An investigation of poor cervical resting posture

In an attempt to measure cervical resting posture, a device was developed to quantify the excursion of anatomical points on the upper and lower cervical spine. Measurements were taken from 427 randomly chosen subjects who had never sustained an injury to the neck or back. Excursion measurements were in good agreement over a month interval. Poor cervical resting posture was described by dividing the excursion angle data at each anatomical point into quintiles, and designating the first and fifth quintiles as extreme. Subjects whose upper and lower aspects of the cervical spine excursed by extremely small angles, and subjects whose upper and lower aspects of the cervical spine excursed by extremely large angles, were considered to have poor posture. These postures were markedly different. The study highlighted the need for further research into influences on habitual cervical resting posture

The association between cervical excursion angles and cervical short flexor muscle endurance

This study employed a randomly selected sample of 427 never-injured subjects to examine the relationship between poor posture and deep cervical short flexor muscle endurance. Poor posture was described as extreme angular excursion of both the upper and lower aspects of the cervical spine. For both men and women, poor deep cervical short flexor muscle endurance was associated only with extremely large excursion angles traced by the upper cervical spine, that is, head posture associated with excessive cervical lordosis ratherthan aforward translated head position. Further research is needed to clearly define poor cervical posture, and to investigate the specific relationship of deep short cervical flexor endurance with head on neck posture, in order that postural correction is specific to the underlying biomechanics

What is adolescent low back pain? Current definitions used to define the adolescent with low back pain

Adolescent low back pain (ALBP) is a common form of adolescent morbidity which remains poorly understood. When attempting a meta-analysis of observational studies into ALBP, in an effort to better understand associated risk factors, it is important that the studies involved are homogenic, particularly in terms of the dependent and independent variables. Our preliminary reading highlighted the potential for lack of homogeneity in descriptors used for ALBP. This review identified 39 studies of ALBP prevalence which fulfilled the inclusion criteria, ie, English language, involving adolescents (aged 10 to 19 years), pain localized to lumbar region, and not involving specific subgroups such as athletes and dancers. Descriptions for ALBP used in the literature were categorized into three categories: general ALBP, chronic/recurrent ALBP, and severe/disabling ALBP. Whilst the comparison of period prevalence rates for each category suggest that the three represent different forms of ALBP, it remains unclear whether they represented different stages on a continuum, or represent separate entities. The optimal period prevalence for ALBP recollection depends on the category of ALBP. For general ALBP the optimal period prevalence appears to be up to 12 months, with average lifetime prevalence rates similar to 1-year prevalence rates, suggesting an influence of memory decay on pain recall

Clinical Guidelines in Sports Medicine: Am I Reading a Guideline or a Consensus Statement: What’s the Difference? Does it Matter?

Introduction: The integration of research evidence into clinical practice is one of the most challenging aspects of sports medicine. The time required to search library databases and read multiple systematic reviews represents a significant barrier to many clinicians. Clinical guidelines and consensus statements provide a summary of best practice for clinical conditions, and provide clinical recommendations. In sports medicine, the terms clinical guideline and consensus statement are often used interchangeably; however, important differences exist between these resources. The aims of this review were to identify the clinical guidelines published in key international sports medicine journals over the last five years, and assess their methodological quality. Methods: In March 2014, the top ten international sports medicine journals (identified on current impact factors) were searched using the single keyword ‘guideline’. Peer-reviewed papers providing clinical recommendations that were described by the authors as a guideline were included. The International Centre for Allied Health Evidence (iCAHE) guideline checklist, which consists of fourteen ‘yes’ and ‘no’ responses, graded 1 or 0 respectively, was used to assess the methodological quality of each clinical guideline. Results: Ten publications were retained from a pool of 34 potentially-relevant publications. The iCAHE guideline checklist scores ranged from 3 to 11 out of a possible 14. Within the ten included publications, the most frequently identified methodological problems were a failure to describe the strategy used to search for evidence, failure to critically appraise the quality of underlying evidence and failure to clearly link the hierarchy and quality of underlying evidence to each recommendation. Discussion: The ten sports medicine journals included in this review published few clinical guidelines, and these were of poor to moderate quality. These clinical guidelines should be interpreted with caution because of methodological problems identified by this review. Consensus statements are useful resources for busy sports medicine clinicians; however, these resources should be subjected to the same rigorous appraisal as clinical guidelines, in order to identify areas where bias may potentially limit the usefulness of the recommendations

Perspectives on use of personal alarms by older fallers

Kylie Johnston1, Karen Grimmer-Somers1, Michele Sutherland21International Centre for Allied Health Evidence, University of South Australia, Adelaide; 2Falls Prevention Unit, Department of Health, Government of South Australia, Adelaide, AustraliaBackground: Personal alarms are proposed as a reliable mechanism for older people to obtain assistance after falling. However, little is known about how older people feel about owning and using personal alarms.Aim: This paper reports on experiences of independently living older people, who have recently fallen, regarding alarm use and their independence.Method: Volunteers older than 65 years who had sustained a fall in the previous six months were sought via community invitations. Semistructured telephone interviews were conducted to gain information about their fall and their perspectives on personal alarm use. Interviews were content-analyzed to identify key concepts and themes.Results: Thirty-one interviews were conducted. Twenty callers owned personal alarms. Four subgroups of older fallers were identified; the first group used personal alarms effectively and were advocates for their benefits, the second group owned an alarm but did not use it effectively, the third group did not own alarms mostly because of cost, although were receptive to an alarm should one be provided, and the fourth group did not have an alarm and would not use it even if it was provided.Discussion: Personal alarms produce positive experiences when used effectively by the right people. The cost of personal alarms prohibits some older fallers from being effective alarm users. However, other elderly fallers remain unwilling to consider alarm use even if one was provided. In view of their cost, personal alarms should be targeted to people who will benefit most. ­Alternative strategies should be considered when alarms are unlikely to be used appropriately.Keywords: personal alarm devices, falls, older people, patient perspectiv

Next-generation Solutions for Indian Health Care: Strengthening the Impact of Allied Health

The contributions of allied health professionals to patient care is well recognized in developed countries. In developed countries, allied health providers can reach the general public easily and cater to the health care needs of the society. However, medical dominance in developing countries often curtails the autonomy of allied health professionals. The Public Health Foundation of India prepared a report in 2012 on allied health professionals in India. This report explained the role of the AHP in improving the health status of the country. The objective of this commentary is to provide a possible opportunity for better integrating the allied health professions in the provision of health care in India based on the report prepared by the Public Health Foundation of India