Publications by authors named "Richard Brindle"

28 Publications

  • Page 1 of 1

The influence of maturation and sex on pelvis and hip kinematics in youth distance runners.

J Sci Med Sport 2021 Oct 7. Epub 2021 Oct 7.

Department of Physical Therapy, Congdon School of Health Sciences, High Point University, United States.

Objectives: This study aimed to investigate differences in stance phase pelvic and hip running kinematics based on maturation and sex among healthy youth distance runners.

Design: Cross-Sectional.

Methods: 133 uninjured youth distance runners (M = 60, F = 73; age = 13.5 ± 2.7 years) underwent a three-dimensional running analysis on a treadmill at a self-selected speed (2.8 ± 0.6 m·s). Participants were stratified as pre-pubertal, mid-pubertal, or post-pubertal according to the modified Pubertal Maturational Observation Scale. Stance phase pelvis and hip range of motion (RoM) and peak joint positions were extracted. Two-way ANCOVAs (sex, maturation; covariate of running velocity) were used with Bonferroni-Holm method to control for multiple comparisons with a target alpha level of 0.05.

Results: A two-way interaction between sex and maturation was detected (p = 0.009) for frontal plane pelvic obliquity RoM. Post-hoc analysis identified a maturation main effect only among females (p˂0.008). Pelvic obliquity RoM was significantly greater among post-pubertal (p = 0.001) compared to pre-pubertal females. Significant main effects of sex (p = 0.02), and maturation (p = 0.01) were found for hip adduction RoM. Post-hoc analysis indicated a significant increase in hip adduction RoM from pre-pubertal to post-pubertal female runners (p = 0.001). A significant main effect of sex was found for peak hip adduction angle (p = 0.001) with female runners exhibiting greater maximum peak hip adduction compared to males.

Conclusions: Maturation influences pelvic and hip kinematics greater in female than male runners. Sex differences became more pronounced during later stages of puberty. These differences may correspond to an increased risk for running-related injuries in female runners compared to male runners.
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http://dx.doi.org/10.1016/j.jsams.2021.09.193DOI Listing
October 2021

The Effect of Blood Flow Restriction Training on Muscle Atrophy Following Meniscal Repair or Chondral Restoration Surgery in Active Duty Military: A Randomized Controlled Trial.

J Sport Rehabil 2021 Oct 22:1-8. Epub 2021 Oct 22.

Context: Recently, blood flow restriction (BFR) training has gained popularity as an alternative to high-load resistance training for improving muscle strength and hypertrophy. Previous BFR studies have reported positive treatment effects; however, clinical benefits to using BFR following meniscal repair or chondral surgery are unknown. The purpose of this study was to determine the effect of resistance exercises with BFR training versus exercises alone on self-reported knee function, thigh circumference, and knee flexor/extensor strength postmeniscal or cartilage surgery.

Design: Single-blinded randomized controlled trial in an outpatient military hospital setting. Twenty participants were randomized into 2 groups: BFR group (n = 11) and control group (n = 9).

Methods: Participants completed 12 weeks of postoperative thigh strengthening. The BFR group performed each exercise with the addition of BFR. Both groups continued with the prescribed exercises without BFR from 12 weeks until discharged from therapy. Thigh circumference and self-reported knee function were measured at 1, 6, 12, and 24 weeks postoperatively along with knee extensor and flexor strength at 12 and 24 weeks. Change scores between time points were calculated for knee function. Limb symmetry indices (LSI) were computed for thigh circumference and knee strength variables.

Results: Seventeen participants were included in the final analyses (BFR = 8 and control = 9) due to COVID-19 restrictions. There were no interactions or main effects for group. Time main effects were established for change in knee function scores, thigh circumference LSI, and knee extensor strength LSI. However, knee flexor strength LSI had no main effect for time.

Conclusion: The outcomes of this trial suggest that resistance exercises with and without BFR training may result in similar changes to function, thigh atrophy, and knee extensor strength postmeniscus repair/chondral restoration, though further study with larger sample sizes is needed.
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http://dx.doi.org/10.1123/jsr.2020-0518DOI Listing
October 2021

An individually randomised controlled multi-centre pragmatic trial with embedded economic and process evaluations of early vocational rehabilitation compared with usual care for stroke survivors: study protocol for the RETurn to work After stroKE (RETAKE) trial.

Trials 2020 Dec 9;21(1):1010. Epub 2020 Dec 9.

Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Level 11 Worsley Building, Leeds, LS2 9JT, UK.

Background: Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising incidence of stroke among younger people, the UK economic forecast, and clinical drivers highlight the need for stroke survivors to receive support with RTW. However, evidence for this type of support is lacking. This randomised controlled trial (RCT) will investigate whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e. usual NHS rehabilitation) is more clinically and cost-effective for supporting post-stroke RTW, than UC alone.

Methods: Seven hundred sixty stroke survivors and their carers will be recruited from approximately 20 NHS stroke services. A 5:4 allocation ratio will be employed to randomise participants to receive ESSVR plus UC, or UC alone. The individually tailored ESSVR intervention will commence within 12 weeks of stroke onset and be delivered for up to 12 months as necessary by trained RETAKE occupational therapists in the community, participants' homes or workplaces, and outpatient/inpatient therapy settings, via telephone, email, or SMS text message. Outcome data will be collected via self-report questionnaires administered by post or online at 3, 6, and 12 months follow-up. The primary outcome will be self-reported RTW and job retention at 12 months (minimum 2 h/week). Secondary outcomes will include mood, function, participation, health-related quality of life, confidence, intervention compliance, health and social care resource use, and mortality. An embedded economic evaluation will estimate cost-effectiveness and cost-utility analyses from National Health Service (NHS) and Personal Social Services (PSS) perspectives. An embedded process evaluation will employ a mixed methods approach to explore ESSVR implementation, contextual factors linked to outcome variation, and factors affecting NHS roll-out.

Discussion: This article describes the protocol for a multi-centre RCT evaluating the clinical- and cost-effectiveness of an early vocational rehabilitation intervention aimed at supporting adults to return to work following a stroke. Evidence favouring the ESSVR intervention would support its roll-out in NHS settings.

Trial Registration: ISRCTN, ISRCTN12464275 . Registered on 26 February 2018.
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http://dx.doi.org/10.1186/s13063-020-04883-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724443PMC
December 2020

The effectiveness of battlefield acupuncture in addition to standard physical therapy treatment after shoulder surgery: a protocol for a randomized clinical trial.

Trials 2020 Dec 3;21(1):995. Epub 2020 Dec 3.

Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, NY, USA.

Introduction: There is a large incidence of shoulder instability among active young athletes and military personnel. Shoulder stabilization surgery is the commonly employed intervention for treating individuals with instability. Following surgery, a substantial proportion of individuals experience acute post-operative pain, which is usually managed with opioid pain medications. Unfortunately, the extended use of opioid medications can have adverse effects that impair function and reduce military operational readiness, but there are currently few alternatives. However, battlefield acupuncture (BFA) is a minimally invasive therapy demonstrating promise as a non-pharmaceutical intervention for managing acute post-operative pain.

Methods: This is a parallel, two-arm, single-blind randomized clinical trial. The two independent variables are intervention (2 levels, standard physical therapy and standard physical therapy plus battlefield acupuncture) and time (5 levels, 24 h, 48 h, 72 h, 1 week, and 4 weeks post shoulder stabilization surgery). The primary dependent variables are worst and average pain as measured on the visual analog scale. Secondary outcomes include medication usage, Profile of Mood States, and Global Rating of Change.

Discussion: The magnitude of the effect of BFA is uncertain; current studies report confidence intervals of between-group differences that include minimal clinically important differences between intervention and control groups. The results of this study may help determine if BFA is an effective adjunct to physical therapy in reducing pain and opioid usage in acute pain conditions.

Trial Registration: ClinicalTrials.gov NCT04094246 . Registered on 16 September 2019.
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http://dx.doi.org/10.1186/s13063-020-04909-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713004PMC
December 2020

Weak associations between hip adduction angle and hip abductor muscle activity during running.

J Biomech 2020 09 18;110:109965. Epub 2020 Jul 18.

Department of Physical Therapy & Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA.

Hip abductor muscle strengthening is often prescribed to reduce the peak hip adduction angle in runners with overuse knee injury. However, no evidence exists associating greater isometric hip abductor muscle strength with smaller peak hip adduction angle during running. Beyond muscle strength, muscle activation patterns may play an important role in controlling joint movement during running. Therefore, the purpose of this investigation was to determine if associations existed among hip adduction angle, hip abductor muscle activity, and isometric hip abductor muscle strength. Twenty-five currently healthy female runners participated. Average gluteus medius muscle activity and tensor fascia lata muscle activity were determined during hip abductor maximal voluntary isometric contractions. Three-dimensional kinematics and hip abductor muscle activity were collected during treadmill running. Dependent variables were analyzed via Pearson product moment correlations. Multi-variable linear regression determined muscle activity's and strength's contributions to the peak hip adduction angle. A fair positive correlation was observed between the peak hip adduction angle and average tensor fascia lata muscle activity magnitude. Additionally, there was a moderate negative correlation between isometric hip abductor muscle strength and average gluteus medius muscle activity magnitude. Tensor fascia lata activity magnitude accounted for the most variance of the peak hip adduction angle. This study adds to the literature which indicates a lack of association between isometric hip abductor muscle strength and peak hip adduction angle in healthy runners. Factors other than hip abductor muscle strength and activation may account for more of the variance in peak hip adduction angles among runners.
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http://dx.doi.org/10.1016/j.jbiomech.2020.109965DOI Listing
September 2020

Accuracy and Reliability of Commercial Wrist-Worn Pulse Oximeter During Normobaric Hypoxia Exposure Under Resting Conditions.

Res Q Exerc Sport 2021 Sep 7;92(3):549-558. Epub 2020 Jul 7.

High Point University.

: The present study analyzed peripheral blood oxygen saturation (SO) and heart rate (HR) measurements taken on the Garmin fēnix® 5X Plus watch, comparing them to measurements taken on a standard medical-grade pulse oximeter during normobaric hypoxia exposure under resting conditions. : Thirteen women (mean ± SD: Age 20 ± 1 years, height 165 ± 5 cm, mass, 67 ± 9 kg) and ten men (mean ± SD: Age 21 ± 3 years, height 177 ± 6 cm, mass 78 ± 11 kg) sat inside a customized environmental chamber while the fraction of inspired oxygen (FO) was adjusted to simulate altitudes of 12,000; 10,000; 8,000; 6,000; and 900 ft. The novel commercial device (Garmin fēnix®) and a medical-grade pulse oximeter (Nonin® 7500) were used to measure SO and HR in triplicate at each simulated altitude. Bland-Altman analyses were used to assess differences between methods. : Bland-Altman analysis indicated 3.3% bias for SO measurements taken on the Garmin fēnix® at 12,000 ft of simulated altitude (limits of agreement: -1.9-8.6%). Mean differences in SO measurements were smaller at the remaining simulated altitudes, where bias measurements ranged from 0.7% to 0.8%. The Garmin fēnix® also underestimated heart rate, but those discrepancies were minimal (bias measurements at all simulated altitude exposures were < 1.0 bpm). : With the exception of readings taken at 12,000 ft of simulated altitude, the Garmin fēnix® exhibits minimal overestimation of SO and minimal underestimation of HR during simulated altitude exposure. These data suggest the Garmin fēnix® watch may be a viable method to monitor SO and HR under most ambient environmental conditions.
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http://dx.doi.org/10.1080/02701367.2020.1759768DOI Listing
September 2021

Antibiotic route and duration of therapy for cellulitis: data extracted from a multi-center clinical trial.

Int J Antimicrob Agents 2020 Sep 3;56(3):106076. Epub 2020 Jul 3.

Public Health England Microbiology Services Bristol, Bristol Royal Infirmary, Bristol, UK; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK; School of Clinical Sciences, University of Bristol, Bristol, UK. Electronic address:

Introduction: Although cellulitis is a relatively common condition, there is uncertainty about the benefit of intravenous (IV) over oral (PO) antibiotic therapy, and the appropriate duration of treatment.

Methods: Data extracted from a clinical trial (NCT01876628) of antibiotic therapy for cellulitis were used to assess the association between the route of administration and duration of treatment, and clinical outcome.

Results: Of 323 patients with antibiotic data, 114 received some IV therapy. IV antibiotic therapy was preferred in those who had received antibiotics prior to trial entry (P < 0.001). Patients characterised as having more severe cellulitis (C-reactive protein > 100 mg/L, affected skin surface area > 5% or systemic inflammatory response syndrome score ≥ 1) were more likely to have had IV therapy. Those given only PO therapy were more likely to have improved at day 5 compared with those given at least a single dose of IV therapy (P = 0.015), and were as likely to be back to their normal activities at day 10 (P = 0.90), and day 30 (P = 0.86). There was no association between initial severity and the duration of antibiotic therapy given within the trial. There was no association between duration of antibiotic therapy and outcome as measured at day 10 and day 30.

Conclusions: This study provides evidence that recovery is not associated with the route of antibiotic administration for patients with cellulitis of similar severity, or that a course length of > 5 days results in any additional benefit.
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http://dx.doi.org/10.1016/j.ijantimicag.2020.106076DOI Listing
September 2020

Relationships of hip abductor strength, neuromuscular control, and hip width to femoral length ratio with peak hip adduction angle in healthy female runners.

J Sports Sci 2020 Oct 16;38(20):2291-2297. Epub 2020 Jun 16.

ReHAB Group, Department of Physical Therapy and Rehabilitation Sciences, Drexel University , Philadelphia, PA, USA.

A large peak hip adduction angle during running is a risk factor for several overuse injuries in women. The purpose of this study was to determine if female runners with a large peak hip adduction angle have differences in eccentric hip abductor muscle strength, hip neuromuscular control, and/or hip width to femoral length ratio (HW:FL) compared to those with a small angle. Hip adduction during running, hip strength, hip control, and HW:FL were measured in sixty healthy female runners (1.66 ± 0.06 m; 63.2 ± 8.3 kg; 27 ± 6 years). Data from twenty runners with the largest and twenty with the smallest peak hip adduction angles were analysed. Between-group differences in hip strength, control, and HW:FL were determined using independent t-tests (p < 0.05). Variables that were significantly different between groups were entered into a regression model. Runners in both groups had similar hip strength (p = 0.90) and control (p = 0.65). HW:FL was greater in the large peak angle group (p = 0.04), but only explained a small amount of peak hip adduction angle variance for all sixty runners (R = 0.05). Alarge peak hip adduction angle in some healthy female runners may simply be instinctive as there were no deficiencies in the strength or neuromuscular control constructs assessed.
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http://dx.doi.org/10.1080/02640414.2020.1779489DOI Listing
October 2020

Correction to: Association Between Temporal Spatial Parameters and Overuse Injury History in Runners: A Systematic Review and Meta-analysis.

Sports Med 2020 Apr;50(4):845-851

Department of Physical Therapy, High Point University, High Point, North Carolina, USA.

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http://dx.doi.org/10.1007/s40279-019-01234-2DOI Listing
April 2020

Association Between Temporal Spatial Parameters and Overuse Injury History in Runners: A Systematic Review and Meta-analysis.

Sports Med 2020 Feb;50(2):331-342

Department of Physical Therapy, High Point University, High Point, North Carolina, USA.

Background: Temporal spatial parameters during running are measurable outside of clinical and laboratory environments using wearable technology. Data from wearable technology may be useful for injury prevention, however the association of temporal spatial parameters with overuse injury in runners remains unclear.

Objective: To identify the association between overuse injury and temporal spatial parameters during running.

Data Sources: Electronic databases were searched using keywords related to temporal spatial parameters, running, and overuse injury, and authors' personal article collections through hand search.

Eligibility Criteria For Selecting Studies: Articles included in this systematic review contained original data, and analytically compared at least one temporal spatial parameter (e.g. cadence) between uninjured and retrospectively or prospectively injured groups of runners. Articles were excluded from this review if they did not meet these criteria or measured temporal spatial parameters via survey.

Study Appraisal And Synthesis Method: The internal validity of each article was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Meta-analyses were conducted for temporal spatial parameters if data existed from at least three separate cohorts of the same prospective or retrospective design. Data were pooled and analyzed using an inverse variance fixed-effect model.

Results: Thirteen articles which tested a total of 24 temporal spatial parameters during running were included in the review. Meta-analyses were conducted on four temporal spatial parameters using data from eleven retrospective studies. Healthy runners and those with a history of overuse injury had a similar average stride time (mean difference: 0.00 s, 95% CI - 0.01 to 0.01 s), contact time (mean difference: 0.00 s, 95% CI 0.00 to 0.01 s), cadence (mean difference: 0.3 steps per minute (spm), 95% CI - 1.8 to 2.5 spm), and stride length (mean difference 0.00 m, 95% CI - 0.05 to 0.05 m) during running.

Limitations: Data pooled for meta-analyses were limited to retrospective design studies. Studies included in the systematic review had low methodological consistency.

Conclusion: Based on pooled results from multiple studies, stride time, contact time, cadence, and stride length averages are not distinguishable between runners either with or without a history of overuse injury. More prospective studies are required to determine the association of temporal spatial parameters with overuse injury development in runners.

Systematic Review Registration Registry And Number: CRD42018112290.
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http://dx.doi.org/10.1007/s40279-019-01207-5DOI Listing
February 2020

Assessment of Antibiotic Treatment of Cellulitis and Erysipelas: A Systematic Review and Meta-analysis.

JAMA Dermatol 2019 Sep;155(9):1033-1040

Acute Medicine Unit, Queen Alexandra Hospital, Portsmouth Hospitals, Portsmouth, United Kingdom.

Importance: The optimum antibiotic treatment for cellulitis and erysipelas lacks consensus. The available trial data do not demonstrate the superiority of any agent, and data are limited on the most appropriate route of administration or duration of therapy.

Objective: To assess the efficacy and safety of antibiotic therapy for non-surgically acquired cellulitis.

Data Sources: The following databases were searched to June 28, 2016: Cochrane Central Register of Controlled Trials (2016, issue 5), Medline (from 1946), Embase (from 1974), and Latin American and Caribbean Health Sciences Information System (LILACS) (from 1982). In addition, 5 trials databases and the reference lists of included studies were searched. Further searches of PubMed and Google Scholar were undertaken from June 28, 2016, to December 31, 2018.

Study Selection: Randomized clinical trials comparing different antibiotics, routes of administration, and treatment durations were included.

Data Extraction And Synthesis: For data collection and analysis, the standard methodological procedures of the Cochrane Collaboration were used. For dichotomous outcomes, the risk ratio and its 95% CI were calculated. A summary of findings table was created for the primary end points, adopting the GRADE approach to assess the quality of the evidence.

Main Outcomes And Measures: The primary outcome was the proportion of patients cured, improved, recovered, or symptom-free or symptom-reduced at the end of treatment, as reported by the trial. The secondary outcome was any adverse event.

Results: A total of 43 studies with a total of 5999 evaluable participants, whose age ranged from 1 month to 96 years, were included. Cellulitis was the primary diagnosis in only 15 studies (35%), and in other studies the median (interquartile range) proportion of patients with cellulitis was 29.7% (22.9%-50.3%). Overall, no evidence was found to support the superiority of any 1 antibiotic over another, and antibiotics with activity against methicillin-resistant Staphylococcus aureus did not add an advantage. Use of intravenous antibiotics over oral antibiotics and treatment duration of longer than 5 days were not supported by evidence.

Conclusions And Relevance: In this systematic review and meta-analysis, only low-quality evidence was found for the most appropriate agent, route of administration, and duration of treatment for patients with cellulitis; future trials need to use a standardized set of outcomes, including severity scoring, dosing, and duration of therapy.
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http://dx.doi.org/10.1001/jamadermatol.2019.0884DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563587PMC
September 2019

Caribbean multi-centre study of Klebsiella pneumoniae: whole-genome sequencing, antimicrobial resistance and virulence factors.

Microb Genom 2019 05 29;5(5). Epub 2019 Apr 29.

1​Wellcome Trust Sanger Institute, Hinxton, UK.

The surveillance of antimicrobial-resistant isolates has proven to be one of the most valuable tools to understand the global rise of multidrug-resistant bacterial pathogens. We report the first insights into the current situation in the Caribbean, where a pilot project to monitor antimicrobial resistance (AMR) through phenotypic resistance measurements combined with whole-genome sequencing was set up in collaboration with the Caribbean Public Health Agency (CARPHA). Our first study focused on Klebsiella pneumoniae, a highly relevant organism amongst the Gram-negative opportunistic pathogens worldwide causing hospital- and community-acquired infections. Our results show that not only carbapenem resistance, but also hypervirulent strains, are circulating in patients in the Caribbean. Our current data does not allow us to infer their prevalence in the population. We argue for the urgent need to further support AMR surveillance and stewardship in this almost uncharted territory, which can make a significant impact on the reduction of antimicrobial usage. This article contains data hosted by Microreact (https://microreact.org).
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http://dx.doi.org/10.1099/mgen.0.000266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6562249PMC
May 2019

The hip control test is a valid and reliable measure of hip neuromuscular control.

Sports Biomech 2020 Apr 13;19(2):235-244. Epub 2018 Jun 13.

Department of Physical Therapy and Rehabilitation Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA.

Insufficient hip neuromuscular control may contribute to non-contact sport injuries. However, the current evaluative test of hip neuromuscular control, the single-leg squat, requires hip abductor muscle strength to complete. The purpose of this study was to develop the hip control test (HCT) and determine the test's reliability and construct validity. Nineteen healthy adults visited the laboratory twice. The HCT is a 10-s test of reciprocal toe-tapping accuracy. Both automated and manual HCT ratings were recorded simultaneously during each visit. Additionally, eccentric hip abductor torque was measured. HCT reliability was assessed with intra-class correlation coefficients (ICC). Agreement between automated and manual ratings was determined with Bland-Altman plots. Construct validity was established if HCT performance significantly decreased with a secondary cognitive task ( < 0.05). Bivariate regression determined the relationship between HCT performance and eccentric hip abductor torque. Automated and manual HCT ratings both had moderate reliability (ICC = 0.72) and yielded similar results (limits of agreement = -1 to 2 taps). The HCT had construct validity ( = 0.001), and no correlation with hip abductor muscle strength ( = 0.213). Thus, the HCT is a reliable and valid test. The HCT is simple to administer and measures hip neuromuscular control separately from strength.
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http://dx.doi.org/10.1080/14763141.2018.1466907DOI Listing
April 2020

Intratester Reliability and Construct Validity of a Hip Abductor Eccentric Strength Test.

J Sport Rehabil 2018 05 6;27(3). Epub 2018 Jun 6.

Context: Side-lying hip abductor strength tests are commonly used to evaluate muscle strength. In a "break" test, the tester applies sufficient force to lower the limb to the table while the patient resists. The peak force is postulated to occur while the leg is lowering, thus representing the participant's eccentric muscle strength. However, it is unclear whether peak force occurs before or after the leg begins to lower.

Objectives: To determine intrarater reliability and construct validity of a hip abductor eccentric strength test.

Design: Intrarater reliability and construct validity study.

Participants: Twenty healthy adults (26 [6] y; 1.66 [0.06] m; 62.2 [8.0] kg) made 2 visits to the laboratory at least 1 week apart.

Main Outcome Measures: During the hip abductor eccentric strength test, a handheld dynamometer recorded peak force and time to peak force, and limb position was recorded via a motion capture system. Intrarater reliability was determined using intraclass correlation, SEM, and minimal detectable difference. Construct validity was assessed by determining if peak force occurred after the start of the lowering phase using a 1-sample t test.

Results: The hip abductor eccentric strength test had substantial intrarater reliability (intraclass correlation = .88; 95% confidence interval, .65-.95), SEM of 0.9 %BWh, and a minimal detectable difference of 2.5 %BWh. Construct validity was established as peak force occurred 2.1 (0.6) seconds (range: 0.7-3.7 s) after the start of the lowering phase of the test (P ≤ .001).

Conclusion: The hip abductor eccentric strength test is a valid and reliable measure of eccentric muscle strength. This test may be used clinically to assess changes in eccentric muscle strength over time.
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http://dx.doi.org/10.1123/jsr.2017-0177DOI Listing
May 2018

Adjunctive clindamycin for cellulitis: a clinical trial comparing flucloxacillin with or without clindamycin for the treatment of limb cellulitis.

BMJ Open 2017 Mar 17;7(3):e013260. Epub 2017 Mar 17.

Acute Medicine Unit, Queen Alexandra Hospital, Portsmouth, UK.

Objective: To compare flucloxacillin with clindamycin to flucloxacillin alone for the treatment of limb cellulitis.

Design: Parallel, double-blinded, randomised controlled trial.

Setting: Emergency department attendances and general practice referrals within 20 hospitals in England.

Interventions: Flucloxacillin, at a minimum of 500 mg 4 times per day for 5 days, with clindamycin 300 mg 4 times per day for 2 days given orally versus flucloxacillin given alone.

Main Outcome Measures: The primary outcome was improvement at day 5. This was defined as being afebrile with either a reduction in affected skin surface temperature or a reduction in the circumference of the affected area. Secondary outcomes included resolution of systemic features, resolution of inflammatory markers, recovery of renal function, reduction in the affected area, decrease in pain, return to work or normal activities and the absence of increased side effects.

Results: 410 patients were included in the trial. No significant difference was seen in improvement at day 5 for flucloxacillin with clindamycin (136/156, 87%) versus flucloxacillin alone (140/172, 81%)-OR 1.55 (95% CI 0.81 to 3.01), p=0.174. There was a significant difference in the number of patients with diarrhoea at day 5 in the flucloxacillin with clindamycin allocation (34/160, 22%) versus flucloxacillin alone (16/176, 9%)-OR 2.7 (95% CI 1.41 to 5.07), p=0.002. There was no clinically significant difference in any secondary outcome measures. There was no significant difference in the number of patients stating that they had returned to normal activities at the day 30 interview in the flucloxacillin with clindamycin allocation (99/121, 82%) versus flucloxacillin alone (104/129, 81%)-adjusted OR 0.90 (95% CI 0.44 to 1.84).

Conclusions: The addition of a short course of clindamycin to flucloxacillin early on in limb cellulitis does not improve outcome. The addition of clindamycin doubles the likelihood of diarrhoea within the first few days.

Trial Registration Number: NCT01876628, Results.
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http://dx.doi.org/10.1136/bmjopen-2016-013260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372109PMC
March 2017

Audit of guidelines for antimicrobial management of cellulitis across English NHS hospitals reveals wide variation.

J Infect 2016 09 16;73(3):291-3. Epub 2016 Jun 16.

Public Health England Laboratory Bristol, Bristol Royal Infirmary, Bristol, UK; University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK.

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http://dx.doi.org/10.1016/j.jinf.2016.06.002DOI Listing
September 2016

A cough that doesn't fit the mould.

Clin Med (Lond) 2016 Jun;16(3):302

Microbiology Department, University Hospitals Bristol, UK.

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http://dx.doi.org/10.7861/clinmedicine.16-3-302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922717PMC
June 2016

Specific PCR, bacterial culture, serology and pharyngeal sampling to enhance the aetiological diagnosis of cellulitis.

J Med Microbiol 2016 Jan;65(1):44-47

Public Health England, Microbiology, Level 8, Queens Building, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK.

It is often difficult to obtain a bacteriological diagnosis in patients with cellulitis. We examined the utility of molecular techniques and skin and throat cultures, as well as serology, in providing evidence of either Staphylococcus aureus or group A Streptococcus (GAS) presence inpatients with cellulitis. Samples were collected from patients with a clinical diagnosis of cellulitis who were recruited into a prospective placebo-controlled clinical trial (C4C study, EudraCT 2013-001218-14). Specific PCR, paired serology and culture for both organisms were carried out on a variety of samples where appropriate. Despite utilizing a range of diagnostic methods,a bacteriological diagnosis was only achieved in 43 % of patients with a clinical diagnosis of cellulitis. Seventeen per cent of patients tested positive for GAS by any method but only 4 % were positive by PCR, whilst S. aureus was detected in 34% of samples. Bacterial diagnosis in cases of cellulitis remains challenging. This is probably due to a very low bacterial burden with toxin production resulting in inflammation mediating skin damage. Further consideration for the need for long courses of antimicrobial therapy for cellulitis therefore appears merited.
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http://dx.doi.org/10.1099/jmm.0.000191DOI Listing
January 2016

Reliability and minimal detectable difference in multisegment foot kinematics during shod walking and running.

Gait Posture 2016 Jan 30;43:192-7. Epub 2015 Sep 30.

Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, PA 19102, USA.

There has been increased interest recently in measuring kinematics within the foot during gait. While several multisegment foot models have appeared in the literature, the Oxford foot model has been used frequently for both walking and running. Several studies have reported the reliability for the Oxford foot model, but most studies to date have reported reliability for barefoot walking. The purpose of this study was to determine between-day (intra-rater) and within-session (inter-trial) reliability of the modified Oxford foot model during shod walking and running and calculate minimum detectable difference for common variables of interest. Healthy adult male runners participated. Participants ran and walked in the gait laboratory for five trials of each. Three-dimensional gait analysis was conducted and foot and ankle joint angle time series data were calculated. Participants returned for a second gait analysis at least 5 days later. Intraclass correlation coefficients and minimum detectable difference were determined for walking and for running, to indicate both within-session and between-day reliability. Overall, relative variables were more reliable than absolute variables, and within-session reliability was greater than between-day reliability. Between-day intraclass correlation coefficients were comparable to those reported previously for adults walking barefoot. It is an extension in the use of the Oxford foot model to incorporate wearing a shoe while maintaining marker placement directly on the skin for each segment. These reliability data for walking and running will aid in the determination of meaningful differences in studies which use this model during shod gait.
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http://dx.doi.org/10.1016/j.gaitpost.2015.09.022DOI Listing
January 2016

Changing step width alters lower extremity biomechanics during running.

Gait Posture 2014 Jan 5;39(1):124-8. Epub 2013 Jul 5.

University of Tennessee, Knoxville, United States. Electronic address:

Step width is a spatiotemporal parameter that may influence lower extremity biomechanics at the hip and knee joint. The purpose of this study was to determine the biomechanical response of the lower extremity joints to step width changes during running. Lower extremity data from 30 healthy runners, half of them male, were collected during running in three step width conditions: preferred, wide, and narrow. Dependent variables and step width were analyzed using a mixed model ANOVA and pairwise t-tests for post hoc comparisons. Step width was successfully altered in the wide and narrow conditions. Generally, frontal plane peak values decreased as step width increased from narrow to preferred to wide. Peak hip adduction and rearfoot eversion angles decreased as step width increased from narrow to wide. Peak knee abduction moment and knee abduction impulse also decreased as step width increased from narrow to wide. Although men and women ran differently, gender only influenced the effect of step width on peak rearfoot inversion moment. In conclusion, step width influences lower extremity biomechanics in healthy runners. When step width increased from narrow to wide, peak values of frontal plane variables decreased. In addition to previously reported changes at the rearfoot, the hip and knee joint biomechanics were also influenced by changes in step width.
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http://dx.doi.org/10.1016/j.gaitpost.2013.06.010DOI Listing
January 2014

Penicillin to prevent recurrent leg cellulitis.

N Engl J Med 2013 May;368(18):1695-703

Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, United Kingdom.

Background: Cellulitis of the leg is a common bacterial infection of the skin and underlying tissue. We compared prophylactic low-dose penicillin with placebo for the prevention of recurrent cellulitis.

Methods: We conducted a double-blind, randomized, controlled trial involving patients with two or more episodes of cellulitis of the leg who were recruited in 28 hospitals in the United Kingdom and Ireland. Randomization was performed according to a computer-generated code, and study medications (penicillin [250 mg twice a day] or placebo for 12 months) were dispensed by a central pharmacy. The primary outcome was the time to a first recurrence. Participants were followed for up to 3 years. Because the risk of recurrence was not constant over the 3-year period, the primary hypothesis was tested during prophylaxis only.

Results: A total of 274 patients were recruited. Baseline characteristics were similar in the two groups. The median time to a first recurrence of cellulitis was 626 days in the penicillin group and 532 days in the placebo group. During the prophylaxis phase, 30 of 136 participants in the penicillin group (22%) had a recurrence, as compared with 51 of 138 participants in the placebo group (37%) (hazard ratio, 0.55; 95% confidence interval [CI], 0.35 to 0.86; P=0.01), yielding a number needed to treat to prevent one recurrent cellulitis episode of 5 (95% CI, 4 to 9). During the no-intervention follow-up period, there was no difference between groups in the rate of a first recurrence (27% in both groups). Overall, participants in the penicillin group had fewer repeat episodes than those in the placebo group (119 vs. 164, P=0.02 for trend). There was no significant between-group difference in the number of participants with adverse events (37 in the penicillin group and 48 in the placebo group, P=0.50).

Conclusions: In patients with recurrent cellulitis of the leg, penicillin was effective in preventing subsequent attacks during prophylaxis, but the protective effect diminished progressively once drug therapy was stopped. (Funded by Action Medical Research; PATCH I Controlled-Trials.com number, ISRCTN34716921.).
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http://dx.doi.org/10.1056/NEJMoa1206300DOI Listing
May 2013

Rare immune-mediated pneumonitis in association with post-streptococcal glomerulonephritis.

Nephrol Dial Transplant 2011 Dec 16;26(12):4140-2. Epub 2011 Sep 16.

Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK.

We describe the case of a 48-year-old man with an acute nephritis and respiratory failure. Clinical history, streptococcal antibody titres and renal biopsy led to a diagnosis of post-streptococcal glomerulonephritis. Respiratory investigations excluded pulmonary oedema and infection. We hypothesize that this man had a co-existing post-streptococcal glomerulonephritis and an immune-mediated pneumonitis. This is a very rare association, which was last described in 1982.
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http://dx.doi.org/10.1093/ndt/gfr526DOI Listing
December 2011

Interventions for cellulitis and erysipelas.

Cochrane Database Syst Rev 2010 Jun 16(6):CD004299. Epub 2010 Jun 16.

School of Health Sciences and Social Work, University of Portsmouth, James Watson West, 2 King Richard 1st Road, Portsmouth, Hampshire, UK, PO1 2FR.

Background: Cellulitis and erysipelas are now usually considered manifestations of the same condition, a skin infection associated with severe pain and systemic symptoms. A range of antibiotic treatments are suggested in guidelines.

Objectives: To assess the efficacy and safety of interventions for non-surgically-acquired cellulitis.

Search Strategy: In May 2010 we searched for randomised controlled trials in the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and the ongoing trials databases.

Selection Criteria: We selected randomised controlled trials comparing two or more different interventions for cellulitis.

Data Collection And Analysis: Two authors independently assessed trial quality and extracted data.

Main Results: We included 25 studies with a total of 2488 participants. Our primary outcome 'symptoms rated by participant or medical practitioner or proportion symptom-free' was commonly reported. No two trials examined the same drugs, therefore we grouped similar types of drugs together.Macrolides/streptogramins were found to be more effective than penicillin antibiotics (Risk ratio (RR) 0.84, 95% CI 0.73 to 0.97). In 3 trials involving 419 people, 2 of these studies used oral macrolide against intravenous (iv) penicillin demonstrating that oral therapies can be more effective than iv therapies (RR 0.85, 95% CI 0.73 to 0.98).Three studies with a total of 88 people comparing a penicillin with a cephalosporin showed no difference in treatment effect (RR 0.99, 95% CI 0.68 to 1.43).Six trials which included 538 people that compared different generations of cephalosporin, showed no difference in treatment effect (RR 1.00, 95% CI 0.94 to1.06).We found only small single studies for duration of antibiotic treatment, intramuscular versus intravenous route, the addition of corticosteroid to antibiotic treatment compared with antibiotic alone, and vibration therapy, so there was insufficient evidence to form conclusions. Only two studies investigated treatments for severe cellulitis and these selected different antibiotics for their comparisons, so we cannot make firm conclusions.

Authors' Conclusions: We cannot define the best treatment for cellulitis and most recommendations are made on single trials. There is a need for trials to evaluate the efficacy of oral antibiotics against intravenous antibiotics in the community setting as there are service implications for cost and comfort.
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http://dx.doi.org/10.1002/14651858.CD004299.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8693180PMC
June 2010

Has the publication of methicillin-resistant Staphylococcus aureus (MRSA) treatment guidelines increased the survival associated with MRSA bacteraemia?

J Antimicrob Chemother 2009 Nov 10;64(5):1111-3. Epub 2009 Sep 10.

Department of Microbiology, Portsmouth Hospitals, Portsmouth, UK.

Objectives: To establish whether local practice review and national methicillin-resistant Staphylococcus aureus (MRSA) treatment guidelines have increased the survival of patients with MRSA bacteraemia.

Methods: A multisite retrospective analysis of survival of patients with MRSA bacteraemia, which included patients from March 1995 to December 2008. Periods before and after the publication of UK guidelines were compared.

Results: Data were analysed for 1675 patients with a mean age of 69.8 years. Survival for the period up to and including 2003 was 64.3%, and was 62.8% for both 2004-2005 and 2006-2008.

Conclusions: No significant difference in survival in relation to local practice review or the publication of national guidelines was detected.
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http://dx.doi.org/10.1093/jac/dkp332DOI Listing
November 2009

Guidelines (2008) for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the United Kingdom.

J Antimicrob Chemother 2009 May 12;63(5):849-61. Epub 2009 Mar 12.

Department of Microbiology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK.

These evidence-based guidelines are an updated version of those published in 2006. They have been produced after a literature review of the treatment and prophylaxis of methicillin-resistant Staphylococcus aureus (MRSA). The guidelines aim to complement those recently published for the antibiotic treatment of common and emerging community-onset MRSA infections in the UK. The guidelines have reviewed and updated, where appropriate, previous recommendations, taking into account any changes in the UK epidemiology of MRSA, ongoing national surveillance data and the value of new antistaphylococcal agents licensed for use in UK practice. Emerging therapies that have not been licensed for UK use are not reviewed, but their future potential role has been mentioned where deemed appropriate. Recommendations are given for the treatment of common infections caused by MRSA, elimination of MRSA from carriage sites and prophylaxis of surgical site infection.
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http://dx.doi.org/10.1093/jac/dkp065DOI Listing
May 2009

Use of nonlinear mixed-effects analysis for improved precision of early pharmacodynamic measures in tuberculosis treatment.

Antimicrob Agents Chemother 2006 Sep;50(9):3154-6

Wellcome Trust Centre for Clinical Tropical Medicine, University of Liverpool, UK.

Nonlinear mixed-effects analysis of serial sputum colony-counting data supports the existence of two bacillary subpopulations in sputum, eliminated at different rates. It distinguishes between combination regimens, removes bias, and greatly improves precision, with significant implications for the analysis of surrogate endpoints of "sterilization" in the development of new antituberculosis regimens.
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http://dx.doi.org/10.1128/AAC.00774-05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1563554PMC
September 2006
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