The lumbar spine has an intrinsic shape specific to each individual that remains a characteristic throughout flexion and extension

Peer reviewedPostprin

Variation in lifting kinematics related to individual intrinsic lumbar curvature:An investigation in healthy adults

Objective Lifting postures are frequently implicated in back pain. We previously related responses to a static load with intrinsic spine shape, and here we investigate the role of lumbar spine shape in lifting kinematics. Methods Thirty healthy adults (18-65 years) performed freestyle, stoop and squat lifts with a weighted box (6-15 kg, self-selected) while being recorded by Vicon motion capture. Internal spine shape was characterised using statistical shape modelling (SSM) from standing mid-sagittal MRIs. Associations were investigated between spine shapes quantified by SSM and peak flexion angles. Results Two SSM modes described variations in overall lumbar curvature (mode 1 (M1), 55% variance) and the evenness of curvature distribution (mode 2 (M2), 12% variance). M1 was associated with greater peak pelvis (r=0.38, p=0.04) and smaller knee flexion (r=-0.40, p=0.03) angles; individuals with greater curviness preferred to lift with a stooped lifting posture. This was confirmed by analysis of those individuals with very curvy or very straight spines (|M1|&gt;1 SD). There were no associations between peak flexion angles and mode scores in stoop or squat trials (p&gt;0.05). Peak flexion angles were positively correlated between freestyle and squat trials but not between freestyle and stoop or squat and stoop, indicating that individuals adjusted knee flexion while maintaining their preferred range of lumbar flexion and that 'squatters' adapted better to different techniques than 'stoopers'. Conclusion Spinal curvature affects preferred lifting styles, and individuals with curvier spines adapt more easily to different lifting techniques. Lifting tasks may need to be tailored to an individual's lumbar spine shape.</p

Is intrinsic lumbar spine shape associated with lumbar disc degeneration? An exploratory study

Acknowledgements Thank you to Lesley Honeyfield (Lead Research Radiographer, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London) for assisting with imaging optimisation and the acquisition of MR images and to all participants in this study. We also thank the University of Aberdeen Data Management Team for programming support for ‘Shape’ software. Funding JD would like to acknowledge the support of Versus Arthritis (Clinical Doctoral Fellowship award, grant number 20172) and the UKSSB and Society for Back Pain Research (Travel Fellowship award) for funding this research. Funders did not have a role in the design of the study, analysis or interpretation of the data.Peer reviewedPublisher PD

Characteristics of antibiotic resistance of non-typhoidal Salmonella circulating in the Russian Federation in the period from 2019 to 2022

Introduction. Non-typhoidal Salmonella make a significant contribution to the incidence of enteric infections and are characterized by an increasing proportion of strains resistant to antimicrobial agents (AMA), including the first choice antibiotics (cephalosporins III and fluoroquinolones). The purpose of the study is to assess the phenotypic resistance of Salmonella to various classes of AMAs and determine the relationship between the phenotypic resistance, serotype, source of isolation and nature of incidence. Materials and methods. We studied 752 representative strains of Salmonella of 2494 strains isolated from various sources (clinical samples, food products, environment) received from 59 regions of Russia in the period from 2019 to 2022. The phenotypic resistance to 22 antibiotics of 11 CLSI classes of AMAs was assessed by broth microdilution method (minimum inhibitory concentration). The diversity of resistance profiles of Salmonella serotypes was compared using the Shannon index. Results. The dominant position in terms of isolation frequency is occupied by the serotypes Salmonella Enteritidis, S. Infantis, S. Muenchen, S. Typhimurium, S. Bovismorbificans, which accounted for 64.4% of the studied strains. 543 (72.2%) strains showed resistance to at least one of the tested antibiotics; 193 (25.7%) strains were characterized by multidrug resistance phenotype (MDR). Resistance to AMA classes was characterized by the following distribution: quinolones (61.3%), tetracyclines (28.1%), penicillins (19.1%), β-lactam combination agents (18.6%), folate pathway antagonists (16, 5%), phenicols (10.1%), aminoglycosides (5.6%), cephems (4.7%), monobactams (4.4%), lipopeptides (3.9%). No penem-resistant strains have been identified. The features of Salmonella resistance by AMA classes are shown to depend on the sources of isolation, the Salmonella serotype and the nature of the incidence (outbreak and sporadic). Conclusions. Monitoring of phenotypic antibiotic resistance is an important tool for epidemiological surveillance in order to prevent the spread of bacterial resistance to AMAs

Which treatments are most effective for common tendinopathies? A systematic review and network meta-analysis protocol.

This is a preprint for a protocol. The purpose of the study described by the protocol was to compare the effectiveness of different treatment classes across a range of tendinopathies and outcomes, to better establish a treatment hierarchy. Where sufficient data were obtained, the potential for covariates - including patient demographics and condition specifics (e.g. symptom severity) - to explain statistical heterogeneity was explored

Comparison of exercise therapies across multiple tendinopathies: a systematic review and network meta-analysis protocol.

This is a preprint for a protocol. The study described by the protocol aimed to use network structures to compare exercise treatments and treatment classes in attempts to identify a treatment hierarchy. Additionally, the large amount of data synthesised was used to explore relevant factors that may explain statistical heterogeneity

The effect of dose on resistance exercise therapies for tendinopathy: a systematic review and meta-analysis protocol.

This is a preprint for a protocol. The purpose of the study described by the protocol was to investigate the effect of resistance exercise dose across multiple common tendinopathies (rotator cuff, lateral elbow, patellar or Achilles), where the frequency, volume and intensity can be accurately quantified. By combining a large data set with contemporary meta-analysis and meta-regression approaches (including relevant covariates within models), the systematic review attempted to explore statistical heterogeneity and better assess potential dose-response relationships that may exist. Where placebo and no-treatment arms were included, these studies were used to reduce heterogeneity and provide sensitivity analyses to support or refute analyses with larger, but more complex data

The effect of dose components on resistance exercise therapies for tendinopathy management: a systematic review and meta-analysis.

The purpose of this study was to investigate potential moderating effects of resistance exercise dose components including intensity, volume and frequency, for the management of common tendinopathies. The research was undertaken through a systematic review and meta-analysis, comprising an extensive search of databases and trial registries. Eligibility criteria for selecting studies included randomised and non-randomised controlled trials investigating resistance exercise as the dominant treatment class and reporting sufficient information regarding at least two components of exercise dose (intensity, frequency, volume). Non-controlled standardised mean difference effect sizes were calculated across a range out outcome domains and combined with Bayesian hierarchical meta-analysis models for domains generating large (disability; function; pain) and small (range of motion; physical function capacity; and quality of life) effect size values. Meta-regressions were used to estimate differences in pooled mean values across categorical variables quantifying intensity, frequency and volume. Ninety-one studies presented sufficient data to be included in meta-analyses, comprising 126 treatment arms (TAs) and 2965 participants. Studies reported on five tendinopathy locations (Achilles: 39 TAs, 31.0%; rotator cuff: 39 TAs, 31.0%; lateral elbow: 25 TAs, 19.8%; patellar: 19 TAs, 15.1%; and gluteal: 4 TAs, 3.2%). Meta-regressions provided consistent evidence of greater pooled mean effect sizes for higher intensity therapies comprising additional external resistance compared to body mass only (large effect size domains: 0.39 [95% CrI: 0.00 to 0.82; p = 0.976]; small effect size domains (0.09 [95% CrI: -0.20 to 0.37; p = 0.723]) when data were combined across tendinopathy locations or analysed separately. Consistent evidence of greater pooled mean effect sizes was also identified for the lowest frequency (less than daily) compared with mid (daily) and high frequencies (more than daily) for both large effect size domain ( -0.66 [95% CrI: -1.2 to -0.19; p >0.999]; -0.54 [95% CrI:-0.99 to -0.10; p >0.999]) and small effect size domains ( -0.51 [95% CrI: -0.78 to -0.24; p >0.999]; -0.34 [95% CrI: -0.60 to -0.06; p = 0.992]) when data were combined across tendinopathy locations or analysed separately. Minimal and inconsistent evidence was obtained for differences for a moderating effect of training volume. The study concluded that resistance exercise dose is poorly reported within the tendinopathy management literature. However, this large meta-analysis identified some consistent patterns indicating greater efficacy on average with therapies prescribing higher intensities (through the inclusion of additional external loads) and lower frequencies, potentially creating stronger stimuli and facilitating adequate recovery

Empirically derived guidelines for interpreting the effectiveness of exercise therapy for tendinopathies: a protocol.

This is a preprint for a protocol. The aim of the study described by the protocol was to perform a large synthesis of the available research investigating exercise therapy for tendinopathies, creating empirically derived thresholds to benchmark interventions and explore potential differences across tendinopathy types and outcome domains

Which treatment classes and combinations are more effective for the management of common tendinopathies? A systematic review and network meta-analysis.

The aim of this research was to quantify the comparative effectiveness of treatment classes used for the management of the most common tendinopathies. The project studied network meta-analyses comparing combinations of exercise, non-exercise, and non-active treatments across a range of tendinopathy locations and outcome domains. The review covered randomised and quasi-randomised controlled trials including an exercise arm and persons with a tendinopathy diagnosis at any location, and of any severity or duration. Outcome measures included outcomes assessing disability, function, pain, shoulder range of motion, physical function capacity, or quality of life. Through network meta-analyses, broad (exercise/non-exercise/combined/non-active) and more specific (exercise/biomechanics/injection/electrotherapy/manual-therapy/non-active/surgery) treatment class models were fitted with hierarchical Bayesian models. Results were interpreted using pooled standardised mean difference effect sizes and ranking through Surface Under the Cumulative Ranking curves (SUCRA). Treatment hierarchies were assessed using the GRADE minimally contextualised framework. Two-hundred studies comprising 458 treatments arms were identified. Many comparisons were within the same class reducing data available to assess comparative effectiveness. Data from 85 studies generating 140 pairwise comparisons consistently identified the superiority of combining exercise and non-exercise treatment classes (SUCRA: 0.70 to 0.88). Central estimates indicated that combining exercise and non-exercise treatments increased effect sizes by ~0.1 to 0.3 compared with exercise alone. Analysis of more specific treatment classes identified with low/very low certainty the superiority of combining exercise with either biomechanical (e.g. taping, bracing or splinting; SUCRA: 0.73) or injection therapies (SUCRA: 0.72). The study concluded that clinicians should consider combining exercise and non-exercise therapies as a starting point for tendinopathy management. The most effective treatment combinations include exercise with the use of biomechanical or injection therapies