‘Involved in every step’: how working practices shape the influence of physiotherapists in elite sport

This paper examines how the medical and non-medical skills of physiotherapists enable members of the profession to become central agents in the multidisciplinary teams (MDTs) which dominate sports health care. Drawing on empirical data derived from interviews with sports physiotherapists and doctors working in UK Olympic sport MDTs, this article argues that the role and influence of physiotherapy in elite sports health care can be explained in relation to physiotherapy’s working practice traditions and the degree to which these traditions correspond to their specific patients’ demands. Drawing on concepts such as medical dominance and relative practice autonomy drawn from the sociology of medicine, the paper argues that extended time, close physical contact and opportunities for experiential learning foster physiotherapist–patient mutuality, locate the physiotherapist as an inherent part of the recovery process and lead to trusting and collaborative health care relations. The practice traditions of physiotherapy enable these practitioners to respond flexibly to the particular demands of elite sports clients, intertwining athletes’ performance orientation with physiotherapists’ treatment through blurring the boundary between health care and sports training. Physiotherapists thus become seen as ‘useful’ in the eyes of the clients who shape the demand for health care delivery in elite sport

The provision of medical care in English professional football: An update

Objectives - To compare the current methods of appointment, qualifications and occupational experience of club doctors and physiotherapists in English professional football with (i) those outlined in a study published in 1999, and (ii) Football Association (FA) medical regulations. Design - Qualitative. Methods - Postal questionnaire survey of (head) doctors and physiotherapists at each of the clubs in the English Premiership, Championship and Football Leagues 1 and 2. Response rates of 35.8% and 45.6% respectively were obtained. Results - The majority of football club doctors are GPs who have sports medicine qualifications and relevant occupational experience. Time commitments vary from full time to a few hours per week. Most are appointed through personal contacts rather than job advertisements and/or interview. Almost all football clubs have a chartered physiotherapist, many of whom have a postgraduate qualification. They work full time and long hours. Most are appointed through personal contacts rather than job advertisements. They are frequently interviewed but not always by someone qualified to judge their professional expertise. Conclusions - Football club medical provision has become more extensive and increasingly professional over the last 10-–20 years, with better qualified, more career-oriented and more formally contracted staff. It is likely that clinical autonomy has subsequently increased. However recruitment procedures still need to be improved, especially in relation to advertising vacancies, interviewing candidates, and including medical personnel on interview panels. In two aspects clubs appear not to be compliant with current FA medical regulations

The social management of medical ethics in sport: confidentiality in English professional football

This paper examines one of the major ethical challenges in the practice of sports medicine, confidentiality. Drawing on interview and questionnaire data with doctors and physiotherapists working in English professional football clubs, it explores the degree to which ethical compliance has improved since the publication of, and publicity surrounding, an earlier study of medical practice in professional football conducted by Waddington and Roderick. Thus, it provides an updated empirical examination of the management of medical ethics in sport. The data illustrate how the physical and social environmental constraints of sports medicine practice impinge upon the protection of athlete-patient confidentiality, how ethical codes and conflicting obligations converge to shape clinician behaviour in relation to lifestyle and injury issues, and the ethically problematic contractual constraints under which clinicians and athletes operate. It demonstrates that medical ethical practice continues to be very variable and draws on Freidson’s work on medical ‘work settings’ to argue that there is a need to augment existing confidentiality policies with more structurally oriented approaches to ensure both professional autonomy and medical ethical compliance in sport

Concussion Reporting and Safeguarding Policy Development in British American Football: An Essential Agenda

he objective of this study was to examine concussion reporting and safeguarding policy in British American Football (BAF). Data were collected via an online survey tool. The data presented are part of a broader study that examined injury profiles, concussion reporting behaviors, and medical provision in BAF. Concussion-like symptoms were found in over half (58.8%) of the participants. Of those, 36.4% reported they had previously been formally diagnosed with a concussion while playing BAF. Just under half of the participants (44.7%) had suspected they had had a concussion, although it was not formally diagnosed, and 23.5% of the participants had previously hidden concussion symptoms. Fifty-eight percent of the teams reported they did not have a regular game-day medic, with a range of hired medical personnel who attended the games. Prominent barriers to hiring a medic included budget, institutional support shortfall, and lack of medic reliability and game knowledge. BAF is a developing sport with a clear vision for growth of participation. Yet, the current concussion and medical provision policies do not address the sport's welfare needs. Through discussion of these policies in the context of this study's findings, we highlight vital areas of concern in policy and practice that the British American Football Association needs to address in their medical and concussion policies

The current state of concussion knowledge and attitudes in British American Football

Objectives To examine concussion knowledge and concussion attitudes of players, coaches, and support staff in British American Football (BAF). Methods Data from players, coaches and support staff (n = 236) were collected from across all leagues in BAF. An online survey tool was used which included the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS), and questions examining concussion education and perceived risk of participating in football. Results The mean score on the RoCKAS concussion knowledge was 21.0 ± 2.1 of a possible score of 25 reflecting good knowledge. Of a possible score of 65, the mean concussion attitude score was 55.6 ± 6.1 showing safe attitude. Whilst an overall safe attitude was seen, almost half of participants (45.3%) noted they would continue to play with a concussion. No relationship was found between CAI and prior concussion history. Fifty seven percent of participants agreed the benefits of playing football outweighed the risks. Forty eight percent reported that they had received no concussion-related education in the past 12 months. Conclusion BAF participants have good concussion knowledge and safe attitudes. However, risky behavior is demonstrated through unsafe likelihood to report and attitude to long-term health risks. Access to the British American Football Association (BAFA) concussion policy and education was poor raising questions over what sources of information stakeholders are drawing their knowledge from. These findings can help form the foundation of educational interventions (e.g. coaching workshops) to challenge current misconceptions and improve likelihood to report concussion in BAF

Eye Movement Desensitisation Reprocessing as a Treatment for PTSD in Conflict Affected Areas

Objective: One recommended psychological intervention for trauma treatment in Western countries, including Post-Traumatic Stress Disorder (PTSD), is Eye Movement Desensitisation Reprocessing (EMDR). However, there is a paucity of data regarding treatment interventions in low-to-middle income countries. This study examined the efficacy of EMDR for treating post-traumatic stress (PTS), Anxiety and Depression among a cohort of individuals with low-socio economic status in a conflict-affected middle-income country as well as a smaller refugee cohort. Methods: 268 adults residing in Lebanon (Male=65, Female=203, SD gender =0.43; µ age = 30.5, SD age =10.49; 85 Lebanese, 15 refugees (9.3 from Syria, and 5.7 from Iraq, Palestine, Philippines or other) received EMDR Therapy. Measures of PTS, Anxiety and Depression were taken at three points: Before Treatment (T0); Post-Treatment (T1); 6-Month Follow-Up (T2). Results: Reduction in PTS symptoms from T0 to T1 (F (1,208) =412.3, p<0.01) and T1 to T2 (F (1,46) = 136.1, p<0.01). Reduction in Anxiety symptoms from T0 to T1 (F (1,208) =387.0, p<0.01), and T1 to T2 (F (1,46) = 153.7, p<0.01). Similarly, for Depression, a reduction of symptoms from T0 to T1 (F (1,207) =309.5, p<0.01) and T0 to T2 (F (1,46) = 96.0, p<0.01). Conclusion: EMDR is an effective treatment for reducing PTS, Depression and Anxiety symptoms in individuals with low socio-economic status and refugees, thus contributing to the research base for populations that are under researched. Mental health services, especially in conflict affected settings, would benefit from using EMDR therapy to target these pathologies in these populations

Evaluation of facial expression in acute pain in cats

OBJECTIVESTo describe the development of a facial expression tool differentiating pain-free cats from those in acute pain.METHODSObservers shown facial images from painful and pain-free cats were asked to identify if they were in pain or not. From facial images, anatomical landmarks were identified and distances between these were mapped. Selected distances underwent statistical analysis to identify features discriminating pain-free and painful cats. Additionally, thumbnail photographs were reviewed by two experts to identify discriminating facial features between the groups.RESULTSObservers (n?=?68) had difficulty in identifying pain-free from painful cats, with only 13% of observers being able to discriminate more than 80% of painful cats. Analysis of 78 facial landmarks and 80 distances identified six significant factors differentiating pain-free and painful faces including ear position and areas around the mouth/muzzle. Standardised mouth and ear distances when combined showed excellent discrimination properties, correctly differentiating pain-free and painful cats in 98% of cases. Expert review supported these findings and a cartoon-type picture scale was developed from thumbnail images.CLINICAL SIGNIFICANCEInitial investigation into facial features of painful and pain-free cats suggests potentially good discrimination properties of facial images. Further testing is required for development of a clinical too

Development of a behaviour-based measurement tool with defined intervention level for assessing acute pain in cats

OBJECTIVES: To develop a Composite Measure Pain Scale - Feline (CMPS-F) tool to assess acute pain in cats and derive an intervention score. METHODS: To develop the prototype CMPS-F, words describing painful cats were collected, grouped into behavioural categories and ranked. To assess prototype validity two observers independentlyassigned CMPS-F and numerical rating scale (NRS) scores to 25 hospitalised cats before and afteranalgesic treatment. Following interim analysis the prototype was revised (rCMPS-F). To determine intervention score two observers independently assigned rCMPS-F and NRS scores to 116 cats. Afurther observer, a veterinarian, stated whether analgesia was necessary. Statistical tests includedWilcoxon, Mann-Whitney, 95% confidence intervals (CI), general linear model ANOVA and linear discriminant analysis (p < 0.05).RESULTS: Mean ± SD decrease in rCMPS-F and NRS scores following analgesia were 2.4 ± 2.87 and 1.9 ± 2.34, respectively (95% CI for mean change in rCMPS-F between 1.21 and 3.6). Changesin rCMPS-F and NRS were significantly correlated (r = 0.8) (

Vascular Endothelial Growth Factor A 165 rescues steroids, inflammation and follicle arrest in High Androstenedione cows

A population of cows with excess androstenedione (A4; High A4) in follicular fluid, with follicular arrest, granulosa cell dysfunction, and a 17% reduction in calving rate was previously identified. We hypothesized that excess A4 in the ovarian microenvironment caused the follicular arrest in High A4 cows and that vascular endothelial growth factor A would rescue the High A4 phenotype. In trial 1, prior to culture, High A4 ovarian cortex (n=9) had greater numbers of early stage follicles (primordial) and fewer later-stage follicles compared to controls (n=11). Culture for 7 days did not relieve this follicular arrest; instead, High A4 ovarian cortex had increased indicators of inflammation, anti-Mullerian hormone, and A4 secretion compared to controls. In trial 2, we tested if vascular endothelial growth factor A (VEGFA) angiogenic (165) and antiangiogenic (VEGFA165b) isoforms could rescue the High A4 phenotype. High A4 (n=5) and control (n=5) ovarian cortex was cultured with (1) PBS, (2) VEGFA165 (50 ng/mL), (3) VEGFA165b (50 ng/mL), or (4) VEGFA165+VEGFA165b (50 ng/mL each) for 7 days. Follicular progression increased with VEGFA165 in High A4 cows with greater early primary, primary, and secondary follicles than controls. Similar to trial 1, High A4 ovarian cortex secreted greater concentrations of A4 and other steroids and had greater indicators of inflammation compared to controls. However, VEGFA165 rescued steroidogenesis, oxidative stress, and fibrosis. Both VEGFA isoforms reduced specific pro-inflammatory cytokines in High A4 cows to control levels. Thus, VEGFA165 may be a potential therapeutic to restore the ovarian steroidogenic microenvironment to promote folliculogenesis