Musculoskeletal Pain:Current and Future Directions of Physical Therapy Practice

Musculoskeletal (MSK) pain is 1 of the most common problems managed by clinicians in MSK care. This article reviews current frameworks for the assessment and management of MSK pain within evidence-based physical therapy practice. Key considerations related to the biopsychosocial model of pain, evidence-based practice, assessment, treatment, physical activity/movement behavior, risk stratification, communication as well as patient education and self-management skills within physical therapy and physical and rehabilitation medicine are addressed. The future direction of MSK pain management is also discussed, including strategies to promote evidence-based practice, behavior change, social prescribing, and the use of technologies.status: Published onlin

Search for the hero: an investigation into the sports heroes of British sports fans

This is an initial study into British sports fans’ heroes. A questionnaire was sent to 95 students (average age ¼ 19.75) to identify their sporting hero, the hero’s sport and nationality and the reasons for this choice. Football was the most common source of sports heroes, identified by 49% of participants with a sporting hero. The majority (60%, N ¼ 48) of heroes chosen by participants were British, with David Beckham the most popular choice. Differences were observed between the gender of participants, gender of hero chosen and the reasons for choosing the hero. The most common reason for selecting a hero was a personal trait rather than skill, while in the questionnaire a category of Local Affiliation was added to those suggested by previous work. It was concluded that to become a hero athletes should combine skill with devotion to family, charity work and a place in popular culture

Quantifying the impact of an extreme climate event on species diversity in fragmented temperate forests: the effect of the October 1987 storm on British broadleaved woodlands

1. We report the impact of an extreme weather event, the October 1987 severe storm, on fragmented woodlands in southern Britain. We analysed ecological changes between 1971 and 2002 in 143 200-m2 plots in 10 woodland sites exposed to the storm with an ecologically equivalent sample of 150 plots in 16 non-exposed sites. In both years, understorey species-richness, species composition, soil pH and woody basal area of the tree and shrub canopy were measured. 2. We tested the hypothesis that the storm had deflected sites from the wider national trajectory of an increase in woody basal area and reduced understorey species-richness associated with ageing canopies and declining woodland management. We also expected storm disturbance to amplify the background trend of increasing soil pH, a UK-wide response to reduced atmospheric sulphur deposition. Path analysis was used to quantify indirect effects of storm exposure on understorey species richness via changes in woody basal area and soil pH. 3. By 2002, storm exposure was estimated to have increased mean species richness per 200 m2 by 32%. Woody basal area changes were highly variable and did not significantly differ with storm exposure. 4. Increasing soil pH was associated with a 7% increase in richness. There was no evidence that soil pH increased more as a function of storm exposure. Changes in species richness and basal area were negatively correlated: a 3.4% decrease in richness occurred for every 0.1-m2 increase in woody basal area per plot. 5. Despite all sites substantially exceeding the empirical critical load for nitrogen deposition, there was no evidence that in the 15 years since the storm, disturbance had triggered a eutrophication effect associated with dominance of gaps by nitrophilous species. 6. Synthesis: Although the impacts of the 1987 storm were spatially variable in terms of impacts on woody basal area, the storm had a positive effect on understorey species richness. There was no evidence that disturbance had increased dominance of gaps by invasive species. This could change if recovery from acidification results in a soil pH regime associated with greater macronutrient availability

Mechanisms-based classifications of musculoskeletal pain: Part 1 of 3: Symptoms and signs of central sensitisation in patients with low back (AEleg) pain

a b s t r a c t As a mechanisms-based classification of pain 'central sensitisation pain' (CSP) refers to pain arising from a dominance of neurophysiological dysfunction within the central nervous system. Symptoms and signs associated with an assumed dominance of CSP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of CSP in patients with low back (AEleg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (AEleg) pain were assessed using a standardised assessment protocol. Patients' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of three symptoms and one sign predictive of CSP, including: 'Disproportionate, non-mechanical, unpredictable pattern of pain provocation in response to multiple/non-specific aggravating/easing factors', 'Pain disproportionate to the nature and extent of injury or pathology', 'Strong association with maladaptive psychosocial factors (e.g. negative emotions, poor self-efficacy, maladaptive beliefs and pain behaviours)' and 'Diffuse/nonanatomic areas of pain/tenderness on palpation'. This cluster was found to have high levels of classification accuracy (sensitivity 91.8%, 95% confidence interval (CI): 84.5e96.4; specificity 97.7%, 95% CI: 95.6e99.0). Pattern recognition of this empirically-derived cluster of symptoms and signs may help clinicians identify an assumed dominance of CSP in patients with low back pain disorders in a way that might usefully inform their management

Model-based hypervolumes for complex ecological data

Developing a holistic understanding of the ecosystem impacts of global change requires methods that can quantify the interactions among multiple response variables. One approach is to generate high dimensional spaces, or hypervolumes, to answer ecological questions in a multivariate context. A range of statistical methods has been applied to construct hypervolumes but have not yet been applied in the context of ecological datasets with spatial or temporal structure, for example where the data are nested or demonstrate temporal autocorrelation. We outline an approach to account for data structure in quantifying hypervolumes based on the multivariate normal distribution by including random effects. Using simulated data we show that failing to account for structure in data can lead to biased estimates of hypervolume properties in certain contexts. We then illustrate the utility of these ‘model‐based hypervolumes’ in providing new insights into a case study of afforestation effects on ecosystem properties where the data has a nested structure. We demonstrate that the model‐based generalisation allows hypervolumes to be applied to a wide range of ecological datasets and questions

Structural brain preservation: a potential bridge to future medical technologies

When faced with the prospect of death, some people would prefer a form of long-term preservation that may allow them to be restored to healthy life in the future, if technology ever develops to the point that this is feasible and humane. Some believe that we may have the capacity to perform this type of experimental preservation today—although it has never been proven—using contemporary methods to preserve the structure of the brain. The idea is that the morphomolecular organization of the brain encodes the information required for psychological properties such as personality and long-term memories. If these structures in the brain can be maintained intact over time, this could theoretically provide a bridge to access restorative technologies in the future. To consider this hypothesis, we first describe possible metrics that can be used to assess structural brain preservation quality. We next explore several possible methods to preserve structural information in the brain, including the traditional cryonics method of cryopreservation, as well as aldehyde-stabilized cryopreservation and fluid preservation. We focus in-depth on fluid preservation, which relies on aldehyde fixation to induce chemical gel formation in a wide set of biomolecules and appears to be a cost-effective method. We describe two theoretical recovery technologies, alongside several of the ethical and legal complexities of brain preservation, all of which will require a prudent approach. We believe contemporary structural brain preservation methods have a non-negligible chance of allowing successful restoration in the future and that this deserves serious research efforts by the scientific community

Assessing the cost of global biodiversity and conservation knowledge

Knowledge products comprise assessments of authoritative information supported by stan-dards, governance, quality control, data, tools, and capacity building mechanisms. Considerable resources are dedicated to developing and maintaining knowledge productsfor biodiversity conservation, and they are widely used to inform policy and advise decisionmakers and practitioners. However, the financial cost of delivering this information is largelyundocumented. We evaluated the costs and funding sources for developing and maintain-ing four global biodiversity and conservation knowledge products: The IUCN Red List ofThreatened Species, the IUCN Red List of Ecosystems, Protected Planet, and the WorldDatabase of Key Biodiversity Areas. These are secondary data sets, built on primary datacollected by extensive networks of expert contributors worldwide. We estimate that US$160million (range: US$116–204 million), plus 293 person-years of volunteer time (range: 278–308 person-years) valued at US$14 million (range US$12–16 million), were invested inthese four knowledge products between 1979 and 2013. More than half of this financingwas provided through philanthropy, and nearly three-quarters was spent on personnelcosts. The estimated annual cost of maintaining data and platforms for three of these knowl-edge products (excluding the IUCN Red List of Ecosystems for which annual costs were notpossible to estimate for 2013) is US$6.5 million in total (range: US$6.2–6.7 million). We esti-mated that an additional US$114 million will be needed to reach pre-defined baselines ofdata coverage for all the four knowledge products, and that once achieved, annual mainte-nance costs will be approximately US$12 million. These costs are much lower than those tomaintain many other, similarly important, global knowledge products. Ensuring that biodi-versity and conservation knowledge products are sufficiently up to date, comprehensiveand accurate is fundamental to inform decision-making for biodiversity conservation andsustainable development. Thus, the development and implementation of plans for sustain-able long-term financing for them is critical

Spatial patterns and environmental constraints on ecosystem services at a catchment scale

Improved understanding and prediction of the fundamental environmental controls on ecosystem service supply across the landscape will help to inform decisions made by policy makers and land-water managers. To evaluate this issue for a local catchment case study, we explored metrics and spatial patterns of service supply for water quality regulation, agriculture production, carbon storage, and biodiversity for the Macronutrient Conwy catchment. Methods included using ecosystem models such as LUCI and JULES, integration of national scale field survey datasets, earth observation products and plant trait databases, to produce finely resolved maps of species richness and primary production. Analyses were done with both 1x1 km gridded and subcatchment data. A common single gradient characterised catchment scale ecosystem services supply with agricultural production and carbon storage at opposing ends of the gradient as reported for a national-scale assessment. Species diversity was positively related to production due to the below national average productivity levels in the Conwy combined with the unimodal relationship between biodiversity and productivity at the national scale. In contrast to the national scale assessment, a strong reduction in water quality as production increased was observed in these low productive systems. Various soil variables were tested for their predictive power of ecosystem service supply. Soil carbon, nitrogen, their ratio and soil pH all had double the power of rainfall and altitude, each explaining around 45% of variation but soil pH is proposed as a potential metric for ecosystem service supply potential as it is a simple and practical metric which can be carried out in the field with crowd-sourcing technologies now available. The study emphasises the importance of considering multiple ecosystem services together due to the complexity of covariation at local and national scales, and the benefits of exploiting a wide range of metrics for each service to enhance data robustness

Assessing the cost of global biodiversity and conservation knowledge

Knowledge products comprise assessments of authoritative information supported by standards, governance, quality control, data, tools, and capacity building mechanisms. Considerable resources are dedicated to developing and maintaining knowledge products for biodiversity conservation, and they are widely used to inform policy and advise decision makers and practitioners. However, the financial cost of delivering this information is largely undocumented. We evaluated the costs and funding sources for developing and maintaining four global biodiversity and conservation knowledge products: The IUCN Red List of Threatened Species, the IUCN Red List of Ecosystems, Protected Planet, and the World Database of Key Biodiversity Areas. These are secondary data sets, built on primary data collected by extensive networks of expert contributors worldwide. We estimate that US$160 million (range: US$116-204 million), plus 293 person-years of volunteer time (range: 278-308 person-years) valued at US$14 million (range US$12-16 million), were invested in these four knowledge products between 1979 and 2013. More than half of this financing was provided through philanthropy, and nearly three-quarters was spent on personnel costs. The estimated annual cost of maintaining data and platforms for three of these knowledge products (excluding the IUCN Red List of Ecosystems for which annual costs were not possible to estimate for 2013 ) is US$6.5 million in total (range: US$6.2-6.7 million). We estimated that an additional US$114 million will be needed to reach pre-defined baselines of data coverage for all the four knowledge products, and that once achieved, annual maintenance costs will be approximately US$12 million. These costs are much lower than those to maintain many other, similarly important, global knowledge products. Ensuring that biodiversity and conservation knowledge products are sufficiently up to date, comprehensive and accurate is fundamental to inform decision-making for biodiversity conservation and sustainable development. Thus, the development and implementation of plans for sustainable long-term financing for them is critical