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Hackett L, Zhang MM, Casey M, Miller J, Smith J, Low C, Aldridge E, Owen PJ, Buntine P. N-95/P2 respirator compliance with fit testing recommendations and respirator satisfaction amongst hospital staff. Infect Dis Health 2024:S2468-0451(24)00023-3. [PMID: 38702235 DOI: 10.1016/j.idh.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Filtering Facepiece Respirators (FFRs) are an important and readily scalable infection control measure; however their effectiveness is ultimately determined by compliance. We aimed to examine staff compliance and satisfaction with wearing the N95/P2 FFRs assigned to them via the standardised fit testing protocol implemented in a single large healthcare network in Victoria, Australia. METHODS In this cross-sectional survey, employees from five hospital campuses who participated in the health networks N95/P2 FFR fit testing process were invited in person to participate in the study. Data were analysed descriptively, after which chi-squared analysis was performed to determine differences between respirator types, gender, and age groups. RESULTS Amongst the 258 staff members surveyed, 28% had either never or only sometimes worn an FFR to which they had been successfully fit tested, and 11% had experienced facial changes that potentially rendered their most recent fit test invalid. More than half (53%) of those surveyed had experienced side effects, the most common being skin irritation and pressure sores. A majority (87%) of staff felt that wearing an FFR had some impact on their ability to perform their duties. Pooled mean self-reported satisfaction ratings were highest for three-panel flat-fold and duckbill models. CONCLUSION 28% of HCWs surveyed described not wearing N-95/P2 FFRs for which they had successfully been fit tested. Reasons for non-compliance remain unclear, but rates of side effects and interference with duties were high. Further research is required to determine and address potential causative factors and ascertain ongoing optimal organisation-level fit test strategies.
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Affiliation(s)
- Liam Hackett
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia.
| | - Melanie Meilun Zhang
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Department of General Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Matthew Casey
- OHS, Emergency Management and Wellbeing, Eastern Health, Melbourne, Victoria, Australia
| | - Joseph Miller
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Jesse Smith
- Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Caitlin Low
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Anaesthesia, Pain and Perioperative Medicine, Eastern Health, Melbourne, Victoria, Australia; Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Emogene Aldridge
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Patrick J Owen
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Paul Buntine
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
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Kaczorowski S, Donath L, Owen PJ, Saueressig T, Mundell NL, Topp M, Samanna CL, Döding R, Belavy DL. Telemedicine for Patients with Musculoskeletal Pain Lacks High-Quality Evidence on Delivery Modes and Effectiveness: An Umbrella Review. Telemed J E Health 2024; 30:1221-1238. [PMID: 38117672 DOI: 10.1089/tmj.2023.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Background: Musculoskeletal (MSK) pain is the leading cause of disability worldwide. Telemedicine is of growing importance, yet impacts on treatment efficacy remain unclear. Objective: This umbrella review (CRD42022298047) examined the effectiveness of telemedicine interventions on pain intensity, disability, psychological function, quality of life, self-efficacy, and adverse events in MSK pain. Methods: PubMed, SPORTDiscus, Cochrane Library, EMBASE, and CINAHL were searched from inception to August 9, 2022, for systematic reviews with meta-analysis, including telemedicine-delivered exercise, education, and psychological interventions, in randomized controlled trials (RCTs). AMSTAR-2 was implemented. Standardized mean differences (SMDs; negative favors telemedicine) were extracted as effect estimates. Results: Of 1,135 records, 20 reviews (RCTs: n = 97, participants: n = 15,872) were included. Pain intensity SMDs were -0.66 to 0.10 for mixed pain (estimates: n = 16), -0.64 to -0.01 for low-back pain (n = 9), -0.31 to -0.15 for osteoarthritis (n = 7), -0.29 for knee pain (n = 1), -0.66 to -0.58 for fibromyalgia (n = 2), -0.16 for back pain (n = 1), and -0.09 for rheumatic disorders (n = 1). Disability SMDs were -0.50 to 0.10 for mixed pain (n = 14), -0.39 to 0.00 for low-back pain (n = 8), -0.41 to -0.04 for osteoarthritis (n = 7), -0.22 for knee pain (n = 1), and -0.56 for fibromyalgia (n = 1). Methodological quality was "critically low" for 17 reviews. Effectiveness tended to favor telemedicine for all secondary outcomes. Conclusions: Primary RCTs are required that compare telemedicine interventions with in-person delivery of the intervention (noninferiority trials), consider safety, assess videoconferencing, and combine different treatment approaches.
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Affiliation(s)
- Svenja Kaczorowski
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit [University of Applied Sciences], Bochum, Germany
- Department of Intervention Research in Exercise Training, German Sport University, Cologne, Germany
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University, Cologne, Germany
| | - Patrick J Owen
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood Victoria, Australia
| | | | - Niamh L Mundell
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood Victoria, Australia
| | - Moritz Topp
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit [University of Applied Sciences], Bochum, Germany
| | - Claire L Samanna
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood Victoria, Australia
| | - Rebekka Döding
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit [University of Applied Sciences], Bochum, Germany
| | - Daniel L Belavy
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit [University of Applied Sciences], Bochum, Germany
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Saueressig T, Owen PJ, Pedder H, Tagliaferri S, Kaczorowski S, Miller CT, Donath L, Belavy DL. Response to "Comment on 'The importance of context (placebo effects) in conservative interventions for musculoskeletal pain: A systematic review and meta-analysis of randomized controlled trials' by Saueressig et al.". Eur J Pain 2024; 28:857-858. [PMID: 38400809 DOI: 10.1002/ejp.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Tobias Saueressig
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit, University of Applied Sciences, Bochum, Germany
- Physio Meets Science GmbH, Leimen, Germany
| | - Patrick J Owen
- Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Hugo Pedder
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Scott Tagliaferri
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Svenja Kaczorowski
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit, University of Applied Sciences, Bochum, Germany
| | - Clint T Miller
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Daniel L Belavy
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit, University of Applied Sciences, Bochum, Germany
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Saueressig T, Owen PJ, Pedder H, Tagliaferri S, Kaczorowski S, Altrichter A, Richard A, Miller CT, Donath L, Belavy DL. The importance of context (placebo effects) in conservative interventions for musculoskeletal pain: A systematic review and meta-analysis of randomized controlled trials. Eur J Pain 2024; 28:675-704. [PMID: 38116995 DOI: 10.1002/ejp.2222] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/04/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Contextual effects (e.g. patient expectations) may play a role in treatment effectiveness. This study aimed to estimate the magnitude of contextual effects for conservative, non-pharmacological interventions for musculoskeletal pain conditions. A systematic review and meta-analysis of randomized controlled trials (RCTs) that compared placebo conservative non-pharmacological interventions to no treatment for musculoskeletal pain. The outcomes assessed included pain intensity, physical functioning, health-related quality of life, global rating of change, depression, anxiety and sleep at immediate, short-, medium- and/or long-term follow-up. DATABASES AND DATA TREATMENT MEDLINE, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL and SPORTDiscus were searched from inception to September 2021. Trial registry searches, backward and forward citation tracking and searches for prior systematic reviews were completed. The Cochrane risk of bias 2 tool was implemented. RESULTS The study included 64 RCTs (N = 4314) out of 8898 records. For pain intensity, a mean difference of (MD: -5.32, 95% confidence interval (CI): -7.20, -3.44, N = 57 studies with 74 outcomes, GRADE: very low) was estimated for placebo interventions. A small effect in favour of the placebo interventions for physical function was estimated (SMD: -0.22, 95% CI: -0.35, -0.09; N = 37 with 48 outcomes, GRADE: very low). Similar results were found for a broad range of patient-reported outcomes. Meta-regression analyses did not explain heterogeneity among analyses. CONCLUSION The study found that the contextual effect of non-pharmacological conservative interventions for musculoskeletal conditions is likely to be small. However, given the known effect sizes of recommended evidence-based treatments for musculoskeletal conditions, it may still contribute an important component. SIGNIFICANCE Contextual effects of non-pharmacological conservative interventions for musculoskeletal conditions are likely to be small for a broad range of patient-reported outcomes (pain intensity, physical function, quality of life, global rating of change and depression). Contextual effects are unlikely, in isolation, to offer much clinical care. But these factors do have relevance in an overall treatment context as they provide almost 30% of the minimally clinically important difference.
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Affiliation(s)
| | - Patrick J Owen
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Hugo Pedder
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Scott Tagliaferri
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Svenja Kaczorowski
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Adina Altrichter
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Antonia Richard
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Clint T Miller
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Daniel L Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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Saueressig T, Owen PJ, Pedder H, Arora NK, Simons M, Kaczorowski S, Miller CT, Donath L, Belavy DL. Boosting treatment outcomes via the patient-practitioner relationship, treatment-beliefs or therapeutic setting. A systematic review with meta-analysis of contextual effects in chronic musculoskeletal pain. J Orthop Sports Phys Ther 2024:1-51. [PMID: 38687160 DOI: 10.2519/jospt.2024.12259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE: To ascertain whether manipulating contextual effects (e.g. interaction with patients, or beliefs about treatments) boosted the outcomes of non-pharmacological and non-surgicaltreatments for chronic primary musculoskeletal pain. DESIGN: Systematic review of randomized controlled trials. DATA SOURCES: We searched for trials in six databases, citation tracking, and clinical trials registers. We included trials that compared treatments with enhanced contextual effects with the same treatments without enhancement in adults with chronic primary musculoskeletal pain. DATA SYNTHESIS: The outcomes of interest were pain intensity, physical functioning, global ratings of improvement, quality of life, depression, anxiety, and sleep. We evaluated risk of bias and certainty of the evidence using Cochrane Risk of Bias tool 2.0 and the GRADE approach, respectively. RESULTS: Of 17637 records, we included 10 trials with 990 participants and identified 5 ongoing trials. The treatments were acupuncture, education, exercise training, and physical therapy. The contextual effects that were improved in the enhanced treatments were patient-practitioner relationship, patient beliefs and characteristics, therapeutic setting/environment, and treatment characteristics. Our analysis showed that improving contextual effects in non-pharmacological and non-surgical treatments may not make much difference on pain intensity (mean difference [MD] : -1.77, 95%-CI: [-8.71; 5.16], k = 7 trials, N = 719 participants, Scale: 0-100, GRADE: Low)) or physical functioning (MD: -0.27, 95%-CI: [-1.02; 0.49], 95%-PI: [-2.04; 1.51], k = 6 , N = 567, Scale: 0-10, GRADE: Low) in the short-term and at later follow-ups. Sensitivity analyses revealed similar findings. CONCLUSION: Whilst evidence gaps exist, per current evidence it may not be possible to achieve meaningful benefit for patients with chronic musculoskeletal pain by manipulating the context of non-pharmacological and non-surgical treatments. TRIAL REGISTRATION: This systematic review was prospectively registered in PROSPERO (registration number: CRD42023391601).
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Affiliation(s)
- Tobias Saueressig
- Physio Meets Science GmbH, Johannes Reidel Str. 19, 69181 Leimen; Germany
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong VIC 3220, Australia
| | - Hugo Pedder
- University of Bristol, Population Health Sciences, Bristol Medical School, UK
| | - Nitin Kumar Arora
- (Hochschule für Gesundheit [University of Applied Sciences], Department of Applied Health Sciences, Division of Physiotherapy, Bochum
- German Sport University, Department of Intervention Research in Exercise Training, Cologne, Germany
| | - Marieke Simons
- (Hochschule für Gesundheit [University of Applied Sciences], Department of Applied Health Sciences, Division of Physiotherapy, Bochum
| | - Svenja Kaczorowski
- (Hochschule für Gesundheit [University of Applied Sciences], Department of Applied Health Sciences, Division of Physiotherapy, Bochum
| | - Clint T Miller
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong VIC 3220, Australia
| | - Lars Donath
- German Sport University, Department of Intervention Research in Exercise Training, Cologne, Germany
| | - Daniel L Belavy
- (Hochschule für Gesundheit [University of Applied Sciences], Department of Applied Health Sciences, Division of Physiotherapy, Bochum
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Tagliaferri SD, Belavy DL, Fitzgibbon BM, Bowe SJ, Miller CT, Ehrenbrusthoff K, Owen PJ. How to Interpret Effect Sizes for Biopsychosocial Outcomes and Implications for Current Research. J Pain 2024; 25:857-861. [PMID: 37871685 DOI: 10.1016/j.jpain.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/27/2023] [Accepted: 10/15/2023] [Indexed: 10/25/2023]
Abstract
Biopsychosocial factors are associated with pain, but they can be difficult to compare. One way of comparing them is to use standardized mean differences. Previously, these effects sizes have been termed as small, medium, or large, if they are bigger than or equal to, respectively, .2, .5, or .8. These cut-offs are arbitrary and recent evidence showed that they need to be reconsidered. We argue it is necessary to determine cut-offs for each biopsychosocial factor. To achieve this, we propose 3 potential approaches: 1) examining, for each factor, how the effect size differs depending upon disease severity; 2) using an existing minimum clinically important difference to anchor the large effect size; and 3) define cut-offs by comparing data from people with and without pain. This is important for pain research, as exploring these methodologies has potential to improve comparability of biopsychosocial factors and lead to more directed treatments. We note assumptions and limitations of these methods that should also be considered. PERSPECTIVE: Standardized mean differences can estimate effect sizes between groups and could theoretically allow for comparison of biopsychosocial factors. However, common thresholds to define effect sizes are arbitrary and likely differ based on outcome. We propose methods that could overcome this and be used to derive biopsychosocial outcome-specific effect sizes.
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Affiliation(s)
- Scott D Tagliaferri
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Geelong, Australia; Orygen, Parkville, Australia; Centre for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Daniel L Belavy
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Division of Physiotherapy, Bochum, Germany
| | - Bernadette M Fitzgibbon
- Monarch Research Institute, Monarch Mental Health Group, Australia; Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Steven J Bowe
- Deakin Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia; Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Clint T Miller
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Geelong, Australia
| | - Katja Ehrenbrusthoff
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Division of Physiotherapy, Bochum, Germany
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Geelong, Australia
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Davison TE, Bhar S, Wells Y, Owen PJ, You E, Doyle C, Bowe SJ, Flicker L. Psychological therapies for depression in older adults residing in long-term care settings. Cochrane Database Syst Rev 2024; 3:CD013059. [PMID: 38501686 PMCID: PMC10949416 DOI: 10.1002/14651858.cd013059.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Depression is common amongst older people residing in long-term care (LTC) facilities. Currently, most residents treated for depression are prescribed antidepressant medications, despite the potential availability of psychological therapies that are suitable for older people and a preference amongst many older people for non-pharmacological treatment approaches. OBJECTIVES To assess the effect of psychological therapies for depression in older people living in LTC settings, in comparison with treatment as usual, waiting list control, and non-specific attentional control; and to compare the effectiveness of different types of psychological therapies in this setting. SEARCH METHODS We searched the Cochrane Common Mental Disorders Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, five other databases, five grey literature sources, and two trial registers. We performed reference checking and citation searching, and contacted study authors to identify additional studies. The latest search was 31 October 2021. SELECTION CRITERIA We included randomized controlled trials (RCTs) and cluster-RCTs of any type of psychological therapy for the treatment of depression in adults aged 65 years and over residing in a LTC facility. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles/abstracts and full-text manuscripts for inclusion. Two review authors independently performed data extraction and risk of bias assessments using the Cochrane RoB 1 tool. We contacted study authors for additional information where required. Primary outcomes were level of depressive symptomatology and treatment non-acceptability; secondary outcomes included depression remission, quality of life or psychological well-being, and level of anxious symptomatology. We used Review Manager 5 to conduct meta-analyses, using pairwise random-effects models. For continuous data, we calculated standardized mean differences and 95% confidence intervals (CIs), using endpoint data, and for dichotomous data, we used odds ratios and 95% CIs. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 19 RCTs with 873 participants; 16 parallel group RCTs and three cluster-RCTs. Most studies compared psychological therapy (typically including elements of cognitive behavioural therapy, behavioural therapy, reminiscence therapy, or a combination of these) to treatment as usual or to a condition controlling for the effects of attention. We found very low-certainty evidence that psychological therapies were more effective than non-therapy control conditions in reducing symptoms of depression, with a large effect size at end-of-intervention (SMD -1.04, 95% CI -1.49 to -0.58; 18 RCTs, 644 participants) and at short-term (up to three months) follow-up (SMD -1.03, 95% CI -1.49 to -0.56; 16 RCTs, 512 participants). In addition, very low-certainty evidence from a single study with 82 participants indicated that psychological therapy was associated with a greater reduction in the number of participants presenting with major depressive disorder compared to treatment as usual control, at end-of-intervention and short-term follow-up. However, given the limited data on the effect of psychological therapies on remission of major depressive disorder, caution is advised in interpreting this result. Participants receiving psychological therapy were more likely to drop out of the trial than participants receiving a non-therapy control (odds ratio 3.44, 95% CI 1.19 to 9.93), which may indicate higher treatment non-acceptability. However, analyses were restricted due to limited dropout case data and imprecise reporting, and the finding should be interpreted with caution. There was very low-certainty evidence that psychological therapy was more effective than non-therapy control conditions in improving quality of life and psychological well-being at short-term follow-up, with a medium effect size (SMD 0.51, 95% CI 0.19 to 0.82; 5 RCTs, 170 participants), but the effect size was small at postintervention (SMD 0.40, 95% CI -0.02 to 0.82; 6 RCTs, 195 participants). There was very low-certainty evidence of no effect of psychological therapy on anxiety symptoms postintervention (SMD -0.68, 95% CI -2.50 to 1.14; 2 RCTs, 115 participants), although results lacked precision, and there was insufficient data to determine short-term outcomes. AUTHORS' CONCLUSIONS This systematic review suggests that cognitive behavioural therapy, behavioural therapy, and reminiscence therapy may reduce depressive symptoms compared with usual care for LTC residents, but the evidence is very uncertain. Psychological therapies may also improve quality of life and psychological well-being amongst depressed LTC residents in the short term, but may have no effect on symptoms of anxiety in depressed LTC residents, compared to control conditions. However, the evidence for these effects is very uncertain, limiting our confidence in the findings. The evidence could be strengthened by better reporting and higher-quality RCTs of psychological therapies in LTC, including trials with larger samples, reporting results separately for those with and without cognitive impairment and dementia, and longer-term outcomes to determine when effects wane.
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Affiliation(s)
- Tanya E Davison
- Research and Innovation, Silverchain, Melbourne, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Health and Innovation Transformation Centre, Federation University, Ballarat, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Yvonne Wells
- Australian Institute for Primary Care & Ageing, La Trobe University, Melbourne, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age (AUPOA), Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Colleen Doyle
- National Ageing Research Institute, Melbourne, Australia
| | - Steven J Bowe
- Deakin Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Australia
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Leon Flicker
- Western Australian Centre for Health and Ageing (WACHA), University of Western Australia, Perth, Australia
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Arora NK, Donath L, Owen PJ, Miller CT, Saueressig T, Winter F, Hambloch M, Neason C, Karner V, Belavy DL. The Impact of Exercise Prescription Variables on Intervention Outcomes in Musculoskeletal Pain: An Umbrella Review of Systematic Reviews. Sports Med 2024; 54:711-725. [PMID: 38093145 PMCID: PMC10978700 DOI: 10.1007/s40279-023-01966-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 04/01/2024]
Abstract
BACKGROUND Musculoskeletal pain conditions are the largest contributors to disability and healthcare burden globally. Exercise interventions improve physical function and quality of life in individuals with musculoskeletal pain, yet optimal exercise prescription variables (e.g. duration, frequency, intensity) are unclear. OBJECTIVE We aimed to examine evidence gaps, methodological quality and exercise prescription recommendations in systematic reviews of exercise for musculoskeletal pain. METHODS In our prospectively registered umbrella review, PubMed, SPORTDiscus, Cochrane Database of Systematic Reviews, EMBASE, and CINAHL were searched from inception to 14 February 2023. Backward citation tracking was performed. We included peer-reviewed, English language, systematic reviews and meta-analyses of randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared exercise with conservative treatment, placebo or other exercise interventions in adults with musculoskeletal pain. Data were extracted from the following groups of reviews based on their reporting of exercise prescription data and analysis of the relationship between prescription variables and outcomes: (1) those that did not report any exercise prescription data, (2) those that reported exercise prescription data but did not perform a quantitative analysis and (3) those that performed a quantitative analysis of the relationship between exercise prescription variables and outcomes. Outcome measures were physical function, pain, mental health, adverse effects and adherence to treatment. AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) was used to assess methodological quality. RESULTS From 6757 records, 274 systematic reviews were included. 6.6% of reviews did not report any exercise prescription data, and only 10.9% quantitatively analyzed the relationship between prescription variables and the outcome(s). The overall methodological quality was critically low in 85% of reviews. CONCLUSION High methodological quality evidence is lacking for optimal exercise training prescription variables in individuals with musculoskeletal pain. To better inform practice and evidence gaps, future systematic reviews should (1) identify optimum exercise prescription variables, for example, via dose-response (network) meta-analysis, (2) perform high-quality reviews per AMSTAR-2 criteria and (3) include outcomes of mental health, adverse events and exercise adherence. PROSPERO REGISTRATION NUMBER CRD42021287440 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021287440 ).
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Affiliation(s)
- Nitin Kumar Arora
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Tobias Saueressig
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | - Felicitas Winter
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Marina Hambloch
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Christopher Neason
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Vera Karner
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Daniel L Belavy
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
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Saueressig T, Pedder H, Owen PJ, Belavy DL. Contextual effects: how to, and how not to, quantify them. BMC Med Res Methodol 2024; 24:35. [PMID: 38350852 PMCID: PMC10863156 DOI: 10.1186/s12874-024-02152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
The importance of contextual effects and their roles in clinical care controversial. A Cochrane review published in 2010 concluded that placebo interventions lack important clinical effects overall, but that placebo interventions can influence patient-reported outcomes such as pain and nausea. However, systematic reviews published after 2010 estimated greater contextual effects than the Cochrane review, which stems from the inappropriate methods employed to quantify contextual effects. The effects of medical interventions (i.e., the total treatment effect) can be divided into three components: specific, contextual, and non-specific. We propose that the most effective method for quantifying the magnitude of contextual effects is to calculate the difference in outcome measures between a group treated with placebo and a non-treated control group. Here, we show that other methods, such as solely using the placebo control arm or calculation of a 'proportional contextual effect,' are limited and should not be applied. The aim of this study is to provide clear guidance on best practices for estimating contextual effects in clinical research.
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Affiliation(s)
- Tobias Saueressig
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
- Physio Meets Science GmbH, Johannes Reidel Str. 19, 69181, Leimen, Germany.
| | - Hugo Pedder
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall 39, Whatley Road, Bristol, BS8 2PN, UK
| | - Patrick J Owen
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Daniel L Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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10
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Memon AR, Owen PJ, Anderson N, Verhagen E, Mundell NL, Belavy DL. Common issues of systematic reviews in the sports and exercise medicine field. BMJ Open Sport Exerc Med 2024; 10:e001784. [PMID: 38268524 PMCID: PMC10806533 DOI: 10.1136/bmjsem-2023-001784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Affiliation(s)
- Aamir Raoof Memon
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Patrick J Owen
- Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Nash Anderson
- Tuggeranong Chiropractic Centre, Canberra, Australian Capital Territory, Australia
| | - Evert Verhagen
- Department of Public and Occupational Health, EMGO, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Niamh L Mundell
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Daniel L Belavy
- Department of Applied Health Sciences, Hochschule für Gesundheit Bochum, Bochum, Germany
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11
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Neason C, Miller CT, Tagliaferri SD, Belavy DL, Main LC, Ford JJ, Hahne AJ, Bowe SJ, Owen PJ. Exercise prescription variables predict reductions in pain intensity in adults with chronic low back pain: secondary analysis of a randomised controlled trial. BMJ Open Sport Exerc Med 2024; 10:e001744. [PMID: 38196942 PMCID: PMC10773405 DOI: 10.1136/bmjsem-2023-001744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/11/2024] Open
Abstract
Objectives The relationship between exercise training variables and clinical outcomes in low back pain (LBP) is unclear. The current study aimed to explore the relationship between exercise training parameters and pain intensity in individuals with chronic LBP. Methods This study is a secondary analysis of a previously reported randomised controlled trial comparing the effects of general strength and conditioning to motor control exercises and manual therapy. This secondary analysis includes adults with chronic LBP (n=20) randomised to the general strength and conditioning programme only. Primary outcomes of this analysis were exercise training parameters (time under tension, rating of perceived exertion (RPE), session duration, session-RPE and training frequency) and pain intensity (0-100 mm visual analogue acale) measured every 2 weeks from baseline to 6 months follow-up. Linear mixed models with random effects (participants) and allowance for heterogeneity of variance (study date) were used to determine the association between pain intensity and training parameters over time. Results Mean (95% CI) pain intensity decreased over time from baseline to 6 months follow-up by 10.7 (2.8 to 18.7) points (p=0.008). Over the 6-month intervention, lower pain intensity was associated with higher RPE (β (95% CI) -27.168 (-44.265 to -10.071), p=0.002), greater time under tension (-0.029 (-0.056 to -0.001), p=0.040) and shorter session duration (1.938 (0.011 to 3.865), p=0.049). Conclusion During 6 months of general strength and conditioning, lower pain intensity was associated with higher participant-reported training intensity, greater volume and shorter session duration. To ensure positive outcomes to exercise training, these variables should be monitored on a short-term basis. Trial registration number ACTRN12615001270505.
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Affiliation(s)
- Christopher Neason
- Institute of Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Clint T Miller
- Institute of Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Scott D Tagliaferri
- Institute of Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Daniel L Belavy
- Institute of Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit Bochum, Bochum, Germany
| | - Luana C Main
- Institute of Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Jon J Ford
- Low Back Research Team, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
- Advance HealthCare, Boronia, Victoria, Australia
| | - Andrew J Hahne
- Low Back Research Team, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Steven J Bowe
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Victoria University of Wellington, Wellington, New Zealand
| | - Patrick J Owen
- Institute of Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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12
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LaMontagne AD, Too L, Witt K, Evans‐Whipp T, Owen PJ, Toumbourou JW. Does adolescent depression modify the association between psychosocial job stressors and mental health in emergent adulthood? Am J Ind Med 2024; 67:44-54. [PMID: 37924234 PMCID: PMC10952472 DOI: 10.1002/ajim.23547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Job stressors can be particularly harmful to the mental health of disadvantaged groups through differential exposure, differential sensitivity to the effects of exposure, or both. In this paper, we assess the extent to which emergent adult workers with an adolescent history of high depression symptoms may be differentially sensitive to the effect of job stressors on mental health. METHODS We conducted a secondary analysis of three waves of the Australian arm of the International Youth Development Study (n = 1262). We used multivariable linear regression to assess whether self-reported measures of high depression symptoms at one or two time points in adolescence (ages 11-16 years) modified the cross-sectional association between four self-reported job stressors (job demands, job control, job strain, and incivility at work) and psychological distress (Kessler-10 scores) in emergent adulthood (ages 23-27 years). RESULTS For all four job stressors, there was a consistent pattern of approximately a doubling in the magnitude of association for participants with a history of high depression symptoms at two points in adolescence compared with those with no history of depression. However, results of effect modification analysisfor only job demands and job strain excluded chance as a potential explanation. CONCLUSIONS Findings showed partial support for the hypothesis that a history of high depression symptoms in adolescence predicts stronger associations between job stressor exposures and psychological distress among those employed in emergent adulthood. The limitations of this secondary analysis suggest a need for purpose-designed studies to answer this important research question more definitively.
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Affiliation(s)
- Anthony D. LaMontagne
- Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
- Melbourne School of Global & Population HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Lay‐San Too
- Melbourne School of Global & Population HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Katrina Witt
- Centre for Youth Mental HealthThe University of MelbourneMelbourneVictoriaAustralia
- OrygenParkvilleVictoriaAustralia
| | - Tracy Evans‐Whipp
- Australian Institute of Family StudiesSouthbankVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
| | - Patrick J. Owen
- Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - John W. Toumbourou
- Centre for Social and Early Emotional Development (SEED)Deakin UniversityGeelongVictoriaAustralia
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13
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Brown RCC, Keating SE, Owen PJ, Jansons PS, McVicar J, Askew CD, Clanchy KM, Maddison R, Maiorana A, Robinson SM, Mundell NL. Client and Clinician Experiences and Perspectives of Exercise Physiology Services During the COVID-19 Pandemic: Qualitative Study. J Med Internet Res 2023; 25:e46370. [PMID: 38127430 PMCID: PMC10767626 DOI: 10.2196/46370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/21/2023] [Accepted: 09/22/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to changes in the delivery of exercise physiology services. The lived experience of those who continued to provide or receive exercise physiology services during the heightened public health restrictions of the inaugural year of the COVID-19 pandemic has received little attention to date. Acquiring this knowledge will be fundamental in addressing whether telehealth is a viable option for service delivery in exercise care, research, and policy. This is especially pertinent in the wake of the COVID-19 pandemic and subsequent global interest in digital health delivery of health care services. OBJECTIVE This study aims to explore the clinician and client experiences and perspectives of exercise physiology services delivered in person or via telehealth during the inaugural year of the COVID-19 pandemic (after January 25, 2020; the date of the first confirmed case in Australia). METHODS Eligible participants for this study were adult (aged 18 years or older; capable of understanding and writing in English) clients who received and clinicians who delivered 1 or more exercise physiology sessions in Australia during the first year of the COVID-19 pandemic (June 2020 to June 2021). The data collection period spanned from January 20, 2021, to September 24, 2021. A total of 18 semistructured individual interviews were conducted with accredited exercise physiologists (n=7) and clients (n=11) who engaged with exercise physiology services during this period. All interviews were digitally recorded and transcribed verbatim. Thematic analysis was conducted with themes and subthemes derived using deductive and inductive approaches. RESULTS A total of 3 dominant themes, each with 2 subthemes, were identified. The first theme was that telehealth enables access to services but limits the use of some clinical tools. Remote access to services was valued by both clinicians and clients, but the exercise clinical environment could not be replicated over telehealth. This was especially true regarding access to exercise equipment. Second, engagement and the "relational space" are limited by telehealth. Perceived challenges regarding social interactions and a sense of community were a limitation for clients, and difficulties fostering clinician-client report were noted by clinicians. Finally, technological challenges are pervasive in the telehealth delivery of exercise services. Both clinicians and clients noted that systems necessary to facilitate telehealth frequently disrupted delivery, and client-based technical issues were influenced by digital health literacy. CONCLUSIONS Shared client and accredited exercise physiologist experiences highlight key considerations for the ongoing implementation of telehealth to facilitate the uptake and effectiveness of exercise physiology services. These findings imply that the co-design of solutions to client-perceived limitations of telehealth delivery is warranted.
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Affiliation(s)
- Riley C C Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Paul S Jansons
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jenna McVicar
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Christopher D Askew
- VasoActive Research Group, School of Health, University of the Sunshine Coast, Sippy Downs, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - Kelly M Clanchy
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Menzies Institute of Health, Griffith University, Gold Coast, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Andrew Maiorana
- Allied Health Department, Fiona Stanley Hospital, Perth, Australia
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Suzanne M Robinson
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Melbourne, Australia
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Niamh L Mundell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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14
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Schumm AK, Craige EA, Arora NK, Owen PJ, Mundell NL, Buehring B, Maus U, Belavy DL. Does adding exercise or physical activity to pharmacological osteoporosis therapy in patients with increased fracture risk improve bone mineral density and lower fracture risk? A systematic review and meta-analysis. Osteoporos Int 2023; 34:1867-1880. [PMID: 37430002 PMCID: PMC10579159 DOI: 10.1007/s00198-023-06829-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/06/2023] [Indexed: 07/12/2023]
Abstract
This prospectively registered systematic review and meta-analysis examines whether exercise (EX) training has an additive effect to osteoanabolic and/or antiresorptive pharmacological therapy (PT) in people with osteoporosis on bone mineral density (BMD), bone turnover markers (BTMs), fracture healing, and fractures. Four databases (inception to 6 May 2022), 5 trial registries, and reference lists were searched. Included were randomized controlled trials comparing the effect of EX + PT vs. PT with regard to BMD, BTM, fracture healing, and fractures. Risk of bias was assessed using the Cochrane RoB2 and certainty of evidence by the GRADE approach. Random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment was used to estimate standardized mean differences and 95% confidence intervals. Out of 2593 records, five RCTs with 530 participants were included. Meta-analysis showed with very low certainty evidence and wide confidence intervals that EX + PT compared to PT had larger effect sizes for BMD at 12 months at the hip (SMD [95%CI]: 0.18 [- 1.71; 2.06], n = 3 studies), tibia (0.25 [- 4.85; 5.34], n = 2), lumbar spine (0.20 [- 1.15; 1.55], n = 4), and forearm (0.05 [- 0.35; 0.46], n = 3), but not femoral neck (- 0.03 [- 1.80; 1.75], n = 3). Furthermore, no improvement was revealed for BTM such as bone ALP (- 0.68 [- 5.88; 4.53], n = 3), PINP (- 0.74 [- 10.42; 8.93], n = 2), and CTX-I (- 0.69 [- 9.61; 8.23], n = 2), but with very wide confidence intervals. Three potentially relevant ongoing trials were identified via registries. No data were found for fracture healing or fracture outcomes. It remains unclear whether EX has an additive impact to PT in people with osteoporosis. High-quality, adequately powered, targetted RCTs are required. PROTOCOL REGISTRATION: PROSPERO CRD42022336132.
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Affiliation(s)
- Ann-Kathrin Schumm
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule Für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Emma A. Craige
- Appleton Institute, Central Queensland University, Adelaide, SA 5034 Australia
| | - Nitin Kumar Arora
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule Für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Patrick J. Owen
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC 3220 Australia
| | - Niamh L. Mundell
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC 3220 Australia
| | - Bjoern Buehring
- Ruhr Universität Bochum, Universitätsstraße 150, 44801 Bochum, Germany
- Krankenhaus St. Josef, Bergstraße 6-12, 42105 Wuppertal, Germany
| | - Uwe Maus
- Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Daniel L. Belavy
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule Für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
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15
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Agrawal AN, Alagarsamy F, Owen PJ, Klein AA. Is the future of nitrous oxide as volatile as the gas itself? Anaesthesia 2023; 78:1315-1319. [PMID: 37415287 DOI: 10.1111/anae.16086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/08/2023]
Affiliation(s)
- A N Agrawal
- Department of Anaesthesia, Addenbrookes Cambridge University Hospitals, Cambridge, UK
| | - F Alagarsamy
- Department of Anaesthesia, Addenbrookes Cambridge University Hospitals, Cambridge, UK
| | - P J Owen
- Department of Trauma and Orthopaedics, Addenbrookes Cambridge University Hospitals, Cambridge, UK
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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16
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Ng CA, Gandham A, Mesinovic J, Owen PJ, Ebeling PR, Scott D. Effects of Moderate- to High-Impact Exercise Training on Bone Structure Across the Lifespan: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Bone Miner Res 2023; 38:1612-1634. [PMID: 37555459 DOI: 10.1002/jbmr.4899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023]
Abstract
Moderate- to high-impact exercise improves bone mineral density (BMD) across the lifespan, but its effects on bone structure, which predicts fracture independent of areal BMD, are unclear. This systematic review and meta-analysis investigated effects of impact exercise on volumetric BMD (vBMD) and bone structure. Four databases (PubMed, Embase, SPORTDiscus, Web of Science) were searched up to March 2022 for randomized controlled trials (RCTs) investigating the effects of impact exercise, with ground reaction forces equal to or greater than running, compared with sham or habitual activity, on bone vBMD and structure. Bone variables were measured by quantitative computed tomography or magnetic resonance imaging at the tibia, radius, lumbar spine, and femur. Percentage changes in bone variables were compared among groups using mean differences (MD) and 95% confidence intervals (CI) calculated via random effects meta-analyses. Subgroup analyses were performed in children/adolescents (<18 years), adults (18-50 years), postmenopausal women, and older men. Twenty-eight RCTs (n = 2985) were included. Across all studies, impact exercise improved trabecular vBMD at the distal tibia (MD = 0.54% [95% CI 0.17, 0.90%]), total vBMD at the proximal femur (3.11% [1.07, 5.14%]), and cortical thickness at the mid/proximal radius (1.78% [0.21, 3.36%]). There was no effect on vBMD and bone structure at the distal radius, femoral shaft, or lumbar spine across all studies or in any subgroup. In adults, impact exercise decreased mid/proximal tibia cortical vBMD (-0.20% [-0.24, -0.15%]). In postmenopausal women, impact exercise improved distal tibia trabecular vBMD (0.79% [0.32, 1.25%]). There was no effect on bone parameters in children/adolescents in overall analyses, and there were insufficient studies in older men to perform meta-analyses. Impact exercise may have beneficial effects on bone structure and vBMD at various skeletal sites, but additional high-quality RCTs in different age and sex subgroups are needed to identify optimal exercise protocols for improving bone health across the lifespan. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Carrie-Anne Ng
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Anoohya Gandham
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, Australia
| | - Jakub Mesinovic
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
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17
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Murphy MC, Stannard J, Sutton VR, Owen PJ, Park B, Chivers PT, Hart NH. Epidemiology of musculoskeletal injury in military recruits: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:144. [PMID: 37898757 PMCID: PMC10612319 DOI: 10.1186/s13102-023-00755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Injuries are a common occurrence in military recruit training, however due to differences in the capture of training exposure, injury incidence rates are rarely reported. Our aim was to determine the musculoskeletal injury epidemiology of military recruits, including a standardised injury incidence rate. METHODS Epidemiological systematic review following the PRISMA 2020 guidelines. Five online databases were searched from database inception to 5th May 2021. Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by military recruits after the year 2000 were included. We reported on the frequency, prevalence and injury incidence rate. Incidence rate per 1000 training days (Exact 95% CI) was calculated using meta-analysis to allow comparisons between studies. Observed heterogeneity (e.g., training duration) precluded pooling of results across countries. The Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies assessed study quality. RESULTS This review identified 41 studies comprising 451,782 recruits. Most studies (n = 26; 63%) reported the number of injured recruits, and the majority of studies (n = 27; 66%) reported the number of injuries to recruits. The prevalence of recruits with medical attention injuries or time-loss injuries was 22.8% and 31.4%, respectively. Meta-analysis revealed the injury incidence rate for recruits with a medical attention injury may be as high as 19.52 injuries per 1000 training days; and time-loss injury may be as high as 3.97 injuries per 1000 training days. Longer recruit training programs were associated with a reduced injury incidence rate (p = 0.003). The overall certainty of the evidence was low per a modified GRADE approach. CONCLUSION This systematic review with meta-analysis highlights a high musculoskeletal injury prevalence and injury incidence rate within military recruits undergoing basic training with minimal improvement observed over the past 20 years. Longer training program, which may decrease the degree of overload experienced by recruit, may reduce injury incidence rates. Unfortunately, reporting standards and reporting consistency remain a barrier to generalisability. TRIAL REGISTRATION PROSPERO (Registration number: CRD42021251080).
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Affiliation(s)
- Myles C Murphy
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia.
| | - Joanne Stannard
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Vanessa R Sutton
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Brendon Park
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Paola T Chivers
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Nicolas H Hart
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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18
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Teichert F, Karner V, Döding R, Saueressig T, Owen PJ, Belavy DL. Effectiveness of Exercise Interventions for Preventing Neck Pain: A Systematic Review With Meta-analysis of Randomized Controlled Trials. J Orthop Sports Phys Ther 2023; 53:594–609. [PMID: 37683100 DOI: 10.2519/jospt.2023.12063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
OBJECTIVE: To update the evidence on the effectiveness of exercise interventions to prevent episodes of neck pain. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, Embase, CENTRAL, CINAHL, SPORTDiscus, PEDro, and trial registries from inception to December 2, 2022. Forward and backward citation searches. STUDY SELECTION CRITERIA: Randomized controlled trials (RCTs) that enrolled adults without neck pain at baseline and compared exercise interventions to no intervention, placebo/sham, attention control, or minimal intervention. Military populations and astronauts were excluded. DATA SYNTHESIS: Random-effects meta-analysis. Risk of bias was assessed using the Cochrane RoB 2 tool. The certainty of evidence was judged according to the GRADE approach. RESULTS: Of 4703 records screened, 5 trials (1722 participants at baseline) were included and eligible for meta-analysis. Most (80%) participants were office workers. Risk of bias was rated as some concerns for 2 trials and high for 3 trials. There was moderate-certainty evidence that exercise interventions probably reduce the risk of a new episode of neck pain (OR, 0.49; 95% confidence interval: 0.31, 0.76) compared to no or minimal intervention in the short-term (≤12 months). The results were not robust to sensitivity analyses for missing outcome data. CONCLUSION: There was moderate-certainty evidence supporting exercise interventions for reducing the risk for an episode of neck pain in the next 12 months. The clinical significance of the effect is unclear. J Orthop Sports Phys Ther 2023;53(10):1-16. Epub: 8 September 2023. doi:10.2519/jospt.2023.12063.
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Affiliation(s)
- Florian Teichert
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Vera Karner
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Rebekka Döding
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | | | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Daniel L Belavy
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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Belavy DL, Tagliaferri SD, Tegenthoff M, Enax-Krumova E, Schlaffke L, Bühring B, Schulte TL, Schmidt S, Wilke HJ, Angelova M, Trudel G, Ehrenbrusthoff K, Fitzgibbon B, Van Oosterwijck J, Miller CT, Owen PJ, Bowe S, Döding R, Kaczorowski S. Evidence- and data-driven classification of low back pain via artificial intelligence: Protocol of the PREDICT-LBP study. PLoS One 2023; 18:e0282346. [PMID: 37603539 PMCID: PMC10441794 DOI: 10.1371/journal.pone.0282346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/10/2023] [Indexed: 08/23/2023] Open
Abstract
In patients presenting with low back pain (LBP), once specific causes are excluded (fracture, infection, inflammatory arthritis, cancer, cauda equina and radiculopathy) many clinicians pose a diagnosis of non-specific LBP. Accordingly, current management of non-specific LBP is generic. There is a need for a classification of non-specific LBP that is both data- and evidence-based assessing multi-dimensional pain-related factors in a large sample size. The "PRedictive Evidence Driven Intelligent Classification Tool for Low Back Pain" (PREDICT-LBP) project is a prospective cross-sectional study which will compare 300 women and men with non-specific LBP (aged 18-55 years) with 100 matched referents without a history of LBP. Participants will be recruited from the general public and local medical facilities. Data will be collected on spinal tissue (intervertebral disc composition and morphology, vertebral fat fraction and paraspinal muscle size and composition via magnetic resonance imaging [MRI]), central nervous system adaptation (pain thresholds, temporal summation of pain, brain resting state functional connectivity, structural connectivity and regional volumes via MRI), psychosocial factors (e.g. depression, anxiety) and other musculoskeletal pain symptoms. Dimensionality reduction, cluster validation and fuzzy c-means clustering methods, classification models, and relevant sensitivity analyses, will classify non-specific LBP patients into sub-groups. This project represents a first personalised diagnostic approach to non-specific LBP, with potential for widespread uptake in clinical practice. This project will provide evidence to support clinical trials assessing specific treatments approaches for potential subgroups of patients with non-specific LBP. The classification tool may lead to better patient outcomes and reduction in economic costs.
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Affiliation(s)
- Daniel L. Belavy
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Scott D. Tagliaferri
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Martin Tegenthoff
- Department of Neurology, BG-University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bochum, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG-University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bochum, Germany
| | - Lara Schlaffke
- Department of Neurology, BG-University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bochum, Germany
| | - Björn Bühring
- Internistische Rheumatologie, Krankenhaus St. Josef Wuppertal, Wuppertal, Germany
| | - Tobias L. Schulte
- Department of Orthopaedics and Trauma Surgery, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Sein Schmidt
- Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, University Hospital Ulm, Ulm, Germany
| | - Maia Angelova
- School of Information Technology, Deakin University, Geelong, Australia
| | - Guy Trudel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katja Ehrenbrusthoff
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Bernadette Fitzgibbon
- Monarch Research Institute, Monarch Mental Health Group, Melbourne, Australia
- School of Psychology and Medicine, Australian National University, Canberra, Australia
- Department of Psychiatry, Monash University, Melbourne, Australia
| | | | - Clint T. Miller
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Patrick J. Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Steven Bowe
- Faculty of Health, Deakin University, Geelong, Australia
- Te Kura Tātai Hauora-The School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Rebekka Döding
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Svenja Kaczorowski
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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Tagliaferri SD, Owen PJ, Miller CT, Angelova M, Fitzgibbon BM, Wilkin T, Masse-Alarie H, Van Oosterwijck J, Trudel G, Connell D, Taylor A, Belavy DL. Towards data-driven biopsychosocial classification of non-specific chronic low back pain: a pilot study. Sci Rep 2023; 13:13112. [PMID: 37573418 PMCID: PMC10423241 DOI: 10.1038/s41598-023-40245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 08/07/2023] [Indexed: 08/14/2023] Open
Abstract
The classification of non-specific chronic low back pain (CLBP) according to multidimensional data could guide clinical management; yet recent systematic reviews show this has not been attempted. This was a prospective cross-sectional study of participants with CLBP (n = 21) and age-, sex- and height-matched pain-free controls (n = 21). Nervous system, lumbar spinal tissue and psychosocial factors were collected. Dimensionality reduction was followed by fuzzy c-means clustering to determine sub-groups. Machine learning models (Support Vector Machine, k-Nearest Neighbour, Naïve Bayes and Random Forest) were used to determine the accuracy of classification to sub-groups. The primary analysis showed that four factors (cognitive function, depressive symptoms, general self-efficacy and anxiety symptoms) and two clusters (normal versus impaired psychosocial profiles) optimally classified participants. The error rates in classification models ranged from 4.2 to 14.2% when only CLBP patients were considered and increased to 24.2 to 37.5% when pain-free controls were added. This data-driven pilot study classified participants with CLBP into sub-groups, primarily based on psychosocial factors. This contributes to the literature as it was the first study to evaluate data-driven machine learning CLBP classification based on nervous system, lumbar spinal tissue and psychosocial factors. Future studies with larger sample sizes should validate these findings.
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Affiliation(s)
- Scott D Tagliaferri
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
- Orygen, 35 Poplar Rd, Parkville, VIC, 3052, Australia.
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Maia Angelova
- Data to Intelligence Research Centre, School of Information Technology, Deakin University, Geelong, Australia
| | - Bernadette M Fitzgibbon
- Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Monarch Research Group, Monarch Mental Health Group, Sydney, Australia
| | - Tim Wilkin
- Data to Intelligence Research Centre, School of Information Technology, Deakin University, Geelong, Australia
| | - Hugo Masse-Alarie
- Département de Réadaptation, Centre Interdisciplinaire de Recherche en Réadaptation et Integration Sociale (Cirris), Université Laval, Quebec City, Canada
| | - Jessica Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Guy Trudel
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, Canada
- Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ottawa, Canada
| | - David Connell
- Imaging@Olympic Park, AAMI Park, 60 Olympic Boulevard, Melbourne, VIC, 3004, Australia
| | - Anna Taylor
- Imaging@Olympic Park, AAMI Park, 60 Olympic Boulevard, Melbourne, VIC, 3004, Australia
| | - Daniel L Belavy
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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Owen PJ, Saueressig T, Braun T, Steglich N, Diemer F, Zebisch J, Herbst M, Zinser W, Belavy DL. Infographic. Primary surgery versus primary rehabilitation for treating anterior cruciate ligament injuries. Br J Sports Med 2023; 57:882-883. [PMID: 36987653 DOI: 10.1136/bjsports-2022-106571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Tobias Saueressig
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | - Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule fur Gesundheit, Bochum, Germany
- HSD Hochschule Dopfer, Cologne, North Rhine-Westphalia, Germany
| | - Nora Steglich
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule fur Gesundheit, Bochum, Germany
| | | | - Jochen Zebisch
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | - Maximilian Herbst
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | | | - Daniel L Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule fur Gesundheit, Bochum, Germany
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Tagliaferri SD, Owen PJ, Miller CT, Mitchell UH, Ehrenbrusthoff K, Belavy DL. Classifying Nonspecific Low Back Pain for Better Clinical Outcomes: Current Challenges and Paths Forward. J Orthop Sports Phys Ther 2023; 53:239–243. [PMID: 37017933 DOI: 10.2519/jospt.2023.11658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
SYNOPSIS: Low back pain classification systems are structured assessments used to guide choices of more specific treatments. Classification systems examined in randomized controlled trials have limited effects on pain intensity and disability compared to nonclassified interventions. Potential reasons for the lack of efficacy include (1) failing to assess multidimensional factors that contribute to pain, (2) relying on clinician judgement, (3) low accessibility, and (4) poor classification reliability. Overcoming these limitations is critical to deciding whether classification systems can improve clinical practice. Only once these limitations are addressed, can we feel certain about the efficacy, or lack thereof, of classification systems. This Viewpoint guides the reader through some limitations of common classification approaches and presents a path forward to open-access, reliable, and multidimensional precision medicine for managing low back pain. J Orthop Sports Phys Ther 2023;53(5):1-5. Epub: 5 April 2023. doi:10.2519/jospt.2023.11658.
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Affiliation(s)
- Scott D Tagliaferri
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
- Orygen, Parkville, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | - Katja Ehrenbrusthoff
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Daniel L Belavy
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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23
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Carrard J, Morais Azevedo A, Gojanovic B, Edouard P, Pandya T, Robinson DG, Dönmez G, Ušacka L, Martínez Stenger RA, Mendonça LDM, Thornton J, Reis e Silva M, Schneider I, Zwerver J, Jederström M, Fagher K, AlSeyrafi O, Zondi P, Ahamed F, Zhang M, Van Oostveldt K, Suvachittanont N, Akinyi Okoth C, Bel L, Matthews E, Nelson L, Kotila K, Hollander K, Owen PJ, Verhagen E. Sport and exercise medicine around the world: global challenges for a unique healthcare discipline. BMJ Open Sport Exerc Med 2023; 9:e001603. [PMID: 37020535 PMCID: PMC10069566 DOI: 10.1136/bmjsem-2023-001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Affiliation(s)
- Justin Carrard
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Ana Morais Azevedo
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- The Australian Ballet, Melbourne, Victoria, Australia
| | - Boris Gojanovic
- Swiss Olympic Medical Center, Hôpital de La Tour, Meyrin, Geneva, Switzerland
| | - Pascal Edouard
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology (EA 7424), Saint-Etienne, France
- Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France
| | - Tej Pandya
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Diana Gai Robinson
- Medical School, Notre Dame University, Sydney, New South Wales, Australia
- Sydney Sportsmed Specialists, Sydney, New South Wales, Australia
| | - Gürhan Dönmez
- Department of Sports Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
- Gençlerbirliği Sports Club, Ankara, Turkey
| | - Laila Ušacka
- Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Rodrigo A Martínez Stenger
- Dr A. Zubizarreta Hospital, Buenos Aires, Argentina
- Argentinian Sports Physicians Association, Buenos Aires, Argentina
| | - Luciana De Michelis Mendonça
- Physical Therapy Department, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jane Thornton
- Western Centre for Public Health & Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Isabel Schneider
- Physio-Motion - Sport treiben gesund bleiben. Sports, Exercise, and Health Advisor and Service Provider, Groebenzell, Germany
| | - Johannes Zwerver
- Sports & Exercise Medicine, SportsValley, Gelderse Vallei Hospital, Ede, Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Moa Jederström
- Athletics Research Center, Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Kristina Fagher
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Omar AlSeyrafi
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Phathokuhle Zondi
- High-Performance Commission, Medical Advisory Committee, South African Sports Confederation and Olympic Committee, Houghton, Johannesburg, South Africa
| | - Fariz Ahamed
- Sri Lanka Sports Medicine Association, National Hospital of Sri Lanka, Colombo, Sri Lanka
- Sports and Exercise Medicine Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka
| | - Mandy Zhang
- Singapore Sport and Exercise Medicine Centre, Changi General Hospital, SingHealth, Singapore
| | | | | | - Carole Akinyi Okoth
- National Spinal Injury Referral Hospital, Ministry of Health, Nairobi, Kenya
- Medical Commission National Olympic Committee, Nairobi, Kenya
| | - Loïc Bel
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | | | - Luke Nelson
- Health & High Performance, Melbourne, Victoria, Australia
| | - Karen Kotila
- Danish Society of Sports Physical Therapy, Odense, Denmark
- Boarding School of Nyborg, Nyborg, Denmark
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Johnsen K, Owen PJ, Tagliaferri SD, Van Oosterwijck J, Fitzgibbon BM, Ford JJ, Belavy DL, Miller CT. The Interaction Between Psychosocial Factors and Exercise-Induced Hypoalgesia in Pain-Free Nurses. J Pain Res 2023; 16:529-541. [PMID: 36824499 PMCID: PMC9942496 DOI: 10.2147/jpr.s386440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/16/2022] [Indexed: 02/22/2023] Open
Abstract
Purpose This cross-sectional study aimed to investigate whether psychosocial factors were predictive for exercise-induced hypoalgesia (EIH) in pain-free adults. Methods A sample of 38 pain-free nurses with a mean (SD) age of 26 (6) years were included in this study. Participants completed psychosocial questionnaires prior to physical tests. Pressure pain threshold (PPT) was assessed bilaterally at the calves (local), lower back (semi-local) and forearm (remote) before and immediately after a maximal graded cycling exercise test. Separate linear mixed effects models were used to determine change in PPT before and after cycling exercise (EIH). Multiple linear regression for all psychosocial variables and best subset regression was used to identify predictors of EIH at all locations. Results The relative mean increase in PPT at the forearm, lumbar, calf, and globally (all sites pooled) was 6.0% (p<0.001), 10.1% (p<0.001), 13.9% (p<0.001), and 10.2% (p=0.013), respectively. Separate best subset multiple linear regression models at the forearm (predictors; Multidimensional Scale of Perceived Social Support (MSPSS) total), lumbar (predictors; MSPSS total, Pain Catastrophizing Scale (PCS) total, Depression Anxiety Stress Scale (DASS) depression), calf (predictors; MSPSS friends, PCS total), and global (predictors; MSPSS friends, PCS total) accounted for 7.5% (p=0.053), 13% (p=0.052), 24% (p=0.003), and 17% (p=0.015) of the variance, respectively. Conclusion These findings confirm that cycling exercise produced EIH in young nurses and provided preliminary evidence to support the interaction between perceived social support, pain catastrophizing and EIH. Further investigation is required to better understand psychological and social factors that mediate EIH on a larger sample of adults at high risk of developing chronic musculoskeletal pain.
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Affiliation(s)
- Kristian Johnsen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Scott D Tagliaferri
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Jessica Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium,Research Foundation – Flanders (FWO), Brussels, Belgium
| | - Bernadette M Fitzgibbon
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jon J Ford
- Advance HealthCare, Boronia, VIC, Australia,Low Back Research Team, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Daniel L Belavy
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia,Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, Germany
| | - Clint T Miller
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia,Correspondence: Clint T Miller, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia, Tel +61 3 9244 6605, Email
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LaMontagne AD, Shann C, Lolicato E, Newton D, Owen PJ, Tomyn AJ, Reavley NJ. Mental health-related knowledge, attitudes and behaviours in a cross-sectional sample of australian university students: a comparison of domestic and international students. BMC Public Health 2023; 23:170. [PMID: 36698138 PMCID: PMC9878763 DOI: 10.1186/s12889-023-15123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There are growing concerns about the mental health of university students in Australia and internationally, with universities, governments and other stakeholders actively developing new policies and practices. Previous research suggests that many students experience poor mental health while at university, and that the risk may be heightened for international students. Mental health-related knowledge, attitudes and behaviours are modifiable determinants of mental health and thus suitable targets for intervention. This study assessed the mental health-related knowledge, stigmatising attitudes, helping behaviours, and self-reported experiences of mental health problems in the student population of a large multi-campus Australian university, and conducted a comparative assessment of international and domestic students. METHODS Participants were 883 international and 2,852 domestic students (overall response rate 7.1%) who completed an anonymous voluntary online survey that was sent to all enrolled students in July 2019 (n = ~ 52,341). Various measures of mental health-related knowledge, attitudes and helping behaviours were assessed. A comparative analysis of international and domestic students was conducted, including adjustment for age and sex. RESULTS Overall, there was evidence of improvements in mental health-related knowledge, attitudes and behaviours relative to previous studies, including higher depression recognition, intentions to seek help, and reported help-seeking behaviour. Comparative analysis indicated that international students scored predominantly lower on a range of indicators (e.g., depression recognition, awareness of evidence-based forms of help); however, differences were narrower difference between the two groups compared to what has been reported previously. Finally, some indicators were more favourable among international students, such as higher help-seeking intentions, and lower prevalence of self-reported mental health problems compared to domestic students. CONCLUSION Though there were some important differences between domestic and international students in this study, differences were narrower than observed in previous studies. Study findings are informing the on-going implementation and refinement of this university's student mental health strategy, and may be used to inform evolving policy and practice in the university sector.
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Affiliation(s)
- Anthony D. LaMontagne
- grid.1021.20000 0001 0526 7079Institute for Health Transformation & School of Health & Social Development, Deakin University, Geelong, VIC Australia ,grid.1008.90000 0001 2179 088XMelbourne School of Population & Global Health, University of Melbourne, Melbourne, VIC Australia
| | | | - Erin Lolicato
- grid.1021.20000 0001 0526 7079Diversity & Inclusion, Deakin University, Geelong, VIC Australia
| | - Danielle Newton
- grid.1021.20000 0001 0526 7079Institute for Health Transformation & School of Health & Social Development, Deakin University, Geelong, VIC Australia ,grid.1008.90000 0001 2179 088XMelbourne School of Population & Global Health, University of Melbourne, Melbourne, VIC Australia
| | - Patrick J Owen
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Adrian J. Tomyn
- grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Melbourne, VIC Australia ,Bupa Asia Pacific, Adelaide, SA Australia
| | - Nicola J. Reavley
- grid.1008.90000 0001 2179 088XMelbourne School of Population & Global Health, University of Melbourne, Melbourne, VIC Australia
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Craige EA, Memon AR, Belavy DL, Vincent GE, Owen PJ. Effects of non-pharmacological interventions on sleep in chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Sleep Med Rev 2023; 68:101761. [PMID: 36805590 DOI: 10.1016/j.smrv.2023.101761] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/29/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
Low back pain is a leading cause of disability worldwide and adults with chronic low back pain (≥12weeks) commonly experience sleep impairments (e.g., insomnia, sleep disturbance). This study examined the effects of non-pharmacological interventions on sleep in adults with chronic low back pain. Six databases (PubMed, CINAHL, SPORTDiscus, PsycINFO, EMBASE, CENTRAL) were searched from inception to 2 June 2021 for randomised controlled trials. Pairwise random-effect meta-analysis estimated standardised mean difference (Hedges' g) at end-of-intervention follow-up. Nineteen studies (participants: 1348) were included. When compared to control, non-pharmacological interventions improved sleep (g [95%CI]: -0.33 [-0.56, -0.11], p = 0.004, small effect, I2 = 59.3%; n = 879; studies: n = 13; GRADE: low). This small improvement in sleep was associated with a moderate reduction in pain intensity (-0.69 [-1.00, -0.38], p < 0.001, I2 = 75.3%; n = 812; studies: n = 12; GRADE: very low) and no changes in back-related disability (-0.50 [-1.13, 0.14], p = 0.129, I2 = 91.4%; n = 517; studies: n = 6; GRADE: low). Notably, all eligible studies reported interventions primarily aimed to reduce pain, although our search criteria were not limited to pain interventions. Key limitations were data paucity and high risk of bias. Future research should investigate sleep-based interventions (i.e., those purposely designed to improve sleep) using subjective and objective measures across a range of sleep domains (CRD42021275227).
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Affiliation(s)
- Emma A Craige
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, South Australia, Australia.
| | - Aamir R Memon
- Institute of Physiotherapy & Rehabilitation Sciences, Peoples University of Medical & Health Sciences for Women, Pakistan.
| | - Daniel L Belavy
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Division of Physiotherapy, Gesundheitscampus 6-8, 44801, Bochum, Germany.
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, South Australia, Australia.
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.
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Tagliaferri SD, Belavy DL, Bowe SJ, Clarkson MJ, Connell D, Craige EA, Gollan R, Main LC, Miller CT, Mitchell UH, Mundell NL, Neason C, Samanna CL, Scott D, Tait JL, Vincent GE, Owen PJ. Assessing safety and treatment efficacy of running on intervertebral discs (ASTEROID) in adults with chronic low back pain: protocol for a randomised controlled trial. BMJ Open Sport Exerc Med 2023; 9:e001524. [PMID: 36684712 PMCID: PMC9853241 DOI: 10.1136/bmjsem-2022-001524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
Poor intervertebral disc (IVD) health is associated with low back pain (LBP). This 12-week parallel randomised controlled trial will evaluate the efficacy of a progressive interval running programme on IVD health and other clinical outcomes in adults with chronic LBP. Participants will be randomised to either a digitally delivered progressive interval running programme or waitlist control. Participants randomised to the running programme will receive three individually tailored 30 min community-based sessions per week over 12 weeks. The waitlist control will undergo no formal intervention. All participants will be assessed at baseline, 6 and 12 weeks. Primary outcomes are IVD health (lumbar IVD T2 via MRI), average LBP intensity over the prior week (100-point visual analogue scale) and disability (Oswestry Disability Index). Secondary outcomes include a range of clinical measures. All outcomes will be analysed using linear mixed models. This study has received ethical approval from the Deakin University Human Research Ethics Committee (ID: 2022-162). All participants will provide informed written consent before participation. Regardless of the results, the findings of this study will be disseminated, and anonymised data will be shared via an online repository. This will be the first study to evaluate whether a progressive interval running programme can improve IVD health in adults with chronic LBP. Identifying conservative options to improve IVD health in this susceptible population group has the potential to markedly reduce the burden of disease. This study was registered via the Australian New Zealand Clinical Trials Registry on 29 September 2022 (ACTRN12622001276741).
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Affiliation(s)
- Scott D Tagliaferri
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Daniel L Belavy
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Division of Physiotherapy, Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Steven J Bowe
- Deakin University, Biostatistics Unit, Faculty of Health, Geelong, Victoria, Australia,Victoria University of Wellington, Wellington, New Zealand
| | - Matthew J Clarkson
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - David Connell
- Imaging @ Olympic Park, AAMI Park, 60 Olympic Boulevard, Melbourne, Victoria, Australia
| | - Emma A Craige
- Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Romina Gollan
- Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Luana C Main
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Clint T Miller
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Niamh L Mundell
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Christopher Neason
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Claire L Samanna
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - David Scott
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia,School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Jamie L Tait
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, South Australia, Australia
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
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Owen PJ, Keating SE, Askew CD, Clanchy KM, Jansons P, Maddison R, Maiorana A, McVicar J, Robinson S, Neason C, Clarkson MJ, Mundell NL. The Effectiveness of Exercise Physiology Services During the COVID-19 Pandemic: A Pragmatic Cohort Study. Sports Med Open 2023; 9:2. [PMID: 36617585 PMCID: PMC9826725 DOI: 10.1186/s40798-022-00539-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/20/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The COVID-19 pandemic markedly changed how healthcare services are delivered and telehealth delivery has increased worldwide. Whether changes in healthcare delivery borne from the COVID-19 pandemic impact effectiveness is unknown. Therefore, we examined the effectiveness of exercise physiology services provided during the COVID-19 pandemic. METHODS This prospective cohort study included 138 clients who received exercise physiology services during the initial COVID-19 pandemic. Outcome measures of interest were EQ-5D-5L, EQ-VAS, patient-specific functional scale, numeric pain rating scale and goal attainment scaling. RESULTS Most (59%, n = 82) clients received in-person delivery only, whereas 8% (n = 11) received telehealth delivery only and 33% (n = 45) received a combination of delivery modes. Mean (SD) treatment duration was 11 (7) weeks and included 12 (6) sessions lasting 48 (9) minutes. The majority (73%, n = 101) of clients completed > 80% of exercise sessions. Exercise physiology improved mobility by 14% (β = 0.23, P = 0.003), capacity to complete usual activities by 18% (β = 0.29, P < 0.001), capacity to complete important activities that the client was unable to do or having difficulty performing by 54% (β = 2.46, P < 0.001), current pain intensity by 16% (β = - 0.55, P = 0.038) and goal attainment scaling t-scores by 50% (β = 18.37, P < 0.001). Effectiveness did not differ between delivery modes (all: P > 0.087). CONCLUSIONS Exercise physiology services provided during the COVID-19 pandemic improved a range of client-reported outcomes regardless of delivery mode. Further exploration of cost-effectiveness is warranted.
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Affiliation(s)
- Patrick J. Owen
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Shelley E. Keating
- grid.1003.20000 0000 9320 7537School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD Australia
| | - Christopher D. Askew
- grid.1034.60000 0001 1555 3415VasoActive Research Group, School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, QLD Australia ,grid.510757.10000 0004 7420 1550Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, QLD Australia
| | - Kelly M. Clanchy
- grid.1022.10000 0004 0437 5432School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD Australia ,grid.1022.10000 0004 0437 5432Menzies Health Institute, Griffith University, Gold Coast, QLD Australia
| | - Paul Jansons
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia ,grid.1002.30000 0004 1936 7857Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Ralph Maddison
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Andrew Maiorana
- grid.459958.c0000 0004 4680 1997Allied Health Department, Fiona Stanley Hospital, Perth, WA Australia ,grid.1032.00000 0004 0375 4078Curtin School of Allied Health, Curtin University, Perth, WA Australia
| | - Jenna McVicar
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Suzanne Robinson
- grid.1032.00000 0004 0375 4078Curtin School of Population Health, Curtin University, Perth, WA Australia ,grid.1021.20000 0001 0526 7079Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Christopher Neason
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia ,Better Exercise Physiology, Healesville, VIC Australia
| | - Matthew J. Clarkson
- grid.1019.90000 0001 0396 9544Institute for Health and Sport, Victoria University, Melbourne, VIC Australia
| | - Niamh L. Mundell
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
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Craige EA, Tagliaferri SD, Ferguson SA, Scott H, Belavy DL, Easton DF, Buntine P, Memon AR, Owen PJ, Vincent GE. Effects of pharmacotherapy on sleep-related outcomes in adults with chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. EClinicalMedicine 2023; 55:101749. [PMID: 36425870 PMCID: PMC9678954 DOI: 10.1016/j.eclinm.2022.101749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adults with chronic low back pain (CLBP) suffer impaired sleep. Medications for CLBP can impact sleep which in turn may influence treatment outcomes. This systematic review and meta-analysis examined the effects of pharmacotherapy (any type) on sleep in adults with CLBP. METHODS In this systematic review and meta-analysis, we searched PubMed, CINAHL, SPORTDiscus, PsycINFO, EMBASE, and CENTRAL from inception to 10 July 2022. Randomised controlled trials that investigated the effects of pharmacotherapy on sleep in adults with CLBP were included. Manual citation search of relevant systematic reviews and included studies were also conducted. Mean change from baseline for sleep outcomes (e.g., sleep quality, total sleep time, wake after sleep onset) was the effect of interest. Pairwise inverse-variance random effect meta-analysis was performed to impute pooled estimates (Hedges' g or risk ratios). The Hartung-Knapp-Sidik-Jonkman method was used where there were ≤5 studies. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used for evaluating the certainty of evidence. This study was registered with PROSPERO (CRD42022309419). FINDINGS Assessment of 3959 records resulted in nine studies (n = 2927) being included. Pharmacotherapy for CLBP management had a small, yet unlikely clinically significant, effect on improving sleep in adults with CLBP, when compared to placebo (g [95% CI]: -0.23 [-0.37, -0.09], p = .0009; I 2 = 30.1%; n = 1433; studies: n = 8; GRADE: low). Notably, no eligible studies investigated the effect of sleep medications in this population, despite being within the scope of this review. INTERPRETATION Pharmacotherapy used to manage CLBP provided improvements in sleep in adults with CLBP. Given that these effects were small and unlikely clinically significant, clinicians could consider alternative treatments (e.g., non-pharmacological interventions) for managing sleep in adults with CLBP. However, low to very low certainty of evidence precluded strong conclusions. To improve certainty of evidence and confidence in the effect estimates, future research needs to use robust method to minimise bias. Additional research evaluating multiple sleep characteristics, using both validated objective and subjective measures, is also warranted to further investigate the influence of distinct sleep parameters. FUNDING The Summer Research Scholarship from the Appleton Institute, Central Queensland University, Australia.
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Affiliation(s)
- Emma A. Craige
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Scott D. Tagliaferri
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Sally A. Ferguson
- Appleton Institute, School of Medical and Applied Sciences, Central Queensland University, South Australia, Australia
| | - Hannah Scott
- Flinders Health and Medical Research Institute: Sleep Health, Flinders University, Adelaide, Australia
| | - Daniel L. Belavy
- Department of Applied Health Sciences, Hochschule für Gesundheit, Bochum, Germany
| | - Dayna F. Easton
- Appleton Institute, School of Medical and Applied Sciences, Central Queensland University, South Australia, Australia
| | - Paul Buntine
- Eastern Health Clinical School, Monash University, Melbourne, Australia
- Eastern Health Emergency Medicine Program, Melbourne, Australia
| | - Aamir R. Memon
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Patrick J. Owen
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Grace E. Vincent
- Appleton Institute, School of Medical and Applied Sciences, Central Queensland University, South Australia, Australia
- Corresponding author. Central Queensland University, Appleton Institute, 44 Greenhill Rd, Wayville, South Australia, Australia, 5034.
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Owen PJ, Keating SE, Askew CD, Clanchy KM, Jansons P, Maddison R, Maiorana A, McVicar J, Robinson S, Mundell NL. Impact of the COVID-19 Pandemic on Exercise Physiology Services in Australia: A Retrospective Audit. Sports Med - Open 2022; 8:94. [PMID: 35867168 PMCID: PMC9306237 DOI: 10.1186/s40798-022-00483-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
Introduction The COVID-19 pandemic has led to a shift in healthcare towards telehealth delivery, which presents challenges for exercise physiology services. We aimed to examine the impact of the COVID-19 pandemic on the reach, efficacy, adoption and implementation of telehealth delivery for exercise physiology services by comparing Australian practises before (prior to 25 January 2020) and during the COVID-19 pandemic (after 25 January 2020).
Methods This retrospective audit included 80 accredited exercise physiology clinicians. We examined relevant dimensions of the RE-AIM framework (reach, effectiveness, adoption and implementation) from the clinician perspective. Results During the COVID-19 pandemic, 91% (n = 73/80) of surveyed clinicians offered telehealth delivery service, compared to 25% (n = 20/80) prior. Mean (SD) telehealth delivery per week doubled from 5 (7) to 10 (8) hours. In-person delivery decreased from 23 (11) to 15 (11) hours per week. Typical reasons for not offering telehealth delivery were client physical/cognitive incapacity (n = 33/80, 41%) and safety (n = 24/80, 30%). Clinician-reported reasons for typical clients not adopting telehealth delivery were personal preference (n = 57/71, 80%), physical capacity (n = 35/71, 49%) and access to reliable delivery platforms (n = 27/71, 38%). Zoom (n = 54/71, 76%) and telephone (n = 53/71, 75%) were the most commonly used platforms. Of the reasons contributing to incomplete treatment, lack of confidence in delivery mode was sevenfold higher for telehealth compared to in-person delivery. No serious treatment-related adverse events were reported. Conclusions During the COVID-19 pandemic, telehealth delivery of exercise physiology services increased and in-person delivery decreased, which suggests the profession was adaptable and agile. However, further research determining comparative efficacy and cost-effectiveness is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00483-2.
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Sprajcer M, Owen PJ, Crowther ME, Harper K, Gupta CC, Ferguson SA, Gibson RH, Vincent GE. Sleep disturbance in caregivers of individuals with Parkinsonism: a systematic review and meta-analysis. BMJ Open 2022; 12:e062089. [PMID: 36379644 PMCID: PMC9668020 DOI: 10.1136/bmjopen-2022-062089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The global prevalence of Parkinsonism continues to rise given ageing populations. Individuals with Parkinsonism who have moderate or severe symptoms typically require a high level of care, including assistance with activities of daily living. This care is often provided across the 24-hour period by a family member or friend. It is likely that providing care significantly impacts the sleep duration and quality of the caregiver given overnight caring responsibilities, in addition to worry and stress associated with the caregiving role. The aim of this systematic review and meta-analysis was to investigate whether providing care to an individual with Parkinsonism was associated with disturbed caregiver sleep, and to identify associated factors that may contribute to disturbed sleep in this population. SETTING Five databases were electronically searched on 30 June 2021 including CINAHL, PubMed, PsycINFO, CENTRAL and EMBASE. PARTICIPANTS Eligibility criteria included a population of caregivers whose care recipient has a form of Parkinsonism. PRIMARY AND SECONDARY OUTCOME MEASURES To be included in this systematic review, outcome measures of caregiver sleep (eg, sleep duration, sleep quality) were required. RESULTS Eighteen studies (n=1998) were included. Findings indicated that caregivers of individuals with Parkinsonism typically experience poor sleep quality (mean (95% CI): 5.6 (4.8 to 6.4) points on the Pittsburgh Sleep Quality Index), increased sleep latency and poor sleep efficiency. CONCLUSIONS The degree of poor sleep quality was clinically significant. However, further investigation of sleep outcomes is required using sleep measurement tools tailored for this population (eg, measures that capture overnight sleep disruption by care recipient/s). Additionally, there is a need for appropriate individual and societal-level interventions to improve caregiver sleep. PROSPERO REGISTRATION NUMBER CRD42021274529.
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Affiliation(s)
- Madeline Sprajcer
- Appleton Institute, Central Queensland University, Wayville, South Australia, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Meagan E Crowther
- Appleton Institute, Central Queensland University, Wayville, South Australia, Australia
| | - Kirsty Harper
- Appleton Institute, Central Queensland University, Wayville, South Australia, Australia
| | | | - Sally A Ferguson
- Appleton Institute, Central Queensland University, Wayville, South Australia, Australia
| | - Rosemary H Gibson
- Sleep Wake Research Centre, School of Health Sciences, Massey University, Wellington, New Zealand
| | - Grace E Vincent
- Appleton Institute, Central Queensland University, Wayville, South Australia, Australia
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Belavy DL, Tagliaferri SD, Buntine P, Saueressig T, Ehrenbrusthoff K, Chen X, Diwan A, Miller CT, Owen PJ. Interventions for promoting evidence-based guideline-consistent surgery in low back pain: a systematic review and meta-analysis of randomised controlled trials. Eur Spine J 2022; 31:2851-2865. [PMID: 36114891 DOI: 10.1007/s00586-022-07378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/09/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Examine the effectiveness of interventions to approach guideline-adherent surgical referrals for low back pain assessed via systematic review and meta-analysis. METHODS Five databases (10 September 2021), Google Scholar, reference lists of relevant systematic reviews were searched and forward and backward citation tracking of included studies were implemented. Randomised controlled/clinical trials in adults with low back pain of interventions to optimise surgery rates or referrals to surgery or secondary referral were included. Bias was assessed using the Cochrane ROB2 tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random effects meta-analysis with a Paule Mandel estimator plus Hartung-Knapp-Sidik-Jonkman method was used to calculate the odds ratio and 95% confidence interval, respectively. RESULTS Of 886 records, 6 studies were included (N = 258,329) participants; cluster sizes ranged from 4 to 54. Five studies were rated as low risk of bias and one as having some concerns. Two studies reporting spine surgery referral or rates could only be pooled via combination of p values and gave evidence for a reduction (p = 0.021, Fisher's method, risk of bias: low). This did not persist with sensitivity analysis (p = 0.053). For secondary referral, meta-analysis revealed a non-significant odds ratio of 1.07 (95% CI [0.55, 2.06], I2 = 73.0%, n = 4 studies, Grading of Recommendations Assessment, Development and Evaluation [GRADE] evidence certainty: very low). CONCLUSION Few RCTs exist for interventions to improve guideline-adherent spine surgery rates or referral. Clinician education in isolation may not be effective. Future RCTs should consider organisational and/or policy level interventions. PROSPERO REGISTRATION CRD42020215137.
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Affiliation(s)
- Daniel L Belavy
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule Für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
| | - Scott D Tagliaferri
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Paul Buntine
- Emergency Department, Box Hill Hospital, Eastern Health, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Katja Ehrenbrusthoff
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Xiaolong Chen
- Department of Orthopaedic Surgery, Spine Service, St. George Hospital, University of New South Wales, Sydney, Australia
| | - Ashish Diwan
- Department of Orthopaedic Surgery, Spine Service, St. George Hospital, University of New South Wales, Sydney, Australia
| | - Clint T Miller
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Patrick J Owen
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Verhagen E, Wilson F, Zelenkova I, Owen PJ. Shining on others, I burn myself: time to disagree with Hippocrates. BMJ Open Sport Exerc Med 2022; 8:e001480. [PMID: 36304722 PMCID: PMC9594505 DOI: 10.1136/bmjsem-2022-001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/24/2023] Open
Affiliation(s)
- Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Fiona Wilson
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Irina Zelenkova
- GENUD Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Mitchell UH, Johnson AW, Adams L, Kho J, Pace N, Owen PJ. Lateral abdominal muscles of adults with hypermobility may be partially impaired during contraction. BMJ Open Sport Exerc Med 2022; 8:e001343. [PMID: 36111125 PMCID: PMC9454039 DOI: 10.1136/bmjsem-2022-001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background Muscle function may be impaired in people with generalised hypermobility, yet prior studies have primarily focused on muscles within the extremities. We aimed to examine changes in lateral abdominal muscle (transversus abdominis (TrA) and the external (EO) and internal abdominal obliques (IO)) thickness and length during contraction between participants with and without hypermobility. Methods This cross-sectional study examined 12 participants with hypermobility and 12 age-matched, sex-matched, height-matched and weight-matched participants without hypermobility. The Beighton and Belavy-Owen-Mitchell score assessed systemic hypermobility. Muscle thickness and length were measured via panoramic ultrasound scans at rest and during contraction. Results When compared with rest across all lumbar levels (L1–L5), contraction produced a lesser increase in TrA thickness (β=0.03, p=0.034) for participants with hypermobility compared with control. No group-by-condition interaction was observed for TrA length across all lumbar levels (L1–L5; p=0.269). Contraction produced a greater decrease in EO thickness (β=0.08, p=0.002) at L3 only for participants with hypermobility compared with control. No group-by-condition interactions were observed for IO thickness. Conclusion Participants with hypermobility had partially impaired lateral abdominal muscle function given a lesser ability to increase TrA muscle thickness during contraction compared with controls.
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Affiliation(s)
- Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - A Wayne Johnson
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Lauren Adams
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Jade Kho
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Nicolas Pace
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
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Tagliaferri SD, Wilkin T, Angelova M, Fitzgibbon BM, Owen PJ, Miller CT, Belavy DL. Chronic back pain sub-grouped via psychosocial, brain and physical factors using machine learning. Sci Rep 2022; 12:15194. [PMID: 36071092 PMCID: PMC9452567 DOI: 10.1038/s41598-022-19542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic back pain (CBP) is heterogenous and identifying sub-groups could improve clinical decision making. Machine learning can build upon prior sub-grouping approaches by using a data-driven approach to overcome clinician subjectivity, however, only binary classification of pain versus no-pain has been attempted to date. In our cross-sectional study, age- and sex-matched participants with CBP (n = 4156) and pain-free controls (n = 14,927) from the UkBioBank were included. We included variables of body mass index, depression, loneliness/social isolation, grip strength, brain grey matter volumes and functional connectivity. We used fuzzy c-means clustering to derive CBP sub-groups and Support Vector Machine (SVM), Naïve Bayes, k-Nearest Neighbour (kNN) and Random Forest classifiers to determine classification accuracy. We showed that two variables (loneliness/social isolation and depression) and five clusters were optimal for creating sub-groups of CBP individuals. Classification accuracy was greater than 95% for when CBP sub-groups were assessed only, while misclassification in CBP sub-groups increased to 35-53% across classifiers when pain-free controls were added. We showed that individuals with CBP could sub-grouped and accurately classified. Future research should optimise variables by including specific spinal, psychosocial and nervous system measures associated with CBP to create more robust sub-groups that are discernible from pain-free controls.
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Affiliation(s)
- Scott D Tagliaferri
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC, 3125, Australia.
| | - Tim Wilkin
- Data to Intelligence Research Centre, School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Maia Angelova
- Data to Intelligence Research Centre, School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Bernadette M Fitzgibbon
- Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Monarch Research Group, Monarch Mental Health Group, Sydney, NSW, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC, 3125, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC, 3125, Australia
| | - Daniel L Belavy
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, Burwood, VIC, 3125, Australia
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule Für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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Saueressig T, Braun T, Steglich N, Diemer F, Zebisch J, Herbst M, Zinser W, Owen PJ, Belavy DL. Primary surgery versus primary rehabilitation for treating anterior cruciate ligament injuries: a living systematic review and meta-analysis. Br J Sports Med 2022; 56:1241-1251. [PMID: 36038357 DOI: 10.1136/bjsports-2021-105359] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Compare the effectiveness of primarily surgical versus primarily rehabilitative management for anterior cruciate ligament (ACL) rupture. DESIGN Living systematic review and meta-analysis. DATA SOURCES Six databases, six trial registries and prior systematic reviews. Forward and backward citation tracking was employed. ELIGIBILITY CRITERIA Randomised controlled trials that compared primary reconstructive surgery and primary rehabilitative treatment with or without optional reconstructive surgery. DATA SYNTHESIS Bayesian random effects meta-analysis with empirical priors for the OR and standardised mean difference and 95% credible intervals (CrI), Cochrane RoB2, and the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence. RESULTS Of 9514 records, 9 reports of three studies (320 participants in total) were included. No clinically important differences were observed at any follow-up for self-reported knee function (low to very low certainty of evidence). For radiological knee osteoarthritis, we found no effect at very low certainty of evidence in the long term (OR (95% CrI): 1.45 (0.30 to 5.17), two studies). Meniscal damage showed no effect at low certainty of evidence (OR: 0.85 (95% CI 0.45 to 1.62); one study) in the long term. No differences were observed between treatments for any other secondary outcome. Three ongoing randomised controlled trials were identified. CONCLUSIONS There is low to very low certainty of evidence that primary rehabilitation with optional surgical reconstruction results in similar outcome measures as early surgical reconstruction for ACL rupture. The findings challenge a historical paradigm that anatomic instability should be addressed with primary surgical stabilisation to provide optimal outcomes. PROSPERO REGISTRATION NUMBER CRD42021256537.
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Affiliation(s)
- Tobias Saueressig
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | - Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, North Rhine-Westphalia, Germany.,HSD Hochschule Döpfer (University of Applied Sciences), Cologne, North Rhine-Westphalia, Germany
| | - Nora Steglich
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, North Rhine-Westphalia, Germany
| | | | - Jochen Zebisch
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | - Maximilian Herbst
- Science and Research, Physio Meets Science GmbH, Leimen, Baden-Württemberg, Germany
| | | | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Daniel L Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, Bochum, North Rhine-Westphalia, Germany
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Owen PJ, Belavy DL, Robinson DG, Anderson N, Harwood A, Mavros Y, Sewry N, Verhagen E. Measuring the growing impact of BOSEM: halfway there or living on a prayer? BMJ Open Sport Exerc Med 2022; 8:e001427. [PMID: 35990759 PMCID: PMC9352992 DOI: 10.1136/bmjsem-2022-001427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Daniel Ludovic Belavy
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Diana Gai Robinson
- Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
| | - Nash Anderson
- Tuggeranong Chiropractic Centre, Fadden, Australian Capital Territory, Australia
| | - Amy Harwood
- Centre for Sport and Exercise Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Yorgi Mavros
- University of Sydney, Sydney, New South Wales, Australia
| | - Nicola Sewry
- University of Pretoria Sport Exercise Medicine and Lifestyle Institute, Pretoria, Gauteng, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
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Tagliaferri SD, Fitzgibbon BM, Owen PJ, Miller CT, Bowe SJ, Belavy DL. Brain structure, psychosocial, and physical health in acute and chronic back pain: a UK Biobank study. Pain 2022; 163:1277-1290. [PMID: 34711762 DOI: 10.1097/j.pain.0000000000002524] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Brain structure, psychosocial, and physical factors underpin back pain conditions; however, less is known about how these factors differ based on pain duration and location. We examined, cross-sectionally, 11,106 individuals from the UK Biobank who (1) were pain-free (n = 5616), (2) had acute back pain (n = 1746), (3) had chronic localised back pain (CBP; n = 1872), or (4) had chronic back pain and additional chronic pain sites (CWP; n = 1872). We found differences in structural brain measures in the chronic pain groups alone. Both CBP and CWP groups had lower primary somatosensory cortex {CBP mean difference (MD) (95% confidence interval [CI]): -250 (-393, -107) mm3, P < 0.001; CWP: -170 (-313, -27)mm3, P = 0.011} and higher caudate gray matter volumes (CBP: 127 [38,216]mm3, P = 0.001; CWP: 122 [33,210]mm3, P = 0.002) compared with pain-free controls. The CBP group also had a lower primary motor cortex volume (-215 [-382, -50]mm3, P = 0.005), whereas the CWP group had a lower amygdala gray matter volume (-27 [-52, -3]mm3, P = 0.021) compared with pain-free controls. Differences in gray matter volumes in some regions may be moderated by sex and body mass index. Psychosocial factors and body mass index differed between all groups and affected those with widespread pain the most (all, P < 0.001), whereas grip strength was only compromised in individuals with widespread pain (-1.0 [-1.4, -0.5] kg, P < 0.001) compared with pain-free controls. Longitudinal research is necessary to confirm these interactions to determine the process of pain development in relation to assessed variables and covariates. However, our results suggest that categorised pain duration and the number of pain sites warrant consideration when assessing markers of brain structure, psychosocial, and physical health.
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Affiliation(s)
- Scott D Tagliaferri
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Bernadette M Fitzgibbon
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne Victoria, Australia
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Clint T Miller
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Steven J Bowe
- Biostatistics Unit, Deakin University, Faculty of Health, Geelong, Australia
| | - Daniel L Belavy
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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Mundell NL, Owen PJ, Dalla Via J, Macpherson H, Daly RM, Livingston PM, Rantalainen T, Foulkes S, Millar J, Murphy DG, Fraser SF. Effects of a multicomponent resistance-based exercise program with protein, vitamin D and calcium supplementation on cognition in men with prostate cancer treated with ADT: secondary analysis of a 12-month randomised controlled trial. BMJ Open 2022; 12:e060189. [PMID: 35750461 PMCID: PMC9234801 DOI: 10.1136/bmjopen-2021-060189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The aim of this preplanned secondary analysis of a 12-month randomised controlled trial was to investigate the effects of a multicomponent exercise programme combined with daily whey protein, calcium and vitamin D supplementation on cognition in men with prostate cancer treated with androgen deprivation therapy (ADT). DESIGN 12-month, two-arm, randomised controlled trial. SETTING University clinical exercise centre. PARTICIPANTS 70 ADT-treated men were randomised to exercise-training plus supplementation (Ex+ Suppl, n=34) or usual care (control, n=36). INTERVENTION Men allocated to Ex + Suppl undertook thrice weekly resistance training with weight-bearing exercise training plus daily whey protein (25 g), calcium (1200 mg) and vitamin D (2000 IU) supplementation. PRIMARY AND SECONDARY OUTCOME MEASURES Cognition was assessed at baseline, 6 and 12 months via a computerised battery (CogState), Trail-making test, Rey auditory-verbal learning test and Digit span. Data were analysed with linear mixed models and an intention-to-treat and prespecified per-protocol approach (exercise-training: ≥66%, nutritional supplement: ≥80%). RESULTS Sixty (86%) men completed the trial (Ex + Suppl, n=31; control, n=29). Five (7.1%) men were classified as having mild cognitive impairment at baseline. Median (IQR) adherence to the exercise and supplement was 56% (37%-82%) and 91% (66%-97%), respectively. Ex + Suppl had no effect on cognition at any time. CONCLUSIONS A 12-month multicomponent exercise training and supplementation intervention had no significant effect on cognition in men treated with ADT for prostate cancer compared with usual care. Exercise training adherence below recommended guidelines does not support cognitive health in men treated with ADT for prostate cancer. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trial Registry (ACTRN12614000317695, registered 25/03/2014) and acknowledged under the Therapeutic Goods Administration Clinical Trial Notification Scheme (CT-2015-CTN-03372-1 v1).
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Affiliation(s)
- Niamh Liana Mundell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Jack Dalla Via
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Helen Macpherson
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | | | - Timo Rantalainen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- Faculty of Sport and Health Sciences, Department of Health Sciences, Jyvaskylan Yliopisto, Jyvaskyla, Finland
| | - Stephen Foulkes
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jerremy Millar
- Radiation Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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van den Hoek DJ, Owen PJ, Garrett JM, Howells RJ, Pearson J, Spathis JG, Latella C. What are the odds? Identifying factors related to competitive success in powerlifting. BMC Sports Sci Med Rehabil 2022; 14:110. [PMID: 35718774 PMCID: PMC9206735 DOI: 10.1186/s13102-022-00505-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
Background The ability for athletes to gain a competitive advantage over their opponents is well recognised. At times, this advantage may be considered a marginal gain. However, in the context of competition, marginal advantages may be the difference between winning and losing. This investigation explores how competition factors influence the odds of competitive success (i.e. winning) in powerlifting (PL) to assist athletes and coaches in achieving a competitive advantage. Methods A cross-sectional, retrospective analysis of competition data from raw/classic, Australian powerlifting competitions 2010–2019 was conducted. Data included 10,599 competition entries (males: n = 6567 [62%], females: n = 4032 [38%]). Independent t-tests were used to compare continuous data between sexes or winners and non-winners at an event. Cohen’s d and the 95% confidence interval (d [95% CI]) were calculated. Univariate odds of winning an event based on independent variables (age [irrespective of category], sex, body weight and weight of first lift attempt [regardless of success]), were assessed by separate simple logistic regression. Results When compared to males, the odds of winning for females were 50% greater (OR [95% CI] 1.500 [1.384, 1.625]; P < 0.001). Athletes who had larger first lift attempts (Squat: + 7.0 kg P < 0.001, Bench Press: + 3.2 kg P < 0.001, and Deadlift: + 6.1 kg P < 0.001and competed for a longer period (winners: 401 vs non-winners: 304 days, P < 0.001) had an increased likelihood winning. Age was associated with increased odds of success for males (OR [95% CI] 1.014 [1.009, 1.019], P < 0.001) per additional year of age for males, but not females (P = 0.509). Conclusions Multiple factors appear to contribute to the likelihood of winning a PL competition. These results may help coaches to develop competition and training strategies that optimise athletes’ likelihood of competitive success in PL.
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Affiliation(s)
- Daniel J van den Hoek
- School of Behavioural and Health Sciences, Faculty of Health Science, Australian Catholic University, 1100 Nudgee Rd, Banyo, Brisbane, QLD, 4014, Australia.
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 75 Pigdons Rd, Geelong, VIC, Australia
| | - Joel M Garrett
- School of Behavioural and Health Sciences, Faculty of Health Science, Australian Catholic University, 1100 Nudgee Rd, Banyo, Brisbane, QLD, 4014, Australia
| | - Robert J Howells
- School of Behavioural and Health Sciences, Faculty of Health Science, Australian Catholic University, 1100 Nudgee Rd, Banyo, Brisbane, QLD, 4014, Australia
| | - Joshua Pearson
- School of Behavioural and Health Sciences, Faculty of Health Science, Australian Catholic University, 1100 Nudgee Rd, Banyo, Brisbane, QLD, 4014, Australia
| | - Jemima G Spathis
- School of Behavioural and Health Sciences, Faculty of Health Science, Australian Catholic University, 1100 Nudgee Rd, Banyo, Brisbane, QLD, 4014, Australia
| | - Christopher Latella
- School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, 270 Joondalup Dr, Joondalup, WA, Australia.,Neurophysiology Research Laboratory, Edith Cowan University, 270 Joondalup Dr, Joondalup, WA, Australia
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Cooper CJ, Owen PJ, Sprajcer M, Crowther ME, Craige EA, Ferguson SA, Gupta CC, Gibson R, Vincent GE. Interventions to improve sleep in caregivers: a systematic review and meta-analysis. Sleep Med Rev 2022; 64:101658. [DOI: 10.1016/j.smrv.2022.101658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 01/01/2023]
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Latella C, Owen PJ, Davies T, Spathis J, Mallard A, VAN DEN Hoek D. Long-Term Adaptations in the Squat, Bench Press, and Deadlift: Assessing Strength Gain in Powerlifting Athletes. Med Sci Sports Exerc 2022; 54:841-850. [PMID: 35019902 DOI: 10.1249/mss.0000000000002858] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Understanding strength changes with resistance training is important in human performance. It also enables better understanding into the expected magnitude of strength increase and factors that influence this change over time. METHODS Squat, bench press, and deadlift scores were collated from 407 powerlifting meets (n = 1896 unique competitors: ~625 females, ~1270 males) between 2003 and 2018. Absolute (in kilograms) and relative starting strength (in kilograms per body weight) for each lift type was expressed for both sexes. Maximum and overall strength gain per day and per year (in kilograms) was calculated by comparing first and final, or maximum scores for each lift, respectively, and considered based on strength quartile classification. Paired and independent t-tests compared strength changes from baseline and between sexes. One-way ANOVAs compared strength changes between quartiles. Pearson correlations assessed relationships between strength changes over time, and baseline strength, number of competitions, and total days competing. RESULTS Maximum strength adaptations were greater for squat (20.2-25.4 kg·yr-1) and deadlift (18.1-21.1 kg·yr-1) compared with bench press (10.5-12.8 kg·yr-1, P ≤ 0.001). However, the change in absolute (all lifts: P = 0.247-0.379) and relative strength (all lifts: P = 0.641-0.821) did not differ between sexes. For females, maximum strength gain per day did not differ by quartile (all lifts: P = 0.091-0.746), nor did overall strength gain per day (P = 0.151-0.575). Conversely, males in the fourth quartile generally displayed lower maximum and overall strength gain per day. CONCLUSIONS These findings show differences in strength gain between upper- and lower-body lifts, but not sex differences in the change in strength. In line with previous research, the strongest males likely gain strength more slowly than weaker counterparts. Professionals should consider this information in the training, assessment, and long-term benchmarking of athletes whose sports require a focus on muscular strength.
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Affiliation(s)
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Victoria, AUSTRALIA
| | - Timothy Davies
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, AUSTRALIA
| | - Jemima Spathis
- School of Behavioural and Health Sciences, Australian Catholic University, Banyo, Queensland, AUSTRALIA
| | - Alistair Mallard
- Australasian Kidney Trials Network, Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, AUSTRALIA
| | - Daniel VAN DEN Hoek
- School of Behavioural and Health Sciences, Australian Catholic University, Banyo, Queensland, AUSTRALIA
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Mitchell UH, Johnson AW, Adams L, Sonnefeld T, Owen PJ. Ultrasound imaging measures of vertebral bony landmark distances are weakly to moderately correlated with intervertebral disc height as assessed by MRI. BMJ Open Sport Exerc Med 2022; 8:e001292. [PMID: 35414957 PMCID: PMC8961152 DOI: 10.1136/bmjsem-2021-001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To assess the validity and reliability of ultrasound-derived interbony landmark distances as a proxy for MRI-derived intervertebral disc (IVD) height. Methods This is a cross-sectional criterion validity study. Twelve college-aged participants without current low back pain completed both MRI and ultrasound imaging of the lumbar spine in a prone position. Single-segment and multisegment distances between the spinous and mammillary processes at the lumbar segments (L2/L3, L3/L4, L4/L5) were measured twice using ultrasound and analysed digitally. Sagittal slices of the lumbar spine were taken via T1-weighted MRI and IVD height, and the overall distance between IVDs L2/L3 and L4/L5 was imaged once and measured twice. Results There was moderate correlation between multilevel-based measurements (overall distance between L2 and L5, r=0.677, p=0.016) and the average across three levels (r=0.596, p=0.041) when using the spinous processes as bony landmarks. Single-segment measures were not significantly correlated (all: p>0.092). Accuracy and precision were better for the overall MRI-derived distance between the three IVDs from L2 and L5 MRI and the distance measured between the spinous processes L2–L5. There was excellent reliability within multiple measurements at each location, with intraclass correlation coefficient, ICC(3,1), ranging from 0.93 to 0.99 (95% CI 0.82 to 0.99) for ultrasound and from 0.98 to 0.99 (95% CI 0.92 to 0.99) for MRI. Conclusion Findings do not support the use of ultrasound imaging for estimating single-segment IVD height, yet it may be used to measure the change in distance over time with a certain degree of precision based on its excellent reliability.
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Affiliation(s)
| | - A Wayne Johnson
- Exercises Sciences, Brigham Young University, Provo, Utah, USA
| | - Lauren Adams
- Exercises Sciences, Brigham Young University, Provo, Utah, USA
| | - Tayva Sonnefeld
- Exercises Sciences, Brigham Young University, Provo, Utah, USA
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
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Belavy DL, Miller CT, Owen PJ, Rantalainen T, Connell D, Hahne AJ, Ford JJ, Trudel G. Exercise may impact on lumbar vertebrae marrow adipose tissue: Randomised controlled trial. Bone 2022; 157:116338. [PMID: 35085839 DOI: 10.1016/j.bone.2022.116338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Animal and human cross-sectional data suggest that bone marrow adipose tissue (MAT) may respond to mechanical loads and exercise. We conducted the first randomised controlled trial of exercise on MAT modulations in humans. METHODS Forty patients with chronic non-specific low back pain (NSCLBP) were enrolled in a six-month single-blinded randomised controlled trial (ACTRN12615001270505). Twenty patients loaded their spines via progressive upright aerobic and resistance exercises targeting major muscle groups (Exercise). Twenty patients performed non-weightbearing motor control training and manual therapy (Control). Testing occurred at baseline, 3-months (3mo) and 6-months (6mo). Lumbar vertebral fat fraction (VFF) was measured using magnetic resonance imaging axial mDixon sequences. RESULTS When compared to baseline (percent change), lumbar vertebral fat fraction (VFF; measured using magnetic resonance imaging axial mDixon sequences) was lower in Exercise at 3mo at L2 (-3.7[6.8]%, p = 0.033) and L4 (-2.6[4.1]%, p = 0.015), but not in Control. There were no between-group effects. The effects of Exercise on VFF were sex-specific, with VFF lower in men at L2, L3, L4 at 3mo and at L1, L2, L3 and L4 at 6mo (p all ≤ 0.05), but not in women. Leg and trunk lean mass were increased at 3mo in Exercise. Changes in VFF correlated significantly with changes in total fat (ρ = 0.40) and lean (ρ = -0.41) masses, but not with lumbar BMD (ρ = -0.10) or visceral adipose tissue volume (ρ = 0.23). CONCLUSIONS This trial provided first prospective evidence in humans that a moderate exercise intervention may modulate lumbar VFF as a surrogate measure of MAT at 3mo, yet not 6mo. The effect of exercise on MAT may be more prominent in males than females.
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Affiliation(s)
- Daniel L Belavy
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Division of Physiotherapy, Gesundheitscampus 6-8, 44801 Bochum, Germany; Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.
| | - Clint T Miller
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.
| | - Timo Rantalainen
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia; Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - David Connell
- Imaging@Olympic Park, Melbourne, Victoria, Australia.
| | - Andrew J Hahne
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.
| | - Jon J Ford
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia; Advance HealthCare, Boronia, Victoria, Australia.
| | - Guy Trudel
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Bone and Joint Research Laboratory, University of Ottawa, The Ottawa Hospital Research Institute, Canada.
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Murphy MC, George HA, Naqi M, Owen PJ, Chivers P, Hart NH. Musculoskeletal injury epidemiology in law enforcement and firefighter recruits during physical training: a systematic review. BMJ Open Sport Exerc Med 2022; 8:e001289. [PMID: 35309374 PMCID: PMC8889355 DOI: 10.1136/bmjsem-2021-001289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 12/26/2022] Open
Abstract
Objectives Report the injury epidemiology of law enforcement and firefighter recruits. Design A systematic epidemiological review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was completed. Data sources Five online databases were searched from database inception to 5 May 2021. Eligibility criteria for selecting studies Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by law enforcement or firefighter recruits were included. We reported on all components of injury where data were available. All injury incidence rates were calculated as per 1000 training days (Poisson 95% CI) to allow comparisons between studies. Study quality was assessed using the Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies. Results No studies reporting firefighter recruits were identified. Eight published studies that reported on injuries to law enforcement recruits were identified. The studies were all low quality, and the credibility of the evidence was assessed as very low. Seven studies reported medical attention injuries, and one study reported the number of medical withdrawals from a recruit training programme. The prevalence of law enforcement recruits with medical attention injuries ranged from 13.7% to 24.5%. The overall medical attention injury incidence rate for law enforcement recruits ranged from 1.67 injuries per 1000 training days (Poisson 95% CI 1.00 to 2.34 injuries per 1000 training days) to 4.24 injuries per 1000 training days (Poisson 95% CI 2.97 to 5.51 injuries per 1000 training days). Conclusion This review reported the prevalence and incidence rates for musculoskeletal injuries in law enforcement officers. However, the credibility of the evidence is very low. PROSPERO registration number CRD42021251084.
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Affiliation(s)
- Myles Calder Murphy
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Holly-Anne George
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Muhammad Naqi
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Paola Chivers
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Nicolas H Hart
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Owen PJ, Main LC, Miller CT, Ford JJ, Hahne AJ, Belavy DL. Protection motivation theory screening tool for predicting chronic low back pain rehabilitation adherence: analysis of a randomised controlled trial. BMJ Open 2022; 12:e052644. [PMID: 35115351 PMCID: PMC8814751 DOI: 10.1136/bmjopen-2021-052644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore a protection motivation theory screening tool for predicting rehabilitation adherence. DESIGN Analysis of a randomised controlled trial. SETTING An exercise physiology and physiotherapist clinic. PARTICIPANTS Patients with chronic low back pain (n=40). INTERVENTIONS General strength and conditioning (GSC) compared with motor control and manual therapy. Primary and secondary outcome measures: predicting patient adherence to supervised sessions and dropout using the Sports Injury Rehabilitation Beliefs Scale, seven-item barriers checklist and Positive and Negative Affect Schedule and Sports Injury Rehabilitation Adherence Scale. RESULTS Average attendance was 77% (motor control and manual therapy) and 60% (GSC) with eight dropouts. No Sports Injury Rehabilitation Adherence Scale values other than 5 across all three components were recorded. Treatment efficacy (p=0.019), self-efficacy (p=0.001), rehabilitation value (p=0.028) and injury severity (p=0.002) positively correlated with susceptibility (the extent of vulnerability to having health problems from not taking action). Rehabilitation value positively correlated with self-efficacy (p=0.005). Injury severity positively correlated with rehabilitation value (p=0.011). The final model for number of cancellations included rehabilitation value only and accounted for approximately 12% of variance (p=0.033). CONCLUSIONS Perceived value of rehabilitation should be considered by clinicians in the rehabilitation setting to improve treatment adherence in patients with chronic low back pain. TRIAL REGISTRATION NUMBER ACTRN12615001270505.
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Affiliation(s)
- Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Luana C Main
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Jon J Ford
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
- Advanced HealthCare, Boronia, Victoria, Australia
| | - Andrew J Hahne
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Daniel L Belavy
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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Belavy DL, Tagliaferri SD, Buntine P, Saueressig T, Sadler K, Ko C, Miller CT, Owen PJ. Clinician education unlikely effective for guideline-adherent medication prescription in low back pain: systematic review and meta-analysis of RCTs. EClinicalMedicine 2022; 43:101193. [PMID: 35028542 PMCID: PMC8741480 DOI: 10.1016/j.eclinm.2021.101193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Effectiveness of implementing interventions to optimise guideline-recommended medical prescription in low back pain is not well established. METHODS A systematic review and random-effects meta-analyses for dichotomous outcomes with a Paule-Mandel estimator. Five databases and reference lists were searched from inception to 4th August 2021. Randomised controlled/clinical trials in adults with low back pain to optimise medication prescription were included. Cochrane Risk of Bias 2 tool and GRADE were implemented. The review was registered prospectively with PROSPERO (CRD42020219767). FINDINGS Of 3352 unique records identified in the search, seven studies were included and five were eligible for meta-analysis (N=11339 participants). Six of seven studies incorporated clinician education, three studies included audit/feedback components and one study implemented changes in medical records systems. Via meta-analysis, we estimated a non-significant odds-ratio of 0·94 (95% CI (0·77; 1.16), I² = 0%; n=5 studies, GRADE: low) in favour of the intervention group. The main finding was robust to sensitivity analyses. INTERPRETATION There is low quality evidence that existing interventions to optimise medication prescription or usage in back pain had no impact. Peer-to-peer education alone does not appear to lead to behaviour change. Organisational and policy interventions may be more effective. FUNDING This work was supported by internal institutional funding only.
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Affiliation(s)
- Daniel L Belavy
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Division of Physiotherapy, Gesundheitscampus 6-8, 44801, Bochum, Germany
- Corresponding author. Prof. Daniel L Belavy, Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Division of Physiotherapy, Gesundheitscampus 6-8, 44801, Bochum, Germany. Tel: +49 234 77727 632
| | - Scott D Tagliaferri
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Paul Buntine
- Eastern Health, Box Hill Hospital, Emergency Department, 5 Arnold St, Box Hill, Victoria 3128, Australia
- Monash University, Eastern Health Clinical School, Level 2, 5 Arnold Street, Box Hill, Victoria 3128, Australia
| | | | - Kate Sadler
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Christy Ko
- Eastern Health, Box Hill Hospital, Emergency Department, 5 Arnold St, Box Hill, Victoria 3128, Australia
| | - Clint T Miller
- Deakin University, School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, 221 Burwood Highway, Burwood, Victoria 3125, Australia
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Mundell NL, Owen PJ, Dalla Via J, Macpherson H, Daly RM, Fraser SF. Does androgen deprivation impact associations between cognition and strength, fitness and function in community-dwelling men with prostate cancer? A cross-sectional study. BMJ Open 2021; 11:e058478. [PMID: 36415046 PMCID: PMC8719205 DOI: 10.1136/bmjopen-2021-058478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We investigated whether there were differences in associations between cognition with muscle strength, fitness and function in men with prostate cancer (PCa) treated with, and without androgen deprivation therapy (ADT) and non-PCa controls. A secondary aim was to compare differences in the prevalence of cognitive impairment. DESIGN This cross-sectional study compared 70 ADT-treated men with PCa aged 50-85 years to non-ADT-treated men (n=52) and non-PCa controls (n=70). SETTING University clinical exercise laboratory. INTERVENTIONS Nil. PRIMARY AND SECONDARY OUTCOME MEASURES Standardised assessments were conducted for cognition (learning, memory, attention, processing speed and executive function), muscle strength (grip strength and leg press), fitness (400 m walk), gait speed (4 m walk) and dual-tasking mobility (timed-up-and-go with a cognitive task). RESULTS ADT-treated men showed stronger associations between fitness and executive function and task switching relative to controls (both: p≤0.03). For both PCa groups (independent of ADT use), poorer dual-task mobility was more strongly associated with decreased psychomotor attention (both: p≤0.027) and global cognitive function (both: p≤0.031) compared with non-PCa controls. The overall prevalence of cognitive impairment was low (4%-13%) and did not differ between the groups. CONCLUSIONS The presence of PCa, with or without ADT treatment, did not increase the risk of cognitive impairment relative to non-PCa controls, yet did alter the associations between physical fitness and some measures of functional performance with certain cognitive domains. This highlights the importance of men with PCa maintaining fitness and functional capacity to optimise cognitive health. TRIAL REGISTRATION NUMBER This study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12614000317695).
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Affiliation(s)
- Niamh L Mundell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Jack Dalla Via
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Helen Macpherson
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Owen PJ, Saueressig T, Belavy DL, Than CA, Ball J, Sadler K, Piedimonte A, Benedetti F, Miller CT. Response to Comment on: "Attempting to Separate Placebo Effects from Exercise in Chronic Pain: A Systematic Review and Meta-Analysis". Sports Med 2021; 52:961-962. [PMID: 34932204 DOI: 10.1007/s40279-021-01622-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Patrick J Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | | | - Daniel L Belavy
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.,Division of Physiotherapy, Department of Applied Health Sciences, Hochschule Für Gesundheit (University of Applied Sciences), Bochum, Germany
| | - Christian A Than
- School of Biomedical Sciences, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Jake Ball
- School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, Australia
| | - Kate Sadler
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Alessandro Piedimonte
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Fabrizio Benedetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Medicine and Physiology of Hypoxia, Plateau Rosà, Zermatt, Switzerland
| | - Clint T Miller
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
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Belavy DL, Diwan AD, Ford J, Miller CT, Hahne AJ, Mundell N, Tagliaferri S, Bowe S, Pedder H, Saueressig T, Zhao X, Chen X, Balasundaram AP, Arora NK, Owen PJ. Network meta-analysis for comparative effectiveness of treatments for chronic low back pain disorders: systematic review protocol. BMJ Open 2021; 11:e057112. [PMID: 34845083 PMCID: PMC8634013 DOI: 10.1136/bmjopen-2021-057112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Chronic low back pain disorders (CLBDs) present a substantial societal burden; however, optimal treatment remains debated. To date, pairwise and network meta-analyses have evaluated individual treatment modes, yet a comparison of a wide range of common treatments is required to evaluate their relative effectiveness. Using network meta-analysis, we aim to evaluate the effectiveness of treatments (acupuncture, education or advice, electrophysical agents, exercise, manual therapies/manipulation, massage, the McKenzie method, pharmacotherapy, psychological therapies, surgery, epidural injections, percutaneous treatments, traction, physical therapy, multidisciplinary pain management, placebo, 'usual care' and/or no treatment) on pain intensity, disability and/or mental health in patients with CLBDs. METHODS AND ANALYSIS Six electronic databases and reference lists of 285 prior systematic reviews were searched. Eligible studies will be randomised controlled/clinical trials (including cross-over and cluster designs) that examine individual treatments or treatment combinations in adult patients with CLBDs. Studies must be published in English, German or Chinese as a full-journal publication in a peer-reviewed journal. A narrative approach will be used to synthesise and report qualitative and quantitative data, and, where feasible, network meta-analyses will be performed. Reporting of the review will be informed by Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance, including the network meta-analysis extension (PRISMA-NMA). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for network meta-analysis will be implemented for assessing the quality of the findings. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review of the published data. Findings will be disseminated via peer-reviewed publication. PROSPERO REGISTRATION NUMBER PROSPERO registration number CRD42020182039.
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Affiliation(s)
- Daniel L Belavy
- Physiotherapy, Hochschule fur Gesundheit, Bochum, Nordrhein-Westfalen, Germany
| | - Ashish D Diwan
- Department of Orthopaedic Surgery, Spine Service, St. George Hospital, Kogarah, New South Wales, Australia
| | - Jon Ford
- Advance Healthcare, Melbourne, Victoria, Australia
- Low Back Research Team, La Trobe University, Bundoora, Victoria, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
| | - Andrew J Hahne
- Low Back Research Team, La Trobe University, Bundoora, Victoria, Australia
| | | | | | - Steven Bowe
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Hugo Pedder
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Xiaohui Zhao
- Xi'an University of Architecture and Technology, Xi'an, China
| | - Xiaolong Chen
- Department of Orthopaedic Surgery, Spine Service, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Nitin Kumar Arora
- Physiotherapy, Hochschule fur Gesundheit, Bochum, Nordrhein-Westfalen, Germany
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
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