Investigation of the use of inertial sensing equipment for the measurement of hip flexion and pelvic rotation in horse riders

Equestrian sports report three to five times higher incidence rates for lower back pain than that of the general population, with hip flexion angles of 50-60° suggested as a causal factor. Inertial motion capture technology enables dynamic measurement of rider kinematics but data extraction is time-consuming. The aim of this study was to develop a software tool to automate the process of extracting biomechanical data from the XsensTM MVN (MoCap) system to investigate postural changes in riders, comparing static position at halt with dynamic position during the sit phase of rising trot. The software was found to be efficient, reducing data extraction time by 97% when used with a sample of 16 riders. Good correlation was found between hip flexion and pelvic anterior-posterior rotation and between halt and trot but with significantly greater values of hip flexion and pelvic anterior rotation in trot. No riders showed hip flexion >50° at halt but 11 riders (69%) showed hip flexion >50° during the sit phase of rising trot, indicating that dynamic assessment is important when considering rider postural faults that may put them at risk of back injury. Keywords: Hip flexion, Horse rider, Inertial sensor, Motion capture, Pelvic rotatio

Cauda Equina screening in physiotherapy : are we asking the right questions and are we asking the questions right?

Purpose: Cauda Equina Syndrome (CES) is a surgical emergency. With Physiotherapists increasingly taking on first-contact and spinal triage roles, screening for CES must be thorough, as effective as possible and easily understood by patients. Diagnosing CES however, can be challenging. Previous, patients’ lived experience studies have developed a ‘toolkit’ to aid early identification of CES recommending what questions to ask and how to ask them. Gaining insight into the experiences of physiotherapists asking these questions had not been studied prior to this. The aims of this study were to explore to what extent Physiotherapists ask the CES questions in accordance with the recommendations from prior evidence and to explore their own personal feelings when asking the questions Methods: This phenomenological study purposively recruited, via invitation, thirty Physiotherapists working in a community musculoskeletal service to participate in individual, semi-structured interviews that were audio recorded, transcribed verbatim, member-checked for accuracy and evaluated using thematic analysis Results: When questioning for CES, all participants routinely asked all bladder and bowel function and saddle anaesthesia screening questions however, only 9 routinely asked about sexual function. Whether questions are asked in the correct way, has never been studied. Sufficient depth of questioning was achieved by 63% of participants, 76% used lay terminology and 73% used explicit language. Only 43% of participants framed the context of CES screening questions before asking them and only 16% combined all four dimensions. Whilst most participants (n = 25) felt comfortable asking CES questions, 50% of participants reported feeling uncomfortable when asking about sexual function. Issues around; gender, age, culture and language were also reported Conclusion(s): Four main themes emerged from this study: (i) physiotherapists do ask the right questions but frequently omit asking about sexual function, (ii) on the whole, Physiotherapists ask CES questions in a way that patients understand however, there needs to be improvement in framing the context of the questions, (iii) physiotherapists generally feel comfortable with CES screening but there is some awkwardness surrounding discussion of sexual function and (iv) physiotherapists perceive there to be barriers to effective CES screening caused by language and culture. Impact: This study provides evidence of the depth and quality of CES screening by MSK Physiotherapists, highlighting areas requiring improvement and ongoing training. The study provides novel understanding into the personal feelings that CES assessment evokes in Physiotherapists and therefore highlights barriers to effective screening. The difficulties reported in this study, that Physiotherapists have talking about sexual function, align with other areas of healthcare (e.g. nursing, general practice, sexual & reproductive health) suggesting that these issues could be multi-professional rather than Physiotherapy specific. The conclusions of this study therefore, are thought to be transferable across all professions within healthcare and can have a positive impact, improving efficacy of CES screening, across medicine in general

‘I am the educator and the learner at the same time’: a qualitative survey of the knowledge and use of adult learning theory in UK musculoskeletal physiotherapists' patient education

Background/Aims Patient education is a core component of musculoskeletal care, yet broad definitions exist and effective delivery methods are unclear. Musculoskeletal physiotherapists' use of patient education has been described as individualised and collaborative, reflecting a person-centred model of care. However, discrepancies between perceived and actual practice, and therapist-centred approaches to education, have been observed. Little is known about the theoretical basis of musculoskeletal physiotherapists' patient education practice, yet the adult learning theory frames how adults interact with education and echoes the principles of person-centred care. The aim of this study was to analyse the use of adult learning theory to inform patient education practice among UK musculoskeletal physiotherapists. Methods This study used a novel, online questionnaire to collect quantitative and qualitative data from a self-selecting sample of UK musculoskeletal physiotherapists, using a multimodal recruitment strategy. Complete responses were provided by 66 participants. Categorical and narrative data were collected and descriptive and thematic analyses undertaken. Results Participants generally self-rated their educational competencies highly, with the exception of evaluating patient education. Participants were more familiar with reflective and self-directed learning than with other adult learning theories. Two main themes were described: implicit adult learning theory knowledge and challenges in applying adult learning theory. Conclusions The results suggest that musculoskeletal physiotherapists may have implicit knowledge of adult learning theory, yet challenges exist in applying them. This finding supports the establishment of ongoing training in educational skills for physiotherapists and could be used as a catalyst for musculoskeletal physiotherapists to reflect on their knowledge and use of adult learning theory

A systematic review of the effectiveness of yoga on pain, physical function, and quality of life in older adults with chronic musculoskeletal conditions

Objectives Exercise interventions suitable for older adults can help to slow and manage age-related conditions. This systematic review looks at age-related musculoskeletal conditions in a population with a mean age over 50 years, evaluating the effectiveness of yoga for pain, physical function, and quality of life. Methods CENTRAL,CINAHL, Pubmed, PsycInfo, SCOPUS, Sports Discus, Web of Science Core Collection, and Google Scholar were searched. Study selection and quality screening using the Cochrane risk of bias tool were conducted by two reviewers to mitigate bias. PRISMA guidelines were followed in conducting and reporting the review. Results 11 studies met inclusion criteria with a total sample of 2221 (≥70% female). Eight studies measured pain, six showing significant effectiveness (p=≤0.05), for lower limb osteoarthritis (OA), hand OA, and neck pain. Nine studies measured physical function, four showing significant effects, for lower limb OA and sarcopenia. Significant quality of life effects were found for restless leg syndrome compared to baseline. Conclusion Moderate evidence was found for pain effects, generalisable for OA based on sub-group analysis. Effective trials were mostly short-term using at minimum one 60-min group class, and an average of four 30-min home practice sessions weekly. Findings support the use of props and modifications to address age-related physical limitations. Yoga was well-received with good adherence, but effects on a par with other exercise. There was an absence of quality of life effects in short term. Mixed methods studies could lead to further insight into the qualitative aspects of yoga practice for older adults

A multi-center randomized control trial, comparing gamification with remote monitoring against standard rehabilitation for patients after arthroscopic shoulder surgery

Gamification has become increasingly popular in rehabilitation and is viewed as a tool to improve patient activation, motivation and engagement. The aim of this study was to compare the efficacy of validated Exergames played through a system using 'depth sensor' and bespoke software against standard physiotherapy in patients treated with arthroscopic shoulder surgery. This included the following common conditions; subacromial impingement syndrome, calcific tendinopathy and rotator cuff tears. Following arthroscopic shoulder surgery patients were randomized into one of two groups: 1. Standard rehabilitation. Patients were followed up for 12 weeks post-surgery with standard postoperative physiotherapy and had electronic measurements of their active range of movement (ROM). 2. Postoperative regime of exergames using the principles of gamification with physiotherapy support. Patients were given an Exergames schedule prescribed by their therapist on Medical Interactive Recovery Assistant (MIRA) software (MIRA Rehab Ltd., London, UK) paired with a Microsoft Kinect sensor (Microsoft Corp., Redmond, WA, USA). The primary outcome was active ROM objectively measured by MIRA + Kinect. Secondary outcome measures included The Oxford Shoulder Score (OSS), the Disabilities of the Arm, Shoulder and Hand (DASH) Score and EQ-VAS at 12 weeks post-surgery. 71 patients were recruited to the study. 7 Patients were excluded due to intra-operative findings. 33 patients were treated with Exergames and 31 patients had conventional physiotherapy. There was no significant difference between the two groups in baseline ROM. Postoperatively there was no significant difference in any of the cardinal planes of movement (Forward flexion (P= 0.64), abduction (p=0.33), external rotation (P=0.75)). The mean OSS in the control group improved from 29.25 to 38.2 (p=0.001) and from 27.1 to 35.1 (p=0.01) in the trial group. There was no significant difference between the groups at 12 weeks (p=.246). The mean DASH improved from 38.13 to 16.98 (p=0.001) in the control group and from 42.3 to 22.54 (p=0.007) in the trial group- there was no significant difference between the two groups (p=.328). There was no significant difference in EQ-VAS in either group at any timepoint (p= 0.5866). This randomized controlled trial demonstrates that Exergames can be used effectively in the rehabilitation of patients following arthroscopic shoulder surgery. Outcomes, judged by range of movement and patient reported outcome measures, are equivalent to conventional physiotherapy rehab protocols. This healthcare innovation has the potential to relieve some of the heavy burden placed on physiotherapy departments for 'routine' postoperative care in shoulder surgery. [Abstract copyright: Copyright © 2021. Published by Elsevier Inc.