An Exploration of Low Back Beliefs of Male Pre-Professional and Professional Dancers

BACKGROUND

Globally, male dancers are affected by low back pain (LBP) up to 2.5 times more than female dancers. While female dancers' beliefs around LBP and dance-specific low back movements exist, no research has explored male dancers' beliefs. This study aimed to (1) examine the low back beliefs of Australian male professional and pre-professional dancers, and (2) determine if beliefs toward common low back movements and lifting differed when current LBP or history of disabling LBP (DLBP) were considered.

METHODS

40 male dancers (mean age [SD] 26.9 years [7.9]) from a range of dance backgrounds (all participating in ballet) were recruited to complete a cross-sectional survey comprising a beliefs questionnaire considering dance-specific movement and lifting tasks, the Back Pain Attitudes Questionnaire (Back-PAQ) and the Athletic Fear Avoidance Questionnaire (AFAQ). Primary analysis included initial descriptives, a repeated measures ANOVA for movement-specific beliefs and visual thematic analysis for written responses within the belief's questionnaire. Secondary subgroup analysis included independent T-tests for those with/without current LBP and those with/without a history of DLBP.

RESULTS

Fourteen dancers reported current LBP and 30 reported a history of DLBP. Dancers held generally negative beliefs toward the low back (Back-PAQ mean 123.1 ± 9.7) with neither subgroup demonstrating significant between-group difference (P < .05). Dance-specific flexion movements were seen as safer than extension movements (P < .05), and more extended-spine lifting was seen as safer than more flexed-spine lifting (P < .05). Dancers experiencing current LBP held less positive beliefs surrounding some dance-specific movements.

CONCLUSIONS

Dancers hold negative general beliefs toward the low back irrespective of current or historical DLBP, however their beliefs surrounding dance-specific movements were relatively positive. Dancers' beliefs surrounding some movements were affected by the presence of current LBP, in particular an arabesque and a fish dive.

Timing is everything, but does it really matter? Impact of 8-weeks morning versus evening iron supplementation in ballet and contemporary dancers

ABSTRACTThe effectiveness of a morning versus evening oral iron supplement strategy to increase iron stores was explored. Ballet and contemporary dancers with serum ferritin (sFer) < 50μg/L (n = 14), were supplemented daily with 105 mg elemental oral iron in either the morning (FeAM) or evening (FePM) for 8 weeks. A control group (n = 6) with sFer >50μg/L were given no supplement over the same period. Dancers' sFer were measured at baseline and post-intervention. Assessment of daily training load, dietary intake, and menstruation were made. A significant interaction (p < 0.001) showed the within group sFer change over the 8-week intervention in FeAM (+25.9 ± 10.5μg/L) and FePM, (+22.3 ± 13.6μg/L) was significantly different to CON (-30.17 ± 28.7μg/L; both p = 0.001). This change was not different between FeAM and FePM (p = 0.778). sFer levels within FeAM and FePM significantly increased over the 8-weeks; however, they significantly decreased in the CON group (all p < 0.05). Post-intervention sFer levels were no longer different between the three groups (p > 0.05). Training load, dietary intake, and number of menstrual cycles incurred were similar between FeAM and FePM (p > 0.05). Oral iron supplementation in either the morning or evening appears equally effective in increasing sFer levels in dancers with sub-optimal iron status.

67 TECHNOLOGY TO SUPPORT INDEPENDENT LIVING AT HOME: ONLINE SURVEY OF USER NEEDS AND REQUIREMENTS

Background

Technology can play a key role in supporting older adults to live independently at home. A User Needs and Requirements study including co-design workshops and an online survey was conducted to inform the development of a technological solution aimed at supporting older adults to remain living independently at home. The online survey component is reported here.

Methods

Eligibility criteria included that respondents were older adults living at home or caregiving stakeholders providing care to older adults at home e.g. family caregivers or health/social care professionals. Recruitment took place throughout Ireland through civil society organisations and age friendly networks in local councils. Quantitative and qualitative data were gathered from June to July 2020. Descriptive statistics were applied to quantitative data and inductive thematic analysis was performed on free text responses.

Results

In total, 380 respondents completed the survey (n= 235 older adults, n=77 family caregivers, n=47 healthcare professionals and n=21 home support workers). Older adults identified key issues where technology might support them to live independently, these included, home security (33% n=77), falls (30% n=69), reduced mobility (23% n=55) and loneliness (23% n=54). Thematic analysis highlighted key areas where technology could assist stakeholders in providing care for older adults living independently, these included, remote monitoring of family members (family caregivers), communication with clients (healthcare professionals) and falls (home support workers). Older adults reported that data privacy and the cost of technology were key concerns. All groups reported a high level of willingness to use technology such as ambient sensors, wearable devices and voice activated assistants to support independent living.

Conclusion

Results of this survey provide insights into user needs and requirements in combination with results from co-design workshops to inform the design, development and trial of a technology system to support independent living at home.

181 UNDERSTANDING OLDER ADULTS’ PERCEPTIONS AND EXPERIENCES OF NOVELTY: A PILOT STUDY

Background

Our institution is currently developing a technology solution to support adults to live well at home for longer. As the system develops, there is an emerging emphasis on strict structure/routine in older adults’ activities of daily living. In contrast, engagement in novel experiences is widely endorsed as a buffer against cognitive decline. Despite this, there is scant research into the perceptions and experiences of novelty in older adults. Understanding older adults’ views on novelty is necessary to inform the advancement of the current project.

Methods

A multiple-methods, exploratory approach was used. A 90-minute focus group was held with 4 older adults to explore their conceptualisations of novelty, discussing what constitutes a novel experience and gauging the value placed on routine and novelty in daily life. Questionnaires measuring Mental Well-Being (MWB), personality, Novelty-Need Satisfaction (NNS), and preference for routine were subsequently completed by each participant.

Results

Four main themes emerged from the qualitative data. They comprised the contrast between planned and unplanned novel experiences, the influence of context on the enjoyment of novelty, the value of the vicarious experience of novelty and the challenge associated with change at a social/global level. The quantitative data revealed that 91.9% of the variation in MWB is attributed to its relationship with NNS.

Conclusion

The focus group served as a strong foundation; especially into the contextual influence of both internal (psychological/attitude-related) and external (environmental/social) factors upon the enjoyment of novelty; as well as indicating that further research is merited into the contrasting views on planned and unplanned novel experiences. The quantitative data corroborate the importance of maintaining novelty in older age. Understanding how to preserve novelty while supporting routines will allow assistive technology projects such as this, to adopt a holistic approach and encourage consideration for this aspect of life, often neglected in the lives of older adults.

141 THE INTENSE PROJECT: IMPROVING DEMENTIA CARE THROUGH SIMULATION OF SELF-EXPERIENCE

Background

The EC is concerned about the growing shortage of experienced health and social care professionals to care for people with dementia. Although specialized dementia education programs have begun to appear in recent years, a lack of consistency and adequate level of knowledge of dementia to anticipate the required treatment remains across Europe. The Improving demeNtia care Through Self-Experience (INTENSE) project supports the creation of skills improvement paths for professionals across Europe that incorporate and promote successful self-experience methodologies and practices to increase knowledge and understanding of the lived experience of dementia (e.g., Virtual Dementia Tours, role plays and practices of theatre workshops).

Methods

A systematic review of self-experience tools, training and interventions was conducted. Participatory stakeholder workshops were then held in Ireland, Italy, Germany and the Netherlands to explore ways in which self-experience could be used to better understand the experience of the person with dementia and how the simulation of self-experience could be incorporated into existing (or new) training programmes. Workshop discussions were transcribed and thematically analysed along with workshop outputs to develop the INTenSE toolkit and supporting platform.

Results

An INTenSE toolkit was developed containing interactive no-tech, low-tech and high-tech approaches to simulating self-experience. Training scenarios, facilitation approaches and sustainability plans were designed and a prototype of the INTenSE Platform (website to house and support use of the toolkit) was developed. Beta versions of each will be presented.

Conclusion

INTenSE has illustrated how participatory research can strengthen cooperation and exchange of experiences between organizations working in the field of dementia care; improve social awareness of the ability of self-experience to improve dementia care; promote the integration of self-experience practices in the training of health and social care professional; and highlight the potential for self-experience simulation to be incorporated into carer training and dementia awareness education, subject to the provision of appropriate supports.

99 CHILDHOOD PERSPECTIVES OF PARENTAL YOUNG-ONSET DEMENTIA: A QUALITATIVE DATA SYNTHESIS

Background

While it is less common, young onset dementia manifests at a significantly younger age (&lt; 65). Many people with young onset dementia are parents; however, little is known about impact of the condition on children and young adults. A qualitative thematic analysis was conducted to synthesise the literature on the perspectives of children and young adults with a parent living with young onset dementia.

Methods

Electronic databases were searched in order to identify all peer-reviewed literature in relation to the perspectives of children and young adults with a parent living with young onset dementia. A thematic analysis was conducted on the relevant literature.

Results

The electronic database search resulted in 15 full texts articles. Four main themes with related subthemes emerged from the thematic analysis. The four main themes were: changing family dynamics; psychological and physical strain; stigma and coping strategies.

Conclusion

The current synthesis outlines the perspectives of children and young adults with a parent living with young onset dementia. There is a significant lack of research in this area which adds to the stereotypical view of dementia as an older person’s disease. This can lead to children and young adults being impacted by lack of awareness and stigma resulting in significant psychosocial problems. As the number of people living with dementia (including young onset) is set to increase, future research with children and young adults with a parent with young onset dementia is important in order to better support this cohort.

189 IMPROVING DEMENTIA CARE THROUGH SELF-EXPERIENCE; CO-DESIGNING A SIMULATION-BASED DEMENTIA EDUCATION TOOLKIT

Background

Although specialised dementia education programmes have begun to appear in recent years, they lack consistency. Knowledge gaps persist, which results in a professional workforce who can struggle to anticipate the care needs of people with dementia. Self-experience or simulation practices (e.g., roleplays, virtual reality, sensory tools) are established teaching methods that can provide learning opportunities to experience aspects of illness. These innovative learning approaches can positively impact empathy, understanding, and quality of care; however, they are rarely implemented in specialised care for people with dementia. The Improving demeNtia care Through Self-Experience (INTENSE) project has co-designed a dementia simulation toolkit to educate, equip, and train professionals to better support people with dementia.

Methods

As part of the Erasmus+ INTenSE project, a series of three participatory, online workshops were conducted with people with dementia, informal caregivers, and dementia-care professionals in Ireland, Italy, Germany, and the Netherlands. The first explored the co-design of training scenarios using simulation tools to demonstrate the lived experience of dementia. The second involved the co-design of an online training platform. The third examined the sustainable implementation of INTenSE into practice. All workshops were inductively coded and analysed thematically.

Results

Recommended training scenarios demonstrate daily activities and environments that impact people with dementia using a combination of existing and newly developed simulation tools. Four themes arose from workshop discussions: 1) representation of dementia, 2) daily challenges that impact people with dementia, 3) applying a person-centred approach, and 4) implementing self-experience training. Together these were used to develop facilitation guides to support the implementation of the INTenSE simulation toolkit into practice.

Conclusion

These findings demonstrate the potential of simulating self-experience across a range of everyday scenarios as a means to increase professionals' empathy and understanding of the lived experience of dementia. Recommendations have been developed that support the use of self-experience tools in practice.

Developing an alcohol and other drug serious game for adolescents: considerations for improving student engagement

OBJECTIVES

To explore perceptions of alcohol and other drug (AOD) education and digital game design preferences among Australian adolescents with the goal of identifying key factors to promote engagement in an AOD serious game for Australian secondary school students.

METHODS

Semi-structured focus groups were conducted with 36 adolescents aged between 13 and 18 years. Qualitative data was analysed using thematic analysis.

RESULTS

Participants described heightened engagement with AOD education that incorporated relatable and relevant real-life stories and interactive discussions. They also expressed a desire for learning to focus on practical strategies to reduce AOD harm and overcome social pressure to use AOD. Participants highlighted the importance of incorporating relatable characters and context-relevant scenarios in promoting engagement, and identified social elements, player choice, and optimal challenge as important game design considerations.

CONCLUSIONS

A focus on meaningful realistic scenarios, relatable characters, relevant information and practical skills may promote high school aged students' engagement with AOD educational content. Game designs incorporating social elements and decision-making opportunities may be conducive to promoting engagement and enhancing learning.

IMPLICATIONS FOR PUBLIC HEALTH

Findings from this study can be used by researchers and game designers for the development of future AOD serious games targeted at Australian adolescents.

Out-of-hospital births and the experiences of emergency ambulance clinicians and birthing parents: a scoping review protocol

INTRODUCTION

Emergency ambulance clinicians attend a wide range of prehospital emergencies, including out-of-hospital births (OOHBs). Intrapartum care comprises approximately 0.05% of emergency medical services' caseload, with only ~10% of intrapartum cases progressing to birth in emergency ambulance clinician care. However, this low exposure rate potentially allows obstetric clinical skills and knowledge to decay, which may impact on patient care. Additionally, unplanned OOHBs are known to have a higher incidence of complications and adverse outcomes than their counterparts born in hospital, such as postpartum haemorrhage or hypothermia. This scoping review will explore OOHBs and associated complications in emergency ambulance clinician care, investigate birth parent, significant partner and clinician experiences regarding OOHBs, and consider barriers and challenges to optimal patient care, to identify future research opportunities and associated knowledge gaps for this patient cohort.

METHODS AND ANALYSIS

This scoping review will follow the nine-step methodological framework suggested by the Joanna Briggs Institute and use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Five electronic databases (MEDLINE via EBSCO, CINAHL, Embase, Web of Science and Wiley Online) will be searched to identify articles for inclusion. The 'participant, concept, context' criteria will be used to identify suitable search words regarding OOHBs in emergency ambulance clinician care. The review will include peer-reviewed and preprint literature. Two reviewers will independently assess articles based on title and abstract for inclusion in the review. Data will be charted using a data extraction tool for consistency and provide a succinct descriptive summary of the results.

ETHICS AND DISSEMINATION

This study does not require ethical review as all the information obtained will come from publicly available resources. Results will be disseminated via a peer-reviewed publication. This scoping review is preregistered with the Open Science Framework (https://osf.io/ta35q).

Development of a Machine Learning Model for the Estimation of Hip and Lumbar Angles in Ballet Dancers

OBJECTIVE

Accurate field-based assessment of dance kinematics is important to understand the etiology, and thus prevention and management, of hip and back pain. The study objective was to develop a machine learning model to estimate thigh elevation and lumbar sagittal plane angles during ballet leg lifting tasks, using wearable sensor data.

METHODS

Female dancers (n=30) performed ballet-specific leg lifting tasks to the front, side, and behind the body. Dancers wore six wearable sensors (100 Hz). Data were simultaneously collected using an 18-camera motion analysis system (250 Hz). Due to synchronization and hardware malfunction issues, only 23 dancers had usable data. Using leave-one-out cross-validation, machine learning models were compared with the optic motion capture system using root mean square error (RMSE) in degrees and correlation coefficients (r) over the complete movement profile of each leg lift and mean absolute error (MAE) and Bland Altman plots for peak angle accuracy.

RESULTS

The average RMSE for model estimation was 6.8° for thigh elevation angle and 5.6° for lumbar spine sagittal plane angle, with respective MAE of 6.3°and 5.7°. There was a strong correlation between the machine learning model and optic motion capture for peak angle values (thigh r=0.86, lumbar r=0.96).

CONCLUSION

The models developed demonstrated an acceptable degree of accuracy for the estimation of thigh elevation angle and lumbar spine sagittal plane angle during dance-specific leg lifting tasks. This provides potential for a near-real-time, field-based measurement system.

Dancers' Joint Strategies for Achieving Turnout in Low and High Friction Conditions

BACKGROUND

Dancing with legs externally rotated (turnout) is a fundamental element of ballet technique. A reliance on floor friction to achieve turnout may contribute toward the high injury rate in dancers. Joint strategies used by dancers in high and low friction turnout conditions are not well understood.

OBJECTIVES

To quantify the lower limb and lumbar spine joint strategies used by female pre-professional dancers to achieve turnout in low-friction (rotation discs) and high-friction (functional and forced) conditions.

METHODS

Twenty-three pre-professional female dancers participated in the study. A 12-camera motion analysis system collected hip and knee external rotation (ER), ankle abduction, and lumbar extension angles in three turnout conditions and passive hip ER range of motion angles. Repeated measures ANOVA analysed the differences between joint angles, maximum turnout angle (foot relative to pelvis), and available hip ER.

RESULTS

Dancers demonstrated lower knee ER (18.5±4.8°) and ankle abduction (6.0±7.7°) angles during low-friction turnout compared to higher friction conditions (p<0.05). Dancers utilised between 70-83% of available hip ER within all conditions. Low-friction turnout demonstrated greater hip ER contribution within maximum turnout (43%) compared to higher friction conditions. Dancers demonstrated greater lumbar extension angles in low-friction turnout compared to higher friction conditions (p<0.05).

CONCLUSIONS

Further hip ER strength training is required to promote greater hip ER range within the position. Rotation discs may be a valuable training tool as dancers demonstrated greater hip ER utilisation with less knee ER and ankle abduction; however, this position did promote undesirable lumbar extension.

Development of a Human Activity Recognition System for Ballet Tasks

Background

Accurate and detailed measurement of a dancer’s training volume is a key requirement to understanding the relationship between a dancer’s pain and training volume. Currently, no system capable of quantifying a dancer’s training volume, with respect to specific movement activities, exists. The application of machine learning models to wearable sensor data for human activity recognition in sport has previously been applied to cricket, tennis and rugby. Thus, the purpose of this study was to develop a human activity recognition system using wearable sensor data to accurately identify key ballet movements (jumping and lifting the leg). Our primary objective was to determine if machine learning can accurately identify key ballet movements during dance training. The secondary objective was to determine the influence of the location and number of sensors on accuracy.

Results

Convolutional neural networks were applied to develop two models for every combination of six sensors (6, 5, 4, 3, etc.) with and without the inclusion of transition movements. At the first level of classification, including data from all sensors, without transitions, the model performed with 97.8% accuracy. The degree of accuracy reduced at the second (83.0%) and third (75.1%) levels of classification. The degree of accuracy reduced with inclusion of transitions, reduction in the number of sensors and various sensor combinations.

Conclusion

The models developed were robust enough to identify jumping and leg lifting tasks in real-world exposures in dancers. The system provides a novel method for measuring dancer training volume through quantification of specific movement tasks. Such a system can be used to further understand the relationship between dancers’ pain and training volume and for athlete monitoring systems. Further, this provides a proof of concept which can be easily translated to other lower limb dominant sporting activities

An Exploration of Machine-Learning Estimation of Ground Reaction Force from Wearable Sensor Data

This study aimed to develop a wearable sensor system, using machine-learning models, capable of accurately estimating peak ground reaction force (GRF) during ballet jumps in the field. Female dancers (n = 30) performed a series of bilateral and unilateral ballet jumps. Dancers wore six ActiGraph Link wearable sensors (100 Hz). Data were collected simultaneously from two AMTI force platforms and synchronised with the ActiGraph data. Due to sensor hardware malfunctions and synchronisation issues, a multistage approach to model development, using a reduced data set, was taken. Using data from the 14 dancers with complete multi-sensor synchronised data, the best single sensor was determined. Subsequently, the best single sensor model was refined and validated using all available data for that sensor (23 dancers). Root mean square error (RMSE) in body weight (BW) and correlation coefficients (r) were used to assess the GRF profile, and Bland–Altman plots were used to assess model peak GRF accuracy. The model based on sacrum data was the most accurate single sensor model (unilateral landings: RMSE = 0.24 BW, r = 0.95; bilateral landings: RMSE = 0.21 BW, r = 0.98) with the refined model still showing good accuracy (unilateral: RMSE = 0.42 BW, r = 0.80; bilateral: RMSE = 0.39 BW, r = 0.92). Machine-learning models applied to wearable sensor data can provide a field-based system for GRF estimation during ballet jumps.

A comparison of self and proxy quality of life ratings for people with dementia and their carers: a European prospective cohort study

Objectives: To identify correlates of self-rated and proxy-rated quality of life (QoL) in people with dementia on (i) a dementia-specific and (ii) a capability-wellbeing QoL measure at baseline and 12-month follow-up, and to consider such factors in the context of QoL intervention development.Method: Prospective clinical and demographic data were collected from 451 community-dwelling dyads (mild-moderate dementia) across eight European countries. QoL was measured using the QOL-AD and the ICECAP-O. Multivariate modelling identified correlates of self- and proxy-rated QoL at baseline and at 12-month follow-up.Results: Carer's proxy-ratings of QoL were significantly lower than self-ratings at all time-points for both measures. Proxy-ratings declined over time, but self-ratings remained stable. Baseline predictors of greater self-rated QoL were education, and greater functional ability and relationship quality. Greater proxy-rated QoL was associated with education and greater functional ability, relationship quality, carer social support and carer QoL, lower carer anxiety/depression and less severe neuropsychiatric symptoms in people with dementia. At follow-up, greater self-rated QoL was predicted by greater functional ability, relationship quality, carer social support and having a spousal carer. Greater proxy-rated QoL at follow-up was associated with the same factors as at baseline; however, the dyad living together was an additional predictive factor.Conclusion: Both proxy-ratings and self-ratings of QoL should be interpreted with caution and in the context of each individual caregiving relationship. Different functional, psychosocial, relational and contextual factors influence self- and proxy-ratings, and both sets of factors should be considered in the context of QoL intervention development for the dyad.

Virtual Reality Triage Training Can Provide Comparable Simulation Efficacy for Paramedicine Students Compared to Live Simulation-Based Scenarios

Background: Mass-casualty incidents (MCIs) are catastrophic. Whether they arise from natural or man-made disasters, the nature of such incidents and the multiple casualties involved can rapidly overwhelm response personnel. Mass-casualty triage training is traditionally taught via either didactic lectures or table top exercises. This training fails to provide an opportunity for practical application or experiential learning in immersive conditions. Further, large-scale simulations are heavily resource-intensive, logistically challenging, require the coordination and time of multiple personnel, and are costly to replicate. This study compared the simulation efficacy of a bespoke virtual-reality (VR) MCI simulation with an equivalent live simulation scenario designed for undergraduate paramedicine students. Methods: Both simulations involved ten injured patients resulting from a police car chase and shooting. Twenty-nine second-year paramedicine students completed the live and VR simulation in a random order. The training efficacy of the VR and live simulation was evaluated with respect to student immersion and task-difficulty, clinical decision-making (i.e. triage card allocation accuracy and timeliness), learning satisfaction, and cost of delivery. Results: While perceived physical demand was higher in the live simulation compared to VR (p < 0.001), no differences were observed across mental demand, temporal demand, performance, effort or frustration domains. No differences were found for participant satisfaction across the two platforms. No differences were observed in the number of triage cards correctly allocated to patients in each platform. However, participants were able to allocate cards far quicker in VR (p < .001). Cost of running the VR came to AUD $712.04 (staff time), compared to the live simulations which came to AUD $9,413.71 (staff time, moulage, actors, director, prop vehicle), approximately 13 times more expensive. Conclusion: The VR simulation provided near identical simulation efficacy for paramedicine students compared to the live simulation. VR MCI training resources represent an exciting new direction for authentic and cost-effective education and training for medical professionals.

An Exploration of Pre-Professional Dancers' Beliefs of the Low Back and Dance-Specific Low Back Movements

OBJECTIVE

Low back pain (LBP) is common in dancers. A biopsychosocial model should be considered in the aetiology of LBP, including a dancer's general beliefs of the low back and movements of the spine. This study aimed to determine pre-professional dancers' beliefs about their lower back in general and dance-specific movements of the spine and to explore whether these beliefs were influenced by a history of disabling LBP.

METHODS

52 pre-professional female dancers (mean age 18.3 [1.4] yrs) were recruited and reported whether they had a history of disabling LBP and completed the Back Pain Attitudes Questionnaire (Back-PAQ) and a dance movement beliefs questionnaire. A linear mixed model was applied to determine the effect of a history of disabling LBP on dancers' beliefs (p<0.05).

RESULTS

20 dancers reported a history of disabling LBP. Regardless of this LBP history, dancers held generally negative beliefs as measured by the Back-PAQ (p=0.130). A history of disabling LBP did not influence dancers' perceived movement safety of all tasks (p=0.867), and dancers held negative beliefs towards extension activities. These beliefs were linked to the conceptions of perceived risk of damage and the need to protect the lower back.

CONCLUSIONS

Dancers hold negative general beliefs around the low back and low back movements, regardless of a history of disabling LBP. Dancers perceive extension activities as more dangerous than flexion activities. These beliefs may reflect a combination of pain experience and beliefs specific to dance.

The prevalence of generalized and syndromic hypermobility in elite Australian dancers

OBJECTIVES

To determine the prevalence of Generalized Joint Hypermobility (GJH) and Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobility Type (JHS/EDS-HT) among dancers using established validated measures.

DESIGN

Observational Cohort Study.

SETTING

Laboratory.

PARTICIPANTS

85 dancers from two dance institutions.

MAIN OUTCOME MEASURES

GJH was determined using the Beighton score (cut-point ≥5/9) and the Lower Limb Assessment Scale (LLAS) (cut-point ≥7/12). Presence of JHS/EDS-HT was assessed using the Brighton and Villefranche criteria. Paired sample t-test was performed to compare LLAS side-to-side scores, and percentage disagreements calculated to determine differences between the two GJH and the two JHS/EDS-HT measures.

RESULTS

72% of dancers met the Beighton cut-point for GJH, while 38% and 42% met the LLAS cut-point on the left and right respectively. The proportion of dancers identified with GJH was different when assessed using the Beighton compared to the left and right LLAS (both p < 0.001), a disagreement of 48% and 46% respectively, with Beighton classifying more participants as having GJH. The Villefranche identified more dancers with JHS/EDS-HT than the Brighton (84% vs 31%, p < 0.001), with 54% disagreement.

CONCLUSIONS

High prevalence of generalized and syndromic hypermobility was found regardless of the criteria used. A higher Beighton cut-point, e.g. ≥6/9, to identify true GJH amongst dancers maybe warranted.

Identifying lower limb specific and generalised joint hypermobility in adults: validation of the Lower Limb Assessment Score

BACKGROUND

The Lower Limb Assessment Score (LLAS) has only been validated in a paediatric population. The aim of this study was to validate the use of the LLAS in an adult population by: i) evaluating its ability to discriminate between different extents of lower limb hypermobility, ii) establishing a cut-off score to identify lower limb hypermobility, and iii) determining if the LLAS is able to identify Generalised Joint Hypermobility (GJH).

METHODS

Participants were recruited across three groups representing varying degrees of hypermobility. They were assessed using the LLAS, Beighton score and clinical opinion. Pearson's correlation coefficient and MANOVA were used to assess between-group differences in the LLAS. The cut-off score was determined using median and inter-quartile ranges and the Receiver Operator Characteristic Curve. The ability of the LLAS to identify GJH was assessed using percent agreement with clinical opinion.

RESULTS

One hundred twelve participants aged 18-40 years were recruited. The LLAS distinguished the control from the likely hypermobile and known hypermobile cohorts (both p < 0.001), as well as the likely hypermobile from the known hypermobile cohort (p = 0.003). The LLAS cut-off score for identifying lower limb hypermobility was ≥7/12 with a specificity of 86% and sensitivity of 68%. The LLAS accurately identified those with GJH with high percentage agreement compared to clinical opinion across all cohorts (69-98%).

CONCLUSIONS

The LLAS is a valid tool for identifying lower limb specific hypermobility and GJH in adults at a cut-off score of ≥7/12. It demonstrates excellent specificity and moderate sensitivity, and discriminates well between extents of hypermobility.

Access to community care for people with dementia and their informal carers : Case vignettes for a European comparison of structures and common pathways to formal care

BACKGROUND

People with dementia and their informal carers often do not receive appropriate professional support or it is not received at the right time.

OBJECTIVES

Description and comparison of common pathways to formal community dementia care in eight European countries as a part of the transnational Actifcare project.

MATERIALS AND METHODS

The German team was responsible for creating an individual case scenario as a starting point. The research teams in Ireland, Italy, the Netherlands, Norway, Portugal, Sweden, and the United Kingdom were then asked to describe a common pathway to formal dementia care by writing their own vignette using the provided individual case scenario.

RESULTS

A transnational qualitative content analysis was used to identify the following categories as being the most important: involved professionals, dementia-specific and team-based approaches, proactive roles, and financial aspects. General practitioners (GPs) are described as being the most important profession supporting the access to formal care in all the involved countries. In some countries other professionals take over responsibility for the access procedure. Dementia-specific approaches are rarely part of standard care; team-based approaches have differing significances in each of the countries. Informal carers are mainly proactive in seeking formal care. The Nordic countries demonstrate how financial support enhances access to the professional system.

CONCLUSION

Enhanced cooperation between GPs and other professions might optimize access to formal dementia care. Team-based approaches focusing on dementia care should be developed further. Informal carers should be supported and relieved in their role. Financial barriers remain which should be further investigated and reduced.

Torso and Bowing Arm Three-Dimensional Joint Kinematics of Elite Cellists: Clinical and Pedagogical Implications for Practice

BACKGROUND

Elite cello playing requires complex and refined motor control. Cellists are prone to right shoulder and thoracolumbar injuries. Research informing injury management of cellists and cello pedagogy is limited. The aims of this study were to quantify the torso, right shoulder, and elbow joint movement used by elite cellists while performing a fundamental playing task, a C major scale, under two volume conditions.

METHODS

An eight degrees of freedom upper limb biomechanical model was applied to 3D motion capture data of the torso, upper arm, and forearm for 31 cellists with a mean experience of 19.4 yrs (SD 9.1). Two-factor ANOVA compared the joint positions between the four cello strings and two volume conditions.

FINDINGS

Significant (p<0.05) effects were found for either the string and/or volume conditions across all torso, shoulder, and elbow joint degrees of freedom. The torso was consistently positioned in left rotation from 5.0° (SD 5.6) at the beginning of the scale, increasing to 16.3° (5.5) at its apogee. The greatest mean shoulder flexion, internal rotation, and abduction joint angles were observed when playing at the tip of the bow on the top string (A): 107.2° (11.6), 59.1° (7.1), and -76.9° (15.7), respectively, during loud playing.

INTERPRETATION

Elite cellists use specific movement patterns to achieve string crossings and volume regulation during fundamental playing tasks. Implications of the static left-rotated torso posture and high degrees of combined shoulder flexion and internal rotation can be used to inform clinical and pedagogical practices.

Progress in the management of retrorectal tumours

AIM

Tumours in the retrorectal space are rare and pathologically heterogeneous. The roles of imaging and preoperative biopsy, nonoperative management and the indications for surgical resection are controversial. This study investigated a series of retrorectal tumours treated in a single institution with the aim of producing a modern improved management algorithm.

METHOD

A retrospective analysis was conducted of the management of all retrorectal lesions identified between 1998 and 2013 from a radiology database search. Patient demographics, presenting symptoms, imaging, biopsy, management and the results were recorded. Descriptive statistics were used and Kaplan-Meier survival analysis was performed.

RESULTS

Sixty-nine patients with a confirmed retrorectal tumour were identified. The median age was 50 (36-67 interquartile range) and 42 (56%) were female. Twenty (29%) of the tumours were malignant: 4 of 41 cystic lesions were malignant (12.9%) vs. 16 of 28 solid (or heterogeneous) lesions (57.1%) (P < 0.0001). Imaging demonstrated a 95% sensitivity and 64% specificity for differentiating benign from malignant tumours. Magnetic resonance imaging (MRI) was significantly better at distinguishing between benign and malignant tumours than computed tomography (94% vs. 64%, P = 0.03). Percutaneous biopsy was performed in 16 patients and only 27 underwent resection. There was no evidence of local recurrence associated with biopsy. Solid lesions were associated with a nonsignificant decreased overall survival (P = 0.348).

CONCLUSION

This study demonstrated that MRI should be the investigation of choice for retrorectal lesions. Biopsy of solid lesions is safe and useful for guiding neoadjuvant and surgical therapy. Cystic lesions without suspicious radiological features can be followed by serial imaging without resection.

A qualitative investigation of the views of primary care dentists on participating in prospective studies in the North-West of England

BACKGROUND

There is a poor understanding of to how to recruit and involve primary care dentists in clinical trials.

AIM

To use a qualitative paradigm to explore the views of primary care dentists towards participating in clinical trials and develop an understanding of the factors that facilitate and prevent their involvement. DESIGN, SETTING, SUBJECTS AND METHODS: An iterative approach was undertaken using a focus group (n = 6) followed by phased semi-structured interviews (n = 18). Data were analysed using thematic analysis and constant comparative analysis.

FINDINGS

The semi-structured interviews generated nine codes which were organised into three themes: technical issues for trials in primary dental care, practical issues for research in primary dental care and primary care dentists as research consumers. Overall, primary care dentists had a poor understanding of research methodology and clinical research. Barriers to participation included loss of clinical freedom and control, practice disruption, patient welfare, staff workload, financial loss and time.

CONCLUSIONS

Barriers to primary dental care research need to be overcome through appropriate protocols, funding, training and support. Joint working of primary dental care teams and academic researchers is essential, along with a constructive and open dialogue, if clinical trials are to be successfully undertaken in a practice environment.

Risk factors for lower back injury in male dancers performing ballet lifts

Lower back injuries are common in ballet dancers. Allegedly there is a higher incidence in males than in females due to their lifting requirements. This study analyzes the estimated forces generated at the L5/S1 joint in five professional and three pre-professional male dancers performing full press (FP) and arabesque (AR) ballet lifts. The estimated peak lumbar anterior shear force (PLASF) was identified using a 3D motion analysis system, and was found to occur at the beginning of each lift, approximately 0.01 seconds prior to the ballerina moving vertically into the lift. Data representing the male dancers' posture at the point of PLASF were input into a 3D Static Strength Prediction Program (3DSSPP, University of Michigan, Centre for Ergonomics, 2006) to calculate the PLASF and corresponding compression forces. The compression forces identified in this way were found to be greater than the National Institute of Occupational Safety and Health, Back Compression Design Limit (3400N). This suggests that administrative controls such as monitoring the number of lifts performed daily are required to reduce the risk of lower back injury in male dancers. Comparison of the two lifts found significantly (p < 0.05) higher compression forces in the FP versus the AR lift. This could be attributed to a significantly (p < 0.05) larger horizontal distance between the male dancer and the ballerina, or the eccentric loading of the male dancers' lower limb and trunk musculature in the preparation phase of the FP. Retrospective regression analysis indicated that peak trunk extension velocity and the horizontal distance between the male dancer and the ballerina were significant (p < 0.05) predictors of PLASF.

Evaluation of radiologist performance using telemedicine services

Observer performance of radiologists using a telemedicine service was evaluated. Diagnoses between the rural and consulting radiologists agreed 84% of the time. The main reason for disagreement was extent of lesion rather than type or absence/presence. Consulting times and image quality were considered adequate.

Acute respiratory distress syndrome in a community hospital ICU

OBJECTIVE

To estimate the incidence of the acute respiratory distress syndrome (ARDS) in an Australian urban community, and to describe the pattern of disease and outcomes in a community hospital intensive care unit (ICU).

SETTING

An eight-bed general ICU in a community hospital.

DESIGN

Retrospective chart review.

PATIENTS

32 patients identified over a 4-year period as having ARDS.

MEASUREMENTS AND RESULTS

The incidence of ARDS in an Australian urban community was estimated to be 7.3-9.3 cases/100,000 population per year. In-hospital mortality was 59%, while ICU mortality was 47%. Sepsis, pneumonia and aspiration were the main aetiological factors accounting for 94% of the patient population. There was no trauma. The Acute Physiology and Chronic Health Evaluation and Murray scores and values for the ratio of the partial pressure of oxygen in arterial blood and fractional inspired oxygen on admission to the ICU were similar between survivors and nonsurvivors, and none of these parameters were reliable predictors of outcome. Mean age, however, was different between survivors (56 +/- 16 years) and non-survivors (69 +/- 9 years) (p < or = 0.01). Mean daily fluid balance was also different between survivors (536 +/- 545 ml/day) and non-survivors (1576 +/- 1255 ml/day) (p < or = 0.02). Haemodynamic data were collected on 21 of the 32 patients within 72 h of the onset of ARDS. None of the haemodynamic parameters reached significance. There was, however, a trend for better cardiac function and oxygen consumption in the survivors.

CONCLUSIONS

These data show that for ARDS, at least, mortality outcome can be comparable in a community ICU to a tertiary referral institution. The pattern of disease in an urban Australian community hospital is different to that often reported from tertiary centres. The incidence of ARDS in an Australian urban community is comparable to the reported incidence in North America and Western Europe.

Influence of smoking habits on change in carbon monoxide transfer factor over 10 years in middle aged men

BACKGROUND

Emphysema is associated with a reduction in carbon monoxide transfer coefficient (TLCO/VA), but little is known about the evolution of changes in TLCO/VA in middle aged smokers at risk of developing chronic airflow obstruction.

METHODS

TLCO/VA (single breath method) was measured on two occasions 10 years apart in 122 middle aged men.

RESULTS

Initially TLCO/VA averaged 97% predicted in never smokers (n = 42, mean age 37.2 years), 99% predicted in ex-smokers (n = 21, mean age 41.9 years), and 85% predicted in those who smoked over 15 cigarettes a day (n = 42, mean age 42.0 years). Mean rates of decrease in TLCO/VA over 10 years, however, were similar in the three groups, so that differences between smokers and non-smokers did not increase during the 10 years. Seventeen men (mean age 40.9 years) who initially were smokers became sustained ex-smokers within two years of the first measurement; in these men mean absolute values of TLCO/VA rose, averaging 89% predicted at the first assessment but 102% predicted 10 years later.

CONCLUSION

By the age of about 40 years TLCO/VA was lower in smokers than in never smokers but this difference did not increase over the following 10 years. Sustained ex-smokers had values similar to those of never smokers even when TLCO/VA was known to have been reduced while they were smoking. Changes in TLCO/VA associated with stopping smoking were considerably larger than could be explained by carbon monoxide back pressure, indicating that mechanisms other than irreversible increase in the size of terminal air spaces underlie the lower values in smokers. To detect emphysema in smokers it is necessary to use reference equations that take account of current smoking.

Pulmonary function after bone marrow transplantation for chronic myeloid leukaemia

Pulmonary function was measured before and at intervals after treatment in 44 patients who received a bone marrow transplant for chronic myeloid leukaemia in the chronic phase. All patients were treated with cytotoxic drugs, total body irradiation, and post-graft immunosuppression. Thirty four patients surviving for 12 months were followed at three monthly intervals and 16 patients for 24 months. Fifteen patients received unmanipulated donor marrow cells and 29 patients received donor marrow cells depleted of lymphocytes ex vivo with the monoclonal antibody Campath-1. The 21 patients treated early in this study received 10 Gy of total body irradiation whereas the 23 patients treated more recently, who were all T lymphocyte depleted, received 12 Gy. Pretransplant lung function for the group was normal and was similar in survivors (n = 34) and nonsurvivors (n = 10), and in smokers (n = 8) and non-smokers (n = 36). (Carbon monoxide transfer factor--TLCO) was under 75% of predicted normal in nine patients before transplantation. TLCO, carbon monoxide transfer coefficient (KCO), FEV1, and vital capacity (VC) values were lower 6 and 12 months after bone marrow transplant than initially. The greatest decline was in TLCO, from an initial value of 89% to 66% at 6 and 70% at 12 months. The 16 longer term survivors showed significant recovery of function between 6 and 24 months after bone marrow transplant for TLCO, KCO, and VC, the increase ranging from 6.3% to 7.3% predicted. Airflow obstruction (FEV1/VC ratio less than 70%) developed in one patient. The major factors associated with deterioration in pulmonary function at 6 and 12 months after transplantation in the 34 survivors (stepwise multiple regression analysis) were (a) transplantation with T cell depleted donor marrow (p less than 0.005) and higher total body irradiation dose (p less than 0.02) with a fall in KCO and an increase in the FEV1/VC ratio; (b) chronic graft versus host disease with a fall in VC (p less than 0.01); and less fall in KCO (p less than 0.01); and (c) acute graft versus host disease with a fall in FEV1 (p less than 0.01). It is considered that most patients who survive the short term risks of bone marrow transplant have only minor long term impairment of pulmonary function.