Bifidobacterial Dominance of the Gut in Early Life and Acquisition of Antimicrobial Resistance.

Bifidobacterium species are important commensals capable of dominating the infant gut microbiome, in part by producing acids that suppress growth of other taxa. Bifidobacterium species are less prone to possessing antimicrobial resistance (AMR) genes (ARGs) than other taxa that may colonize infants. Given that AMR is a growing public health crisis and ARGs are present in the gut microbiome of humans from early life, this study examines the correlation between a Bifidobacterium-dominated infant gut microbiome and AMR levels, measured by a culture-independent metagenomic approach both in early life and as infants become toddlers. In general, Bifidobacterium dominance is associated with a significant reduction in AMR in a Bangladeshi cohort, both in the number of acquired AMR genes present and in the abundance of AMR genes. However, by year 2, Bangladeshi infants had no significant differences in AMR related to their early-life Bifidobacterium levels. A generalized linear model including all infants in a previously published Swedish cohort found a significant negative association between log-transformed total AMR and Bifidobacterium levels, thus confirming the relationship between Bifidobacterium levels and AMR. In both cohorts, there was no change between early-life and later-life AMR abundance in high-Bifidobacterium infants but a significant reduction in AMR abundance in low-Bifidobacterium infants. These results support the hypothesis that early Bifidobacterium dominance of the infant gut microbiome may help reduce colonization by taxa containing ARGs.IMPORTANCE Infants are vulnerable to an array of infectious diseases, and as the gut microbiome may serve as a reservoir of AMR for pathogens, reducing the levels of AMR in infants is important to infant health. This study demonstrates that high levels of Bifidobacterium are associated with reduced levels of AMR in early life and suggests that probiotic interventions to increase infant Bifidobacterium levels have the potential to reduce AMR in infants. However, this effect is not sustained at year 2 of age in Bangladeshi infants, underscoring the need for more detailed studies of the biogeography and timing of infant AMR acquisition

Using evidence‐based co‐design to develop a hybrid delivered exercise intervention that aims to increase confidence to exercise in people with haemophilia

Introduction: Due to advances in treatments, people with haemophilia (PWH) are living longer. They are not as active as the general population due to joint damage and lack confidence to be active due to concerns about further bleeds and pain. There is a need to facilitate healthy aging through promotion of physical activity (PA) and exercise. Changing patient beliefs and increasing physical literacy and confidence to move are thought to be key to helping PWH become more active. Aim: This paper describes the development of an exercise and behaviour change intervention to improve confidence to exercise in PWH. Methods: The 4‐stage Medical Research Council framework for complex intervention development was used. Results: Stakeholders included 17 PWH and 7 physiotherapists working in haemophilia. Seven online focus group meetings were held. The final intervention is a hybrid 12‐week physiotherapist led progressive exercise programme. Classes are 45 min including Pilates, High intensity interval training and balance elements, together with discussion sessions focusing on PA recommendations, the types and benefits of different exercise styles and the effects of PA, together with the effects of aging for PWH. The COM‐B model of behaviour change was used to develop the intervention. Conclusion: Co‐design helps to produce an intervention that understands the stakeholders needs. Through this process the intervention developed to incorporate not only increasing PA but also confidence to exercise. The use of behaviour change theory identified the behaviour techniques included in the intervention and aims to increase physical literacy in this population

Development of a haemophilia physiotherapy intervention for optimum musculoskeletal health (Dolphin trial)

Introduction: Haemophilic arthropathy is associated with muscle weakness and may be reduced prior to the onset of clinical arthropathy.Muscle weakness is strongly correlated to reduced walking distances, slower ascent and descent of stairs, and altered joint motion and forces during weight bearing activities. Our aim was to develop a muscle strengthening exercise intervention for children that could be tested in a randomised clinical trial. Methods: We conducted modified Nominal Group Technique focus groups with academic experts and specialist physiotherapists, and most importantly in consultation with patients. The exercise programme was demonstrated to five boys with haemophilia and their parents. Children and parents were asked; what they thought about the exercises and whether they could undertake them on a regular basis, where they thought the best place was for undertaking them, and how they would like to receive information on the exercise programme. They were also asked questions about how they would feel about taking part in a study testing the benefits of the exercises, issues around being allocated randomly into study groups, and what would encourage the children to continue on the exercise programme. Results: Strong consensus from physiotherapists indicated the exercise programme should include exercises focused on strength, balance, proprioception, flexibility and mobility, and a motor learning component. Families noted the best place for the intervention being carried out was at home and that twice per week would be achievable. Parents felt that in order to sustain interest and motivation, it was important to build in an incentive that would be valued by the child. They also said that in order to find out whether or not the exercise programme worked, they would not have a problem with their child being allocated into an intervention or usual care groups. Discussion/Conclusion: Engaging clinicians and patients in partnership as part of the research process enhanced the design of an exercise intervention ensuring it is acceptable and potentially beneficial for children with chronic disorders. The efficacy of a 24-session progressive exercise programme of stretching, strengthening, balance, proprioceptive and mobility using functional movement patterns is currently being tested in a randomised controlled trial

Clinical outcome measures for monitoring physical function in pediatric obesity: An integrative review

Objective: Measuring physical function in children with obesity is important to provide targets for clinical intervention to reduce impairments and increase participation in activities. The objective of this integrative review was to evaluate measurement properties of performance‐based measures of physical function in overweight and obese children. Methods: An integrative review of literature published in Cochrane reviews, SPORTDiscus, CINAHL, Plos, Medline and Scopus was conducted. Results: Twenty‐eight studies were eligible and represented 66 performance‐based measures of physical function. Assessments of repeatability and feasibility were not conducted in the majority of performance measures reported, only 6 minute‐timed‐walk (6MTW) was examined for test‐retest repeatability. Measures of flexibility, strength, aerobic performance, anaerobic performance, coordination and balance demonstrated construct validity and responsiveness, but findings were inconsistent across all performance‐based measures. Multi‐item tests of physical function demonstrated acceptable construct validity and responsiveness, but internal consistency was not determined. Conclusions: There is moderate evidence 6MTW is suitable for measurement of physical function in children with obesity. But, evidence is low for use of aerobic and anaerobic performance, muscle strength, MABC and BOT2 multi‐item performance instruments and, very low for flexibility, coordination and balance tests. Based on this review, measurement of physical function utilising 6MTW is recommended

The role of physiotherapy in the new treatment landscape for haemophilia

The physiotherapist plays an essential role for people with haemophilia, an inherited bleeding disease responsible for musculoskeletal complications. Yet, with the advent of new and advanced therapies, the medical landscape is changing, and physiotherapy must adapt alongside. This paper considers whether there will still be a need for physiotherapy in the era of advanced therapies, and discusses ways in which services should evolve to complement emerging treatment paradigms for haemostasis in people with haemophilia. Ultimately, physiotherapy will remain an important element of care, even for people with little joint damage and low risks in the era of the new mild phenotype. However, competencies will need to evolve, and physiotherapists in both primary care and specialist treatment centres should work with haematology colleagues to develop more sensitive tools for detecting early joint changes. Physiotherapists will also play a crucial role in counselling and physically coaching, monitoring the musculoskeletal status of people with haemophilia who have transitioned to new treatments

Natural history of radiographic first metatarsophalangeal joint osteoarthritis: A nineteen‐year population‐based cohort study

Objective: To assess the long-term prevalence, natural history, progression and incidence of 73 radiographic first metatarsophalangeal joint (1st MTPJ) osteoarthritis (OA). Methods: A longitudinal, cohort design was used in which radiographic OA at the 1st MTPJ was 75 investigated in participants at year 6 (1995) and year 23 (2013-2015) from the Chingford 1000 76 Women study. Radiographic features of osteophytes (OPs) and/or joint space narrowing (JSN) at the 77 1st MTPJ were scored according to a validated foot atlas. Natural history was determined by the 78 change in prevalence, incidence, progression and worsening of OA in the 1st MTPJ. Results: Complete case matched foot radiographic data were available for 193 of the women 80 currently enrolled in the study, mean age: 75.7 years (SD: 5.2; range 69-90). At the level of the 1st 81 MTPJ, prevalence of OA at year 6 was 21.76% in the left and 24.35% in the right and at year 23 was 82 23.83% in the left and 32.64% in the right. Over the 19-year period, 13.5% of women developed 83 incident OA in the right 1st MTPJ and 8.3% in the left. Both progression and worsening of OA were 84 more evident for OPs and in the right 1st MTPJs. Conclusion: In this longest study of the natural history of radiographic 1st MTPJ OA to date, the 86 prevalence and incidence of 1st MTPJ OA increased over a 19-year period. Progression and/or 87 worsening of 1st MTPJ OA over time appears to be driven by OP development rather than JSN 88 suggestive of a biomechanical cause

Recommending swimming to people with low back pain: A scoping review

Background: It is common practice for health professionals to recommend swimming to people with low back pain (LBP) despite limited evidence. The aim of this review was to gain an understanding of the current evidence base supporting the recommendation of swimming to people with LBP. Methods: A scoping review was conducted searching five electronic databases, CINAHL, MEDLINE, PEDro, PubMed, and SPORTdiscus using the keywords back pain AND swim*. The studies were grouped by study design and the following uncertainties were considered; the impact of swimming on the spine and LBP, evidence of swimming increasing or reducing the risk of LBP and the use of swimming in LBP rehabilitation programmes. Results: 25 studies met the eligibility criteria; including sixteen observational studies exploring the relationship between swimming and LBP, three biomechanical studies investigating the impact of swimming on the spine, and five interventional studies of which four integrated swimming into a rehabilitation programme and one used swimming to modify lumbar lordosis. Conclusion: The review confirmed there is limited research and only low-level evidence to support the recommendation of swimming to people with LBP. Observational studies make up the greater proportion of research undertaken in the field; the data indicates that swimming is a low-risk form of exercise but not without risk. The findings from biomechanical research suggest that lumbar lordosis does not increase excessively when swimming breaststroke, but certain swimming techniques could negatively impact LBP and interventional trials illustrate that there are various ways to integrate swimming into a rehabilitation programme

Feasibility and safety of a powered exoskeleton for balance training for people living with multiple sclerosis: A single-group preliminary study (Rapper III)

Objective: To evaluate the feasibility, usability, safety, and potential health benefits of using an exoskeleton device for rehabilitation of people living with multiple sclerosis.Design:Single-group preliminary study.Subjects: Eleven adults living with multiple sclerosis, with Expanded Disability Status Scores that ranged from 6 to 7.5 (mean age (standard deviation; SD) 54.2 (11.8) years), were recruited. Methods: Individual participants undertook a balance rehabilitation exercise programme using the Rex Rehab robotic exoskeleton device. Each participant undertook 4 × 45–60 min supervised, balance exercise sessions. Primary outcomes were: (i) the number of participants who completed the trial protocol safely, and (ii) the number and nature of adverse events reported. Secondary outcomes were: mobility; balance; spasticity; sleep; functional independence; quality of life; and device satisfaction. Results: Ten out of 11 participants completed the trial protocol safely. Four adverse events were recorded (1 serious), all of which were deemed unrelated to the trial. Secondary outcomes showed allied improvements in balance, joint mobility, spasticity and quality of life. All participants found the device acceptable to use. Conclusion: These results suggest that it is feasible and safe to use the Rex Rehab exoskeleton device to assist with balance rehabilitation for people living with multiple sclerosis. Conclusion: These results suggest that it is feasible and safe to use the Rex Rehab exoskeleton device to assist with balance rehabilitation for people living with multiple sclerosis

Identifying performance-based outcome measures of physical function in people with haemophilia (IPOP)

Introduction: Recent recommendations of core outcome sets for haemophilia highlight the need for including measures of performance-based physical health and physical function sustainability. To date, there is no consensus on what outcomes might be of value to clinicians and patients. Aim: To identify instruments of performance-based physical function to monitor musculoskeletal health in people with haemophilia that are practical in the clinical setting. Methods: Utilising components from the Activities and Participation Category of the WHO International Classification of Functioning (WHO-ICF), a consensus-based, decision analysis approach was used to: identify activities people with haemophilia have most difficulty performing; identify quantitative performance-based measures of identified activities via a scoping review; and obtain views on acceptability of the tests utilising a DELPHI approach. Results: Eleven activities were identified: maintaining a standing position, walking long distances, walking up and down stairs, walking on different surfaces, running, hopping, jumping, squatting, kneeling, undertaking a complex lower limb task, undertaking a complex upper limb task. Following a 2-round DELPHI survey of international physiotherapists, the 6-min walk test, timed up and down stairs, 30-s sit to stand, single leg stance, tandem stance, single hop for distance (children only) and timed up and go (adults only) reached consensus. Conclusion: This study is the first step in defining a core set of performance-based instruments to monitor physical health and sustainability of physical function outcomes in people with haemophilia. Establishing the psychometric properties of the instruments and whether they are meaningful to people with haemophilia is essential