Running-related injuries are highly prevalent.
Synthesise published evidence with international expert opinion on the use of running retraining when treating lower limb injuries.
Mixed methods.
A ...systematic review of clinical and biomechanical findings related to running retraining interventions were synthesised and combined with semistructured interviews with 16 international experts covering clinical reasoning related to the implementation of running retraining.
Limited evidence supports the effectiveness of transition from rearfoot to forefoot or midfoot strike and increase step rate or altering proximal mechanics in individuals with anterior exertional lower leg pain; and visual and verbal feedback to reduce hip adduction in females with patellofemoral pain. Despite the paucity of clinical evidence, experts recommended running retraining for: iliotibial band syndrome; plantar fasciopathy (fasciitis); Achilles, patellar, proximal hamstring and gluteal tendinopathy; calf pain; and medial tibial stress syndrome. Tailoring approaches to each injury and individual was recommended to optimise outcomes. Substantial evidence exists for the immediate biomechanical effects of running retraining interventions (46 studies), including evaluation of step rate and strike pattern manipulation, strategies to alter proximal kinematics and cues to reduce impact loading variables.
Our synthesis of published evidence related to clinical outcomes and biomechanical effects with expert opinion indicates running retraining warrants consideration in the treatment of lower limb injuries in clinical practice.
Telehealth services have helped enable continuity of care during the coronavirus pandemic. We aimed to investigate use and views towards telehealth among allied health clinicians treating people with ...musculoskeletal conditions during the pandemic.
Cross-sectional international survey of allied health clinicians who used telehealth to manage musculoskeletal conditions during the coronavirus pandemic. Questions covered demographics, clinician-related factors (e.g. profession, clinical experience and setting), telehealth use (e.g. proportion of caseload, treatments used), attitudes towards telehealth (Likert scale), and perceived barriers and enablers (open questions). Data were presented descriptively, and an inductive thematic content analysis approach was used for qualitative data, based on the Capability-Opportunity-Motivation Behavioural Model.
827 clinicians participated, mostly physiotherapists (82%) working in Australia (70%). Most (71%, 587/827) reported reduced revenue (mean (SD) 62% (24.7%)) since the pandemic commenced. Median proportion of people seen via telehealth increased from 0% pre (IQR 0 to 1) to 60% during the pandemic (IQR 10 to 100). Most clinicians reported managing common musculoskeletal conditions via telehealth. Less than half (42%) of clinicians surveyed believed telehealth was as effective as face-to-face care. A quarter or less believed patients value telehealth to the same extent (25%), or that they have sufficient telehealth training (21%). Lack of physical contact when working through telehealth was perceived to hamper accurate and effective diagnosis and management.
Although telehealth was adopted by allied health clinicians during the coronavirus pandemic, we identified barriers that may limit continued telehealth use among allied health clinicians beyond the current pandemic.
•Allied health clinicians rapidly adopted telehealth during the coronavirus pandemic.•They view telehealth as part of their clinical role.•However, most felt they lacked adequate training to deliver telehealth services.•And that telehealth is inferior to face-to-face care and undervalued by patients.•These barriers may limit use of telehealth beyond the pandemic.
Quadriceps voluntary activation measured net corticospinal excitability, and was quantified as the difference between force before and during a superimposed electrical stimulation of the femoral ...nerve while performing maximum voluntary isometric knee extension ((MVIC/superimposed force during MVIC)) x100). Based on the data of this study, and a comparison to previous investigations, it is possible reduced spinal excitability may be a mechanism underlying motor impairments in patellar tendinopathy, and cortical excitability may increase to counter this. Impact and applications to the field: -This study is an important step towards quantifying segmental contributions to net corticospinal excitability in patellar tendinopathy.
Although telehealth is becoming more popular for delivery of care for individuals with musculoskeletal pain, to our knowledge telehealth has not been used to manage Achilles tendinopathy. This ...research aimed to explore the experience of participants and physiotherapists with gym-based exercise interventions for Achilles tendinopathy monitored via videoconference.
A qualitative, interpretive description design was performed using semi-structured interviews (8 participants) and a focus group (7 physiotherapists). Participants and physiotherapists were interviewed about their experiences of the use of telehealth during a gym-based exercise intervention incorporating different calf load parameters for Achilles tendinopathy. We employed an inductive thematic analysis approach to analyse the data.
Three themes identified from both participants and physiotherapists included i) acceptability of telehealth; ii) enablers to adherence with telehealth; and iii) barriers to adherence with telehealth. Two extra themes arose from participants regarding adherence with gym-based exercise, including enablers to adherence with the exercise intervention, and barriers to adherence with the exercise intervention. Both participants and physiotherapists expressed overall satisfaction and acceptability of telehealth monitoring of gym-based exercise.
Gym-based exercise intervention for Achilles tendinopathy involving weekly telehealth monitoring was acceptable to both participants and physiotherapists. Potential enablers and barriers were identified that may improve adherence to this type of intervention.
Rotator cuff related shoulder pain (RCRSP) is a common and disabling shoulder condition and surgical management is becoming more common. The rates and costs of surgical interventions have been on the ...rise. Understanding decision-making related to surgery and providing adequate information to people with RCRSP may improve patient-centred care and potentially reduce rates of surgery.
To explore the decision-making processors of people who have undertaken surgery for RCRSP.
An in-depth thematic analysis.
Interviews were conducted with patients from Melbourne who had had surgical management for RCRSP. Data were analysed using an inductive thematic approach.
Fifteen participants were recruited. Six key themes emerged: (1) Needing to get it done: "It was necessary to remedy the dire situation"; (2) Non-surgical treatment experience:" I knew that I'd done all I could"; (3) Mechanical problem:" Physio's not going to repair a torn tendon"; (4) Trust in medical professionals "If they told me that I needed to swallow a thousand spiders, I would have done it."; (5) Varied information sources "Dr Google played a big part in it"; (6) Organisational barriers "It was absolutely useless, my insurance."
Surgery appears to be commonly precipitated by unremitted severe symptoms and failed non-surgical treatment. While there was strong trust in highly trained surgeons, decision to undergo surgery also drew on questionable pathoanatomical beliefs and instances of inadequate patient information about treatment choices and risks that may be addressed by adopting a more patient-centred care approach.
IMPLICATIONS FOR REHABILITATION
Understanding decision-making related to surgery and providing adequate information to people with rotator cuff related shoulder pain may improve patient-centred care.
Surgery appears to be commonly precipitated by unremitted severe symptoms and failed non-surgical treatment.
Decision to undergo surgery sometimes drew on questionable pathoanatomical beliefs.
There was strong trust in highly trained surgeons but there were instances of inadequate patient information about treatment choices and risks.
Identified behaviour change techniques and mechanisms of action that may influence adherence were extracted and mapped to the capability, opportunity, motivation model of behaviour (COM-B) as a ...summary of the approaches of adherence. If the CERT criteria are followed in reporting of the protocols, factors influencing adherence will be more explicitly identifiable, enabling adoption by health professionals implementing the exercise protocols in clinical practice. Embedding explicit motivational strategies into exercise protocols delivered by health professionals for adults with tendinopathy may improve adherence, which would likely improve patient outcomes.
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