EFFECTS OF BILATERAL AND UNILATERAL SEMI-RIGID ANKLE ORTHOSES ON ANKLE STABILITY AND GROUND CONTACT KINETICS

Injuries of the ankle complex are common in the sporting, civilian and military populations. The purpose of this study was to ascertain and compare the effects of unilateral and bilateral orthoses on the range of inversion and eversion at the ankle complex and on Ground Reaction Forces. Isokinetic goniometric measurement and the assessment of peak loads and timing parameters during the gait cycle were assessed in subjects with no history of ankle injury (n=31) and subjects recovering from ankle injury (n=24). There were differences in inversion angle between the braces (

Clinical academic career pathway for nursing and allied health professionals: clinical academic role descriptors

The clinical academic pathway outlined highlights the range of typical practice and research-focused activities that a practitioner on a clinical academic career pathway might normally engage in at different levels and points along this career path. The activities are intended as a guide for practitioners interested in learning more about the practice and research components of a clinical academic career, as well as those already employed in clinical academic roles. They may also be useful for health care organisations and Higher Education Institutions as a tool for developing clinical academic roles

The mechanics of patello-femoral joint dysfunction: the usefulness of the Q-angle

Patello-femoral joint syndrome (PFJS) is a common problem that is challenging to treat. The dominant theory of its aetiology is „patellar malalignment?, in which the vastus medialis oblique (VMO) muscle is ineffective in controlling patellar position but this is based on assumption. The Q-angle, a frontal plane measure, indicates patellar position relative to the pelvis and tibia; however, there is no standardised measurement protocol and it is assumed to be a fixed value.The work reported highlights the tension between measurement rigour and clinical utility. Valid measurement of the Q-angle and VMO muscle were established using: motion analysis, magnetic resonance imaging (MRI) andultrasound imaging, in recreationally active healthy participants, then applied in various experiments involving people with PFJS, with the following conclusions:The Q-angle:* varied over 60 seconds in relaxed standing* exhibited differences in movement patterns of the threemarkers which form the Q-angle between healthy and PFJSgroups during the stance phase of gait* was generally at its maximum at the beginning of the stance phase of gait and at its minimum at the end* did not correlate with pronation at the sub-talar jointVMO muscle size:* linear and CSA measures of the VMO muscle correlated well* measures of VMO muscle size from ultrasound were shown tobe valid when compared with MRI and were equally reliableNo correlation between the Q-angle and VMO muscle size was found.These results increase our understanding of the usefulness of the Q-angle, particularly its natural variation of between 30 and 40 in static standing and its different movement pattern during gait in PFJS. It was established that ultrasound imaging provides valid measures of VMO muscle size and the relationships between its CSA and linear dimensions were characterised

The Improving Global Health fellowship: a qualitative analysis of innovative leadership development for NHS healthcare professionals

Abstract Background The importance of leadership development in the early stages of careers in the NHS has been highlighted in recent years and many programmes have been implemented which seek to develop leadership skills in healthcare professionals. The Improving Global Health (IGH) Fellowship scheme is one such programme, it provides a unique leadership development opportunity through an overseas placement with a focus on quality improvement work. This evaluation examines the impact of completing an IGH Fellowship on the career and leadership development of participants, who are referred to as Fellows. Methods Fellows who had returned from overseas placement between August 2008 and February 2015 were invited to complete an anonymised online questionnaire, which collected information on: demographic details, motivations for applying to the programme, leadership development and the impact of the IGH Fellowship on their career. Fifteen semi-structured interviews were conducted to further explore the impact of the programme on Fellows’ leadership development and career progression. Interview transcripts were manually coded and underwent thematic content analysis. Results The questionnaire had a 67% (74/111) response rate. The number of fellows who self-identified as a leader more than doubled on completion of the IGH Fellowship (24/74 pre-fellowship versus 58/74 post-fellowship). 74% (55/74) reported that the IGH Fellowship had an impact upon their career, 35 of which reported that the impact was “substantial”. The themes that emerged from the interviews revealed a personal development cycle that consolidated the fellows’ interests and values whilst enhancing their self-efficacy and subsequently impacted positively upon their career choices. Three interviewees expressed frustration at the lack of opportunity to utilise their new skills on returning to the United Kingdom (UK). Conclusions The IGH Fellowship successfully empowered healthcare professionals to self-identify as leaders. Of the 45/74 respondents who commented on the impact of the IGH Fellowship on their career, 41/45 comments were positive. The fellows described a process of experiential learning, reflection and evolving cultural intelligence, which consolidated their interests and values. The resultant increase in self-efficacy empowered these returned fellows in their choice of career

Implementing a clinical academic career pathway in nursing: criteria for success and challeneges ahead

Following the United Kingdom Clinical Research Collaboration’s (UKCRC) (2007) recommendations on careers in clinical research, there has been growing anticipation in the United Kingdom about the real potential for establishing career pathways for nurses and allied health professionals that will enable them to combine a focus on both clinical and academic roles. However, it is recognized that the implementation of this initiative will require charting largely untested waters, with issues ranging from establishing joint University: health service employment contracts, to harmonizing clinical and research roles and ensuring sustainability of funding for clinical academic posts. This paper will outline the implementation of a pilot clinical academic career initiative, which has been modelled on the UKCRC framework. We will illuminate the processes and structures employed and reflect on the factors that appear critical to the successful establishment of a clinical academic career pathway. Additionally, our experience has enabled us to identify challenges that will need to be addressed by a range of stakeholders if clinical academic careers are to flourish and deliver their potential at a national level as a modern career option for nurses and allied health professionals

Validity of measuring distal vastus medialis muscle using rehabilitative ultrasound imaging versus magnetic resonance imaging

Objective quantification of muscle size can aid clinical assessment when treating musculoskeletal conditions. To date the gold standard of measuring muscle morphology is magnetic resonance imaging (MRI). However, there's a growing body of evidence validating rehabilitative ultrasound imaging (RUSI) against MRI.Objective: This study aimed to validate RUSI against MRI for the linear measurements of the distal fibres of vastus medialis muscle in the thigh.Twelve healthy male participants were recruited from a local university population. The distal portion of their right vastus medialis was imaged with the participant in long-sitting, using MRI and RUSI whilst the leg was in extension and neutral hip rotation. Cross sectional area (CSA) and three linear measures were taken from the MRI and compared with the same linear measures from RUSI. Statistical analysis included comparison of MRI and RUSI measures using the paired t-test and correlation using intra-class correlation coefficients (ICC 3,1).Mean differences between the linear measures taken from the MRI and RUSI were -0.5mm to 2.9mm (95% confidence intervals -0.6 to 8.3mm), which were not statistically different (p>0.05) and were highly correlated (ICCs3,1 0.84-0.94). Correlations between the three linear measurements and muscle CSA ranged from r=0.23 to 0.87, the greatest being muscle thickness. Multiplying the linear measures did not improve the correlation of 0.87 found for muscle thickness.Linear measures of vastus medialis depth made using RUSI were shown to be as valid as using MRI. Muscle thickness measures using RUSI could be used within an objective assessment of this muscle

Is the Q-angle an absolute or a variable measure? Measurement of the Q-angle over one minute in healthy subjects

Background and PurposeThe quadriceps angle (Q-angle) is currently the only measurement of patellofemoral mechanics available in the clinical situation which does not necessitate the use of sophisticated radiographic equipment. It is generally assumed that for a given subject position and measurement procedure, the Q-angle is an absolute value rather than one which may vary with time. However, this assumption has never been tested. The purpose of this study was to determine whether the Q-angle varies with time.MethodsThe Q-angle of 51 healthy subjects was measured continuously for one minute in the standing position using a video motion analysis system of proven accuracy and reliability.ResultsThe Q-angle varied by an average of 3.12° (1.46°-6.97°) over the one minute tested, with a repeatability coefficient of 3.4°.ConclusionThe data indicate that when measured in the standing position the Q-angle is not an absolute measure, but one which varies with time. It is proposed that when the Q-angle is measured in the clinical situation with a goniometer, the value achieved is not a definitive measurement, but a snapshot in time of the individual's Q-angle within a given range