Determining the ideal mattress firmness based on anthropometric measurements

Introduction: Mattresses need to provide enough support to keep spinal alignment close to a neutral posture, whilst minimising muscle activity and providing optimum pressure relief. There is limited evidence to sug­gest that a 'one size fits all' mattress provides the appropriate support for individuals with diverse body shapes, so a greater understanding of how different mattresses affect the human body is key. By having a more objective approach to choosing a mattress an individual may have an improved quality of sleep. Materials and methods: A ten-camera infrared movement analysis sys­tem recorded the movement of retro-reflective markers placed on the Upper-Mid Thoracic, Mid-Lower Thoracic, Lower Thoracic-Upper Lumbar, Upper-Lower Lumbar and Lower Lumbar-Pelvic areas of the spine. A static image of the spine was taken in a standing position and was used to define each individual's neutral posture. Deviations away from this neutral po­sition were assessed under three different conditions in side lying. Three visually identical mattresses were tested, internally each mattress con­tained a different firmness of spring unit (soft, medium, firm) with an identical gel foam comfort layer. In addition, height, weight, shoulder width and hip circumference measurements were taken to determine differences in body types. Results: Spinal alignment was assessed on 59 healthy participants and no significant differences were seen between the different mattress config­urations. However, further analysis showed significant differences in spi­nal alignment between the different mattress conditions within different body shape subgroups. Subgroups were defined using body weight, height, BMI, shoulder width and hip circumference. Those with a higher body weight had a more neutral spinal alignment when on a firmer mattress, whereas those with a lower body weight were better suited to a softer mattress. Shorter people were better aligned on a softer mattress, and a medium mattress kept the spine in a more neutral position amongst taller people. There were no differentiating factors between shoulder width or BMI groups. However, those with a larger hip circumference had signifi­cantly greater spinal deviations when on a softer mattress. implying that a softer mattress should be avoided by this subgroup. Conclusions: This study suggests that a ·one size fits all' approach to mattresses may not be appropriate. Contrasting body types need different levels of support to improve overall spinal alignment, allowing the inter­vertebral disc to re-hydrate, and spinal muscles to relax throughout the night. The use of simple anthropometric measurements could make the selection of the most appropriate mattress easier for the general public. Acknowledgements: This is part of an Innovate UK Knowledge Transfer Partnership between the University of Central Lancashire and Silentnight Group Ltd

Do people who consciously attend to their movements have more self-reported knee pain? An exploratory cross-sectional study

Objectives: This study explored the relationship between propensity for conscious control of movement (assessed by the Movement-Specific Reinvestment Scale) and self-reported knee pain. Design: Cross-sectional study. Setting: General population. Subjects: Adults aged 18 to 55 years of age. Measures: Participants completed the movement-specific reinvestment scale and a self-report questionnaire on knee pain at the same time on one occasion. Results: Data was collected on 101 adults of whom 34 (33.7%) self-reported knee pain. Mean scores on the conscious motor processing subscale of the movement-specific reinvestment scale, but not the movement self-consciousness subscale, were significantly higher for participants who reported knee pain within the previous year compared with those who did not (mean difference 3.03; t-test 2.66, df = 97, P = 0.009; 95% confidence interval (CI) 0.77 to 5.30). The association between self-reported knee pain and propensity for conscious motor processing was still observed, even after controlling for movement self-consciousness subscale scores, age, gender and body mass index (adjusted odds ratio 1.16, 95% CI 1.04 to 1.30)

Examination of a new mobile intermittent pneumatic compression device in healthy adults

Aim: Intermittent pneumatic compression (IPC) is an alternative method of compression treatment designed to compress the leg and mimic ambulatory pump action to actively promote venous return. This study explores the efficacy of a new portable IPC device on tissue oxygenation (StO2) in two sitting positions. Methods: Twenty-nine participants were screened and recruited using (PAR-Q, CA). All data conformed to the Declaration of Helsinki and ethical principles. Participants attended two separate one-hour sessions to evaluate StO2 in a chair-sitting and long-sitting position. StO2 was recorded for 20-minutes pre-, during and post- a 20-minute intervention of the IPC unit (VenaproTM, DJO Global, CA). Results: A significant difference was seen between the two seating positions (p=0.003) with long-sitting showing a 12% higher StO2 level than chair-sitting post intervention. A similar effect was seen in both seating positions when analysing data over three, time points (p=0.000). Post-hoc pairwise comparisons showed that significant improvements in StO2 (p≤0.000) were seen from baseline, throughout the intervention, continuing up to 15 minutes post intervention, indicating a continued effect of the device after a short intervention. Conclusion: Post-operative care poses huge demands and cost to health services worldwide, so promotion of portable rehabilitation tools that facilitate community rehabilitation affords immense potential. Increasing StO2 through short-intervention sessions with this portable device within various health and sports-based practices, improving tissue health, potentially reducing post-operative DVT risk or inflammation. Such devices lend themselves to wide self-management implementation

Determining effectiveness of a passive gravity assisted traction (PGAT) device in the management of simple, mechanical low back pain

Objectives Anecdotal evidence supports stretching exercises to minimize symptoms of low back pain (LBP) and improve function. This study aimed to assess whether a passive gravity assisted traction (PGAT) device can reduce LBP through stretching techniques. Methods Sixty-seven participants with simple mechanical LBP were randomly assigned to a control or intervention group for 4 weeks, the intervention group receiving standardized advice and PGAT device and the control group received standardized advice. Outcome measures via questionnaire assessments included; Roland Morris Disability Questionnaire (RMDQ), Patient Reported Outcome Measure (PROMs), Oswestry Disability Index (ODI) and Core Outcome Measures Index (COMI). Results Statistically significant score reduction in RMDQ (p=0.01) occurred within the intervention group and PROMs (p=0.01) when comparing intervention to control. There were no significant differences (p=0.06) within the control group. Within the intervention group significant reductions in ‘average’ pain over the previous 24 hours, 7 days and ‘worst’ pain scores over previous 7 days (p<0.05). Significant decreases in ‘average’ and ‘worst’ pain (p=0.01) when comparing intervention to control group when rating an activity that participants found difficult to do, due to LBP. Conclusions Improvements in LBP were demonstrated within the intervention group and comparing intervention to control group. Further research should consider assessing subgroups of posture types to compare response between groups. The use of PGAT devises such as LumbaCurve™ may be useful in the management of back pain

Determination of ankle and metatarsophalangeal stiffness during walking and jogging

Forefoot stiffness has been shown to influence joint biomechanics. However, little or no data exist on metatarsophalangeal stiffness. Twenty-four healthy rearfoot strike runners were recruited from a staff and student population at the University of Central Lancashire. Five repetitions of shod, self-selected speed level walking, and jogging were performed. Kinetic and kinematic data were collected using retroreflective markers placed on the lower limb and foot to create a 3-segment foot model using the calibrated anatomical system technique. Ankle and metatarsophalangeal moments and angles were calculated. Stiffness values were calculated using a linear best fit line of moment versus of angle plots. Paired t tests were used to compare values between walking and jogging conditions. Significant differences were seen in ankle range of motion, but not in metatarsophalangeal range of motion. Maximum moments were significantly greater in the ankle during jogging, but these were not significantly different at the metatarsophalangeal joint. Average ankle joint stiffness exhibited significantly lower stiffness when walking compared with jogging. However, the metatarsophalangeal joint exhibited significantly greater stiffness when walking compared with jogging. A greater understanding of forefoot stiffness may inform the development of footwear, prosthetic feet, and orthotic devices, such as ankle foot orthoses for walking and sporting activities

Can the use of Proprioceptive Knee Braces have Implications in the Management of Osteoarthritic Knees: An exploratory study?

Background: Use of proprioceptive knee braces to control symptomology by altering neuromuscular control mechanisms has been shown in patellofemoral pain. Though their potential in patients with knee osteoarthritis (OA) is vast, little research has examined their efficacy. Methods: Thirteen healthy participants were asked to perform a 10cm stepdown task with and without a Proprioceptive Brace. Data was collected using a 10-camera Qualisys system. Individuals with OA completed the Knee Osteoarthritis Outcome Score (KOOS) pre- and post 4-week intervention. Results: During stepdown reductions in knee maximum internal rotation, transverse range of movement, transverse plane angular velocity and maximum internal rotation angular velocity was seen. Ankle plantar flexion and inversion angular velocity decreased while inversion and maximum supination angular velocity increased. Improvements in KOOS were noted across all parameters with brace use. Conclusions: Positive changes in kinematic variables in multiple planes can be achieved with proprioceptive bracing alongside improved patient outcome. These changes occur at the knee but analysis of other weight bearing joints should not be overlooked in future studies. This study supports the concept of neuromuscular reinforcement and re-education through proprioceptive bracing and its application in the management in knee OA

“Spinal alignment” cushion in the management of low back pain – a randomized controlled study

Objectives: To assess the clinical effectiveness of using a spinal alignment cushion compared to standardized care in the management of simple mechanical LBP, whilst laying in the semi-fetal position. Methods: 71 individuals (aged between 18 and 50) with simple mechanical LBP for at least 3 months were recruited to the 4-week intervention after screening using the Red Flags and STarT Back tools. Participants were randomly assigned to either the control (standardized care) or intervention group (standardized care plus spinal alignment cushion). Pre and post assessments were taken using the Roland Morris Disability Questionnaire (RMDQ) (0-24), to assess physical disability associated with low back pain; the Core Outcomes Measure Index (COMI) (0-10), and Patient Reported Outcome Measures that included measures of sleep quality and comfort as well as back and muscle pain and stiffness. Questionnaires were completed online using SNAP survey. Each post assessment was analyzed using ANCOVA with corresponding pre-assessment as a covariate. Results: Clinically and statistically significant differences were seen in the RMDQ (p=0.034) and COMI scores (p=0.008) with the intervention group showing the greater improvement in scores over the four-week intervention. Significant differences were also seen in favor of the intervention group in the frequency (p=0.004) and intensity of back pain (p<0.001), joint/muscle stiffness (p=0.046) and intensity of back stiffness (p=0.022). Conclusions: Overall, results suggest that use of targeted treatments such as a spinal alignment cushion, for symptoms at night can provide clinically important and statistically significant improvements for individuals with LBP with high levels of treatment satisfaction and adherenc

Perceptions of Stigma Associated with Chronic Knee Pain: Voices of Selected Women in Thailand and Malaysia

Introduction A higher prevalence of knee pain in Southeast Asian countries, compared with non-Asian countries, is an established fact. This article hypothesizes that this fact, combined with personal, cultural, and environmental factors, may influence attitudes towards illness and treatment-seeking behaviour and adherence. Objective This study aimed to determine current attitudes, stigma, and barriers of women to the management of chronic knee pain and treatment in two Southeast Asian countries. Methods Fourteen semi-structured interviews explored female lived perceptions of chronic knee pain in Southeast Asia. Using a phenomenological reduction process, open-ended questions allowed participants to voice their perceptions of their experience of this knee condition. Particular foci were potential stigma associated with the perceptions of others, health-seeking attitudes, and attitudes towards exercise. Results The shared experiences of managing chronic knee pain revealed the impact of their condition on participants' normality of life and their struggles with pain, limitations, and fear for the future. Key individual, interpersonal, organisational and community barriers and facilitators impacted the health seeking attitudes and engagement with conservative rehabilitation programmes. Conclusion Improved socio-cultural competency and consideration for an individuals’ intersectional identity and interpersonal relationships are key to designing rehabilitation and conservative management solutions. Co-creating alternative pathways for rehabilitation for individuals that are more distant from health facilities may help reduce socio-cultural barriers at a community level

Postural management system for bedbound patients

Objectives To explore the potential effectiveness of postural management system considering peak contact pressure and user perceptions. Methods Fifteen healthy participants were screened using a modified Red Flags Screening tool. Conformat® system was used to analyze contact pressure under the shoulder and buttocks and was recorded for 10 minutes in supine and side-lying positions with and without a postural management system. Participants were asked about their comfort and restrictiveness using a numerical rating scale. Results In side-lying position, the peak contact pressure at greater trochanter was significantly lower when a postural management system was applied. In supine position, the peak contact pressure at shoulders was respectively lower. In turn, the peak contact pressure at ischial tuberosity was significantly higher lower when a postural management system was applied. The postural management system did not affect the level of perceived comfort. Participants reported that they felt more restricted with the intervention. Conclusions A postural management system reduced pressure at the shoulders in supine-lying position and at the greater trochanter in side-lying position lowering the risk of pressure injury formation. A postural management system may reduce the economic burden of health problems associated with poor positioning, enhance patient care, and reduce the risks associated with manual handling techniques when repositioning