Forming norms: informing diagnosis and management in sports medicine

Clinicians aim to identify abnormalities, and distinguish harmful from harmless abnormalities. In sports medicine, measures of physical function such as strength, balance and joint flexibility are used as diagnostic tools to identify causes of pain and disability and monitor progression in response to an intervention. Comparing results from clinical measures against ‘normal’ values guides decision-making regarding health outcomes. Understanding ‘normal’ is therefore central to appropriate management of disease and disability. However, ‘normal’ is difficult to clarify and definitions are dependent on context. ‘Normal’ in the clinical setting is best understood as an appropriate state of physical function. Particularly as disease, pain and sickness are expected occurrences of being human, understanding ‘normal’ at each stage of the lifespan is essential to avoid the medicalisation of usual life processes. Clinicians use physical measures to assess physical function and identify disability. Accurate diagnosis hinges on access to ‘normal’ reference values for such measures. However our knowledge of ‘normal’ for many clinical measures in sports medicine is limited. Improved knowledge of normal physical function across the lifespan will assist greatly in the diagnosis and management of pain, disease and disability

A qualitative study of influences on older women's practitioner choices for back pain care

Background: Back pain is an increasingly prevalent health concern amongst Australian women for which a wide range of treatment options are available, offered by biomedical, allied health and complementary and alternative medicine (CAM) providers. Although there is an emerging literature on patterns of provider utilisation, less is known about the reasons why women with back pain select their chosen practitioner. In this paper we explore the influences on back pain sufferers' decision-making about treatment seeking with practitioners for their most recent episode of back pain. Methods. Drawing on 50 semi-structured interviews with women aged 60-65 years from the Australian Longitudinal Study on Women's Health (ALSWH) who have chronic back pain, we focus on the factors which influence their choice of practitioner. Analysis followed a framework approach to qualitative content analysis, augmented by NVivo 9 qualitative data analysis software. Key themes were identified and tested for rigour through inter-rater reliability and constant comparison. Results: The women identified four predominant influences on their choice of practitioner for back pain: familiarity with treatment or experiences with individual practitioners; recommendations from social networks; geographical proximity of practitioners; and, qualifications and credentials of practitioners. The therapeutic approach or evidence-base of the practices being utilised was not reported by the women as central to their back pain treatment decision making. Conclusions: Choice of practitioner appears to be unrelated to the therapeutic approaches, treatment practices or the scientific basis of therapeutic practices. Moreover, anecdotal lay reports of effectiveness and the 'treatment experience' may be more influential than formal qualifications in guiding women's choice of practitioner for their back pain. Further work is needed on the interpersonal, collective and subjective underpinnings of practitioner choice, particularly over time, in order to better understand why women utilise certain practitioners for back pain. © 2014 Kirby et al.; licensee BioMed Central Ltd

Rehabilitation interventions for foot drop in neuromuscular disease

"Foot drop" or "Floppy foot drop" is the term commonly used to describe weakness or contracture of the muscles around the ankle joint. It may arise from many neuromuscular diseases

1000 Norms Project: Protocol of a cross-sectional study cataloging human variation

Background Clinical decision-making regarding diagnosis and management largely depends on comparison with healthy or ‘normal’ values. Physiotherapists and researchers therefore need access to robust patient-centred outcome measures and appropriate reference values. However there is a lack of high-quality reference data for many clinical measures. The aim of the 1000 Norms Project is to generate a freely accessible database of musculoskeletal and neurological reference values representative of the healthy population across the lifespan. Methods/design In 2012 the 1000 Norms Project Consortium defined the concept of ‘normal’, established a sampling strategy and selected measures based on clinical significance, psychometric properties and the need for reference data. Musculoskeletal and neurological items tapping the constructs of dexterity, balance, ambulation, joint range of motion, strength and power, endurance and motor planning will be collected in this cross-sectional study. Standardised questionnaires will evaluate quality of life, physical activity, and musculoskeletal health. Saliva DNA will be analysed for the ACTN3 genotype (‘gene for speed’). A volunteer cohort of 1000 participants aged 3 to 100 years will be recruited according to a set of self-reported health criteria. Descriptive statistics will be generated, creating tables of mean values and standard deviations stratified for age and gender. Quantile regression equations will be used to generate age charts and age-specific centile values. Discussion This project will be a powerful resource to assist physiotherapists and clinicians across all areas of healthcare to diagnose pathology, track disease progression and evaluate treatment response. This reference dataset will also contribute to the development of robust patient-centred clinical trial outcome measures

Tillidsarbejde og tydelighed: Et studie af tillid, magt og afhængighed blandt pædagoger og forældre i danske vuggestuer

Afhandlingen undersøger relationer og interaktioner mellem forældre og personalet i danske vuggestuer.På baggrund af et etnografisk feltarbejde blandt pædagoger og familier i fire danske vuggestuer, samt en historisk redegørelse for og analyse af vuggestuernes fremkomst og udviklingen af idealer for kulturelle omgangsformer, analyseres de logikker og rationaler om relationen mellem forældre og pædagoger, som er på spil i vuggestuernes dagligdag; hvordan disse kan forklares; samt hvilken betydning de får for interaktionerne mellem forældre og pædagoger i dagens vuggestuer i Danmark