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    Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79097/1/j.1600-0447.2010.01630.x.pd

    The pathomechanics of shoulder injuries in cricket bowlers

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    Injury surveillance research has established that over 20 % of cricket injuries are related to the upper limb (Leary & White, 2000; Ranson & Gregory, 2008; Stretch, 2003), with bowlers associated altered rotational joint range of motion (Aginsky et al., 2004, BellJenje & Gray, 2005 and Stuelcken et al., 2008). As the applicability of such observations is limited, the aim of this thesis was to provide researchers with a greater understanding of the pathomechanics of shoulder injuries afflicting cricket bowlers though quantifying associated musculoskeletal adaptations and subsequently through the development and validation of a bowling specific kinematic model, establish the influence these may impart on bowling technique. The use of diagnostic ultrasound within the first experimental study in a cohort of bowlers without a history of shoulder injury, established a high prevalence of supraspinatus (45 %) and subscapularis (50 %) tendon pathology, providing insight into common musculotendinous pathology and adaptations that are indicative of the future potential of injury. Data presented within the second study aimed to first quantify the kinematics of the shoulder during the bowling delivery in relation to humerothoracic motion and, second, the influence of rotation sequence to described humerothoracic motion was investigated. Findings established that whilst the bowling delivery was associated with large variability, future research must acknowledge the contribution of the scapula to shoulder motion. As such, due to the complexity of quantifying shoulder motion during cricket bowling, the following three experimental studies evaluated and developed the CSBT shoulder model through modifying current methods. The mCAST method in conjunction with an acromion cluster, was established to not only reduce resultant RMSE associated with scapula landmarks by up to 0.016 m, but also increase the repeatability and robustness of reconstructing GHJ location using the SCoRE method. The emphasis of the final experimental study was to apply the CSBT shoulder model to establish the contribution of individual rotator cuff muscles to shoulder joint stability and, to identify phases of the bowling delivery which increases the risk of injury. This case study established that during the bowling delivery the shoulder experiences large multi-planar forces placing demand on musculature, in particular supraspinatus and Subscapularis to stabilise the joint. These findings in conjunction with those of the first experimental study, not only identify structures at risk of injury but also establish that for the effective formulation of injury prevention strategies the bowling delivery must be investigated in its entirety.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

    Confirmatory factor analysis of Clinical Outcomes in Routine Evaluation (CORE-OM) used as a measure of emotional distress in people with tinnitus

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    BACKGROUND: People with troublesome tinnitus often experience emotional distress. Therefore a psychometrically sound instrument which can evaluate levels of distress and change over time is necessary to understand this experience. Clinical Outcomes in Routine Evaluation (CORE-OM) is a measure of emotional distress which has been widely used in mental health research. Although originally designed as a 4-factor questionnaire, factor analyses have not supported this structure and a number of alternative factor structures have been proposed in different samples. The aims of this study were to test the factor structure of the CORE-OM using a large representative tinnitus sample and to use it to investigate levels of emotional distress amongst people with a range of tinnitus experience. METHODS: The CORE-OM was completed by 342 people experiencing tinnitus who self-rated their tinnitus on a 5-point scale from ‘not a problem’ to ‘a very big problem’. Confirmatory factor analysis was used to test all ten factor models which have been previously derived across a range of population samples. Model fit was assessed using fit criterion and theoretical considerations. Mean scores on the full questionnaire and its subscales were compared between tinnitus problem categories using one-way ANOVA. RESULTS: The best fitting model included 33 of the 34 original items and was divided into three factors: negatively worded items, positively worded items and risk. The full questionnaire and each factor were found to have good internal consistency and factor loadings were high. There was a statistically significant difference in total CORE-OM scores across the five tinnitus problem categories. However there was no significant difference between those who rated their tinnitus ‘not a problem’, and ‘a small problem’ or ‘a moderate problem.’ CONCLUSION: This study found a 3-factor structure for the CORE-OM to be a good fit for a tinnitus population. It also found evidence of a relationship between emotional distress as measured by CORE-OM and perception of tinnitus as a problem. Its use in tinnitus clinics is to be recommended, particularly when emotional distress is a target of therapy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12955-016-0524-5) contains supplementary material, which is available to authorized users
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