target muscle across multiple cranial sites.

METHODS

Database searches were performed to identify diagnostic reliability studies published before May 2015. Two independent reviewers extracted data from studies employing single-pulse TMS to measure (i) the corticomotor excitability at a single cranial site or (ii) the topographic cortical organisation of a target muscle across a number of cranial sites. Outcome measures included motor evoked potential amplitude, map volume, number of active map sites and location of the map centre of gravity.

RESULTS

Only studies comparing the reliability of varying numbers of stimuli delivered to a single cranial site were identified. Five was the lowest number of stimuli that could be delivered to produce excellent within-session motor evoked potential (MEP) amplitude reliability (intraclass correlation coefficient (ICC) = 0.92, 95% CI 0.87 to 0.95). Ten stimuli were required to achieve consistent between-session MEP amplitudes among healthy participants (ICC = 0.89, 95% CI 0.76 to 0.95). However, between-session reliability was influenced by participant characteristics, intersession intervals and target musculature.

CONCLUSIONS

Further exploration of the reliability of multi-site TMS mapping is required. Five stimuli produce reliable MEP recordings during single-site TMS investigations involving one session. For single-site analyses involving multiple sessions, ten stimuli are recommended when investigating corticomotor excitability in healthy participants or the upper limb musculature. However, greater numbers of stimuli may be required for clinical populations or assessments involving the lower limb.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015024579.

Hand therapy versus corticosteroid injections in the treatment of de Quervain's disease: A systematic review and meta-analysis

STUDY DESIGN

Systematic review with meta-analysis.

INTRODUCTION

Although corticosteroid injections are often cited as best practice in the treatment of de Quervain's disease, no reviews have compared their effectiveness to a multimodal definition of hand therapy.

PURPOSE

To compare the effectiveness of corticosteroid injections with that of i) hand therapy alone and ii) combined hand therapy/corticosteroid injection approaches in the treatment of de Quervain's disease.

METHODS

Searches of key databases were performed to identify experimental studies published between January 1950 and November 2014. Outcome measures included treatment success, pain, quality of life, and function.

RESULTS

Both corticosteroid injections and hand therapy improved pain and function from baseline, but between-group differences were not significant (across 6 studies). However, significantly more participants were treated successfully when combined orthosis/corticosteroid injection approaches were compared to i) orthoses (RR 0.53, 95% CI 0.35-0.80) and ii) injections alone (RR 0.76, 95% CI 0.64-0.89).

CONCLUSION

Combined orthosis/corticosteroid injection approaches are more effective than either intervention alone in the treatment of de Quervain's disease.

LEVEL OF EVIDENCE

1a.

Anticipatory and compensatory postural adjustments in people with low back pain: a protocol for a systematic review and meta-analysis

BACKGROUND

Anticipatory (APAs) and compensatory (CPAs) postural adjustments are organised by the central nervous system (CNS) and serve to control postural perturbations. Ineffective APAs and CPAs have been hypothesised to contribute to the persistence of symptoms and disability in people with low back pain (LBP). Despite two decades of research, there is no systematic review investigating APAs and CPAs in people with LBP. Thus, the aim of the current review is to determine if APA and CPA onset or amplitude, as measured by electromyography (EMG), centre of pressure (COP), and kinematics, are altered in people with LBP.

METHODS/DESIGN

A systematic review and meta-analysis will be conducted. Searches will be conducted in electronic databases for full-text articles published before January 2016 using pre-defined search strategies that utilise combinations of keywords and medical subject heading terms. Two independent reviewers will screen potentially relevant articles for inclusion, extract data, and assess risk of bias for individual studies. Any disagreements will be resolved by a third reviewer. Studies comparing APA onset and amplitude and CPA onset and amplitude measured by EMG, COP, or kinematics between people with LBP and healthy individuals will be included if all aspects of the eligibility criteria are met. Data will be synthesised if studies are homogeneous; otherwise, results will be reviewed narratively.

DISCUSSION

To our knowledge, this is the first systematic review to examine APAs and CPAs, as measured by EMG, COP, and kinematics in people with LBP. The findings of this review may aid in the identification of factors that play a role in the persistence of symptoms and disability and aid in the development of interventions to treat symptoms.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016032815.

Organisation and function of the primary motor cortex in chronic pain: protocol for a systematic review and meta-analysis

INTRODUCTION

Primary motor cortical (M1) adaptation in the form of altered organisation and function is hypothesised to underpin motor dysfunction observed in chronic pain. The aim of this review is to assess the evidence for altered M1 organisation and function in chronic pain.

METHODS AND ANALYSIS

Systematic review and meta-analysis. We will search electronic databases with predetermined search terms to identify relevant studies and evaluate the studies for inclusion and risks of bias. Two independent reviewers will extract data. Any disagreement will be resolved through a third reviewer. Cross-sectional or prospective studies published in English before May 2015 that investigate M1 organisation and function in chronic pain will be included if they meet the eligibility criteria. Primary outcomes will include M1 cortical excitability, spatial cortical representation, the function of inhibitory and facilitatory intracortical networks, cortical reactivity and cortical glucose metabolism. Clinical measures such as pain and disability will be included where the correlation with the primary outcomes of M1 organisation and function were investigated in the included studies.

ETHICS AND DISSEMINATION

This systematic review does not require ethical approval. The results of this review will be submitted for peer-reviewed publication regardless of outcome and will be presented at relevant conferences.

TRIAL REGISTRATION NUMBER

Our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42015014823).

Determining the number of stimuli required to reliably assess corticomotor excitability and primary motor cortical representations using transcranial magnetic stimulation (TMS): a protocol for a systematic review and meta-analysis

BACKGROUND

Transcranial magnetic stimulation (TMS) is a technique that can be used to assess corticospinal plasticity. Current TMS practices involve the administration of multiple stimuli over target areas of the participant's scalp. However, these procedures require 1 to 2 h per assessment. Decreasing the number of stimuli delivered during TMS assessments would improve time efficiency and decrease participant demand. Thus, the aim of this review is to determine the number of TMS stimuli required to reliably measure (1) corticomotor excitability to a target muscle at a single cranial site and (2) the topography of the primary motor cortical representation for a target muscle across multiple cranial sites (termed 'mapping').

METHODS/DESIGN

A systematic review and meta-analysis will be conducted. Electronic databases will be searched using pre-determined search terms to identify relevant studies and evaluate the studies for inclusion and risks of bias. Two independent reviewers will extract the data. Any disagreements will be resolved by a third reviewer. Studies employing single-pulse TMS to measure (1) corticomotor excitability at a single cranial site or (2) the topographic cortical organisation of a target muscle across a number of cranial sites, published before May 2015, will be included if they meet the eligibility criteria. Outcomes will include motor-evoked potential amplitude, map volume, number of active map sites, location of the map centre of gravity, and distance between the centres of gravity of the target muscle and one or more neighbouring muscles.

DISCUSSION

To our knowledge, this review will be the first to systematically explore the number of TMS stimuli required to reliably measure both corticomotor excitability and the topography of primary motor cortical representations. This research has the capacity to improve the efficiency of TMS, decrease participant demand, and facilitate the use of TMS as an outcome measurement tool in clinical populations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015024579.

The effect of interactive neurostimulation therapy on myofascial trigger points associated with mechanical neck pain: a preliminary randomized, sham-controlled trial

OBJECTIVES

This trial was conducted to assess the effectiveness of interactive neurostimulation (INS) therapy on the treatment of pain associated with myofascial trigger points (MTPs) in adults with mechanical neck pain.

DESIGN

This was a preliminary, randomized, sham-controlled trial.

SETTING

The trial was conducted in a tertiary-care institution.

SUBJECTS

The participants were 23 adults with pain and MTPs in the neck or shoulder lasting>2 weeks.

INTERVENTIONS

INS (active or sham) was delivered for 10 minutes in a single session over the MTP area in each patient.

OUTCOME MEASURES

Immediately following the intervention, subjects were tested for pressure pain thresholds (PPTs) and 10-cm visual analogue scale score (VAS) for pain intensity. At the 5 day follow-up, two additional tests were performed: the neck disability index (NDI) and the patient specific functional scale (PSFS) for function.

RESULTS

Improvements in function (PSFS) were observed in the treatment group, which were of clinical significance in selected subjects. These effects were statistically greater than those obtained in the sham group but were overall not at a level of clinical significance in this small population. Improvements in pain intensity (VAS) and neck disability (NDI) were observed in both the treatment and sham groups, indicating that INS had no greater benefit using these measures. There was no change in PPTs following either the active or sham treatment.

CONCLUSIONS

INS is a new and emerging therapy, which may be efficacious for managing musculoskeletal conditions, such as myofascial pain syndrome. This study demonstrated improvements in function in individuals with MTPs following INS therapy, which may be of clinical significance in certain patients with neck or shoulder pain. Further large-scale clinical trials are required to confirm this effect and to determine if INS also reduces pain and neck disability.

Effects of whole body vibration on strength and functional mobility in multiple sclerosis

The aim of this study was to examine the effectiveness of regular whole body vibration (WBV) training on lower limb muscle strength and functional mobility in individuals with multiple sclerosis. A single subject experimental design was replicated on three subjects. Phases included a 4-week baseline phase without intervention, 6 weeks of twice weekly WBV intervention on a VibroGym apparatus, and a 4-week baseline phase without intervention. During all phases, strength of the ankle plantarflexors and knee extensors was assessed twice weekly with the Nicholas Manual Muscle tester and functional mobility with the Timed Up and Go test. All subjects improved significantly in plantarflexor strength (p<0.05). One subject improved significantly in knee extensor strength bilaterally and one subject in the weaker leg. Two subjects improved significantly in functional mobility. These improvements in strength and mobility were maintained in the final baseline phase. In conclusion, regular WBV training can improve lower limb strength and mobility in some individuals with multiple sclerosis. Individuals who do not perform any other exercise, are in a moderate stage of disease progression, and have a more intensive exercise protocol in conjunction with WBV seem to benefit most. However, further high-quality studies are needed.

Peripheral electrical stimulation to induce cortical plasticity: a systematic review of stimulus parameters

Peripheral electrical stimulation (ES) is commonly used as an intervention to facilitate movement and relieve pain in a variety of conditions. It is widely accepted that ES induces rapid plastic change in the motor cortex. This leads to the exciting possibility that ES could be used to drive cortical plasticity in movement disorders, such as stroke, and conditions where pain affects motor control. This paper aimed to critically review the literature to determine which parameters induced cortical plasticity in healthy individuals using ES. A literature search located papers that assessed plasticity in the primary motor cortex of adult humans. Studies that evaluated plasticity using change in the amplitude of potentials evoked by transcranial magnetic stimulation of the motor cortex were included. Details from each study including sample size, ES parameters and reported findings were extracted and compared. Where data were available, Cohen's standardised mean differences (SMD) were calculated. Nineteen studies were located. Of the parameters evaluated, variation of the intensity of peripheral ES appeared to have the most consistent effect on modulation of excitability of corticomotor pathway to stimulated muscles. There was a trend for stimulation above motor threshold to increase excitability (SMD 0.79 mV, CI -0.10 to 1.64). Stimulation below motor threshold, but sufficient to induce sensory perception, produced conflicting results. Further studies with consistent methodology and larger subject numbers are needed before definitive conclusions can be drawn. There also appeared to be a time effect. That is, longer periods of ES induced more sustained changes in cortical excitability. There is insufficient evidence to determine the effect of other stimulation parameters such as frequency and waveform. Further research is needed to confirm whether modulation of these parameters affects plastic change.

Effect of a low-Dye application of Scotchcast Soft Cast on peak and mean plantar pressures in subjects with a navicular drop greater than 10 mm

BACKGROUND

We investigated whether a low-Dye application of Scotchcast Soft Cast significantly altered plantar pressure distribution during gait in patients with a navicular drop greater than 10 mm.

METHODS

An experimental, same-subject, repeated-measures design was used. Thirty-two subjects aged 18 to 35 years were screened with the navicular drop test and were included if a navicular drop greater than 10 mm was established. The Emed-AT-2 platform system was used to measure the plantar pressure distribution under the right foot of each subject using the midgait method of data collection. Each subject performed six barefoot walks and six walks with Soft Cast applied to the right foot. Average peak and mean plantar pressure measurements were recorded for ten discrete areas (masks). The heel and midfoot were each divided into two masks, and the forefoot and toe regions were divided into three masks each. Paired t tests were used to detect differences in peak and mean plantar pressures for each mask.

RESULTS

Soft Cast significantly affected peak and mean plantar pressures in seven and nine of the ten masks, respectively. No significant change in peak or mean plantar pressure was found beneath the medial midfoot.

CONCLUSION

Plantar pressure may represent dynamic foot and ankle joint motion. With further research, Soft Cast may provide an alternative to current management techniques in controlling foot pronation and reducing symptoms of lower-limb abnormalities.

Factors affecting curriculum content and the integration of evidence-based practice in entry-level physiotherapy programs

Decisions about curricular content in entry-level health professional programs are influenced by a variety of external and internal factors. However, little is known about how lecturers make decisions about the curricular content to be included or excluded from entry-level programs. This study aimed to explore the factors influencing such decision making regarding curricular content in entry-level Australian and New Zealand programs for physiotherapy, as well as how evidence-based practice (EBP) is integrated into the teaching and learning framework. Thirteen lecturers from 13 institutions (100% response rate) responsible for teaching a core part of physiotherapy practice, electrophysical agents, participated in a semistructured telephone interview. Decision making for curricular content involved an overall democratic process with the program team, but the day-to-day content was determined by the lecturer. Factors that lecturers reported as impacting on the choice of curriculum were current clinical practice, evidence, and accreditation or registration requirements. Thematic analysis of open-ended questions identified four main themes relating to the integration of the EBP paradigm within teaching: resource materials, use of broad definitions of evidence, inclusion of specific instructional strategies, and context of curriculum. Lecturers used a variety of research methodologies as a backdrop for the presentation of techniques and interventions that are used commonly in clinical practice despite limitations in the evidence base. The results highlighted tensions that exist when designing entry-level curricula with the need to prepare competent and safe practitioners while working within an EBP paradigm.

Do early quadriceps exercises affect the outcome of ACL reconstruction? A randomised controlled trial

A prospective, blinded, randomised controlled trial investigated the effectiveness of quadriceps exercises following anterior cruciate ligament reconstruction. A treatment group (Quadriceps exercise group) performed straight leg raises and isometric quadriceps contractions throughout the first two postoperative weeks, and a second group (No quadriceps exercise group) did not. A battery of outcome measures assessed subjects postoperatively at day one, two weeks, and one, three and six months. A total of 103 patients (Quadriceps exercise n = 48, No quadriceps exercise n = 55) commenced the study with 91 subjects available at final follow up (Quadriceps exercise n = 47, No quadriceps exercise n = 44). Performance of quadriceps exercises significantly improved a number of knee flexion and extension range of motion measurements (p = 0.01 to 0.04). No significant differences were found between the two groups at any postoperative period for quadriceps lag (p = 0.36), functional hop testing (p = 0.49 to 0.51), isokinetic quadriceps strength (p = 0.70 to 0.72), the majority of numerical analogue scores (p = 0.1 to 0.94) and Cincinnati scores (p = 0.10 to 0.84). Subjects performing quadriceps exercises reported significantly higher pain scores with exercise on the first postoperative day (p = 0.02). At six months postoperatively, the Quadriceps exercise subjects reported significantly more favourable Cincinnati scores for symptoms (p = 0.005) and problems with sport (p = 0.05). While average knee laxity was not significantly different between treatment groups over time (p = 0.27 to 0.94), quadriceps exercise performance was associated with a significantly lower incidence of abnormal knee laxity. Isometric quadriceps exercises and straight leg raises can be safely prescribed during the first two postoperative weeks and confer advantages for faster recovery of knee range of motion and stability. It remains to be proven whether the magnitude of differences between groups is clinically significant.

Gait aid use by ambulatory older people in a residential setting: a descriptive exploration

The aim of this study was to describe the use of gait aids by ambulatory older people in a residential care setting. A cross-sectional exploration generating both qualitative and quantitative data was undertaken in a South Australian low-care population (n = 31). Demographic data were collected via case note review. Type of aid, mode of use and reasons for gait aid use were investigated via a structured face-to-face interview.

Results identified four discrete groups of gait aid users in this population: those who used no aid (n = 5), those who used a stick only (n = 7), those who used a frame only (n = 13) and those who used both a stick and a frame (n = 6). In total, 31% of gait aids were self-prescribed and 33% of frames were used inappropriately. A vast range of psychosocial and behavioural factors was described by subjects to influence gait aid type and use. These findings suggest that self-prescription by older people may indicate alternative underlying needs that may be better met by therapeutic interventions other than gait aid prescription.

The effect of low-Dye taping on peak plantar pressures of normal feet during gait

This study investigated whether low-Dye anti-pronation taping altered peak plantar pressures of normal feet during gait. The Emed-AT-2 platform system was used to measure peak plantar pressures. Forty subjects performed two sets of six walks over the Emed-AT-2 forceplate. One set of walks was performed barefoot whilst the other set was performed with the low-Dye tape applied to the right foot. Computer software divided the heel, midfoot and forefoot into six areas (masks) for analysis. The mean for the peak plantar pressures (N/cm(2)) of each of these masks was determined for both sets of walks. Paired t-tests found a significant difference between the barefoot and taped peak plantar pressures in each of the six masks. Overall low-Dye anti-pronation taping significantly altered the peak plantar pressures of normal feet during gait. Of particular interest was that a significant reduction in mean peak plantar pressure was observed in the medial midfoot (1.4 N/cm(2)) whilst a significant increase occurred in the lateral midfoot (2.6 N/cm(2)).

Hip fracture rates in South Australia: into the next century

BACKGROUND

Fractures of the femoral neck already represent a major public health problem in Australia. This situation is set to worsen as the population ages. The present study estimates the number of patients over 50 years of age with femoral neck fractures that is expected to impact on the South Australian healthcare service into the next century.

METHODS

Population projections from the Australian Bureau of Statistics 1996 census were combined with age- and gender-specific incidence rates for fractures of the femoral neck for persons over the age of 50 in South Australia. Projections for the expected number of hip fractures in this State were then calculated.

RESULTS

Assuming there are no changes in the age- and gender-specific incidence of fracture rates, the number of fractures in South Australia is estimated to increase by approximately 66% by the year 2021 and 190% by 2051.

CONCLUSION

Based on the population projections and the assumption that conditions contributing to hip fractures remain constant, the number of fractured neck of femurs will increase in far greater proportion than the overall population in the next century. The results of the present study indicate the serious implications for the South Australian healthcare system if there is no reduction in incidence rates.

Shoulder impingement syndrome: preoperative health status

Eighty-one patients with chronic shoulder impingement resistant to conservative treatment completed a generic quality-of-life questionnaire (SF-36) and shoulder-specific questionnaire (Simple Shoulder Test [SST]). SF-36 data were compared with those of an Australian normative data set. Patients with chronic shoulder impingement were found to be significantly lower in all health dimensions of the SF-36 than the normal population. Results from the SST test indicated that patients were functionally very limited, particularly in being unable to work full time at their usual job and being unable to lift a weight above the head. Our results indicate that chronic shoulder impingement results in significant functional disability and a reduction in quality of life. Baseline descriptive data of this nature are important, because they provide a point of comparison for the effect of different conditions and for determining the effect of surgical treatment.

Arthroscopic subacromial decompression: responsiveness of disease-specific and health-related quality of life outcome measures

Twenty-eight patients who presented with stage II or early stage III impingement syndrome were evaluated before and after decompression surgery to examine the sensitivity and responsiveness of health-related quality of life and disease-specific measures. The outcome instruments used included the Medical Outcomes Study SF36 health survey; the Constant-Murley shoulder scoring system (CM), the University of California at Los Angeles shoulder rating scale (UCLA) and visual analogue scales (VAS) for pain. Preoperative and short-term postoperative evaluations showed significant improvements in all outcome instruments, including pain and physical role dimensions of the SF36. However, the UCLA and VAS pain scores were confirmed as the most responsive and sensitive measures to short-term change following arthroscopic decompression.

Primary total knee replacement: short-term outcomes in an Australian population

This study evaluated the short-term outcome of primary total knee replacement, using standard and reliable outcome measures, for osteoarthritis in an Australian population. This study also compared the pre-operative health status of the patient population with population norms using a quality of life questionnaire. Using the medical outcome study (MOS) 36-item short form health survey (SF-36), there was a statistically significant improvement in physical functioning and bodily pain in males and bodily pain, vitality, role-emotional and mental health in females (P < 0.05). A statistically significant improvement was also seen in Knee Society Scores following surgery for both males and females (P < 0.05). Comparison of pre-operative SF-36 data to age-matched Australian normative values demonstrate that female patients requiring total knee replacement were significantly below the norms in virtually all health dimensions while males were significantly below the norms in mainly physical health dimensions (P < 0.01).

Intraarticular fractures of the distal radius treated with metaphyseal external fixation. Early clinical results

Twenty-two patients with unstable Frykman grade 7 or 8 intra-articular fractures of the distal radius were treated with an external fixator. The distal pins were inserted into the distal radial fracture fragments, permitting movement of the wrist and hand. Eleven patients were male and 11 female, with a mean age of 50 years. All patients had regained full function with good range of motion at mean final follow-up of 12 months. However function, pain and range of motion had returned to acceptable levels 4 weeks after removal of the external fixator. This method of external fixation provides a reliable method of maintaining fracture reduction whilst allowing early return of function.