The extent and risk of knee injuries in children aged 9-14 with Generalised Joint Hypermobility and knee joint hypermobility:the CHAMPS-study Denmark

BACKGROUND: Generalised Joint Hypermobility (GJH) is suggested as an aetiological factor for knee injuries in adolescents and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of knee injuries during challenging situations like jumping and landing. The aim was to study the extent and risk of knee injuries in children with GJH and knee hypermobility. METHODS: In total, 999 children (9–14 years) were tested twice during spring 2012 and 2013 with Beighton´s Tests (BT) for hypermobility, a 0–9 scoring system. GJH was classified with cut-point ≥5/9 on both test rounds. On basis of weekly cell phone surveys of knee pain, children requiring clinical examination were seen. Traumatic and overuse knee injuries were registered by WHO ICD-10 diagnoses. Logistic regression and Poisson regression models with robust standard errors were used to examine the association between GJH and knee injuries, taking into account clustering on school class levels. RESULTS: Totally, 36 children were classified GJH on both test rounds. Overuse knee injuries were the most frequent injury type (86 %), mainly apophysitis for both groups (61 %), other than patella-femoral pain syndrome for the control group (13 %). For traumatic knee injuries, distortions and contusions were most frequent in both groups (51 % resp. 36 %), besides traumatic lesions of knee tendons and muscles for the control group (5 %). No significant association was found between overuse knee injuries and GJH with/without knee hypermobility (OR 0.69, p = 0.407 resp. OR 0.75, p = 0.576) or traumatic knee injuries and GJH with/without knee hypermobility (OR 1.56, p = 0.495 resp. OR 2.22, p = 0.231). CONCLUSIONS: Apophysitis, distortions and contusions were the most frequent knee injuries. Despite the relatively large study, the number of children with GJH and knee injuries was low, with no significant increased risk for knee injuries for this group. This questions whether GJH is a clinically relevant risk factor for knee injuries in school children aged 9–14 years. A fluctuation in the individual child´s status of GJH between test rounds was observed, suggesting that inter- and intra-tester reproducibility of BT as well as growth may be considered important confounders to future studies of children with GJH

Single leg mini squat:an inter-tester reproducibility study of children in the age of 9-10 and 12-14 years presented by various methods of kappa calculation

BACKGROUND: Multiple studies suggest that reduced postural orientation is a possible risk factor for both patello-femoral joint pain (PFP) and rupture of the anterior cruciate ligament (ACL). In order to prevent PFP and ACL injuries in adolescent athletes, it is necessary to develop simple and predictive screening tests to identify those at high risk. Single Leg Mini Squat (SLMS) is a functional and dynamic real-time screening test, which has shown good validity and reproducibility in evaluation of postural orientation of the knee in an adult population. The aim of this study was to determine the inter-tester reproducibility of SLMS in the age group of 9–10 and 12–14 years by evaluating postural orientation of the ankle, knee, hip and trunk. Further on, this study exemplify the divergence of kappa values when using different methods of calculating kappa for the same dataset. METHODS: A total of 72 non-injured children were included in the study. Postural orientation of the ankle, knee, hip and trunk for both legs was determined by two testers using a four-point scale (ordinal, 0–3). Prevalence, overall agreement as well as four different methods for calculating kappa were evaluated: linear weighted kappa in comparison with un-weighted kappa, prevalence-adjusted bias-adjusted kappa (PABAK) and quadratic weighted kappa. RESULTS: The linear weighted kappa values ranged between 0.54-0.86 (overall agreement 0.86-0.97), reflecting a moderate to almost perfect agreement. When calculating un-weighted kappa (with and without PABAK) and quadratic weighted kappa, the results spread between 0.46-0.88, 0.50-0.94, and 0.76-0.95, reflecting the various results when using different methods of kappa calculation. CONCLUSIONS: The Single Leg Mini Squat test has moderate to almost perfect reproducibility in children aged 9–10 and 12–14 years when evaluating postural orientation of the ankles, knees, hips and trunk, based on the excellent strength of agreement as presented by linear weighted kappa. The inconsistency in results when using different methods of kappa calculation demonstrated the linear weighted kappa being generally 15% lower than the quadratic weighted values. On average, prevalence-adjusted bias-adjusted kappa increased the un-weighted kappa values by 7% and 12% by children aged 9–10 and 12–14, respectively

Social innovation i indsatsen for hjemløse kvinder:tilblivelsen af en natcafé

I forbindelse med de nationale strategiplaner ”Det fælles ansvar II” og ”Den nationale hjemløsestrategi” er der blevet iværksat flere aktiviteter i Københavns Kommune for at skabe øget viden og forbedre indsatsen i forhold til hjemløse og andre grupper af socialt udsatte kvinder. Flere af disse er sociale innovationer. De har som formål at imødekomme kvindernes behov og problemer på nye og bedre måder. I artiklen analyseres tilblivelsen af en af disse sociale innovationer, ”Café Klare – Natcaféen for kvinder”. Det undersøges således hvorledes ideen til natcaféen er fremkommet, og hvordan processen bag implementeringen af den er forløbet. Analysen viser bl.a., at der er tale om en længerevarende proces, hvor medarbejdere og ledere i Socialforvaltningen og i organisationer på hjemløseområdet, mere eller mindre strategisk har skabt, udnyttet og forhandlet muligheder for at skabe en forbedret indsats for de hjemløse kvinder, heriblandt natcaféen. Analysen er baseret på et længerevarende, kvalitativt casestudie. ENGELSK ABSTRACT: Catharina Juul Kristensen: Social Innovation in Services for Homeless Women – the Creation of a Night Shelter Within the framework of the Danish national action plans ”Our Common Responsibility II” and ”The National Homeless Strategy”, the municipality of Copenhagen launched a number of initiatives to improve social services for socially vulnerable and homeless women. Another goal of these initiatives was to increase awareness and knowledge of these women’s needs. Many of these efforts are social innovations that endeavor to meet the needs and problems of homeless women in new ways. This article analyzes the emergence of one of these social innovations, ”Café Klare – the night shelter for women”. It focuses on the process of idea generation and implementation of the night shelter. The analysis shows how employees and managers in both the municipal social administration and in organizations for homelessness created, used and negotiated the opportunity to improve the social services for homeless women more or less strategically. Among these services was ”Café Klare”. The analysis is based on an in depth case study. Key words: Social innovation, innovation processes, entrepreneurship, night shelters, homeless women

Alterations in neuromuscular function in girls with generalized joint hypermobility

BACKGROUND: Generalized Joint Hypermobility (GJH) is associated with increased risk of musculoskeletal joint pain. We investigated neuromuscular performance and muscle activation strategy. METHODS: Girls with GJH and non-GJH (NGJH) performed isometric knee flexions (90°,110°,130°), and extensions (90°) at 20 % Maximum Voluntary Contraction, and explosive isometric knee flexions while sitting. EMG was recorded from knee flexor and extensor muscles. RESULTS: Early rate of torque development was 53 % faster for GJH. Reduced hamstring muscle activation in girls with GJH was found while knee extensor and calf muscle activation did not differ between groups. Flexion-extension and medial-lateral co-activation ratio during flexions were higher for girls with GJH than NGJH girls. CONCLUSIONS: Girls with GJH had higher capacity to rapidly generate force than NGJH girls which may reflect motor adaptation to compensate for hypermobility. Higher medial muscle activation indicated higher levels of medial knee joint compression in girls with GJH. Increased flexion-extension co-activation ratios in GJH were explained by decreased agonist drive to the hamstrings

Efficacy of ‘Tailored Physical Activity’ or ‘Chronic Pain Self-Management Program’ on return to work for sick-listed citizens: design of a randomised controlled trial

BACKGROUND: Pain affects quality of life and can result in absence from work. Treatment and/or prevention strategies for musculoskeletal pain-related long-term sick leave are currently undertaken in several health sectors. Moreover, there are few evidence-based guidelines for such treatment and prevention. The aim of this study is to evaluate the efficacy of ‘Tailored Physical Activity’ or ‘Chronic Pain Self-Management Program’ for sick-listed citizens with pain in the back and/or the upper body. METHODS: This protocol describes the design of a parallel randomised controlled trial on the efficacy of ‘Tailored Physical Activity’ or a ‘Chronic Pain Self-management Program’ versus a reference group for sick-listed citizens with complaints of pain in the back or upper body. Participants will have been absent from work due to sick-listing for 3 to 9 weeks at the time of recruitment. All interventions will be performed at the ‘Health Care Center’ in the Sonderborg Municipality, and a minimum of 138 participants will be randomised into one of the three groups. All participants will receive ‘Health Guidance’, a (1.5-hour) individualised dialogue focusing on improving ways of living, based on assessments of risk behavior, motivation for change, level of self-care and personal resources. In addition, the experimental groups will receive either ‘Tailored Physical Activity’ (three 50-minute sessions/week over 10 weeks) or ‘Chronic Pain Self-Management Program’ (2.5-hours per week over 6 weeks). The reference group will receive only ‘Health Guidance’. The primary outcome is the participants’ sick-listed status at 3 and 12 months after baseline. The co-primary outcome is the time it takes to return to work. In addition, secondary outcomes include anthropometric measurements, functional capacity and self-reported number of sick days, musculoskeletal symptoms, general health, work ability, physical capacity, kinesiophobia, physical functional status, interpersonal problems and mental disorders. DISCUSSION: There are few evidence-based interventions for rehabilitation programmes assisting people with musculoskeletal pain-related work absence. This study will compare outcomes of interventions on return to work in order to increase the knowledge of evidence-based rehabilitation of sick-listed citizens to prevent long-term sick-leave and facilitate return to work. TRIAL REGISTRATION: The trial is registered in the ClinicalTrials.gov, number NCT01356784

The association between generalized joint hypermobility and active horizontal shoulder abduction in 10–15 year old competitive swimmers

BACKGROUND: Increased shoulder mobility and Generalised Joint Hypermobility (GJH) are assumed to be predisposing risk factors for shoulder injuries. The association between GJH and shoulder mobility among competitive swimmers is unknown. The aim was to study the association between GJH and active horizontal shoulder abduction (AHSA) in young, competitive swimmers and to describe normative values of AHSA in this group. METHODS: In total, 92 swimmers (10–15 years) without shoulder pain participated. GJH was evaluated with the Beighton Tests (BT) for joint hypermobility. Shoulder mobility was measured as maximum AHSA. A multiple regression model was used to assess associations between GJH and AHSA. RESULTS: Overall, positive associations were found between GJH and AHSA. An increase of BT score was associated with an increase of AHSA, seen as an increased AHSA of 3.9°, 5.7° and 7.9° by BT cut off points ≥5/9, ≥6/9 and ≥7/9, respectively. Normative values for AHSA ranged from 40° to 52°, depending on age. CONCLUSIONS: Positive associations were found between GJH and AHSA, as maximum AHSA range increased with increasing BT scores. Due to lack of shoulder mobility tests in the BT scoring system, the AHSA test seems to be a promising supplemental test