Musculoskeletal Injury Rates in Multiday Marathon Runners Performing Ten Consecutive Marathons on a Repeat Course

Objective: To describe musculoskeletal injury rates in recreational runners completing ten marathons over ten consecutive days to help event organisers plan future injury preventative advice and strategies. Methods: An observational study involving 27 recreational runners (age 45.1 ± 7.47 yrs, mass 74.5 ± 12.39 kg, years running 11.6 ± 9.42 yrs, average weekly mileage 41.9 ± 12.72 miles). Main outcome measures included total and percentage of musculoskeletal injuries, timing of injury occurrence during 10-day event, and daily individual marathon times. Results: Twenty-six runners sustained 108 injuries, averaging 4 injuries per runner (90.13 per 1000hr). 89% of injuries involved the lower extremity; 24.1% foot, 18.5% hip/buttock, 16.7% ankle and 16.7% lower leg. Common injuries were blisters (15.7%), Achilles tendinitis (11.1%), medial tibial stress syndrome (MTSS) (10.2%), iliotibial band syndrome (ITBS) (9.3%) and low back pain (LBP) (9.3%). 64.3% of injuries were sustained to the left limb. Chisquared analysis revealed more injuries in days 1-3 than days 4-6 (p=0.013) and days 7-10 (p=0.001). Repeated measures ANOVA comparing Days 1-3, 4-6 and 7-10 showed a significant main effect (p=0.039). Post hoc analysis revealed Days 1-3 were significantly quicker time than days 7-10 (p=0.037, difference of 0.276 hrs). Conclusion: Blisters, Achilles tendinitis, MTSS and ITBS are the most common lower extremity injuries in multiday marathons runners performing a repeat course over 10 consecutive days.Runners entering these events should perform appropriate injury prevention programmes. Runners should also be more reserved at the beginning of multiday events to avoid high initial injury risk. However, further investigation of injury rates and risk factors using larger sample sizes is required

The effect of running nine marathons in nine days on proprioception and balance

Background: Multi-day running events are becoming increasingly popular with nonprofessional athletes. However, it is unknown how and when this type of event affects injury risk factors such as proprioception and balance. Objective: To evaluate the effect of running one, five consecutive and nine consecutive marathons on joint position sense (JPS) and dynamic balance. Design: Cross-sectional, observational study. Setting: Sports-injury clinic. Participants: 21 athletes completing the event (age 44.8±8.09 yrs, mass 74.4±13.14 kg, years running 10.4±7.39 yrs, average weekly mileage 44.8±12.09 miles) entered the study. Ten athletes completed the JPS testing and five athletes completed the dynamic balance testing. Assessment of Risk Factors: Risk factors were assessed the day before the event (day zero) and then following completion of one (day one), five (day five) and nine (day nine) consecutive marathons. The independent variable was time. Main Outcome Measurements: JPS error into flexion and extension, star-excursion balance test (SEBT) and number of injuries per runner. Results: Friedman's ANOVAs indicated no effects of time on JPS into extension (p=0.94), dominant-leg anterior (p=0.52) or posterior-lateral (p=0.65) SEBT reach. JPS flexion error significantly decreased by 1.3° from day one to five (p=0.032). Non-dominant leg anterior, posterior-medial and posterior-lateral SEBT reaches significantly decreased from day zero to nine by 0.09% (p=0.043), 0.13% (p=0.043) and 0.17% (p=0.043) of leg length respectively. Dominant leg posterior-medial SEBT reach also significantly decreased by 0.12% of leg length (p=0.043) from day zero to nine. There were 4.2 injuries per runner. Conclusions: The results suggest multi-day running events can cause over four lower limb injuries per runner and reduce dynamic balance ability. Nonprofessional athletes completing these events should be aware of this high injury occurrence and prepare appropriately. Injury prevention programmes incorporating dynamic balance may be recommended. However future studies with additional risk factors and larger sample sizes are needed to substantiate these findings

Previous high-intensity activity affects lower limb strength ratios

Lower limb strength ratios are important in assessing muscular imbalances. Typically, these ratios are derived from assessment of explosive, maximum effort activities. Such assessment can be functional or isokinetic. The single-effort nature of these assessments does not provide information on imbalance changes after muscular contractions. Any such change could indicate an increased risk of injury after a period of activity, thus raising questions as to the correct procedure of muscle imbalance assessment. Therefore, the aim of the current study was to assess muscle imbalances over maximum effort repeated cycling sprints. Seventeen healthy, physically active young adults (females: n=4, height 1.62±0.03 m, body mass 68.0±6.5 kg; males: n=13, height 1.80±0.06 m, body mass 80.5±13.8 kg) performed five 6-s sprints with 24-s rest interval on a Lode Excalibur bike with torque and power data recorded for each leg. Average, average maximum (average of maximum from each sprint) and peak torque (TAv, TAvM and TP respectively) and power (PAv, PAvM and PP respectively) were obtained for each leg. Ratios of these variables were calculated as . Wilcoxon's test revealed a significantly stronger leg (p<0.05) for all torque and power variables. Friedman's test indicated a significant ratio increase between TAv (11.7±6.8%) and TAvM (4.6±3.0%, p=0.001) and TP (4.1±3.5%, p=0.001), as well as between PAv (8.8±5.0%) and PAvM (4.5±2.9%, p=0.003) and PP (4.2±2.6, p=0.003%) but not between TAvM and TP (p=0.421) or PAvM and PP (p=0.981). The results indicate that high-intensity activity increases lower limb strength imbalance, resulting in different ratios. The authors posit that muscle imbalance assessment activities conducted at rested state may not accurately reflect the true strength difference between limbs, leading to inaccurate training or rehabilitation advice

Implementing a digital patient feedback system: an analysis using normalisation process theory

Background: Patient feedback in the English NHS is now widespread and digital methods are increasingly used. Adoption of digital methods depends on socio-technical and contextual factors, alongside human agency and lived experience. Moreover, the introduction of these methods may be perceived as disruptive of organisational and clinical routines. The focus of this paper is on the implementation of a particular digital feedback intervention that was co-designed with health professionals and patients (the DEPEND study). Methods: The digital feedback intervention was conceptualised as a complex intervention and thus the study focused on the contexts within which it operated, and how the different participants made sense of the intervention and engaged with it (or not). Four health care sites were studied: An acute setting, a mental health setting, and two general practices. Qualitative data was collected through interviews and focus groups with professionals, patients and carers. In total 51 staff, 24 patients and 8 carers were included. Forty-two observations of the use of the digital feedback system were carried out in the four settings. Data analysis was based on modified grounded theory and Normalisation Process Theory (NPT) formed the conceptual framework. Results: Digital feedback made sense to health care staff as it was seen as attractive, fast to complete and easier to analyse. Patients had a range of views depending on their familiarity with the digital world. Patients mentioned barriers such as kiosk not being visible, privacy, lack of digital know-how, technical hitches with the touchscreen. Collective action in maintaining participation again differed between sites because of workload pressure, perceptions of roles and responsibilities; and in the mental health site major organisational change was taking place. For mental health service users, their relationship with staff and their own health status determined their digital use. Conclusion: The potential of digital feedback was recognised but implementation should take local contexts, different patient groups and organisational leadership into account. Patient involvement in change and adaptation of the intervention was important in enhancing the embedding of digital methods in routine feedback. NPT allowed for a in-depth understanding of actions and interactions of both staff and patients

Musculoskeletal injury rates in multiday marathon runners performing a repeat course

Background: Ultramarathon events are increasingly popular amongst non-elite athletes. However, there is little research investigating musculoskeletal injury rates, specifically multiday events using the same racing route. Objective: To describe musculoskeletal injury rates in runners completing ten marathons over ten consecutive days. Design: Observational. Setting: Sports-injury clinic. Participants: 27 athletes entered the study (age 45.1±7.47 yrs, mass 74.5±12.39 kg, years running 11.6±9.42 yrs, average weekly mileage 41.9±12.72 miles). 26 athletes completed all 10 marathons on a repeat, anti-clockwise, circular road course. One athlete withdrew due to serious injury. Main Outcome Measurements: Musculoskeletal injuries were recorded by trained medical staff three times each day. An injury audit questionnaire was used to document injury rate, type and location. Injuries were defined as a specific musculoskeletal abnormality that the runner perceived to effect performance. Results: 26 athletes sustained 108 injuries, averaging 4 injuries per athlete. 89% of injuries involved the lower extremity, 24.1% occurred in the foot, 18.5% the hip/buttock, 16.7% the ankle and 16.7% in the lower leg. The most common injuries were blisters (15.7%), Achilles tendinitis (11.1%), medial tibial stress syndrome (10.2%), iliotibial band syndrome (ITBS) (9.3%) and low back pain (LBP) (9.3%). 64.3% of injuries were sustained to the left limb. Chi-squared analysis revealed more injuries in days 1–3 than days 4–6 (p=0.013) and days 7–10 (p=0.001). Conclusions: Lower extremity injuries are highly likely in multiday marathon running; the most common being blisters, Achilles tendinitis, medial tibial stress syndrome, ITBS and LBP. Athletes entering these events should engage in appropriate injury prevention programmes. The majority of injuries were sustained to the left limb and during the first three days. Multiday marathon event organisers should consider alternating route direction to reduce injury risk; potentially the result of prolonged, altered gait biomechanics. However, further investigation of injury risk factors using larger sample sizes is required

Previous high-intensity activity affects lower limb strength ratios

Lower limb strength ratios are important in assessing muscular imbalances. Typically, these ratios are derived from assessment of explosive, maximum effort activities. Such assessment can be functional or isokinetic. The single-effort nature of these assessments does not provide information on imbalance changes following muscular contractions. Any such change could indicate an increased risk of injury after a period of activity, thus raising questions as to the correct procedure of muscle imbalance assessment. Therefore, the aim of the current study was to assess muscle imbalances over maximum effort repeated cycling sprints. Seventeen healthy, physically active young adults (females: n=4, height 1.62±0.03 m, body mass 68.0±6.5 kg; males: n=13, height 1.80±0.06 m, body mass 80.5±13.8 kg) performed five 6-s sprints with 24-s rest interval on a Lode Excalibur bike with torque and power data recorded for each leg. Average, average maximum (average of maximum from each sprint) and peak torque (TAv, TAvM and TP, respectively) and power (PAv, PAvM and PP, respectively) were obtained for each leg. Ratios of these variables were calculated as (((stronger leg-weaker leg) / (average of two legs))*100). Wilcoxon’s test revealed a significantly stronger leg (P<0.05) for all torque and power variables. Friedman’s test indicated a significant ratio increase between TAv (11.7±6.8%) and TAvM (4.6±3.0%, P=0.001) and TP (4.1±3.5%, P=0.001), as well as between PAv (8.8±5.0%) and PAvM (4.5±2.9%, P=0.003) and PP (4.2±2.6, P=0.003%) but not between TAvM and TP (P=0.421) or PAvM and PP (P=0.981). The results indicate that high-intensity activity increases lower limb strength imbalance, resulting in different ratios. We posit that muscle imbalance assessment activities conducted at rested state may not accurately reflect the true strength difference between limbs, leading to inaccurate training or rehabilitation advice

Engagement with consumer smartwatches for tracking symptoms of individuals living with multiple long-term conditions (multimorbidity)::A longitudinal observational study

INTRODUCTION: People living with multiple long-term conditions (multimorbidity) (MLTC-M) experience an accumulating combination of different symptoms. It has been suggested that these symptoms can be tracked longitudinally using consumer technology, such as smartphones and wearable devices. AIM: The aim of this study was to investigate longitudinal user engagement with a smartwatch application, collecting survey questions and active tasks over 90 days, in people living with MLTC-M. METHODS: ‘Watch Your Steps’ was a prospective observational study, administering multiple questions and active tasks over 90 days. Adults with more than one clinician-diagnosed long-term conditions were loaned Fossil® Sport smartwatches, pre-loaded with the study app. Around 20 questions were prompted per day. Daily completion rates were calculated to describe engagement patterns over time, and to explore how these varied by patient characteristics and question type. RESULTS: Fifty three people with MLTC-M took part in the study. Around half were male ( = 26; 49%) and the majority had a white ethnic background (n = 45; 85%). About a third of participants engaged with the smartwatch app nearly every day. The overall completion rate of symptom questions was 45% inter-quartile range (IQR 23–67%) across all study participants. Older patients and those with greater MLTC-M were more engaged, although engagement was not significantly different between genders. CONCLUSION: It was feasible for people living with MLTC-M to report multiple symptoms per day over 3 months. User engagement appeared as good as other mobile health studies that recruited people with single health conditions, despite the higher daily data entry burden

Assessing mental health service user and carer involvement in physical health care planning: The development and validation of a new patient-reported experience measure

BackgroundPeople living with serious mental health conditions experience increased morbidity due to physical health issues driven by medication side-effects and lifestyle factors. Coordinated mental and physical healthcare delivered in accordance with a care plan could help to reduce morbidity and mortality in this population. Efforts to develop new models of care are hampered by a lack of validated instruments to accurately assess the extent to which mental health services users and carers are involved in care planning for physical health.ObjectiveTo develop a brief and accurate patient-reported experience measure (PREM) capable of assessing involvement in physical health care planning for mental health service users and their carers.MethodsWe employed psychometric and statistical techniques to refine a bank of candidate questionnaire items, derived from qualitative interviews, into a valid and reliable measure involvement in physical health care planning. We assessed the psychometric performance of the item bank using modern psychometric analyses. We assessed unidimensionality, scalability, fit to the partial credit Rasch model, category threshold ordering, local dependency, differential item functioning, and test-retest reliability. Once purified of poorly performing and erroneous items, we simulated computerized adaptive testing (CAT) with 15, 10 and 5 items using the calibrated item bank.ResultsIssues with category threshold ordering, local dependency and differential item functioning were evident for a number of items in the nascent item bank and were resolved by removing problematic items. The final 19 item PREM had excellent fit to the Rasch model fit (x2 = 192.94, df = 1515, P = .02, RMSEA = .03 (95% CI = .01-.04). The 19-item bank had excellent reliability (marginal r = 0.87). The correlation between questionnaire scores at baseline and 2-week follow-up was high (r = .70, P DiscussionWe developed a flexible patient reported outcome measure to quantify service user and carer involvement in physical health care planning. We demonstrate the potential to substantially reduce assessment length whilst maintaining reliability by utilizing CAT