Publications by authors named "Marnee J McKay"

20 Publications

  • Page 1 of 1

Correlates of night-time and exercise-associated lower limb cramps in healthy adults.

Muscle Nerve 2021 Jun 29. Epub 2021 Jun 29.

Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.

Introduction/aims: We explored correlates of night-time and exercise-associated lower limb cramps in participants of the 1000 Norms Project.

Methods: A volunteer community sample of healthy people aged ≥18 y underwent assessment of motor function and physical performance, and were questioned about muscle cramps in the previous 3 mo.

Results: Of 491 (221 female) participants age 18-101 y (mean: 59.12; SD: 18.03), about 1 in 3 experienced night-time lower limb cramps, and about 1 in 4 experienced exercise-associated lower limb cramps. For night-cramps, a one unit increase in Beighton score (greater whole-body flexibility) was associated with a 31% reduced odds of cramps (odds ratio [OR] = 0.69, 95% confidence interval [CI]:0.45, 0.99) and passing all three lesser-toe strength tests was associated with 50% reduced odds of cramps (OR = 0.50, 95% CI: 0.32, 0.78). For exercise-associated cramps, participants in the fourth (lowest arch) quartile of Foot Posture Index were 2.1 times (95% CI: 1.11, 3.95) more likely to experience cramps than participants in the first (highest arch) quartile. Odds of experiencing both types of cramps versus no cramps were lower with passing all three lesser-toe strength tests (OR = 0.40, 95% CI: 0.19, 0.85) and better performance in the six-minute walk test (OR = 0.997, 95% CI: 0.996, 0.998).

Discussion: People who experienced both exercise-associated and night-time cramps were less functional. The association between night-time cramps with less whole-body flexibility and reduced lesser-toe flexor strength should be explored to determine causation. Planovalgus (low-arched) foot type was independently associated with exercise-associated cramps. The effectiveness of foot orthoses for secondary prevention of exercise-associated cramps in people with low-arched feet should be explored.
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http://dx.doi.org/10.1002/mus.27359DOI Listing
June 2021

L-carnitine supplementation for muscle weakness and fatigue in children with neurofibromatosis type 1: A Phase 2a clinical trial.

Am J Med Genet A 2021 Jun 21. Epub 2021 Jun 21.

Orthopaedic Research & Biotechnology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.

Reduced muscle tone, muscle weakness, and physical fatigue can impact considerably on quality of life for children with neurofibromatosis type 1 (NF1). Human muscle biopsies and mouse models of NF1 deficiency in muscle show intramyocellular lipid accumulation, and preclinical data have indicated that L-carnitine supplementation can ameliorate this phenotype. The aim of this study is to examine whether daily L-carnitine supplementation is safe and feasible, and will improve muscle strength and reduce fatigue in children with NF1. A 12-week Phase 2a trial was conducted using 1000 mg daily oral levocarnitine tartrate supplementation. Recruited children were between 8 and 12 years old with a clinical diagnosis of NF1, history of muscle weakness and fatigue, and naïve to L-carnitine. Primary outcomes were safety (self-reporting, biochemical testing) and compliance. Secondary outcomes included plasma acylcarnitine profiles, functional measures (muscle strength, long jump, handwriting speed, 6-minute-walk test [6MWT]), and parent-reported questionnaires (PedsQL™, CBCL/6-18). Six children completed the trial with no self-reported adverse events. Biochemical tests for kidney and liver function were normal, and the average compliance was 95%. Plasma acylcarnitine levels were low, but within a range not clinically linked to carnitine deficiency. For strength measures, there was a mean 53% increase in dorsiflexion strength (95% confidence interval [CI] 8.89-60.75; p = 0.02) and mean 66% increase in plantarflexion strength (95% CI 12.99-134.1; p = 0.03). In terms of muscle performance, there was a mean 10% increase in long jump distance (95% CI 2.97-16.03; p = 0.01) and 6MWT distance (95% CI 5.88-75.45; p = 0.03). Comparison with the 1000 Norms Project data showed a significant improvement in Z-score for all of these measures. Parent reports showed no negative impact on quality of life, and the perceived benefits led to the majority of individuals remaining on L-carnitine after the study. Twelve weeks of L-carnitine supplementation is safe and feasible in children with NF1, and a Phase 3 trial should confirm the efficacy of treatment.
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http://dx.doi.org/10.1002/ajmg.a.62392DOI Listing
June 2021

Is there a relationship between sagittal cervical spine mobility and generalised joint hypermobility? A cross-sectional study of 1000 healthy Australians.

Physiotherapy 2021 Jan 2;112:150-157. Epub 2021 Jan 2.

The University of Sydney, School of Medical Sciences, Faculty of Medicine and Health, Camperdown, NSW 2006, Australia. Electronic address:

Objectives: The primary aim was to determine the association between sagittal cervical mobility and the presence and extent of GJH across the lifespan. Secondary aims were to determine which features explain variability in cervical range of motion (CROM) and to establish the sagittal cervical hypermobile range in both genders across the lifespan.

Design: Cross-sectional observational study. Spearman's rho determined the relationship between presence and extent of GJH and CROM, age, gender and ethnicity. Multiple regression identified the factors explaining variability in CROM. The hypermobile CROM was identified as the upper 5% of flexion, extension and combined ranges for age and gender.

Setting: University laboratory in Sydney Australia.

Participants: One thousand healthy individuals, aged 3-101 years.

Outcome Measures: Cervical active range of motion was assessed using an inclinometer, extent of and presence of generalised joint hypermobility were assessed using the Beighton scoring system and age- and gender-specific criteria respectively.

Results: CROM correlated positively with GJH (Beighton score as a continuous or dichotomous age and gender specific variable) (rho=0.12-0.50; p < 0.001) and negatively with age (rho=0.54; p < 0.001). Age, gender and extent of GJH (Beighton as a continuous score) accounted for 19 to 51% of variability in CROM. Cut-offs for cervical hypermobility were calculated across the lifespan.

Conclusions: Increased sagittal CROM was observed in individuals identified with GJH. Extension CROM decreased with age more than flexion; the greatest loss in the second and third decades. CROM screening is warranted for patients identified with GJH and for rehabilitation goal-setting.
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http://dx.doi.org/10.1016/j.physio.2020.12.003DOI Listing
January 2021

Joint hypermobility and its association with self-reported knee health: A cross-sectional study of healthy Australian adults.

Int J Rheum Dis 2021 May 17;24(5):687-693. Epub 2021 Mar 17.

Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia.

Aim: The primary aim of this study was to determine the association between generalized joint hypermobility (GJH), knee-specific hypermobility (KSH) and self-reported knee health in an Australian population. Secondary aims included elucidating ethnic/gender differences in GJH/KSH prevalence and knee health, and identifying KSH using a novel knee extension range of motion cut-off method.

Method: Knee extension range, Beighton score, and 5 domains of the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected from adults aged 18-101 years self-identifying as healthy, and were grouped by ethnicity and gender. Two established Beighton score criteria and 1 novel knee extension range cut-off method were used to determine GJH and KSH respectively. Point-biserial correlation tested the associations between GJH/KSH and KOOS. Differences in GJH/KSH prevalence and knee health between ethnic/gender groups were determined with the Chi-squared test.

Results: Of 732 participants (50% male), 80.3% were Caucasian. No correlations were found between GJH and KOOS while a very weak correlation was found between KSH and 1 KOOS domain (r > -.30; P = .04). Prevalence of GJH was higher in non-Caucasians (17.4% vs 5.6%, P < .001) and females (4.4% vs 1.1%, P = .007). Prevalence of KSH between ethnic and gender groups was not significantly different (P = .50 and P = .69 respectively). Non-Caucasians scored higher (better) in all KOOS domains than Caucasians (all P < .05).

Conclusion: Those who met the age- and gender-specific criteria for GJH/KSH did not report worse knee health than their non-hypermobile counterparts. Clinicians can assure individuals who exhibit GJH/KSH that these are not associated with lower knee health and function.
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http://dx.doi.org/10.1111/1756-185X.14096DOI Listing
May 2021

12-Month progression of motor and functional outcomes in congenital myotonic dystrophy.

Muscle Nerve 2021 03 10;63(3):384-391. Epub 2021 Jan 10.

Department of Neurology, Virginia Commonwealth University Health, Richmond, Virginia, USA.

Background: We aim to describe 12-mo functional and motor outcome performance in a cohort of participants with congenital myotonic dystrophy (CDM).

Methods: CDM participants performed the 6 Minute Walk Test (6MWT), 10 Meter Run, 4 Stair Climb, Grip Strength, and Lip Force at baseline and 12-mo visits. Parents completed the Vineland Adaptive Behavior Scale.

Results: Forty-seven participants, aged 0 to 13 y old, with CDM were enrolled. 6MWT, 10 Meter Run, and 4 Stair Climb were completed in >85% of eligible participants. The only significant difference between mean baseline and 12-mo performance was an improvement in 6MWT in children 3-6 y old (P = .008). This age group also had the largest mean % improvement in performance in all other timed functional testing. In children >7 y, the slope of change on timed functional tests decreased or plateaued, with further reductions in performance in children ≥10 y. Participants with CTG repeat lengths <500 did not perform differently than those with repeat lengths >1000.

Conclusions: The 6MWT, 10 Meter Run, and 4 Stair Climb were the most feasible measures. Our findings are consistent with the clinical profile and prior cross-sectional data, helping to establish reasonable expectations of functional trajectories in this population as well as identifying points in which therapeutic interventions may be best studied. Further study of outcomes in children >10 y old and <3 y is warranted, but this new information will assist planning of clinical trials in the CDM population.
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http://dx.doi.org/10.1002/mus.27147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038871PMC
March 2021

Physical performance of children with longitudinal fibular deficiency (fibular hemimelia).

Disabil Rehabil 2020 Dec 17:1-11. Epub 2020 Dec 17.

Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.

Purpose: Longitudinal fibular deficiency (LFD) is the most common congenital long bone deficiency. This study aimed to objectively assess the physical performance of children and adolescents with LFD compared with unaffected peers, and to examine trends over age for subgroups of the LFD population.

Methods: Differences between children with LFD and unaffected peers were examined with hand-held dynamometry for lower-limb muscle strength, Six-Minute Walk Test, Timed up and down stairs test, Star Excursion Balance Test, and Standing long jump.

Results: Thirty-nine children with LFD and 284 unaffected peers participated. Children with LFD performed at a lower level than their unaffected peers, on all measures of physical performance (mean 2.1 -scores lower, all  < 0.01), except in long jump ( = 0.27). When comparing the performance of children with LFD to their unaffected peers across four age groups, there was a significant between-groups difference on all strength measures, and on the Six-Minute Walk distance, between children with and without LFD. These differences were smallest in young children (3-6 years) and largest in the older children (15-18 years) (all  < 0.01). Children with no lengthening surgery performed better on the Six-Minute Walk Test, covering a greater distance during the test, than those who had surgery (mean difference 83 metres,  < 0.01). There were no significant differences between children who had or had not undergone an amputation.

Conclusions: Children with LFD performed at a significantly lower level than unaffected peers on all measures of physical performance other than jumping. The largest differences were in older children. This paper provides baseline functional data for future interventions in LFD.

Level Of Evidence: Cross-sectional study.Implications for RehabilitationThis paper provides the first baseline functional data using validated objective measures on a consecutive cohort of children and adolescents with longitudinal fibular deficiency.Children with LFD performed significantly worse than their unaffected peers on all measures of physical performance other than jumping, with children falling further behind their peers as they age.Children who undergo an amputation typically have the most severe anatomical presentation and yet perform at an equivalent functional level.This paper identifies multiple modifiable impairments that represent potential opportunities for rehabilitation professionals to target with conservative treatment options to improve functional performance.
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http://dx.doi.org/10.1080/09638288.2020.1849420DOI Listing
December 2020

Limited Support for Trunk and Hip Deficits as Risk Factors for Athletic Knee Injuries: A Systematic Review With Meta-analysis and Best-Evidence Synthesis.

J Orthop Sports Phys Ther 2020 09 1;50(9):476-489. Epub 2020 Aug 1.

Objective: To determine whether neuromuscular deficits in trunk and hip-related function are risk factors for athletic knee injuries.

Design: Etiology systematic review with meta-analysis.

Literature Search: Six online databases (MEDLINE, Web of Science, Embase, CINAHL, Scopus, and SPORTDiscus) were searched up to April 2019.

Study Selection Criteria: Studies assessing trunk and hip neuromuscular function as risk factors for knee injuries in healthy athletic populations were included.

Data Synthesis: Outcomes were synthesized quantitatively using meta-analysis of odds ratios, and qualitatively using best-evidence synthesis.

Results: Twenty-one studies met the inclusion criteria. There was very low-certainty evidence that greater hip external rotation strength protected against knee injuries (odds ratio = 0.78; 95% confidence interval: 0.70, 0.87; <.05). There was limited evidence that deficits in trunk proprioception and neuromuscular control, and the combination of excessive knee valgus and ipsilateral trunk angle when landing unilaterally from a jump, may be risk factors for knee injuries.

Conclusion: Most variables of trunk and hip function were not risk factors for injuries. Further research is required to confirm whether hip external rotation strength, trunk proprioception and neuromuscular control, and the combination of knee valgus angle and ipsilateral trunk control are risk factors for future knee injuries. .
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http://dx.doi.org/10.2519/jospt.2020.9705DOI Listing
September 2020

Feasibility of the Archercise biofeedback device to strengthen foot musculature.

J Foot Ankle Res 2020 Jul 13;13(1):43. Epub 2020 Jul 13.

The University of Sydney, School of Health Sciences, Faculty of Medicine and Health, Lidcombe, New South Wales, 2141, Australia.

Background: Foot muscle weakness can produce foot deformity, pain and disability. Toe flexor and foot arch exercises focused on intrinsic foot muscle strength and functional control may mitigate the progression of foot deformity and disability. Ensuring correct exercise technique is challenging due to the specificity of muscle activation required to complete some foot exercises. Biofeedback has been used to improve adherence, muscle activity and movement patterns. We investigated the feasibility of using a novel medical device, known as "Archercise", to provide real-time biofeedback of correct arch movement via pressure change in an inflatable bladder, and foot location adherence via sensors embedded in a footplate during four-foot exercises.

Methods: Thirty adults (63% female, aged 23-68 years) performed four-foot exercises twice on the Archercise sensor footplate alone and then with biofeedback. One-way repeated measures ANOVA with pairwise comparisons were computed to assess the consistency of the exercise protocol between trial 1 and trial 2 (prior to biofeedback), and the effectiveness of the Archercise biofeedback device between trial 2 and trial 3 (with biofeedback). Outcome measures were: Arch movement exercises of arch elevation and lowering speed, controlled arch elevation, controlled arch lowering, endurance of arch elevation; Foot location adherence was determined by percentage of time the great toe, fifth toe and heel contacted footplate sensors during testing and were analysed with paired sample t-tests. Participant survey comments on the use of Archercise with biofeedback were reported thematically.

Results: Seventeen (89%) arch movement and foot location variables were collected consistently with Archercise during the foot exercises. Archercise with biofeedback improved foot location adherence for all exercises (p = 0.003-0.008), coefficient of determination for controlled arch elevation (p < 0.0001) and endurance area ratio (p = 0.001). Twenty-nine (97%) participants reported Archercise with biofeedback, helped correct exercise performance.

Conclusions: Archercise is a feasible biofeedback device to assist healthy participants without foot pathologies perform foot doming exercises.

Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): 12616001559404. Registered 11 November 2016, http://www.ANZCTR.org.au/ACTRN12616001559404p.aspx.
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http://dx.doi.org/10.1186/s13047-020-00394-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359285PMC
July 2020

Limitations of 6-minute walk test reference values for spinal muscular atrophy.

Muscle Nerve 2020 03 16;61(3):375-382. Epub 2020 Jan 16.

Department of Rehabilitation and Regenerative Medicine, Program in Physical Therapy, Columbia University Irving Medical Center, New York, New York.

Introduction: The 6-minute walk test (6MWT) is a well-established clinical assessment of functional endurance, validated as a measure of walking ability in spinal muscular atrophy (SMA). The current availability of disease-modifying therapies for SMA indicates a growing need for normative reference data to compare SMA patients with healthy controls.

Methods: The literature was searched in two scientific databases. Studies were evaluated and selected based on adherence to American Thoracic Society guidelines for administering the 6MWT. Reference equations from the selected studies were applied to 6MWT data collected from SMA patients to calculate and compare % predicted values.

Results: Three pediatric and six adult studies were selected for comparison. The % predicted values using the pediatric and adult equations ranged from 47.7 ± 18.2% to 67.6 ± 26.2% and 43.0 ± 17.9% to 59.5 ± 26.2%, respectively, and were significantly different (P < 0.001).

Discussion: Results suggest significant variability between % predicted values derived from published reference equations in children and adults, despite adherence to 6MWT standardization.
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http://dx.doi.org/10.1002/mus.26794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7024648PMC
March 2020

Can pedobarography predict the occurrence of heel rocker in children with lower limb spasticity?

Clin Biomech (Bristol, Avon) 2020 01 23;71:208-213. Epub 2019 Oct 23.

Paediatric Gait Analysis Service of NSW, Sydney Children's Hospitals Network (Randwick and Westmead), Sydney, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia.

Background: Pedobarography software calculates the centre-of-pressure trajectory in relation to the foot to quantify foot contact patterns. This study presents two new pedobarography measures using the centre-of-pressure trajectory to assess heel rocker.

Methods: To validate these pedobarography measures against 3D gait analysis, emed-x and Vicon Nexus gait analysis data were captured from 25 children aged 8-16 years (11 male) with unilateral (n = 18) and bilateral (n = 7) cerebral palsy or acquired brain injury. 3D gait analysis identified whether heel rocker was intact (n = 22 feet) or absent (n = 28 feet) based on centre-of-pressure at initial contact and the ankle kinematic curve between 0 and 2% of the gait cycle. Pedobarography measures calculated from the initial centre-of-pressure point were the distance to the heel (point of initial contact) and to the most posterior point of the trajectory (rollback), reported as a percentage of foot length.

Findings: The median point of initial contact in limbs with an intact heel rocker was 9% (range 7-12%) and median rollback was 0% (range 0-0.2%), whereas the median point of initial contact in limbs with an absent heel rocker was 58% (range 8-78%) and rollback was 18% (range 0-40%). Point of initial contact is the more accurate method for predicting heel rocker, with a threshold of 14% of foot length identifying the correct heel rocker status in 94% of cases.

Interpretation: Point of initial contact can assess heel rocker with high accuracy. Both point of initial contact and rollback provide sensitive information on foot strike pattern, enhancing the utility of pedobarography.
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http://dx.doi.org/10.1016/j.clinbiomech.2019.10.022DOI Listing
January 2020

Longitudinal Fibular Deficiency: A Cross-Sectional Study Comparing Lower Limb Function of Children and Young People with That of Unaffected Peers.

Children (Basel) 2019 Mar 15;6(3). Epub 2019 Mar 15.

Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales 2109, Australia.

Longitudinal fibular deficiency (LFD), or fibular hemimelia, is congenital partial or complete absence of the fibula. We aimed to compare the lower limb function of children and young people with LFD to that of unaffected peers. A cross-sectional study of Australian children and young people with LFD, and of unaffected peers, was undertaken. Twenty-three (12 males) children and young people with LFD (74% of those eligible) and 213 unaffected peers, all aged 7⁻21 years were subject to the Knee Osteoarthritis Outcome Score (KOOS/KOOS-Child) and the Cumberland Ankle Instability Tool (CAIT/CAIT-Youth). Linear regression models compared affected children and young people to unaffected peers. Participants with LFD scored lower in both outcomes (adjusted < 0.05). The difference between participants with LFD and unaffected peers was significantly greater among younger participants than older participants for KOOS activities and sports domain scores (adjusted ≤ 0.01). Differences in the other KOOS domains (pain/symptoms/quality of life) and ankle function (CAIT scores) were not affected by age (adjusted ≥ 0.08). Children and young people with LFD on average report reduced lower limb function compared to unaffected peers. Knee-related activities and sports domains appear to be worse in younger children with LFD, and scores in these domains become closer to those of unaffected peers as they become older.
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http://dx.doi.org/10.3390/children6030045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463130PMC
March 2019

What are the similarities and differences between healthy people with and without pain?

Scand J Pain 2018 01;18(1):39-47

The University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia.

Background And Aims: Knowledge of pain characteristics among the healthy population or among people with minimal pain-related disability could hold important insights to inform clinical practice and research. This study investigated pain prevalence among healthy individuals and compared psychosocial and physical characteristics between adults with and without pain.

Methods: Data were from 1,000 self-reported healthy participants aged 3-101 years (1,000 Norms Project). Single-item questions assessed recent bodily pain ("none" to "very severe") and chronic pain (pain every day for 3 months in the previous 6 months). Assessment of Quality of Life (AQoL) instrument, New Generalised Self-Efficacy Scale, International Physical Activity Questionnaire, 6-min walk test, 30-s chair stand and timed up-and-down stairs tests were compared between adults with and without pain.

Results: Seventy-two percent of adults and 49% of children had experienced recent pain, although most rated their pain as mild (80% and 87%, respectively). Adults with recent pain were more likely to be overweight/obese and report sleep difficulties, and had lower self-efficacy, AQoL mental super dimension scores and sit-to-stand performance, compared to adults with no pain (p<0.05). Effect sizes were modest (Cohen's d=0.16-0.39), therefore unlikely clinically significant. Chronic pain was reported by 15% of adults and 3% of children. Adults with chronic pain were older, more likely to be overweight/obese, and had lower AQoL mental super dimension scores, 6-min walk, sit-to-stand and stair-climbing performance (p<0.05). Again, effect sizes were modest (Cohen's d=0.25-0.40).

Conclusions: Mild pain is common among healthy individuals. Adults who consider themselves healthy but experience pain (recent/chronic) display slightly lower mental health and physical performance, although these differences are unlikely clinically significant.

Implications: These findings emphasise the importance of assessing pain-related disability in addition to prevalence when considering the disease burden of pain. Early assessment of broader health and lifestyle risk factors in clinical practice is emphasised. Avenues for future research include examination of whether lower mental health and physical performance represent risk factors for future pain and whether physical activity levels, sleep and self-efficacy are protective against chronic pain-related disability.
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http://dx.doi.org/10.1515/sjpain-2017-0156DOI Listing
January 2018

Spatiotemporal and plantar pressure patterns of 1000 healthy individuals aged 3-101 years.

Gait Posture 2017 10 18;58:78-87. Epub 2017 Jul 18.

The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), New South Wales, Australia. Electronic address:

Objective: The purpose of this study was to establish normative reference values for spatiotemporal and plantar pressure parameters, and to investigate the influence of demographic, anthropometric and physical characteristics.

Methods: In 1000 healthy males and females aged 3-101 years, spatiotemporal and plantar pressure data were collected barefoot with the Zeno™ walkway and Emed platform. Correlograms were developed to visualise the relationships between widely reported spatiotemporal and pressure variables with demographic (age, gender), anthropometric (height, mass, waist circumference) and physical characteristics (ankle strength, ankle range of motion, vibration perception) in children aged 3-9 years, adolescents aged 10-19 years, adults aged 20-59 years and older adults aged over 60 years.

Results: A comprehensive catalogue of 31 spatiotemporal and pressure variables were generated from 1000 healthy individuals. The key findings were that gait velocity was stable during adolescence and adulthood, while children and older adults walked at a comparable slower speed. Peak pressures increased during childhood to older adulthood. Children demonstrated highest peak pressures beneath the rearfoot whilst adolescents, adults and older adults demonstrated highest pressures at the forefoot. Main factors influencing spatiotemporal and pressure parameters were: increased age, height, body mass and waist circumference, as well as ankle dorsiflexion and plantarflexion strength.

Conclusion: This study has established whole of life normative reference values of widely used spatiotemporal and plantar pressure parameters, and revealed changes to be expected across the lifespan.
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http://dx.doi.org/10.1016/j.gaitpost.2017.07.004DOI Listing
October 2017

Relationship between physical performance and self-reported function in healthy individuals across the lifespan.

Musculoskelet Sci Pract 2017 08 2;30:10-17. Epub 2017 May 2.

Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), Australia.

Background: Functional outcome measures in clinical trials of musculoskeletal conditions need to be meaningful to individuals.

Objectives: To investigate the relationship between physical performance and self/proxy-reported function in 1000 healthy children and adults.

Design: Cross-sectional observational study (1000 Norms Project).

Methods: One thousand males and females aged 3-101 years, healthy by self-report and without major physical disability, were recruited. Twelve performance-based tests were analysed: vertical and long jump, two hand dexterity tests, four balance tests, stepping reaction time, 30-second chair stand, timed up-and-down stairs, and six-minute walk. Self/proxy-reported function was assessed using the Infant-Toddler Quality of Life questionnaire, Child Health Questionnaire, Assessment of Quality of Life (AQoL)-6D Adolescent, AQoL-8D, International Physical Activity Questionnaire and work ability question. Bivariate and multivariate correlational analyses were constructed for infants (3-4y), children (5-10y), adolescents (11-17y), adults (18-59y) and older adults (60+).

Results/findings: Socio-demographic characteristics were similar to the Australian population. Among infants/children, greater jump and sit-to-stand performance correlated with higher proxy-reported function (p < 0.05). There were no significant relationships observed for adolescents (p > 0.05). Greater jump, dexterity, balance, reaction time, sit-to-stand, stair-climbing and six-minute walk performance correlated with higher self-reported function in adults (r = -0.097 to.231; p < 0.05) and older adults (r = -0.135 to 0.625; p < 0.05). Multivariate regression modelling revealed a collection of independent performance measures explaining up to 46% of the variance in self/proxy-reported function.

Conclusions: Many performance-based tests were significantly associated with self/proxy-reported function. We have identified a set of physical measures which could form the basis of age-appropriate functional scales for clinical trials of musculoskeletal conditions.
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http://dx.doi.org/10.1016/j.msksp.2017.05.001DOI Listing
August 2017

Reference values and factors associated with musculoskeletal symptoms in healthy adolescents and adults.

Musculoskelet Sci Pract 2017 06 23;29:99-107. Epub 2017 Mar 23.

Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, University of Sydney, Australia; Paediatric Gait Analysis Service of New South Wales, Sydney Children's Hospitals Network (Randwick and Westmead), Australia.

Background: Insufficient attention has been given to individuals who report musculoskeletal symptoms yet experience minimal disability.

Objectives: To examine musculoskeletal symptoms among healthy individuals, and compare demographic, psychological and physical factors between individuals with and without symptoms.

Design: Cross-sectional observational study.

Method: Data were from the 1000 Norms Project which recruited 1000 individuals aged 3-101 years. Participants were healthy by self-report and had no major physical disability. Musculoskeletal symptoms (ache/pain/discomfort, including single-site and multi-site symptoms) were assessed in adolescents (11-17y) and adults (18-101y) using the Extended Nordic Musculoskeletal Questionnaire (NMQ-E). To compare individuals with single-site, multi-site and no symptoms, body mass index, grip strength, 6-min walk, 30-s chair stand and timed up-and-down stairs (all participants), and mental health, sleep difficulties, self-efficacy and physical activity (adults), were collected.

Results: /findings: Socio-demographic characteristics were similar to the Australian population. Twelve-month period prevalence of all symptoms was 69-82%; point prevalence was 23-39%. Adults with single-site symptoms were more likely to be overweight/obese and had lower sit-to-stand and stair-climbing performance (p < 0.05). Adults with multi-site symptoms were more likely to be female and overweight/obese, had lower mental health, greater sleep difficulties and lower grip strength, 6-min walk and sit-to-stand performance (p < 0.05). Differences were only observed among 50-59, 60-69, 70-79 and 80-101 year-olds.

Conclusions: Normative reference data for the NMQ-E have been generated. Musculoskeletal symptoms are common among healthy individuals. In older adults, musculoskeletal symptoms are linked with overweight/obesity, lower mental health, sleep difficulties and lower physical performance, emphasising the importance of multi-dimensional assessments in musculoskeletal disorders.
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http://dx.doi.org/10.1016/j.msksp.2017.03.010DOI Listing
June 2017

Reference values for developing responsive functional outcome measures across the lifespan.

Neurology 2017 Apr 22;88(16):1512-1519. Epub 2017 Mar 22.

From the Arthritis and Musculoskeletal Research Group (M.J.M., J.N.B., P.F., M.S., J.B.), Faculty of Health Sciences, University of Sydney, New South Wales, Australia; Sport, Health and Exercise Science (N.V.), School of Life Sciences, University of Hull, UK; Faculty of Health Sciences (J.B.), University of Sydney and Sydney Children's Hospitals Network (Randwick and Westmead); and Paediatric Gait Analysis Service of New South Wales (J.B.), Children's Hospital at Westmead, Sydney, Australia.

Objective: To generate a reference dataset of commonly performed functional outcome measures in 1,000 children and adults and investigate the influence of demographic, anthropometric, strength, and flexibility characteristics.

Methods: Twelve functional outcome measures were collected from 1,000 healthy individuals aged 3-101 years: 6-minute walk test, 30-second chair stand test, timed stairs test, long jump, vertical jump, choice stepping reaction time, balance (Star Excursion Balance Test, tandem stance eyes open and closed, single-leg stance eyes closed), and dexterity (9-hole peg test, Functional Dexterity Test). Correlation and multiple regression analyses were performed to identify factors independently associated with each measure.

Results: Age- and sex-stratified reference values for functional outcome measures were generated. Functional performance increased through childhood and adolescence, plateaued during adulthood, and declined in older adulthood. While balance did not differ between the sexes, male participants generally performed better at gross motor tasks while female participants performed better at dexterous tasks. Height was the most consistent correlate of functional performance in children, while lower limb muscle strength was a major determinant in adolescents and adults. In older adults, age, lower limb strength, and joint flexibility explained up to 63% of the variance in functional measures.

Conclusions: These normative reference values provide a framework to accurately track functional decline associated with neuromuscular disorders and assist development and validation of responsive outcome measures for therapeutic trials.
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http://dx.doi.org/10.1212/WNL.0000000000003847DOI Listing
April 2017

Repeatability, consistency, and accuracy of hand-held dynamometry with and without fixation for measuring ankle plantarflexion strength in healthy adolescents and adults.

Muscle Nerve 2017 Nov 30;56(5):896-900. Epub 2017 May 30.

Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Australia.

Introduction: Hand-held dynamometry (HHD) is commonly used to measure ankle plantarflexion strength but has variable reliability measuring higher forces. Fixed HHD is suggested to improve reliability. We, therefore, compared the reliability, consistency, and accuracy of measuring plantarflexion strength.

Methods: Plantarflexion strength was measured in 25 healthy individuals with fixed HHD and HHD alone. Intraclass correlation coefficients (ICC ), SEM, minimal detectable change, and Spearman correlation coefficients were calculated to assess inter-trial repeatability, consistency, agreement, and accuracy.

Results: Both methods were repeatable (ICC 0.96 to 0.98) and highly correlated (Spearman rho = 0.815; P < 0.01). Fixed HHD produced significantly higher force outputs. HHD alone provided more consistent force values.

Conclusions: Both methods of measuring ankle plantarflexion force were reliable. Force measured with fixed HHD will likely be more accurate for adults and individuals with greater strength, while HHD alone will be more consistent for individuals with lower strength. Muscle Nerve 56: 896-900, 2017.
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http://dx.doi.org/10.1002/mus.25576DOI Listing
November 2017

Normative reference values for strength and flexibility of 1,000 children and adults.

Neurology 2017 Jan 23;88(1):36-43. Epub 2016 Nov 23.

From the Faculty of Health Sciences (M.J.M., J.N.B., P.F., M.S., J.B.), University of Sydney, New South Wales, Australia; Department of Sport, Health and Exercise Science (N.V.), University of Hull, UK; and Sydney Children's Hospitals Network (Randwick and Westmead) and Paediatric Gait Analysis Service of New South Wales (J.B.), Children's Hospital at Westmead, Sydney, Australia.

Objective: To establish reference values for isometric strength of 12 muscle groups and flexibility of 13 joint movements in 1,000 children and adults and investigate the influence of demographic and anthropometric factors.

Methods: A standardized reliable protocol of hand-held and fixed dynamometry for isometric strength of ankle, knee, hip, elbow, and shoulder musculature as well as goniometry for flexibility of the ankle, knee, hip, elbow, shoulder, and cervical spine was performed in an observational study investigating 1,000 healthy male and female participants aged 3-101 years. Correlation and multiple regression analyses were performed to identify factors independently associated with strength and flexibility of children, adolescents, adults, and older adults.

Results: Normative reference values of 25 strength and flexibility measures were generated. Strong linear correlations between age and strength were identified in the first 2 decades of life. Muscle strength significantly decreased with age in older adults. Regression modeling identified increasing height as the most significant predictor of strength in children, higher body mass in adolescents, and male sex in adults and older adults. Joint flexibility gradually decreased with age, with little sex difference. Waist circumference was a significant predictor of variability in joint flexibility in adolescents, adults, and older adults.

Conclusions: Reference values and associated age- and sex-stratified z scores generated from this study can be used to determine the presence and extent of impairments associated with neuromuscular and other neurologic disorders, monitor disease progression over time in natural history studies, and evaluate the effect of new treatments in clinical trials.
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http://dx.doi.org/10.1212/WNL.0000000000003466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5200854PMC
January 2017

Correlates of Perceived Ankle Instability in Healthy Individuals Aged 8 to 101 Years.

Arch Phys Med Rehabil 2017 01 22;98(1):72-79. Epub 2016 Sep 22.

Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia; Paediatric Gait Analysis Service of New South Wales, The Sydney Children's Hospitals Network, Randwick and Westmead, Australia.

Objectives: To provide reference data for the Cumberland Ankle Instability Tool (CAIT) and to investigate the prevalence and correlates of perceived ankle instability in a large healthy population.

Design: Cross-sectional observational study.

Setting: University laboratory.

Participants: Self-reported healthy individuals (N=900; age range, 8-101y, stratified by age and sex) from the 1000 Norms Project.

Interventions: Not applicable.

Main Outcome Measures: Participants completed the CAIT (age range, 18-101y) or CAIT-Youth (age range, 8-17y). Sociodemographic factors, anthropometric measures, hypermobility, foot alignment, toes strength, lower limb alignment, and ankle strength and range of motion were analyzed.

Results: Of the 900 individuals aged 8 to 101 years, 203 (23%) had bilateral and 73 (8%) had unilateral perceived ankle instability. The odds of bilateral ankle instability were 2.6 (95% confidence interval [CI], 1.7-3.8; P<.001) times higher for female individuals, decreased by 2% (95% CI, 1%-3%; P=.001) for each year of increasing age, increased by 3% (95% CI, 0%-6%; P=.041) for each degree of ankle dorsiflexion tightness, and increased by 4% (95% CI, 2%-6%, P<.001) for each centimeter of increased waist circumference.

Conclusions: Perceived ankle instability was common, with almost a quarter of the sample reporting bilateral instability. Female sex, younger age, increased abdominal adiposity, and decreased ankle dorsiflexion range of motion were independently associated with perceived ankle instability.
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http://dx.doi.org/10.1016/j.apmr.2016.08.474DOI Listing
January 2017

1000 Norms Project: protocol of a cross-sectional study cataloging human variation.

Physiotherapy 2016 Mar 22;102(1):50-6. Epub 2015 Jan 22.

Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, NSW 2151, Australia; Paediatric Gait Analysis Service of New South Wales, The Children's Hospital at Westmead, Hawkesbury Road, Westmead, NSW 2145, Australia; Faculty of Medicine, The University of Sydney, NSW 2006, Australia. Electronic address:

Background: Clinical decision-making regarding diagnosis and management largely depends on comparison with healthy or 'normal' values. Physiotherapists and researchers therefore need access to robust patient-centred outcome measures and appropriate reference values. However there is a lack of high-quality reference data for many clinical measures. The aim of the 1000 Norms Project is to generate a freely accessible database of musculoskeletal and neurological reference values representative of the healthy population across the lifespan.

Methods/design: In 2012 the 1000 Norms Project Consortium defined the concept of 'normal', established a sampling strategy and selected measures based on clinical significance, psychometric properties and the need for reference data. Musculoskeletal and neurological items tapping the constructs of dexterity, balance, ambulation, joint range of motion, strength and power, endurance and motor planning will be collected in this cross-sectional study. Standardised questionnaires will evaluate quality of life, physical activity, and musculoskeletal health. Saliva DNA will be analysed for the ACTN3 genotype ('gene for speed'). A volunteer cohort of 1000 participants aged 3 to 100 years will be recruited according to a set of self-reported health criteria. Descriptive statistics will be generated, creating tables of mean values and standard deviations stratified for age and gender. Quantile regression equations will be used to generate age charts and age-specific centile values.

Discussion: This project will be a powerful resource to assist physiotherapists and clinicians across all areas of healthcare to diagnose pathology, track disease progression and evaluate treatment response. This reference dataset will also contribute to the development of robust patient-centred clinical trial outcome measures.
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http://dx.doi.org/10.1016/j.physio.2014.12.002DOI Listing
March 2016
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