Lumbar disc herniation (LDH) with radiculopathy is associated with greater pain, disability, healthcare use, and costs compared with nonspecific low back pain. Reliable information about its incidence and risk factors were lacking. (1) What is the incidence of lumbar disc herniation (LDH) with radiculopathy in adults? (2) What are the risk factors for LDH with radiculopathy in adults? Systematic review. We searched five electronic databases from 1970 to September 2023. Eligible cohort and case–control studies were identified and independently assessed for risk of bias. A qualitative best evidence synthesis of low and moderate risk of bias studies was conducted. We critically reviewed 87 studies and synthesised data from 59 (68

•Sophisticated, but informal education informs the practice of this interprofessional health care team.•As a consequence this community of learning practice is vulnerable to work time pressure and logistical limitations.•Interprofessional education is recognized as a potential tool to enhance the practice goals of the health care team.

The objective of the current study was to examine whether physical activity and sedentary behavior were associated with appetite among community‐dwelling older adults.

Abstract Objective Few clinical prediction models are available to clinicians to predict the recovery of patients with post-collision neck pain and associated disorders. We aimed to develop evidence-based clinical prediction models to predict (1) self-reported recovery and (2) insurance claim closure from neck pain and associated disorders (NAD) caused or aggravated by a traffic collision. Methods The selection of potential predictors was informed by a systematic review of the literature. We used Cox regression to build models in an incident cohort of Saskatchewan adults (n = 4923). The models were internally validated using bootstrapping and replicated in participants from a randomized controlled trial conducted in Ontario (n = 340). We used C-statistics to describe predictive ability. Results Participants from both cohorts (Saskatchewan and Ontario) were similar at baseline. Our prediction model for self-reported recovery included prior traffic-related neck injury claim, expectation of recovery, age, percentage of body in pain, disability, neck pain intensity and headache intensity (C = 0.643; 95% CI 0.634–0.653). The prediction model for claim closure included prior traffic-related neck injury claim, expectation of recovery, age, percentage of body in pain, disability, neck pain intensity, headache intensity and depressive symptoms (C = 0.637; 95% CI 0.629–0.648). Conclusions We developed prediction models for the recovery and claim closure of NAD caused or aggravated by a traffic collision. Future research needs to focus on improving the predictive ability of the models.

Background: Patients with hypermobility spectrum disorder (HSD) and shoulder complaints may suffer from symptoms related to shoulder instability, laxity, and hypermobility. It is currently unknown whether having a more complex clinical status with several diagnoses (i.e., anterior instability (AI), multidirectional instability (MDI), and/or symptomatic localised shoulder hypermobility (LSH), relates to higher functional impairments and pain.Objectives: To investigate the associations between either <= 1, 2, or 3 clinical shoulder diagnoses (AI, MDI, and LSH) or the number (0-10) of positive clinical shoulder tests with shoulder function using the western Ontario shoulder instability index (WOSI, 0-2100, 0 = best) and pain intensity using numerical pain rating scale (NPRS, 0-10, 10 = worse). Design: Exploratory cross-sectional study.Method: From a randomised controlled trial, baseline data from 100 participants with HSD and shoulder com-plaints for at least three months were included. Associations were investigated using linear regression models, adjusted for age, sex, body mass index, and hand dominance.Results: Compared with having <= 1 diagnosis, neither participants with two (WOSI 76.9, 95% CI-136.3, 290.0; NPRS 0.3, 95% CI-0.9, 1.5) nor three (WOSI 35.5, 95% CI-178.5, 249.6; NPRS 0.1, 95% CI-1.1, 1.3) clinical shoulder diagnoses had significantly worse shoulder function or pain. Likewise, the number of positive clinical shoulder tests was not associated with function (WOSI-20.8 95%CI (-55.3, 13.7)) or pain (NPRS-0.1 95%CI (-0.2, 0.1)).Conclusions: In participants with HSD and shoulder complaints, having more additional shoulder diagnoses or increased number of positive shoulder tests were not related to functional impairments or pain intensities.

Low protein intake may accelerate age-related loss of lean mass and physical function. We investigated the prevalence of low protein intake (<1·0 g/kg/day) and the associations between dietary patterns, modifiable risk factors and low protein intake in self-reliant community-dwelling adults ≥ 80 years. This cross-sectional study consisted of two home visits. Data collection consisted of physical measurements (e.g. physical function, physical activity) and self-report of nutritional intake (4-d food records), appetite, eating symptoms and medical conditions. Binary analyses were performed to compare participants with low and normal protein intake. Multiple logistic regression analyses were performed to investigate associations between low protein intake, dietary patterns and modifiable risk factors adjusted for age, sex, BMI categories and diseases. One hundred twenty-six were included in the study. Prevalence of low protein intake was 54 %. A greater day-to-day variation in protein intake was associated with low protein intake (adjusted OR 2·5; 95 % CI 1·14, 5·48). Participants with low protein intake had a higher prevalence of nausea, diarrhoea and mouth dryness. Reduced appetite, mouth dryness and pain increased odds of low protein intake (adjusted OR 3·06, 95 % CI 1·23, 7·63; OR 3·41, 95 % CI 1·51, 7·7; OR 1·54, 95 % CI 1·00, 2·36, respectively). There was a high prevalence of low protein intake in community-dwelling adults aged ≥ 80 years. Day-to-day variability, appetite, mouth dryness and pain may be potentially modifiable risk factors. Targeting dietary patterns and risk factors in primary prevention strategies may potentially improve intake of protein and minimise risk of physical frailty.

Sporadic inclusion body myositis (sIBM) is characterised by skeletal muscle inflammation, progressive muscle loss and weakness, which is largely refractory to immunosuppressive treatment. Low-load blood-flow restricted (BFR) training has been shown to evoke gains in myofibre cross sectional area (mCSA) in healthy adults. This could partially be due to the activation and integration of muscle satellite cells (SC) resulting in myonuclei addition. Consequently, this study investigated the effect of 12-weeks lower limb low-load BFR resistance training in sIBM patients on SC and myonuclei content, myofibre size and capillarization. Muscle biopsies from sIBM patients randomised to 12-weeks of low-load BFR resistance training (n = 11) or non-exercising controls (CON) (n = 9) were analysed for SC and myonuclei content, myofibre size and capillarization using three-colour immunofluorescence microscopy and computerised quantification procedures. No between-group differences (time-by-group interactions) or within-groups changes were observed for resident SCs (Pax7(+)/Six1(+)), proliferating SCs (Pax7(+)/ Ki67(+)), myonuclei (Six1(+)), type 1 mCSA or capillary number (CD31(+)). However, a time-by-group interaction for type 2 mCSA was observed (p = 0.04). Satellite cell content, myonuclei number, mCSA and capillary density remained unaffected following 12-weeks low-load BFR resistance training, indicating limited myogenic capacity and satellite cell plasticity in long-term sIBM patients. (C) 2022 The Authors. Published by Elsevier B.V.

OBJECTIVE:To describe the clinical characteristics of patients with hypermobility spectrum disorders (HSD) and shoulder complaints with or without mechanical symptoms, and to compare characteristics between these groups.DESIGN:A cross-sectional study.SETTING:Primary care.PARTICIPANTS:One-hundred patients with HSD and shoulder complaints for at least 3 months were included from primary care (N=100).INTERVENTIONS:Not applicable.MAIN OUTCOME MEASURES:Medical history, self-reported (shoulder pain and function, discomfort due to other symptoms, fatigue, fear of movement, quality of life) and objective (strength, range of motion, proprioception) characteristics were collected by physiotherapists. Mechanical symptoms (yes/no) were defined as self-reported shoulder instability, subluxation, and/or laxity.RESULTS:Sixty-seven reported mechanical symptoms. Patients in both groups reported impairments related to shoulder pain, function, fatigue, fear of movement, and quality of life. Patients with mechanical symptoms were younger (mean, 35.1 years [95% CI, 32.3-37.9 years] vs 43.3 years [95% CI, 38.4-48.1 years]), had longer symptom duration (median, 46 months [95% CI, 36-66 months] vs 24 months [95% CI, 9-56 months]), reported a previous shoulder dislocation (25% [95% CI, 16-37] vs 3% [95% CI, 0-16]), experienced that their shoulder was loose (64% [95% CI, 52-76] vs 15% [95% CI, 5-32]), and reported discomfort due to other symptoms (odds ratio, 1.48 [95% CI, 1.17-1.87]). Furthermore, a larger proportion had received supplemental treatment (analgesic medication, steroid injection/surgery).CONCLUSIONS:Both groups with HSD and shoulder complaints presented with substantial shoulder-related impairments. Two-thirds reported mechanical symptoms, were younger, and more severely impaired than those without mechanical symptoms. These findings highlight the importance of managing mechanical shoulder symptoms to fully address the patients' impairments.

BackgroundAssociations between dizziness-related handicap and a variety of self-reported measures have been reported. However, research regarding associations between dizziness-related handicap and aspects of functioning that includes both physical tests and self-reported measures is scarce.ObjectiveThe purpose of the study was to describe the variations in signs and symptoms in people with persistent dizziness using physical tests and self-reported outcomes across three severity levels of the Dizziness Handicap Inventory (DHI) and investigate their associations with the DHI.MethodParticipants with persistent dizziness (n = 107) were included in this cross-sectional study. The participants underwent (1) physical tests (gait tests, grip strength, body flexibility, and movement-induced dizziness) and completed questionnaires regarding (2) psychological measures (Mobility Inventory of Agoraphobia, Body Sensation Questionnaire, Agoraphobic Cognitions Questionnaire, and Hospital Depression and Anxiety Questionnaire), and (3) fatigue, dizziness severity, and quality of life (Chalders Fatigue Scale, Vertigo Symptom Scale-Short Form, and EQ visual analog scale), in addition to the DHI. Data were presented by descriptive statistics for three DHI severity levels (mild, moderate, and severe). A multiple linear backward regression analysis was conducted for each group of measures in relation to the DHI total score, with additional analyses adjusting for age and sex. Based on these results, significant associations were tested in a final regression model.ResultsWith increasing severity levels of DHI, the participants demonstrated worse performance on most of the physical tests (preferred and fast gait velocity, dizziness intensity after head movements), presented with worse scores on the self-reported measures (avoidance behavior, fear of bodily sensation, fear of fear itself, psychological distress, fatigue, dizziness severity, quality of life). After adjusting for age and sex, significant associations were found between total DHI and avoidance behavior, psychological distress, dizziness severity, and quality of life, but not with any of the physical tests, explaining almost 56% of the variance of the DHI total score.ConclusionThere was a trend toward worse scores on physical tests and self-reported measurements with increasing DHI severity level. The DHI seems to be a valuable tool in relation to several self-reported outcomes; however, several signs and symptoms may not be detected by the DHI, and thus, a combination of outcomes should be utilized when examining patients with persistent dizziness.

Objective To determine the inter-rater reliability of identifying differences and types of differences in lumbar degenerative findings comparing supine and upright MRI. Materials and methods Fifty-nine participants, low back pain patients (LBP) with or without leg pain and no-LBP individuals were consecutively enrolled to receive supine and upright MRI of the lumbar spine. Three raters independently evaluated the MRIs for degenerative spinal pathologies and compared for differences. Presence/absence of degenerative findings were recorded for all supine and upright images, and then differences from the supine to the upright positions were classified into no-change, appeared, disappeared, worsened, or improved at each individual disc level. Reliability and agreement were calculated using Gwet's agreement coefficients (AC(1) or AC(2)) and absolute agreement. Results Inter-rater reliability of evaluating differences in eight degenerative lumbar findings comparing the supine and upright MRI position, ranged from 0.929 to 0.996 according to Gwet's agreement coefficients (AC(2)). The total number of positive MRI findings in the supine position ranged from 270 to 453, with an average of 366 per rater. Observed differences from supine to upright MRI ranged from 18 to 80, with an average of 56 per rater. Conclusion Inter-rater reliability was found overall acceptable for classification of differences in eight types of degenerative pathology observed with supine and upright MRI of the lumbar spine. Results were primarily driven by high numbers and high reliability of rating negative findings, whereas agreement regarding positive findings and positive positional differences was lower.

Background: Traumatic full-thickness rotator cuff tears are typically managed surgically, followed by rehabilitation, but the load progression to reach an optimal clinical outcome during postoperative rehabilitation is unknown. Purpose: To evaluate whether there was a superior effect of 12 weeks of progressive active exercise therapy on shoulder function, pain, and quality of life compared with usual care. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients with surgically repaired traumatic full-thickness rotator cuff tears were recruited from 2 orthopaedic departments and randomized to progressive active exercise therapy (PR) or limited passive exercise therapy (UC [usual care]). The primary outcome was the change in the Western Ontario Rotator Cuff Index (WORC) score between groups from before surgery to 12 weeks after surgery. Secondary outcomes included changes in the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, pain, range of motion, and strength. Adverse events were registered during the intervention period. Results: A total of 82 patients were randomized to the PR (n = 41) or UC (n = 41) group. All 82 patients (100%) participated in the 12-week assessment and 79 in the 1-year follow-up. At 12 weeks, there was no significant difference between the groups in the change in the WORC score from baseline adjusted for age, sex, and center (physical symptoms: P = .834; sports and recreation: P = .723; work: P = .541; lifestyle: P = .508; emotions: P = .568). Additionally, there was no between-group difference for the secondary outcomes including the WORC score at 1 year and the DASH score, pain, range of motion, and strength at 12 weeks and 1 year. Both groups showed significant improvements over time in all outcomes. In total, there were 13 retears (16%) at 1-year follow-up: 6 in the PR group and 7 in the UC group. Conclusion: PR did not result in superior patient-reported and objective outcomes compared with UC at either short- or long-term follow-up (12 weeks and 1 year). Registration: NCT02969135 ( ClinicalTrials.gov identifier)

Background: Little is known about how a prior knee injury affects the clinical profile of individuals with knee osteoarthritis (KOA) although this is potentially important to personalize care. Objectives: To compare individual and clinical characteristics of individuals with KOA with and without a self-reported prior knee injury. Design: Secondary data analysis of baseline data from the Good Life with osteoArthritis in Denmark (GLA:D (R)) registry. Methods: Individuals with symptomatic KOA, self-reporting a prior knee injury requiring a doctor's assessment, were compared to individuals without prior knee injury on a range of individual and clinical characteristics using multivariable logistic regression. Results: The analysis included 10,973 individuals with KOA of which 54% self-reported a prior knee injury. The average age was 64 years and 73% were female. We found that being male (Odds Ratio (OR): 0.99), having longer symptom duration of knee pain (OR: 1.07), having more painful body sites (OR: 1.03), being able to do more chair rises (OR: 1.02) and being more physically active in a week (2-4 days; OR:1.33) (>4 days; OR: 1.24) were associated with self-reporting a prior knee injury whereas being older (OR: 0.99), having higher BMI (OR: 0.99) and higher quality of life (OR: 0.98) were not associated with reporting a prior knee injury. Conclusion: The overall pattern of our findings rather than specific characteristics indicates that individuals with KOA and a history of a self-reported knee injury have a somewhat different clinical profile than their non-injured peers. (C) 2021 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Purpose: The objectives were to: 1) describe the rate of total hip replacement (THR) and 2) identify prognostic factors for receiving THR within two years in patients with hip osteoarthritis (OA) participating in a supervised patient education and exercise therapy program. Methods: Patients aged 45 or older with hip OA enrolled in Good Life with osteoArthritis in Denmark (GLA:D®) from July 1st, 2014 to March 1st, 2017 were included in the study (n=3,965). GLA:D® is an 8-week supervised education and exercise therapy program provided to people with symptoms associated with knee or hip OA. Information on THR was collected via surgical codes from The Danish National Patient Registry. Questionnaires were filled in by clinicians and patients and potential prognostic factors included demographic and disease-specific baseline characteristics as well as measures of baseline physical function, physical activity and quality of life (QoL). The proportion of patients receiving THR during the 2-year period was evaluated using a Kaplan-Meier plot. A multivariable Cox proportional hazards model was developed using backward stepwise elimination and age as the time scale. The final model’s beta estimates were bootstrapped to check the internal validity of the model. Lastly, we calculated Harrell’s c-index to evaluate the discriminative ability of the model. Results: Three hundred and eight patients were excluded due to THR in the index hip at baseline or incomplete data for the predictor variables and we therefore included 3,657 patients. The mean age was 66.5 years (SD 8.6), and 2,687 (73%) were women. During the study period 1,114 patients (30%) received a THR. One hundred patients reported being waitlisted for THR at baseline, and of these 60 received a THR. Fig. 1 illustrates the rate of THR within the study period. Results of the multivariable Cox regression model is presented in table 1. Self-reported radiologic hip OA compared to no known radiologic hip OA predicted THR within the two years follow-up with a HR of 2.34 (95% CI 1.88-2.91) and being waitlisted for surgery predicted THR with a HR of 2.19 (95% CI 1.68-2.85). Use of pain medication, joint replacement in the other hip or in the knees, and lower hip-related QoL evaluated using the quality-of-life subscale score from Hip Disability and Osteoarthritis Outcome Score (HOOS QoL) were also prognostic factors. Variables reflecting poor health status e.g. comorbidities and smoking, which has previously demonstrated to be associated with an increased risk of complications during surgery, were associated with a lower hazard ratio for THR. The internal validation revealed low bias, and the discriminative ability of the model was acceptable (Harrell’s c-index=0.7).Table 1Multivariable Cox regression analysis on the relationship between baseline variables and Time-to-Surgery in the final model.Baseline patient characteristic (candidate prognostic factor)Hazard Ratio (95% CI)Male (vs. female)1.36 (1.19-1.55)BMI, kg/m20.99 (0.97-1.0)Smoking (vs. no smoking)0.74 (0.59-0.92)At labor marked (vs. retired)1.23 (1.01-1.51)Use of pain medication the last 3 months (vs. no pain medication)1.31 (1.12-1.54)Self-reported radiologic OA (vs. no known radiologic OA)2.34 (1.89-2.91)Two or more comorbidities (vs. none)0.79 (0.67-0.93)Waitlisted for surgery (vs. not waitlisted)2.19 (1.68-2.85)Joint replacement in other hip or knees (vs. no previous THR/TKR)1.46 (1.22-1.75)Bilateral hip symptoms (vs. unilateral symptoms)0.77 (0.66-0.89)Widespread pain (numeric: 0-56 possible pain areas)0.94 (0.92-0.95)Hip pain (VAS 0-10, converted from a 0-100 scale)1.07 (1.04-1.11)HOOS* QoL score (0-100)0.98 (0.97-0.98)ASES**(10-100)1.00 (0.99-1.00)40 meters walk test (second)1.01 (1.00-1.01)*Quality of life subscale score from the Hip disability and osteoarthritis Outcome score**ASES: Arthritis Self-Efficacy Scale. Higher scores indicate higher self-efficacy Open table in a new tab *Quality of life subscale score from the Hip disability and osteoarthritis Outcome score**ASES: Arthritis Self-Efficacy Scale. Higher scores indicate higher self-efficacy Conclusions: In patients with hip OA participating in supervised education and exercise therapy, 30% had a THR within two years. Of those waitlisted for THR at baseline, only 60% underwent surgery. A range of modifiable and non-modifiable prognostic factors for 2-year THR were identified.

The objective was to investigate, first, whether six weeks of intensive ballet dance exposure is associated with structural and clinical changes in the Achilles tendon; second, the importance of demographics, self‐reported Achilles pain, and generalized joint hypermobility (GJH). Data were collected at baseline and at six weeks’ follow‐up, using Achilles tendon ultrasound tissue characteristics (UTC) as primary outcome (percentage distribution of echo‐type I–IV: type I = intact and aligned bundles, type II = discontinuous/wavy bundles, type III = fibrillar, and type IV = amorphous cells/fluid). Secondary outcomes included clinical signs of Achilles tendinopathy, Achilles tendon pain during single‐leg heel raise, self‐reported symptoms (VISA‐A questionnaire), and GJH. Sixty‐three ballet dancers (aged 18–41) participated. From baseline to follow‐up, UTC echo‐type I decreased significantly (β = −3.6, p = 0.001; 95% CI: −5.8;−1.4), whereas echo‐type II increased significantly (β = 3.2, p < 0.0001, 95% CI: 1.6;4.8). Furthermore, a significant effect of limb (left limb showed decreased echo‐type I and increased echo‐type III + IV) and sex (women showed decreased echo‐type I and increased in type II) was found. No significant changes in the remaining secondary outcomes were found. Ballet dancers showed structural changes in UTC, corresponding to a decreased echo‐type I distribution after six weeks of rehearsing for Swan Lake ballet. No changes in self‐reported symptoms, clinical signs of Achilles tendinopathy, and single‐leg heel raise test were seen from pre‐ to post‐rehearsal. Thus, UTC changes in the Achilles tendon seem to appear earlier than clinical signs of tendinopathy.

Background As is the case around the globe, the Danish chiropractic community appears to be an active service provider for the athletic sub-population. However, a paucity of evidence elucidating the experiences, perceptions, and practices of individuals who identify as ‘sports chiropractors’ complicates strategic development efforts. Methods A sequential mixed-methods study was conceptualized in which interview responses from seven purposefully selected stakeholders provided context and informed a national descriptive survey exploring practice characteristics and opinions regarding sports chiropractic among Danish chiropractors. Results Thematic highlights included divided opinions on the criteria that define a sports chiropractor, the role of a chiropractor functioning beyond the clinic setting, and the need for a structured approach to developing sports chiropractic as a legitimate sub-specialty. The survey response rate was 34.9% (227 of 651), with 27% of responders identifying as a ‘sports chiropractor’. Compared to non-sports chiropractors, sports chiropractors engaged in a significantly higher level of interprofessional practice (3.8 versus 2.7 partners), in particular medical doctors ( p = 0.016) and personal trainers ( p < 0.001). Whether participants identified as a sports chiropractor or not, there was consensus that a high-quality post-graduate qualification and continued education was important. Generally speaking, the framing of sports chiropractic into a protected title was not a priority. Conclusion The Danish sports chiropractor tends to be male, has a specialist education and engages other chiropractors, medical practitioners and professional trainers more often as practice partners than generalist chiropractors. The position of the sports chiropractor as a ‘knowledgeable expert’ was seen as more important than establishing a protected title. Experiential training appears to be an untapped resource for developing real-world competency and gaining greater professional exposure. Given the potential for development across Europe, more focus is required on a strategic plan for embedding chiropractic professionals in inter-professional athletic health and performance practice settings.

OBJECTIVE:The purpose of this study was to systematically explore the reporting of trigger-point dry needling (DN) in high-quality randomized clinical trials (RCTs) and to evaluate those trials' intervention fidelity. METHODS:A focused systematic review and meta-analysis was conducted. PubMed and Cochrane databases were searched for systematic reviews focusing on DN, published from January 2014 to January 2019. Randomized clinical trials with a low risk of bias were identified and their reported intervention data extracted. Dry-needling interventions were categorized according to common technique elements, and the Template for Intervention Description and Replication (TIDieR) was used to appraise their intervention fidelity. RESULTS:Fifteen systematic reviews were identified, and from these we extracted data from 26 RCTs. Twelve unique technique descriptors were identified, and 8 technique archetype categories were distinguishable, based on whether a local twitch response defined the start of the intervention, whether continuous needle insertion and withdrawal was used, and what criteria determined the cessation of needling. The median number of TIDieR items reported was 8.5 out of 12. Explicit procedure reporting was uncommon for intervention tailoring (38%) and rare for intervention mode (19%) and modifications (7%). CONCLUSION:Across the RCTs included in this review, substantial heterogeneity in the choice and reporting of DN was evident. In particular, systematic underreporting of intervention tailoring, mode clarification, and procedure modification undermined intervention fidelity. The development and adoption of standardized intervention guidelines is recommended to enhance uniform and nuanced reporting of DN interventions.

The authors found that the variable Knee Injury and Osteoarthritis Outcome Score (KOOS), subscale quality of life (QOL) has been recoded twice in the dataset. This means that the reported KOOS QOL values of 60 (no prior knee injury) and 56 (prior knee injury) is inflated by 13 and 12 points, respectively. The correct KOOS QOL values for the two groups are 47 (no prior knee injury) and 44 (prior knee injury), respectively. Apart from negligible changes to second and third decimals in the odds ratios (OR) and in the 95% CI for some of the included variables in the logistic regression model, the results and subsequent interpretation of the logistic regression model remains the same. Please see revised Table I. The authors apologize for any inconvenience caused.Table IIndividual and clinical characteristics (presented in means (SD)/frequencies (proportions)) and multivariable logistic regression model with odds ratios (OR) and 95% CI using prior knee injury (yes/no) as the exposureNo prior knee injuryPrior knee injuryMultivariable logistic regression modelOR (95% CI)n = 5000n = 5973n = 7155†Symptom duration was not collected for participants between May 2016 and November 2016. This has reduced the response rate for this outcome and thereby reduced the overall number of participants included in the logistic regression model.Age, years (mean (SD))65 (9.6)64 (9.9)0.990 (0.985–0.996)∗P < 0.05.Male (n (%))1242 (24.9)1752 (29.5)1.330 (1.189–1.489)∗P < 0.05.BMI§Body Mass Index (0.1 kg/m2 units). (mean (SD))28.7 (5.4)28.6 (5.2)0.985 (0.976–0.995)∗P < 0.05.Number of Comorbidities (n (%)) none1711 (34.2)2085 (34.9)reference 11829 (36.6)2092 (35)0.894 (0.797–1.005) 2986 (19.7)1138 (19.1)0.846 (0.735–0.974)‡Insignificant when imputing data for missing answers for 'symptom duration' (data not shown). >2474 (9.5)658 (11)1.077 (0.896–1.291)KOOS, QOL‖Knee injury and Osteoarthritis Outcome Score, subscale quality of life. (mean (SD))47 (14.9)44 (14.3)0.980 (0.976–0.983)∗P < 0.05.ASES¶Arthritis Self-Efficacy Scale, subscales pain and other symptoms. (mean (SD))70 (17.2)68 (17.4)0.998 (0.995–1.002)Pain, VAS#Visual Analog Scale. 0–100 (mean (SD))48 (22.2)50 (21.9)0.998 (0.996–1.001)Symptom duration, years (mean (SD))3 (5.4)6 (8.8)1.068 (1.057–1.080)∗P < 0.05.Painful body sites (mean (SD))4 (3)4 (3.6)1.027 (1.011–1.044)∗P < 0.05.Pain medication (n (%))3010 (60.2)3726 (62.4)0.947 (0.854–1.051)40 m walkTime in 40 m walk test. (mean (SD))28.8 (8.1)28.4 (9.4)0.999 (0.992–1.007)30 s chair-riseNumber of chair stands in chair-rise test in 30 s. (mean (SD))12 (3.5)12 (3.7)1.020 (1.004–1.036)∗P < 0.05.UCLAUniversity of California, Los Angeles activity scale. (mean (SD))6 (1.8)6 (1.8)1.029 (0.999–1.060)Weekly physical activity (n (%)) 0–1 days467 (9.3)490 (8.2)reference 2–4 days1535 (30.7)1920 (32.1)1.329 (1.105–1.597)∗P < 0.05. >4 days2998 (60)3563 (60)1.240 (1.036–1.484)∗P < 0.05.∗ P < 0.05.† Symptom duration was not collected for participants between May 2016 and November 2016. This has reduced the response rate for this outcome and thereby reduced the overall number of participants included in the logistic regression model.‡ Insignificant when imputing data for missing answers for 'symptom duration' (data not shown).§ Body Mass Index (0.1 kg/m2 units).‖ Knee injury and Osteoarthritis Outcome Score, subscale quality of life.¶ Arthritis Self-Efficacy Scale, subscales pain and other symptoms.# Visual Analog Scale.∗∗ Time in 40 m walk test.†† Number of chair stands in chair-rise test in 30 s.‡‡ University of California, Los Angeles activity scale. Open table in a new tab The clinical profile of people with knee osteoarthritis and a self-reported prior knee injury: A cross-sectional study of 10,973 peopleOsteoarthritis and CartilageVol. 29Issue 3PreviewLittle is known about how a prior knee injury affects the clinical profile of individuals with knee osteoarthritis (KOA) although this is potentially important to personalize care. Full-Text PDF

ABSTRACT Introduction and aims: Guidelines for low back pain (LBP) management recommend patient education and exercises. GLA:D Back, a structured group-based patient-education exercise program for LBP, facilitates evidence-based care implementation. This study aimed to inform on the implementation processes, assessing clinician-related factors. Objectives were to describe profiles of implementers and nonimplementers by demographics, and responses to the tailored version of the Determinants of Implementation Behaviour Questionnaire (DIBQ-t) qualitatively explore clinician perspectives on implementation, and compare the results of the DIBQ-t with the interview data to evaluate their fit of integration for facilitators, barriers, and new insights. Methods: A mixed-methods parallel design study was conducted. Physiotherapists and chiropractors, educated in the GLA:D Back program, were asked to complete the DIBQ-t (measuring theoretical determinants of implementation) 6 months after their training. Implementers and nonimplementers of the program were selected for interviews. Qualitative data were used to understand clinicians’ viewpoints on implementation, providing a broader perspective on the quantitative data and exploring new aspects. Results: More physiotherapists than chiropractors implemented the program. Implementers responded more positively on most domains of the DIBQ-t. The interviews revealed three themes important for implementation: personal gain, practicalities, and buying-in on the program. Clinicians’ attitudes to the program appeared additionally as relevant to implementation. Conclusion: The profession of the clinician was associated with implementation behavior. Implementers and nonimplementers identified the same themes but perceived them as either positive or negative. Both groups reported high levels of knowledge and skills, indicating that training alone is insufficient for implementation.

Introduction Idiopathic inflammatory myopathies (IIMs) are rare diseases characterised by non-suppurative inflammation of skeletal muscles and muscle weakness. Additionally, IIM is associated with a reduced quality of life. Strength training is known to promote muscle hypertrophy and increase muscle strength and physical performance in healthy young and old adults. In contrast, only a few studies have examined the effects of high intensity strength training in patients with IIM and none using a randomised controlled trial (RCT) set-up. Thus, the purpose of this study is to investigate the effects of high-intensity strength training in patients affected by the IIM subsets polymyositis (PM), dermatomyositis (DM) and immune-mediated necrotising myopathy (IMNM) using an RCT study design. Methods and analysis 60 patients with PM, DM or IMNM will be included and randomised into (1) high-intensity strength training or (2) Care-as-Usual. The intervention period is 16 weeks comprising two whole-body strength exercise sessions per week. The primary outcome parameter will be the changes from pre training to post training in the Physical Component Summary measure in the Short Form-36 health questionnaire. Secondary outcome measures will include maximal lower limb muscle strength, skeletal muscle mass, functional capacity, disease status (International Myositis Assessment and Clinical Studies Group core set measures) and questionnaires assessing physical activity levels and cardiovascular comorbidities. Furthermore, blood samples and muscle biopsies will be collected for subsequent analyses. Ethics and dissemination The study complies with the Helsinki Declaration II and is approved by The Danish Data Protection Agency (P-2020–553). The study is approved by The Danish National Committee on Health Research Ethics (H-20030409). The findings of this trial will be submitted to relevant peer-reviewed journals. Abstracts will be submitted to international conferences. Trial registration number NCT04486261 .

Importance: The management of traffic injuries is challenging for clinicians. Knowledge about predictors of nonrecovery from traffic injuries may help to improve patient care. Objective: To develop a prediction model for self-reported overall nonrecovery from traffic injuries six months post-collision in adults with incident traffic injuries including post-traumatic headache (PTH). Design: Inception cohort studies of adults with incident traffic injuries (including PTH) injured in traffic collisions between November 1997 and December 1999 in Saskatchewan, Canada; and between January 2004 and January 2005 in Sweden. Methods: Prediction model development and geographical external validation. Setting: The Saskatchewan cohort (development) was population-based (N = 4,162). The Swedish cohort (vali-dation) (N = 379) were claimants from two insurance companies covering 20% of cars driven in Sweden in 2004. Participants: All adults injured in traffic collisions who completed a baseline questionnaire within 30 days of collision. Excluded were those hospitalized > 2 days, lost consciousness > 30 min, or reported headache < 3/10 on the numerical rating scale. Follow-up rates for both cohorts were approximately 80%. Predictors: Baseline sociodemographic, pre-injury, and injury factors. Outcome: Self-reported nonrecovery from all injuries (not "all better (cured)" on the self-perceived recovery scale) six months after traffic collision. Results: Both cohorts were predominantly female (69.8% in Saskatchewan, 65.2% in Sweden), with median ages 35.9 years (Saskatchewan), and 38.0 years (Sweden). Predictors were age, low back pain, symptoms in arms or hands, hearing problems, sleeping problems, pre-existing headache, and lower recovery expecta-tions. With a positive score (i.e., >= 0.85 probability), the model can rule in the presence of self-reported nonrecovery from all injuries at six months (development: specificity = 91.3%, 95% CI 89.2%-93.0%; sensitivity = 27.8%, 95% CI 26.0%-29.7%; positive likelihood ratio (LR + ) = 3.2, 95% CI 2.5-4.0; negative likelihood ratio (LR-) = 0.79, 95% CI 0.76-0.82; validation: specificity = 72.6%, 95% CI 61.4%- 81.5%; sensitivity = 60.5%, 95% CI 53.9%-66.7%); LR+ = 2.2, 95% CI 1.5-3.3; LR-= 0.5, 95% CI 0.4-0.7). Conclusions and relevance: In adults with incident traffic injuries including PTH, predictors other than those related to baseline head and neck pain drive overall nonrecovery. Developing and testing interventions targeted at the modifiable predictors may help to improve outcomes for adults after traffic collision.