Publications by authors named "Bill Vicenzino"

278 Publications

Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework-an international multidisciplinary consensus.

Br J Sports Med 2021 Jun 22. Epub 2021 Jun 22.

School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.

Background: Despite being the most commonly incurred sports injury with a high recurrence rate, there are no guidelines to inform return to sport (RTS) decisions following acute lateral ankle sprain injuries. We aimed to develop a list of assessment items to address this gap.

Methods: We used a three-round Delphi survey approach to develop consensus of opinion among 155 globally diverse health professionals working in elite field or court sports. This involved surveys that were structured in question format with both closed-response and open-response options. We asked panellists to indicate their agreement about whether or not assessment items should support the RTS decision after an acute lateral ankle sprain injury. The second and third round surveys included quantitative and qualitative feedback from the previous round. We defined a priori consensus being reached at >70% agree or disagree responses.

Results: Sixteen assessment items reached consensus to be included in the RTS decision after an acute lateral ankle sprain injury. They were mapped to five domains with 98% panellist agreement-PAASS: ain (during sport participation and over the last 24 hours), nkle impairments (range of motion; muscle strength, endurance and power), thlete perception (perceived ankle confidence/reassurance and stability; psychological readiness), ensorimotor control (proprioception; dynamic postural control/balance), port/functional performance (hopping, jumping and agility; sport-specific drills; ability to complete a full training session).

Conclusion: Expert opinion indicated that pain severity, ankle impairments, sensorimotor control, athlete perception/readiness and sport/functional performance should be assessed to inform the RTS decision following an acute lateral ankle sprain injury.

Trial Registration Number: ACTRN12619000522112.
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http://dx.doi.org/10.1136/bjsports-2021-104087DOI Listing
June 2021

Effect of a Consumer-Focused Website for Low Back Pain on Health Literacy, Treatment Choices, and Clinical Outcomes: Randomized Controlled Trial.

J Med Internet Res 2021 Jun 15;23(6):e27860. Epub 2021 Jun 15.

Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.

Background: The internet is used for information related to health conditions, including low back pain (LBP), but most LBP websites provide inaccurate information. Few studies have investigated the effectiveness of internet resources in changing health literacy or treatment choices.

Objective: This study aims to evaluate the effectiveness of the MyBackPain website compared with unguided internet use on health literacy, choice of treatments, and clinical outcomes in people with LBP.

Methods: This was a pragmatic, web-based, participant- and assessor-blinded randomized trial of individuals with LBP stratified by duration. Participants were randomly allocated to have access to the evidence-based MyBackPain website, which was designed with input from consumers and expert consensus or unguided internet use. The coprimary outcomes were two dimensions of the Health Literacy Questionnaire (dimension 2: "having sufficient information to manage my health;" dimension 3: "actively managing my health;" converted to scores 1-100) at 3 months. Secondary outcomes included additional Health Literacy Questionnaire dimensions, quality of treatment choices, and clinical outcomes.

Results: A total of 453 participants were recruited, and 321 (70.9%) completed the primary outcomes. Access to MyBackPain was not superior to unguided internet use on primary outcomes (dimension 2: mean difference -0.87 units, 95% CI -3.56 to 1.82; dimension 3: mean difference -0.41 units, 95% CI -2.78 to 1.96). Between-group differences in other secondary outcomes had inconsistent directions and were unlikely to be clinically important, although a small improvement of unclear importance in the quality of stated treatment choices at 1 month was found (mean difference 0.93 units, 95% CI 0.03 to 1.84).

Conclusions: MyBackPain was not superior to unguided internet use for health literacy, but data suggest some short-term improvement in treatment choices. Future research should investigate if greater interactivity and engagement with the website may enhance its impact.

Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001292369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372926.

International Registered Report Identifier (irrid): RR2-10.1136/bmjopen-2018-027516.
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http://dx.doi.org/10.2196/27860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277358PMC
June 2021

REPORT-PFP: a consensus from the International Patellofemoral Research Network to improve REPORTing of quantitative PatelloFemoral Pain studies.

Br J Sports Med 2021 Jun 14. Epub 2021 Jun 14.

Sports and Exercise Medicine, Queen Mary University of London, London, UK.

Patellofemoral pain is a common and often debilitating musculoskeletal condition. Clinical translation and evidence synthesis of patellofemoral pain research are compromised by heterogenous and often inadequately reported study details. This consensus statement and associated checklist provides standards for REPORTing of quantitative PatelloFemoral Pain (REPORT-PFP) research to enhance clinical translation and evidence synthesis, and support clinician engagement with research and data collection. A three-stage Delphi process was initiated at the 2015 International Patellofemoral Research Network (iPFRN) retreat. An initial e-Delphi activity (n=24) generated topics and items, which were refined at the 2017 iPFRN retreat, and voted on prior to and following the 2019 iPFRN retreat (n=51 current and past retreat participants). Voting criteria included 'strongly recommended' (essential), 'recommended' (encouraged) and uncertain/unsure. An item was included in the checklist if ≥70% respondents voted 'recommended'. Items receiving ≥70% votes for 'strongly recommended' were labelled as such. The final REPORT-PFP checklist includes 31 items (11 strongly recommended, 20 recommended), covering (i) demographics (n=2,4); (ii) baseline symptoms and previous treatments (n=3,7); (iii) outcome measures (2,4); (iv) outcomes measure description (n=1,2); (v) clinical trial methodology (0,3) and (vi) reporting study results (n=3,0). The REPORT-PFP checklist is ready to be used by researchers and clinicians. Strong stakeholder engagement from clinical academics during development means consistent application by the international patellofemoral pain research community is likely. Checklist adherence will improve research accessibility for clinicians and enhance future evidence synthesis.
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http://dx.doi.org/10.1136/bjsports-2020-103700DOI Listing
June 2021

LOAD-intensity and time-under-tension of exercises for men who have Achilles tendinopathy (the LOADIT trial): a randomised feasibility trial.

BMC Sports Sci Med Rehabil 2021 May 25;13(1):57. Epub 2021 May 25.

Physiotherapy Department, School of Primary and Allied Health Care, Monash University, Frankston, Melbourne, Victoria, 3199, Australia.

Background: One potential reason for disparate outcomes of exercise for Achilles tendinopathy is poor knowledge about whether exercise parameters (i.e. different exercise doses) influence outcome. Whether parameters that are important for tendon adaptation influence clinical outcomes in Achilles tendinopathy has not been investigated. Therefore, this research aimed to assess the feasibility of conducting a fully powered randomised trial to investigate the efficacy of different load-intensity and time-under-tension exercise parameters for Achilles tendinopathy.

Methods: A factorial four-arm, randomised trial. Forty-eight male participants (18-70 years old) with mid-portion Achilles tendinopathy (≥ 3 months) were recruited. Participants were randomly allocated to high (6 repetition maximum) or low intensity (18 repetition maximum) exercise, performed with either high (6 s per cycle) or low (2 s per cycle) time-under-tension. Participants performed 12-weeks of standing and seated calf raise exercises three times per week in a gym setting using a Smith machine. One session per week was supervised (via videoconference). Primary feasibility outcomes (recruitment and retention rate, exercise adherence and fidelity [i.e. time-under-tension, volume, load intensity], incidence of adverse events, health care use and productivity cost) were collected weekly. Means and standard deviations were determined for parametric data, medians and interquartile range for non-parametric continuous data, and frequency counts for discrete data.

Results: Total recruitment (76%) and retention (90%) rates were high. Exercise adherence ranged from 45 to 63% and fidelity ranged from 8 to 83% across the groups. Thirty-one participants reported 64 adverse events over the 3 months. Twenty-one participants (70%) reported mild events. Participants reported reduced presenteeism more than absenteeism.

Conclusions: A fully powered trial is feasible. The proposed trial design and interventions demonstrated acceptable recruitment and retention rates and safety profile. However, exercise fidelity and adherence to the gym-based intervention was not acceptable. Strategies to improve intervention adherence and fidelity should be considered in future trials.

Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12618001315202 . Registered retrospectively on August 6th, 2018.
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http://dx.doi.org/10.1186/s13102-021-00279-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152048PMC
May 2021

Exploration of shear wave elastography measures of the iliotibial band during different tasks in pain-free runners.

Phys Ther Sport 2021 Jul 30;50:121-129. Epub 2021 Apr 30.

The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Qld, 4072, Australia. Electronic address:

Objectives: To determine whether shear wave velocity (SWV) of the iliotibial band (ITB): i) increases with active and passive static tasks, and a dynamic task, ii) differs between ITB regions, iii) changes after exposure to running. Additionally, it aimed to determine the between-day reliability.

Design: Case series & test-retest.

Setting: Human movement unit laboratory.

Participants: Fifteen runners.

Main Outcome Measures: SWV was measured unilaterally in three regions of the ITB (proximal, middle and distal), during six tasks: rest and contraction (pre- and post-running), modified Ober test, standing, pelvic drop, and weight shift.

Results: Compared to rest, SWV was higher during contraction and Ober test in the distal and middle regions, and higher for the middle region in standing and pelvic drop. No differences were found between regions. A tendency of decreased SWV was observed after running. Compared to the start of the dynamic task, SWV was greater at the end of the movement. Reliability was moderate-to-good for the middle region in the standing tasks (ICCs = 0.68 to 0.84).

Conclusion: SVW of the ITB was higher under passive or active tension. Comparisons between tasks/regions need to be considered in light of the small sample size and poor repeatability of some regions/conditions.
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http://dx.doi.org/10.1016/j.ptsp.2021.04.006DOI Listing
July 2021

Protocol for the development of a core outcome set for lateral elbow tendinopathy (COS-LET).

Trials 2021 May 10;22(1):339. Epub 2021 May 10.

School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, St Lucia, Brisbane, Australia.

Background: Lateral elbow tendinopathy (LET) is a common condition that can cause significant disability and associated socioeconomic cost. Although it has been widely researched, outcome measures are highly variable which restricts evidence synthesis across studies. In 2019, a working group of international experts, health care professionals and patients, in the field of tendinopathy (International Scientific Tendinopathy Symposium Consensus (ICON) Group), published the results of a consensus exercise defining the nine core domains that should be measured in tendinopathy research. The aim of this study is to develop a core outcome set (COS) for LET mapping to these core domains. The primary output will provide a template for future outcome evaluation of LET. In this protocol, we detail the methodological approach to the COS-LET development.

Methods: This study will employ a three-phase approach. (1) A systematic review of studies investigating LET will produce a comprehensive list of all instruments currently employed to quantify the treatment effect or outcome. (2) Instruments will be matched to the list of nine core tendinopathy outcome domains by a Steering Committee of clinicians and researchers with a specialist interest in LET resulting in a set of candidate instruments. (3) An international three-stage Delphi study will be conducted involving experienced clinicians, researchers and patients. Within this Delphi study, candidate instruments will be selected based upon screening using the Outcome Measures in Rheumatology (OMERACT) truth, feasibility and discrimination filters with a threshold of 70% agreement set for consensus.

Conclusions: There is currently no COS for the measurement or monitoring of LET in trials or clinical practice. The output from this project will be a minimum COS recommended for use in all future English language studies related to LET. The findings will be published in a high-quality journal and disseminated widely using professional networks, social media and via presentation at international conferences.

Trial Registration: Registered with the Core Outcome Measures in Effectiveness Trials (COMET) database, November 2019. https://www.comet-initiative.org/Studies/Details/1497 .
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http://dx.doi.org/10.1186/s13063-021-05291-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111763PMC
May 2021

Perspectives and experiences of people who were randomly assigned to wait-and-see approach in a gluteal tendinopathy trial: a qualitative follow-up study.

BMJ Open 2021 04 21;11(4):e044934. Epub 2021 Apr 21.

School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia

Objective: To explore participants' perspectives on, and experiences of, being assigned to a wait-and-see arm of a gluteal tendinopathy trial.

Design: Descriptive qualitative.

Setting: General community in Brisbane and Melbourne, Australia.

Participants: Fifteen participants who had been randomly allocated to the wait-and-see group in a recent parallel group superiority clinical trial. That trial compared the wait-and-see approach to a physiotherapist-led education plus exercise approach, and an ultrasound-guided corticosteroid injection. The wait-and-see approach involved one physiotherapy session in which participants received reassurance, general advice and encouragement to stay active for the management of gluteal tendinopathy.

Data Collection And Analysis: Semistructured interviews were conducted by four interviewers in person or over the internet, audio recorded and transcribed verbatim. Transcripts were coded and data analysed using an inductive thematic approach.

Results: Five themes were extracted from the interview transcripts: (1) Feeling disenfranchised by being assigned to a wait-and-see approach; (2) the importance of having a clinical and imaging diagnosis during screening for inclusion into the clinical trial; (3) feelings regarding the effectiveness of the approach; (4) the convenient and easy to follow nature of the wait-and-see approach and (5) the connotation of wait-and-see not always being perceived as an intervention.

Conclusions: Participants found the wait-and-see approach convenient and easy to follow, yet almost always felt disenfranchised that nothing was being done. Participants highlighted the importance of a definite clinical and imaging diagnosis.

Trial Registration Number: ACTRN12612001126808; Post-results.
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http://dx.doi.org/10.1136/bmjopen-2020-044934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061810PMC
April 2021

Effectiveness of Mobilization of the Talus and Distal Fibula in the Management of Acute Lateral Ankle Sprain.

Phys Ther 2021 Apr 20. Epub 2021 Apr 20.

Physiotherapy, Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Leioa, Spain.

Objective: Distal fibula mobilization with movement (MWM), with and without a posterior gliding fibular tape, and anteroposterior mobilization of the talus (MOB) are widely used to treat acute lateral ankle sprains. The purpose of this study was to investigate the short-term and long-term relative effectiveness of these techniques.

Methods: In this double-blind randomized controlled trial, 45 amateur soccer players with acute (<72 hours) lateral ankle sprain were randomly allocated to 6 sessions (3 per week within the first 2 weeks) of either MWM, MWM with tape (MWMtape), or MOB. All participants also received general advice, transcutaneous electrical nerve stimulation (TENS), edema draining massage. and a program of proprioception exercises. Participant ratings of function on the Foot and Ankle Ability Measure (FAAM) and Patient Global Impression of Improvement Scale (PGI-I) were the primary outcomes measured over 52 weeks. Secondary outcomes were ankle pain, pressure pain threshold, range of motion, volume, and strength.

Results: Participants receiving MWM and MWMtape were equally effective and demonstrated greater function on FAAM at 12 and 52 weeks when compared with those receiving MOB; however, the latter demonstrated superior function at 2 weeks. No differences between groups were observed for PGI-I or any of the secondary outcomes.

Conclusion: There are limited differences in the short term among techniques, with the exception of better sport function with MOB. Over the longer term, the distal fibula MWM is most effective to achieve activities of daily living (ADL) and sport function, when added to usual physical therapy care. The addition of a posterior gliding fibular tape provides no additional benefit.

Impact: Distal fibula mobilization with movement may be the most appropriate choice of treatment for acute lateral ankle sprain to achieve long term ADL and sport function. In the short term, antero-posterior mobilization of the talus offers greater improvement in sport function. The use of fibular tape provides no added benefit as an adjunct to a treatment that includes distal fibula mobilization with movement.
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http://dx.doi.org/10.1093/ptj/pzab111DOI Listing
April 2021

Proximal Hamstring Tendinopathy: A Systematic Review of Interventions.

Int J Sports Phys Ther 2021 Apr 2;16(2):288-305. Epub 2021 Apr 2.

Department of Rehabilitation, Nutrition and Sport, La Trobe University; Northern Centre for Health Education and Research, Northern Health.

Background: Proximal hamstring tendinopathy affects athletic and non-athletic populations and is associated with longstanding buttock pain. The condition is common in track and field, long distance running and field-based sports. Management options need to be evaluated to direct appropriate clinical management.

Purpose/hypothesis: To evaluate surgical and non-surgical interventions used in managing proximal hamstring tendinopathy.

Study Design: Systematic review.

Methods: Electronic databases were searched to January 2019. Studies (all designs) investigating interventions for people with proximal hamstring tendinopathy were eligible. Outcomes included symptoms, physical function, quality of life and adverse events. Studies were screened for risk of bias. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Randomized Controlled Trials [RCT]) and the Joanna Briggs Institute Checklist (Case Series). Effect sizes (Standard mean difference or Standard paired difference) of 0.2, 0.5 and 0.8 were considered as small, medium and large respectively. Overall quality of evidence was rated according to GRADE guidelines.

Results: Twelve studies (2 RCTs and 10 case series) were included (n=424; males 229). RCTs examined the following interventions: platelet-rich plasma injection (n=1), autologous whole-blood injection (n=1), shockwave therapy (n=1) and multi-modal intervention (n=1). Case series included evaluation of the following interventions: platelet-rich plasma injection (n=3), surgery (n=4), corticosteroid injection (n=2), multi-modal intervention + platelet-rich plasma injection (n=1). Very low-level evidence found shockwave therapy was more effective than a multi-modal intervention, by a large effect on improving symptoms (-3.22 SMD; 95% CI -4.28, -2.16) and physical function (-2.42 SMD; 95% CI-3.33, -1.50) in the long-term. There was very low-level evidence of no difference between autologous whole-blood injection and platelet-rich plasma injection on physical function (0.17 SMD; 95% CI -0.86, 1.21) to (0.24 SMD; 95% CI -0.76, 1.24) and quality of life (-0.04 SMD; 95%CI -1.05, 0.97) in the medium-term. There was very low-quality evidence that surgery resulted in a large reduction in symptoms (-1.89 SPD; 95% CI -2.36, -1.41) to (-6.02 SPD; 95% CI -8.10, -3.94) and physical function (-4.08 SPD; 95%CI -5.53, -2.63) in the long-term.

Conclusions: There is insufficient evidence to recommend any one intervention over another. A pragmatic approach would be to initially trial approaches proven successful in other tendinopathies.

Level Of Evidence: Level 2a.
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http://dx.doi.org/10.26603/001c.21250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016446PMC
April 2021

Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values.

Br J Sports Med 2021 Mar 30. Epub 2021 Mar 30.

Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia.

Objective: To develop a best practice guide for managing people with plantar heel pain (PHP).

Methods: Mixed-methods design including systematic review, expert interviews and patient survey.

Data Sources: Medline, Embase, CINAHL, SPORTDiscus, Cochrane Central Register of Controlled Trials, trial registries, reference lists and citation tracking. Semi-structured interviews with world experts and a patient survey.

Eligibility Criteria: Randomised controlled trials (RCTs) evaluating any intervention for people with PHP in any language were included subject to strict quality criteria. Trials with a sample size greater than n=38 were considered for proof of efficacy. International experts were interviewed using a semi-structured approach and people with PHP were surveyed online.

Results: Fifty-one eligible trials enrolled 4351 participants, with 9 RCTs suitable to determine proof of efficacy for 10 interventions. Forty people with PHP completed the online survey and 14 experts were interviewed resulting in 7 themes and 38 subthemes. There was good agreement between the systematic review findings and interview data about taping (SMD: 0.47, 95% CI 0.05 to 0.88) and plantar fascia stretching (SMD: 1.21, 95% CI 0.78 to 1.63) for first step pain in the short term. Clinical reasoning advocated combining these interventions with education and footwear advice as the core self-management approach. There was good expert agreement with systematic review findings recommending stepped care management with focused shockwave for first step pain in the short-term (OR: 1.89, 95% CI 1.18 to 3.04), medium-term (SMD 1.31, 95% CI 0.61 to 2.01) and long-term (SMD 1.67, 95% CI 0.88 to 2.45) and radial shockwave for first step pain in the short term (OR: 1.66, 95% CI 1.00 to 2.76) and long term (OR: 1.78, 95% CI 1.07 to 2.96). We found good agreement to 'step care' using custom foot orthoses for general pain in the short term (SMD: 0.41, 95% CI 0.07 to 0.74) and medium term (SMD: 0.55, 95% CI 0.09 to 1.02).

Conclusion: Best practice from a mixed-methods study synthesising systematic review with expert opinion and patient feedback suggests core treatment for people with PHP should include taping, stretching and individualised education. Patients who do not optimally improve may be offered shockwave therapy, followed by custom orthoses.
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http://dx.doi.org/10.1136/bjsports-2019-101970DOI Listing
March 2021

Clinical Tests of Tibialis Posterior Tendinopathy: Are They Reliable, and How Well Are They Reflected in Structural Changes on Imaging?

J Orthop Sports Phys Ther 2021 05 28;51(5):253-260. Epub 2021 Mar 28.

Objective: To determine the reliability of common clinical tests for tibialis posterior tendinopathy (TPT) and to investigate their relationship with grayscale ultrasound findings in individuals who have medial foot/ankle pain.

Design: Prospective cohort.

Methods: Fifty-two individuals reporting medial foot/ankle pain were clinically examined by 2 physical therapists using 4 clinical tests for TPT: pain on tendon palpation, swelling around the tendon, pain/weakness with tibialis posterior contraction, and pain during or inability to perform a single-leg heel raise (SLHR). Individuals also underwent an ultrasound examination by a sonographer. Physical therapists and the sonographer were blind to each other's findings. Positive ultrasound examination included at least 1 of the following grayscale changes: hypoechogenicity, fibrillar disruption, or thickening of the tendon. For reliability between the 2 physical therapists, we calculated kappa coefficients and 95% confidence intervals (CIs). To assess relationships between clinical and imaging findings, we calculated odds ratios and 95% CIs.

Results: The SLHR was the most reliable test, with substantial agreement between physical therapists ( = 0.74; 95% CI: 0.54, 0.93), while the other tests had moderate levels of reliability. Of all clinical tests, the SLHR was most related to grayscale findings on ultrasound (odds ratio = 5.8), but was imprecisely so, with a 95% CI of 1.7 to 20.4.

Conclusion: Of all tests, the SLHR was the most reliable between clinicians and best related to imaging findings in individuals presenting with TPT, aligning with contemporary thinking of tendinopathy as a load-related clinical presentation. There was a disconnect between clinical findings and ultrasound grayscale changes in the tibialis posterior tendon in individuals with TPT. .
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http://dx.doi.org/10.2519/jospt.2021.9707DOI Listing
May 2021

Upper limb position affects pain-free grip strength in individuals with lateral elbow tendinopathy.

Physiother Res Int 2021 Jul 27;26(3):e1906. Epub 2021 Mar 27.

College of Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia.

Background And Purpose: Pain-free grip (PFG) force is commonly used to monitor treatment outcomes in lateral elbow tendinopathy (LET); however, it is unclear whether changes in forearm and elbow position affect PFG force values. This study aims to examine the effect of elbow/shoulder and forearm position on non-normalised and normalised PFG force in individuals with unilateral LET.

Methods: A cohort study including 21 subjects with clinically diagnosed unilateral LET (13 females, mean [SD] age 50 [8] years) performed PFG force (symptomatic arm) and maximal grip (asymptomatic arm) tasks using four upper limb positions: (1) shoulder neutral, elbow flexed (90°), forearm pronated; (2) shoulder neutral, elbow flexed (90°), forearm neutral; (3) shoulder flexed (90°), elbow extended, forearm pronated; and (4) shoulder flexed (90°), elbow extended, forearm neutral. PFG force was normalised to the maximal grip of the asymptomatic side. Repeated-measures analyses of variance were used to compare non-normalised and PFG force normalised to maximal grip between positions.

Results: Both non-normalised and normalised PFG forces were greater in position 2 than position 1, position 3 and position 4 (elbow-by-forearm interaction non-normalised p = 0.002, normalised p = 0.004). There were no differences between positions 1, 3 and 4 for either non-normalised or normalised PFG strength.

Discussion: This study shows that PFG force was higher when performed with forearm neutral supination/pronation, elbow flexion and shoulder neutral than other tested positions, and irrespective of whether PFG force was normalised to the maximal grip force of the contralateral limb. This indicates that arm position should be standardised for comparison.
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http://dx.doi.org/10.1002/pri.1906DOI Listing
July 2021

Influence of transducer orientation on shear wave velocity measurements of the iliotibial band.

J Biomech 2021 05 1;120:110346. Epub 2021 Mar 1.

The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Qld 4072, Australia. Electronic address:

Tissue anisotropy influences estimation of mechanical properties of connective tissues, such as the iliotibial band (ITB). This study investigated the influence of ultrasound transducer rotation and tilt on shear wave velocity (SWV, an index of stiffness) measurements of the ITB and the intra-rater repeatability of SWV measurements in the longitudinal direction. SWV was measured unilaterally (dominant limb) using ultrasound shear wave elastography in the middle region of the ITB in supine at rest (20-25° knee flexion) in ten healthy volunteers (4 females). A 3-dimensional video system provided real-time feedback of probe orientation with respect to the thigh. Measurements were made at 10° increments of probe rotation, from longitudinal to transverse alignment relative to the approximate direction of ITB fibres, and 5-10° tilts about the longitudinal and sideways axes of the transducer. One-way repeated measures ANOVA compared SWV between angles and tilts. Intraclass correlation coefficients (ICCs) and standard error of measurement (SEM) were used to calculate repeatability for two to five (longitudinal only) repetitions. SWV was greatest when the transducer was aligned to ITB fibres (longitudinal: 10.5 ± 1.7 m/s) and lowest when perpendicular (transverse: 5.8 ± 2.4 m/s). Compared to longitudinal alignment, SWV decreased significantly (p < 0.01) when the transducer was rotated 20° or more. Tilted measurements did not differ between angles. Intra-rater repeatability was excellent with the average of two measurements (ICC = 0.99, 95% CI 0.95, 0.99; SEM = 0.31 m/s). These findings show that SWV changes with orientation relative to fibre direction. Transducer orientation requires careful control to ensure comparable measures.
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http://dx.doi.org/10.1016/j.jbiomech.2021.110346DOI Listing
May 2021

Efficacy of a Combination of Conservative Therapies vs an Education Comparator on Clinical Outcomes in Thumb Base Osteoarthritis: A Randomized Clinical Trial.

JAMA Intern Med 2021 Apr;181(4):429-438

Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia.

Importance: A combination of conservative treatments is commonly used in clinical practice for thumb base osteoarthritis despite limited evidence for this approach.

Objective: To determine the efficacy of a 6-week combination of conservative treatments compared with an education comparator.

Design, Setting, And Participants: Randomized, parallel trial with 1:1 allocation ratio among people aged 40 years and older with symptomatic and radiographic thumb base osteoarthritis in a community setting in Australia.

Interventions: The intervention group (n = 102) received education on self-management and ergonomic principles, a base-of-thumb splint, hand exercises, and diclofenac sodium, 1%, gel. The comparator group (n = 102) received education on self-management and ergonomic principles alone. Intervention use was at participants' discretion from 6 to 12 weeks.

Main Outcomes And Measures: Hand function (Functional Index for Hand Osteoarthritis; 0-30) and pain (visual analog scale; 0-100 mm) were measured at week 6 (primary time point) and week 12. An α of .027 was used at week 6 to account for co-primary outcomes.

Results: Of the 204 participants randomized, 195 (96%) and 194 (95%) completed follow-ups at 6 and 12 weeks, respectively; the mean (SD) age of the population was 65.6 (8.1) years, and 155 (76.0%) were female. At week 6, hand function improved significantly more in the intervention group than the comparator (between-group difference, -1.7 units; 97.3% CI, -2.9 to -0.5; P = .002). This trend was sustained at 12 weeks (-2.4 units; 95% CI, -3.5 to -1.3; P < .001). Pain scores improved similarly at week 6 (between-group difference, -4.2 mm; 97.3% CI, -11.3 to 3.0; P = .19). At week 12, pain reduction was significantly greater in the intervention group (-8.6 mm; 95% CI, -15.2 to -2.0; P = .01). There were 34 nonserious adverse events, all in the intervention group-mostly skin reactions and exercise-related pain exacerbations.

Conclusions And Relevance: In this randomized clinical trial of people with thumb base osteoarthritis, combined treatments provided small to medium and potentially clinically beneficial effects on hand function but not pain.

Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12616000353493.
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http://dx.doi.org/10.1001/jamainternmed.2020.7101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941246PMC
April 2021

Hip and knee muscle torque and its relationship with dynamic balance in chronic ankle instability, copers and controls.

J Sci Med Sport 2021 Jul 9;24(7):647-652. Epub 2021 Feb 9.

School of Health and Rehabilitation Sciences, The University of Queensland, Australia. Electronic address:

Objectives: We compared hip and knee isometric muscle torque between individuals with chronic ankle instability (CAI), those who have sustained one ankle sprain with no ongoing problems (copers) and healthy controls. Our secondary objective was to compare balance between groups and investigate the relationship between muscle torque and balance.

Design: Cross-sectional study.

Methods: 22 CAI, 20 copers and 22 uninjured participants were tested. Isometric torque (normalised to body mass (Nm/kg)) was measured using a rigidly-fixated hand-held dynamometer. Balance was assessed with the Y-balance test.

Results: Knee and hip flexor and extensor, and hip adductor and abductor muscle torque was less in individuals with CAI compared to controls (standardised mean difference (SMD) >1.2). Hip and knee flexor and extensor muscle torque was less in CAI participants than copers (SMD: 0.69-1.1). Hip external and internal rotator torque did not differ between groups. There was no difference in hip or knee muscle torque between controls and copers (SMD: 0.01-0. 54). Balance was impaired in CAI participants compared to copers and controls in all directions. There was a strong positive correlation between posterolateral Y-balance test performance and torque of the hip adductors (r=0.53), flexors (r=0.52) and extensors (r=0.50).

Conclusions: Individuals with CAI have weak knee and hip muscles compared to copers and controls. Hip strength was shown to be related to posterolateral balance performance. Future studies may investigate the effect of hip and knee strengthening exercise on ongoing ankle problems, such as episodic giving way in individuals with CAI.
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http://dx.doi.org/10.1016/j.jsams.2021.01.009DOI Listing
July 2021

Contralateral mechanical hyperalgesia and altered pain modulation in men who have unilateral insertional Achilles tendinopathy: A cross-sectional study.

Musculoskelet Sci Pract 2021 04 20;52:102353. Epub 2021 Feb 20.

Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Victoria, Australia; Complete Sports Care, Hawthorn, Victoria, Australia.

Objective: The primary aim was to assess whether men who have insertional Achilles tendinopathy (IAT) have altered endogenous modulation of painful stimuli, and secondarily if they exhibit unaffected-side pressure hyperalgesia.

Methods: Using a cross-sectional design, we recruited men with unilateral IAT and asymptomatic men as controls matched for age, body mass index (BMI) and activity history (participation in running, lower limb loading sport or sedentary). We collected pressure pain threshold (PPT) at the asymptomatic side Achilles tendon insertion for cases, and dominant side Achilles tendon insertion for controls. We compared PPT between groups before and after immersion of the hand in painful cold water.

Results: Twenty men with unilateral IAT (45.4 years [SD 10.02], BMI 29.09 [SD 4.61], 60% sedentary) and 34 men without symptoms (43.2 years [SD 8.78], BMI 27.59 [SD 3.18], 50% sedentary) participated. An interaction effect was found for group x time (F (1,50) = 7.67, p = 0.008), with PPT increase after cold water immersion being 1.20 (95%CI 0.25 to 2.15) Kg greater in the control group (1.44 Kg [SD 1.79]) compared to IAT unaffected side (0.24 Kg [SD 1.47]). Before cold water immersion, PPT was 4.77 (CI 3.22 to 6.31; p < 0.001) Kg greater in the control group.

Discussion: This study provides evidence men with IAT have altered endogenous modulation of a painful stimulus, and display pressure hyperalgesia at their unaffected side compared to men without symptoms. These findings infer alterations to pain processing in men with IAT, suggesting nociplastic mechanism(s) may contribute to pain.
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http://dx.doi.org/10.1016/j.msksp.2021.102353DOI Listing
April 2021

Occupational Therapists, Physiotherapists and Orthopaedic Surgeons Agree on the Decision for Carpal Tunnel Surgery.

Int J Health Policy Manag 2020 Dec 16. Epub 2020 Dec 16.

Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.

Background: Therapist-led pathways have been proposed as waitlist management strategies prior to surgery for conditions such as carpal tunnel syndrome (CTS) in public hospitals. These models of care typically shift the initial care of patients and decision-making from surgeons to therapists and, have been shown to reduce the number of patients requiring surgery and improve wait-times. This occurs despite limited evidence of surgeon-therapist agreement on key decisions, such as the need for surgery. The purpose of this was study was to assess the agreement between therapists and orthopaedic surgeons regarding the need for surgery for patients who have CTS.

Methods: This blinded inter-rated agreement study was embedded in a multicentre randomised parallel groups trial of 105 patients with CTS referred to four orthopaedic departments and waitlisted for an appointment. The trial evaluated the effect of a therapist-led care pathway on the need for surgery and outcomes related to symptoms and function. Patients were randomised to either remain on the orthopaedic waitlist or receive group education, a splint and home exercises. The decision on the need for surgery at 6 months was made by a member of the orthopaedic consultant team or by one of the 14 participating therapists. The therapists and surgeons were blinded to each other's decision. Agreement was determined using percentage agreement, kappa coefficients (k), prevalence-adjusted and bias-adjusted kappa (PABAK), and Gwet's first-order agreement coefficient (AC1).

Results: Substantial agreement was seen between therapists and surgeons regarding the need for surgery (PABAK=0.74 (0.60-0.88)). Agreement was significantly associated with experience (P=.02). Therapists with advanced experience and scope of practice demonstrated perfect agreement with surgeons (PABAK=1.00 (95% CI: 1.00-1.00)). Mid-career therapists demonstrated substantial agreement (PABAK=0.67 (95% CI: 0.42-0.91)) and early-career therapists demonstrated fair agreement (PABAK=0.43 (95% CI: -0.04-0.90)).

Conclusion: Therapists with advanced scope of practice make decisions that are consistent with orthopaedic surgeons.
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http://dx.doi.org/10.34172/ijhpm.2020.227DOI Listing
December 2020

New insights into intrinsic foot muscle morphology and composition using ultra-high-field (7-Tesla) magnetic resonance imaging.

BMC Musculoskelet Disord 2021 Jan 21;22(1):97. Epub 2021 Jan 21.

School of Health and Rehabilitation Sciences, The University of Queensland, 4072, Brisbane, QLD, Australia.

Background: The intrinsic muscles of the foot are key contributors to foot function and are important to evaluate in lower limb disorders. Magnetic resonance imaging (MRI), provides a non-invasive option to measure muscle morphology and composition, which are primary determinants of muscle function. Ultra-high-field (7-T) magnetic resonance imaging provides sufficient signal to evaluate the morphology of the intrinsic foot muscles, and, when combined with chemical-shift sequences, measures of muscle composition can be obtained. Here we aim to provide a proof-of-concept method for measuring intrinsic foot muscle morphology and composition with high-field MRI.

Methods: One healthy female (age 39 years, mass 65 kg, height 1.73 m) underwent MRI. A T1-weighted VIBE - radio-frequency spoiled 3D steady state GRE - sequence of the whole foot was acquired on a Siemens 7T MAGNETOM scanner, as well as a 3T MAGNETOM Prisma scanner for comparison. A high-resolution fat/water separation image was also acquired using a 3D 2-point DIXON sequence at 7T. Coronal plane images from 3T and 7T scanners were compared. Using 3D Slicer software, regions of interest were manually contoured for each muscle on 7T images. Muscle volumes and percentage of muscle fat infiltration were calculated (muscle fat infiltration % = Fat/(Fat + Water) x100) for each muscle.

Results: Compared to the 3T images, the 7T images provided superior resolution, particularly at the forefoot, to facilitate segmentation of individual muscles. Muscle volumes ranged from 1.5 cm and 19.8 cm, and percentage muscle fat infiltration ranged from 9.2-15.0%.

Conclusions: This proof-of-concept study demonstrates a feasible method of quantifying muscle morphology and composition for individual intrinsic foot muscles using advanced high-field MRI techniques. This method can be used in future studies to better understand intrinsic foot muscle morphology and composition in healthy individuals, as well as those with lower disorders.
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http://dx.doi.org/10.1186/s12891-020-03926-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818930PMC
January 2021

Proximal hamstring tendinopathy; expert physiotherapists' perspectives on diagnosis, management and prevention.

Phys Ther Sport 2021 Mar 18;48:67-75. Epub 2020 Dec 18.

La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia; Northern Centre for Health Education and Research, Northern Health, Victoria, Australia.

Objectives: To explore and summarise expert physiotherapists' perceptions on their assessment, management and prevention of proximal hamstring tendinopathy (PHT).

Methods: We conducted semi-structured interviews with expert physiotherapists until data saturation was met (n = 13). Interviews were transcribed verbatim and data were analysed systematically and organised into categories and sub-categories according to study aims.

Results: Experts report using a clinical reasoning-based approach, incorporating information from the patient interview and results of clinical load-based provocation tests, in the physical examination to diagnose PHT. Experts manage the condition through education and progressive loading targeting the hamstring unit and kinetic chain, avoiding provocative activities in positions of compression in early-mid stage rehab and a gradated and controlled return to sport. Passive therapies including injection therapies and surgery were believed to have limited utility. Prevention of recurrence primarily involved continuation of hamstring and kinetic chain strengthening programs and management of physical workload.

Conclusion: Experts rely on a combination of information from the patient interview and a battery of pain provocation tests to diagnose PHT. Education and graded exercise of the hamstring group and synergists, minimising early exposure to hip flexion, were the foundation of management of the condition.
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http://dx.doi.org/10.1016/j.ptsp.2020.12.008DOI Listing
March 2021

A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service.

BMC Musculoskelet Disord 2020 Dec 3;21(1):807. Epub 2020 Dec 3.

Clinical Informatics Directorate, Metro South Hospital and Health Service, Brisbane, Australia.

Background: Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service.

Methods: Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure.

Results: Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17-6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01-1.77) per 10/100 point score increase, p = 0.046).

Conclusions: A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.
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http://dx.doi.org/10.1186/s12891-020-03839-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713165PMC
December 2020

Disability, Physical Impairments, and Poor Quality of Life, Rather Than Radiographic Changes, Are Related to Symptoms in Individuals With Ankle Osteoarthritis: A Cross-sectional Laboratory Study.

J Orthop Sports Phys Ther 2020 Dec;50(12):711-722

Objective: To compare physical and patient-reported outcomes between (1) individuals with symptomatic radiographic ankle osteoarthritis (OA) and asymptomatic individuals, and (2) asymptomatic individuals with and without radiographic ankle OA.

Design: Cross-sectional study.

Methods: Ninety-six volunteers (31 symptomatic individuals with radiographic ankle OA, 41 asymptomatic individuals with radiographic ankle OA, and 24 asymptomatic individuals without radiographic ankle OA) completed a survey on quality of life (QoL), function, pain, disability, kinesiophobia, ankle instability, and physical activity, and undertook physical assessments of ankle muscle strength, heel-raise endurance, dorsiflexion range of motion (ROM), and ambulatory function.

Results: Symptomatic individuals with radiographic ankle OA reported greater pain (standardized mean difference [SMD], 1.70; 95% confidence interval [CI]: 1.18, 2.23), disability (SMD, 1.44; 95% CI: 0.93, 1.95), and instability (SMD, -3.92; 95% CI: -4.68, -3.17), and lower patient-reported function (SMD, -2.10; 95% CI: -2.66, -1.54) and QoL (SMD, -0.98; 95% CI: -1.47, -0.50), than asymptomatic individuals. Muscle strength (all SMDs, -0.73 or greater), heel-raise endurance (SMD, -0.71; 95% CI: -1.16, -0.25), dorsiflexion ROM (SMD, -1.54; 95% CI: -2.02, -1.06), and ambulatory function (all SMDs, 0.57 or greater) were significantly impaired in symptomatic individuals with radiographic ankle OA compared to asymptomatic individuals. Most patient-reported and physical outcomes were similar between asymptomatic individuals with and without radiographic ankle OA.

Conclusion: Individuals with symptomatic radiographic ankle OA had poorer physical outcomes, function, and QoL compared to asymptomatic individuals with and without radiographic ankle OA. This suggests that disability in ankle OA is related to symptoms rather than to radiographic evidence of degeneration. .
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http://dx.doi.org/10.2519/jospt.2020.9376DOI Listing
December 2020

Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis.

Br J Sports Med 2020 Oct 26. Epub 2020 Oct 26.

Centre for General Practice at Aalborg University, Aalborg, Denmark.

Objective: To investigate the comparative effectiveness of all treatments for patellofemoral pain (PFP).

Design: Living systematic review with network meta-analysis (NMA).

Data Sources: Sensitive search in seven databases, three grey literature resources and four trial registers.

Eligibility Criteria: Randomised controlled trials evaluating any treatment for PFP with outcomes 'any improvement', and pain intensity.

Data Extraction: Two reviewers independently extracted data and assessed risk of bias with Risk of Bias Tool V.2. We used Grading of Recommendations, Assessment, Development and Evaluation to appraise the strength of the evidence.

Primary Outcome Measure: 'Any improvement' measured with a Global Rating of Change Scale.

Results: Twenty-two trials (with forty-eight treatment arms) were included, of which approximately 10 (45%) were at high risk of bias for the primary outcome. Most comparisons had a low to very low strength of the evidence. All treatments were better than wait and see for any improvement at 3 months (education (OR 9.6, 95% credible interval (CrI): 2.2 to 48.8); exercise (OR 13.0, 95% CrI: 2.4 to 83.5); education+orthosis (OR 16.5, 95% CrI: 4.9 to 65.8); education+exercise+patellar taping/mobilisations (OR 25.2, 95% CrI: 5.7 to 130.3) and education+exercise+patellar taping/mobilisations+orthosis (OR 38.8, 95% CrI: 7.3 to 236.9)). Education+exercise+patellar taping/mobilisations, with (OR 4.0, 95% CrI: 1.5 to 11.8) or without orthosis (OR 2.6, 95% CrI: 1.7 to 4.2), were superior to education alone. At 12 months, education or education+any combination yielded similar improvement rates.

Summary/conclusion: Education combined with a physical treatment (exercise, orthoses or patellar taping/mobilisation) is most likely to be effective at 3 months. At 12 months, education appears comparable to education with a physical treatment. There was insufficient evidence to recommend a specific type of physical treatment over another. All treatments in our NMA were superior to wait and see at 3 months, and we recommend avoiding a wait-and-see approach.

Prospero Registeration Number: PROSPERO registration CRD42018079502.
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http://dx.doi.org/10.1136/bjsports-2020-102819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982922PMC
October 2020

Response profile of fibular repositioning tape on ankle osteokinematics, arthrokinematics, perceived stability and confidence in chronic ankle instability.

Musculoskelet Sci Pract 2020 12 9;50:102272. Epub 2020 Oct 9.

School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, 4072, Australia.

Background: Preliminary evidence suggests that fibular repositioning tape reduces risk of recurrent ankle injuries, but the underlying mechanism has not been investigated.

Objective: To investigate the effects of fibular repositioning tape on ankle osteokinematics, arthrokinematics and perceived stability and confidence in individuals with chronic ankle instability immediately post-tape and following exercise.

Design: Cross-sectional repeated measures study.

Method: Passive ankle plantarflexion-inversion range of motion, weight-bearing dorsiflexion range of motion, anteroposterior translation, inversion-eversion tilt, and perceived ankle stability and confidence during hopping were assessed before and immediately after the application of fibular repositioning tape and after 15 min of exercise in 14 individuals with chronic ankle instability.

Results: Ankle plantarflexion-inversion range of motion, inversion-eversion tilt and anteroposterior translation were reduced immediately after the application of tape compared to pre-tape (p < 0.01). After exercise, total inversion-eversion tilt was significantly lower than pre-tape (p = 0.01), but there were no differences for any of the other mechanical outcomes. Dorsiflexion range of motion did not differ between conditions (p > 0.11). Perceived ankle stability, ankle and task confidence were greater immediately post-tape and post-exercise compared to pre-tape (p < 0.01).

Conclusions: Fibular repositioning tape was associated with a restriction of ankle total inversion-eversion tilt and improved perceived ankle stability and confidence both immediately after application of tape and after participating in exercise. This data provides grounds for exploring mechanical and psychological mechanisms underpinning any clinical efficacy of fibular repositioning tape.
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http://dx.doi.org/10.1016/j.msksp.2020.102272DOI Listing
December 2020

Patient characteristics associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis: a multisite prospective longitudinal study in an advanced practice physiotherapist-led tertiary service.

BMJ Open 2020 10 6;10(10):e037070. Epub 2020 Oct 6.

Clinical Informatics Directorate, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.

Objectives: To explore patient characteristics recorded at the initial consultation associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis (KOA) in tertiary care.

Design: Prospective multisite longitudinal study.

Setting: Advanced practice physiotherapist-led multidisciplinary orthopaedic service within eight tertiary hospitals.

Participants: 238 patients with KOA.

Primary And Secondary Outcome Measures: Standardised measures were recorded in all patients prior to them receiving non-surgical multidisciplinary management in a tertiary hospital service across multiple sites. These measures were examined for their relationship with a poor response to management 6 months after the initial consultation using a 15-point Global Rating of Change measure (poor response (scores -7 to +1)/positive response (scores+2 to+7)). Generalised linear models with binomial family and logit link were used to examine which patient characteristics yielded the strongest relationship with a poor response to management as estimated by the OR (95% CI).

Results: Overall, 114 out of 238 (47.9%) participants recorded a poor response. The odds of a poor response decreased with higher patient expectations of benefit (OR 0.74 (0.63 to 0.87) per 1/10 point score increase) and higher self-reported knee function (OR 0.67 (0.51 to 0.89) per 10/100 point score increase) (p<0.01). The odds of a poor response increased with a greater degree of varus frontal knee alignment (OR 1.35 (1.03 to 1.78) per 5° increase in varus angle) and a severe (compared with mild) radiological rating of medial compartment degenerative change (OR 3.11 (1.04 to 9.3)) (p<0.05).

Conclusions: These characteristics may need to be considered in patients presenting for non-surgical multidisciplinary management of KOA in tertiary care. Measurement of these patient characteristics may potentially better inform patient-centred management and flag the need for judicious monitoring of outcome for some patients to avoid unproductive care.
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http://dx.doi.org/10.1136/bmjopen-2020-037070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539614PMC
October 2020

Effect of gait retraining on segment coordination and joint variability in individuals with patellofemoral pain.

Clin Biomech (Bristol, Avon) 2020 12 20;80:105179. Epub 2020 Sep 20.

School of Health and Rehabilitation Sciences, Physiotherapy, University of Queensland, Australia.

Background: Gait retraining is advocated for the management of patellofemoral pain. This case series examined changes in lower limb variability following 6-weeks of gait retraining in individuals with patellofemoral pain.

Methods: Six runners with patellofemoral pain completed a 6-week physiotherapist-guided gait retraining program using minimalist footwear and increased cadence. Approximate entropy joint variability and segment coordination variability were calculated across the entire gait cycle during running at baseline, 6 and 12 weeks and compared using repeated measures analysis of variance and the standardised mean difference (SMD).

Findings: Compared to baseline, there were large increases in hip joint transverse plane kinematic variability at 6 (SMD = 1.7) and 12 weeks (SMD = 1.3). Moderate increases in hip joint frontal plane and knee joint sagittal plane kinematic variability were also observed at 6 (SMD = 1.1 & 0.96) and 12 weeks (SMD = 1.1 & 0.89). Knee joint frontal plane and hip joint transverse plane kinetic variability demonstrated large increases from baseline at 6 (SMD = 1.3 & 0.9) and 12 weeks (SMD = 0.9 & 1.0). There was no main effect of time for segment coordination variability. All participants had clinically meaningful improvements in pain (visual analogue change score > 20 mm).

Interpretation: Gait retraining increased joint kinematic and kinetic variability in those with patellofemoral pain and these changes persisted over 12 weeks. Increased variability was observed in joint kinematics and kinetics known to influence patellofemoral joint stress, which may vary patellofemoral joint loading patterns and partly explain the clinical effect.
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http://dx.doi.org/10.1016/j.clinbiomech.2020.105179DOI Listing
December 2020

Pericapsular hip muscle activity in people with and without femoroacetabular impingement. A comparison in dynamic tasks.

Phys Ther Sport 2020 Sep 25;45:135-144. Epub 2020 Jul 25.

The University of Queensland, School of Health & Rehabilitation Sciences, Brisbane, Queensland, 4072, Australia; La Trobe Sport and Exercise Medicine Research Centre (LASEM), College of Science, Health and Engineering, School of Allied Health, La Trobe University, Melbourne, Victoria, 3086, Australia. Electronic address: https://twitter.com/ASemciw.

Objectives: Compare anterior pericapsular muscle activity between individuals with and without femoroacetabular impingement syndrome (FAIS) during dynamic tasks, to investigate whether muscle activity is consistent with a role in retracting the capsule to prevent impingement and active restraint of the femoral head in walking.

Design: Cross-sectional.

Setting: University-laboratory.

Participants: Thirteen athletes with FAIS and 13 pain-free controls.

Main Outcome Measures: Muscle activity was recorded using fine-wire (Iliocapsularis, iliacus and anterior gluteus minimus) and surface (rectus femoris) electromyography (EMG), during three hip flexion tasks (active and assisted hip flexion; squatting) and four walking trials.

Results: Iliocapsularis EMG amplitude was no different between active and assisted hip flexion tasks around 90° of hip flexion in FAIS. There was no difference in EMG between groups in squatting. The pattern of burst activity preceding peak hip extension in iliacus, iliocapsularis, and anterior gluteus minimus was similar in both groups during walking.

Conclusion: In FAIS, similar activation of iliocapsularis during active and assisted hip flexion, despite reduced flexion torque demand in the latter, suggests a role in capsular retraction or enhanced hip joint protection. Pericapsular muscle activity in advance of peak hip extension during walking is consistent with a proposed contribution to femoral head control.
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http://dx.doi.org/10.1016/j.ptsp.2020.06.004DOI Listing
September 2020

HAPPi Kneecaps! Protocol for a participant- and assessor-blinded, randomised, parallel group feasibility trial of foot orthoses for adolescents with patellofemoral pain.

J Foot Ankle Res 2020 Aug 2;13(1):50. Epub 2020 Aug 2.

Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, 4072, Australia.

Background: Patellofemoral pain (PFP) is a common cause of knee pain in adolescents, but there are limited evidence-based treatment options for this population. Foot orthoses can improve pain and function in adults with PFP, and may be effective for adolescents. The primary aim of this study is to determine the feasibility of conducting a full-scale randomised controlled trial (RCT) evaluating the effects of contoured foot orthoses on knee pain severity and patient-perceived global change, compared to flat shoe insoles, in adolescents with PFP. The secondary aim is to provide an estimate of treatment effects for foot orthoses, compared to flat insoles, in adolescents with PFP.

Methods: This randomised, controlled, participant- and assessor-blinded, feasibility trial has two parallel groups. Forty adolescents (aged 12-18 years) with clinical symptoms of PFP will be recruited from Queensland, Australia. Participants will be randomised to receive either prefabricated contoured foot orthoses or flat shoe insoles. Both interventions will be fit by a physiotherapist, and worn for 3 months. Feasibility will be evaluated through assessing willingness of volunteers to enrol, number of eligible participants, recruitment rate, adherence with the study protocol, adverse effects, success of blinding, and drop-out rate. Secondary outcomes will evaluate knee-related pain, symptoms, function, quality of life, global rating of change, patient acceptable symptom state, and use of co-interventions, at 6 weeks and 3 months. Primary outcomes will be reported descriptively, while estimates of standard deviation and between-group differences (with 95% confidence intervals) will be reported for secondary outcomes.

Discussion: Findings of this study will inform the feasibility of a full-scale RCT investigating the efficacy of contoured foot orthoses in adolescents with PFP. This full-scale study is necessary to improve the evidence base for management of adolescent PFP, and enhance outcomes for this population.

Trial Registration: ACTRN12619000957190 .
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http://dx.doi.org/10.1186/s13047-020-00417-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397622PMC
August 2020

Efficacy of different load intensity and time-under-tension calf loading protocols for Achilles tendinopathy (the LOADIT trial): protocol for a randomised pilot study.

Pilot Feasibility Stud 2020 13;6:99. Epub 2020 Jul 13.

Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria 3199 Australia.

Background: Modifying variables in exercise prescription can produce specific effects on Achilles tendinopathy outcomes. This study aims to determine the feasibility of conducting an adequately powered randomised trial in the future to assess the efficacy of different load intensity and time-under-tension exercise parameters for improving pain and function in individuals with persistent midportion Achilles tendinopathy.

Methods: The trial is designed as prospective, four-armed feasibility and randomised pilot trial with 3 months follow-up. Interventions will be provided in a gym setting. The investigator, who will be blind to the allocation of participants, will conduct all pre- and post-intervention assessments. Forty-eight male participants with Achilles tendinopathy will be recruited from the community. We will use a 2 × 2 factorial design with factors of load intensity (six or eighteen repetitions maximum) and time-under-tension (two or six second repetitions). Participants will be randomised into one of the testing groups: six RM with two second repetitions, six RM with six second repetitions, eighteen RM with two second repetitions or eighteen RM with six second repetitions. Trial feasibility will be indicated by the rate of conversion, recruitment and retention, adherence to the interventions by participants, the utility of videoconferencing mode for weekly exercise supervision, incidence of adverse events, and feasibility of future economic evaluation. The secondary clinical outcomes will assess pain and disability, participant impression of change, satisfaction, health-related quality of life, physical activity, work absenteeism, psychological measures at baseline, 6 and 12 weeks, and plantarflexor contractile dysfunction (torque, rate of force development and muscle force steadiness) at baseline and 12 weeks. These clinical outcomes are primarily measured to provide information regarding potential treatment effects and trends.

Discussion: The proposed study and follow-up powered randomised trial will be a first step towards determining exercise dose parameters that may optimise outcomes for Achilles tendinopathy. We have chosen to focus on load intensity and time-under-tension, as these parameters are important for tendon adaptation. This work has the potential to lead to more effective exercise loading interventions for Achilles tendinopathy.

Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12618001315202. Registered retrospectively on August 6th, 2018.
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http://dx.doi.org/10.1186/s40814-020-00639-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359581PMC
July 2020
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