Modifying patterns of movement in people with low back pain -does it help? A systematic review

Background: Physiotherapy for people with low back pain frequently includes assessment and modification of lumbo-pelvic movement. Interventions commonly aim to restore normal movement and thereby reduce pain and improve activity limitation. The objective of this systematic review was to investigate: (i) the effect of movement-based interventions on movement patterns (muscle activation, lumbo-pelvic kinematics or postural patterns) of people with low back pain (LBP), and (ii) the relationship between changes in movement patterns and subsequent changes in pain and activity limitation. Methods. MEDLINE, Cochrane Central, EMBASE, AMI, CINAHL, Scopus, AMED, ISI Web of Science were searched from inception until January 2012. Randomised controlled trials or controlled clinical trials of people with LBP were eligible for inclusion. The intervention must have been designed to influence (i) muscle activity patterns, (ii) lumbo-pelvic kinematic patterns or (iii) postural patterns, and included measurement of such deficits before and after treatment, to allow determination of the success of the intervention on the lumbo-pelvic movement. Twelve trials (25% of retrieved studies) met the inclusion criteria. Two reviewers independently identified, assessed and extracted data. The PEDro scale was used to assess method quality. Intervention effects were described using standardised differences between group means and 95% confidence intervals. Results: The included trials showed inconsistent, mostly small to moderate intervention effects on targeted movement patterns. There was considerable heterogeneity in trial design, intervention type and outcome measures. A relationship between changes to movement patterns and improvements in pain or activity limitation was observed in one of six studies on muscle activation patterns, one of four studies that examined the flexion relaxation response pattern and in two of three studies that assessed lumbo-pelvic kinematics or postural characteristics. Conclusions: Movement-based interventions were infrequently effec tive for changing observable movement patterns. A relationship between changes in movement patterns and improvement in pain or activity limitation was also infrequently observed. No independent studies confirm any observed relationships. Challenges for future research include defining best methods for measuring (i) movement aberrations, (ii) improvements in movements, and (iii) the relationship between changes in how people move and associated changes in other health indicators such as activity limitation

Multi-scale network analysis shows scale-dependency of significance of individual protected areas for connectivity

Context: The problem of how ecological mechanisms create and interact with patterns across different scales is fundamental not only for understanding ecological processes, but also for interpretations of ecological dynamics and the strategies that organisms adopt to cope with variability and cross-scale influences.\ud \ud Objectives: Our objective was to determine the consistency of the role of individual habitat patches in pattern-process relationships (focusing on the potential for dispersal within a network of patches in a fragmented landscape) across a range of scales.\ud \ud Methods: Network analysis was used to assess and compare the potential connectivity and spatial distribution of highland fynbos habitat in and between protected areas of the Western Cape of South Africa. Connectivity of fynbos patches was measured using ten maximum threshold distances, ranging from five to 50 km, based on the known average dispersal distances of fynbos endemic bird species.\ud \ud Results: Network connectivity increased predictably with scale. More interestingly, however, the relative contributions of individual protected areas to network connectivity showed strong scale dependence.\ud \ud Conclusions: Conservation approaches that rely on single-scale analyses of connectivity and context (e.g., based on data for a single species with a given dispersal distance) are inadequate to identify key land parcels. Landscape planning, and specifically the assessment of the value of individual areas for dispersal, must therefore be undertaken with a multi-scale approach. Developing a better understanding of scaling dependencies in fragmenting landscapes is of high importance for both ecological theory and conservation planning

The effect of changing movement and posture using motion-sensor biofeedback, versus guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial

Background: The aims of this pilot trial were to (i) test the hypothesis that modifying patterns of painful lumbo-pelvic movement using motion-sensor biofeedback in people with low back pain would lead to reduced pain and activity limitation compared with guidelines-based care, and (ii) facilitate sample size calculations for a fully powered trial. Methods: A multicentre (8 clinics), cluster-randomised, placebo-controlled pilot trial compared two groups of pati ents seeking medical or physiotherapy primary care for sub-acute and chronic back pain. It was powered for longitudinal analysis, but not for adjusted single-time point comparisons. The intervention group (n?=?58) received modification of movement patterns augmented by motion-sensor movement biofeedback (ViMove, dorsaVi.com) plus guidelines-based medical or physiotherapy care. The control group (n?=?54) received a placebo (wearing the motion-sensors without biofeedback) plus guidelines-based medical or physiotherapy care. Primary outcomes were self-reported pain intensity (VAS) and activity limitation (Roland Morris Disability Questionnaire (RMDQ), Patient Specific Functional Scale (PSFS)), all on 0-100 scales. Both groups received 6-8 treatment sessions. Outcomes were measured seven times during 10-weeks of treatment and at 12, 26 and 52 week follow-up, with 17.0 % dropout. Patients were not informed of group allocation or the study hypothesis. Results: Across one-year, there were significant between-group differences favouring the intervention group [generalized linear model coefficient (95 % CI): group effect RMDQ -7.1 (95 % CI-12.6;-1.6), PSFS -10.3 (-16.6; -3.9), QVAS -7.7 (-13.0; -2.4); and group by time effect differences (per 100 days) RMDQ -3.5 (-5.2; -2.2), PSFS -4.7 (-7.0; -2.5), QVAS -4.8 (-6.1; -3.5)], all p? < ?0.001. Risk ratios between groups of probability of improving by > 30 % at 12-months?=?RMDQ 2.4 (95 % CI 1.5; 4.1), PSFS 2.5 (1.5; 4.0), QVAS 3.3 (1.8; 5.9). The only device-related side-effects involved transient skin irritation from tape used to mount motion sensors. Conclusions: Individualised movement retraining using motion-sensor biofeedback resulted in significant and sustained improvements in pain and activity limitation that persisted after treatment finished. This pilot trial also refined the procedures and sample size requirements for a fully powered RCT. This trial (Australian New Zealand Clinical Trials Registry NCT01572779) was equally funded by dorsaVi P/L and the Victorian State Government

Towards common ground in measuring acceptance of evolution and knowledge about evolution across Europe: a systematic review of the state of research

Background Relatively little information is available regarding the level of acceptance of evolution and knowledge about evolution in different educational settings in Europe. The aim of the present study is to fill this gap and provide a comprehensive overview of the current state of research regarding evolutionary knowledge and acceptance of students and teachers across Europe, based on a systematic literature review. Results We identified 56 papers for the period 2010–2020, presenting results for 29 European countries. Both knowledge and acceptance of evolution were assessed in 17 studies. Out of 13 instruments most commonly used in the literature, five have been used in the European context so far: ACORNS, CINS, I-SEA, KEE and MATE. Thirty-one other instruments were identified of which 16 were used in studies on knowledge and 15 in studies on acceptance. The extent of knowledge was hard to compare even within groups of the same education level due to the application of different instruments and assessment of different key concepts. Our results illustrate the persistence of misconceptions through all education levels. Comparing acceptance among different education levels and countries revealed a high diversity. However, a lack of evolution in curricula tended to be associated with rejection of evolution in some countries. European studies that investigated both acceptance of evolution and knowledge about evolution varied highly concerning the existence and strength of the relationship between these factors. However, some trends are visible, such as an increase of strength of the relationship the higher the education level. Conclusions The present review highlights the lack of a standardized assessment of evolutionary knowledge and acceptance of evolution across Europe and, therefore, of reasonably comparable data. Moreover, the review revealed that only about one-third of all studies on acceptance and/or knowledge about evolution provided evidence for local validity and reliability. We suggest the use of assessment categories for both knowledge and acceptance instruments to allow for interpretation and comparison of sum scores among different sample groups. This, along with prospective comparative research based on similar samples, paves the way for future research aimed at overcoming current biases and inconsistencies in results.European Cooperation in Science and Technology http://dx.doi.org/10.13039/501100000921Peer Reviewe