- Email: [email protected]
226 Reliability and variability of measures of lower limb performance
Talking sport injuries in physiotherapy consultations: the role of sport injury narratives in legitimizing the visit
225
A. Lamont-Mills1* 1 Centre For Rural And Remote Area Health, University Of Southern Queensland
How patients present new health problems to physiotherapists is not well understood in the sport physiotherapy literature. This is surprising given that patients’ problem statements are part of the clinical material that physiotherapists use to construct a subjective inventory against which differential diagnoses are tested. Therefore, the aim of this presentation is to address this gap. This presentation will explore how patients present their realisation that they have a problem that requires physiotherapy attention and how physiotherapists understand this. Digital audio-recordings of 98 real-life physiotherapy consultations between 98 patients and 3 physiotherapists comprise the data corpus for this presentation. These patients had either a sporting or physical activity injury. This data was analysed using conventions of conversation analysis and discursive psychology with a focus on how patients and physiotherapists used their discourse to make sense of the presenting problem and what actions do problem statements perform. Analysis revealed that patients primarily presented their new health problem in the form of a sport injury narrative. An exemplar narrative will be presented that demonstrates common narrative features including how sport injury narratives are shaped by physiotherapists’ moment-by-moment reactions. Discussion will then centre on how such narratives are designed to help patients legitimise their visit. The practice implication is that the actions performed by sport injury narratives may be of central importance to the consultation and that problem statements may be more than just reflections potential tissue damage and injury severity.
Reliability and variability of measures of lower limb performance
226
A. Miller1* & R. Callister1 1 University Of Newcastle
The purpose of this study was to determine the reliability and variability of testing procedures used to evaluate lower limb performance and potentially for injury risk screening. Twenty-four athletes (n=17 male, n=7 female) were tested on three occasions 5-12 days apart. Tests were vertical jumps and a box step-up (30cm box). The flight time of vertical jumps on a contact mat and maximum thigh angle relative to horizontal (valgus) during movements were measured; athletes were filmed from the front using 2-dimensional video during all tests. Vertical jumps consisted of double-leg vertical, single-leg vertical and depth jumps (30cm box) for each leg. Measures analysed were relative power (double and single-leg vertical jumps) and knee valgus (single-leg vertical jumps, depth jumps and box step-up). Single leg measurements provided right leg, left leg and right/left ratio scores. Change in mean (%), typical error of measurement (%), and intraclass correlation coefficient (ICC) were calculated on log-transformed data for each variable using sportssci.org statistical spreadsheets. Changes in means (range: -2.0% – 4.5%) and mean typical error (3.2% – 6.1%) were considered excellent to good for all measures. ICCs for all right/left ratio data were poor (ICC 0.279 – 0.580), knee valgus measures varied substantially (ICC 0.326 – 0.819) whereas ICCs for all relative power measures were high (ICC 0.976 – 0.991). These findings suggest that when assessed using a contact mat and two dimensional video, double-leg vertical, single-leg vertical and depth jumps and a step up test are reliable measures for use in performance monitoring and/or injury risk screening.
Physical activity and exercise advice: views of older people admitted to hospital with a fall-related injury
227
J. Nolan1,2* 1 Flinders Medical Centre 2 University of Adelaide, Discipline of General Practice
To optimise uptake and adherence at individual and population levels, it is crucial to incorporate the views of older people for fall prevention advice regarding uptake of physical activity or exercise. This study aimed to understand the views of older people admitted to hospital with fall-related injuries about advice to promote exercise as a fall prevention strategy, and develop future advice recommendations. Thirteen adults (8 female, 5 male) aged 65-95, hospitalised with fall-related injuries participated. Individual semi-structured in-depth interviews which explored vulnerability to falls and intention to act on exercise advice as a fall prevention strategy were conducted, analysed and key themes summarised. Demographic and descriptive data about falls were collected and analysed. Participants stayed in hospital 2-91 days and the majority were concerned about falling during daily activities. Qualitative results suggest that participants viewed falls as unpredictable, unavoidable events, which commonly threatened their independence and identity as competent individuals. Whilst exercise was viewed as being beneficial, participants’ intention to commence exercise was commonly limited by concern regarding the suitability of the exercise program for their physical ability. Advice promoting independence, better balance and strength was strongly preferred to fall prevention advice. Future exercise or physical activity advice in this group should promote positive concepts of older people, eg independence and strength, and ensure that individuals understand that the recommended exercise is accessible and appropriate to their current physical abilities. These recommendations require further testing regarding impact on uptake and adherence in a controlled trial before incorporation into practice.
School shoes reduce children’s foot motion during walking & jogging compared to barefoot
228
D. O’Meara1*, R. Smith1, A. Hunt1 & B. Vanwanseele1 1 The University Of Sydney
Footwear influences adult foot mechanics and overall performance, however it is unclear whether this is true for a child’s developing foot. There is a need to quantify children’s shod foot mechanics. This study compares children’s 1stMTP, midfoot and ankle joint sagittal plane range of motion (ROM) while shod (school shoe) and barefoot during walking and jogging. Twelve children aged 6 to 13 years performed five walking and jogging trials while shod and barefoot. A motion analysis system (MAC) calculated 3D marker trajectories of the right toe, 1st & 5th MTP, navicular, calcaneus, malleoli and shank. In-shoe and barefoot rearfoot segment motion was measured with a wand marker cluster, which extended through a 10mm hole in the rear of the shoe. Motion at the 1stMTP joint was defined by the included angle between the first ray and the hallux. Midfoot and ankle motion were determined using embedded axis systems in the segments. Mean 1stMTP and midfoot ROM decreased during shod walking and jogging. While walking ROM decreased for the 1stMTP by 7˚, from 32˚ (p<0.001) and for the midfoot by 6˚, from 21˚ (p=0.016). While jogging ROM decreased for the 1stMTP by 14˚, from 39˚ (p<0.001) and for the midfoot by 11˚, from 29˚ (p=0.002). Mean ankle ROM remained at 25˚ during walking and 35˚ during jogging. School shoes restricted children’s foot motion during walking and jogging, compared to barefoot. The medium and long term implications of this change to a child’s foot motion remain to be discovered.
80
225
A. Lamont-Mills1* 1 Centre For Rural And Remote Area Health, University Of Southern Queensland
How patients present new health problems to physiotherapists is not well understood in the sport physiotherapy literature. This is surprising given that patients’ problem statements are part of the clinical material that physiotherapists use to construct a subjective inventory against which differential diagnoses are tested. Therefore, the aim of this presentation is to address this gap. This presentation will explore how patients present their realisation that they have a problem that requires physiotherapy attention and how physiotherapists understand this. Digital audio-recordings of 98 real-life physiotherapy consultations between 98 patients and 3 physiotherapists comprise the data corpus for this presentation. These patients had either a sporting or physical activity injury. This data was analysed using conventions of conversation analysis and discursive psychology with a focus on how patients and physiotherapists used their discourse to make sense of the presenting problem and what actions do problem statements perform. Analysis revealed that patients primarily presented their new health problem in the form of a sport injury narrative. An exemplar narrative will be presented that demonstrates common narrative features including how sport injury narratives are shaped by physiotherapists’ moment-by-moment reactions. Discussion will then centre on how such narratives are designed to help patients legitimise their visit. The practice implication is that the actions performed by sport injury narratives may be of central importance to the consultation and that problem statements may be more than just reflections potential tissue damage and injury severity.
Reliability and variability of measures of lower limb performance
226
A. Miller1* & R. Callister1 1 University Of Newcastle
The purpose of this study was to determine the reliability and variability of testing procedures used to evaluate lower limb performance and potentially for injury risk screening. Twenty-four athletes (n=17 male, n=7 female) were tested on three occasions 5-12 days apart. Tests were vertical jumps and a box step-up (30cm box). The flight time of vertical jumps on a contact mat and maximum thigh angle relative to horizontal (valgus) during movements were measured; athletes were filmed from the front using 2-dimensional video during all tests. Vertical jumps consisted of double-leg vertical, single-leg vertical and depth jumps (30cm box) for each leg. Measures analysed were relative power (double and single-leg vertical jumps) and knee valgus (single-leg vertical jumps, depth jumps and box step-up). Single leg measurements provided right leg, left leg and right/left ratio scores. Change in mean (%), typical error of measurement (%), and intraclass correlation coefficient (ICC) were calculated on log-transformed data for each variable using sportssci.org statistical spreadsheets. Changes in means (range: -2.0% – 4.5%) and mean typical error (3.2% – 6.1%) were considered excellent to good for all measures. ICCs for all right/left ratio data were poor (ICC 0.279 – 0.580), knee valgus measures varied substantially (ICC 0.326 – 0.819) whereas ICCs for all relative power measures were high (ICC 0.976 – 0.991). These findings suggest that when assessed using a contact mat and two dimensional video, double-leg vertical, single-leg vertical and depth jumps and a step up test are reliable measures for use in performance monitoring and/or injury risk screening.
Physical activity and exercise advice: views of older people admitted to hospital with a fall-related injury
227
J. Nolan1,2* 1 Flinders Medical Centre 2 University of Adelaide, Discipline of General Practice
To optimise uptake and adherence at individual and population levels, it is crucial to incorporate the views of older people for fall prevention advice regarding uptake of physical activity or exercise. This study aimed to understand the views of older people admitted to hospital with fall-related injuries about advice to promote exercise as a fall prevention strategy, and develop future advice recommendations. Thirteen adults (8 female, 5 male) aged 65-95, hospitalised with fall-related injuries participated. Individual semi-structured in-depth interviews which explored vulnerability to falls and intention to act on exercise advice as a fall prevention strategy were conducted, analysed and key themes summarised. Demographic and descriptive data about falls were collected and analysed. Participants stayed in hospital 2-91 days and the majority were concerned about falling during daily activities. Qualitative results suggest that participants viewed falls as unpredictable, unavoidable events, which commonly threatened their independence and identity as competent individuals. Whilst exercise was viewed as being beneficial, participants’ intention to commence exercise was commonly limited by concern regarding the suitability of the exercise program for their physical ability. Advice promoting independence, better balance and strength was strongly preferred to fall prevention advice. Future exercise or physical activity advice in this group should promote positive concepts of older people, eg independence and strength, and ensure that individuals understand that the recommended exercise is accessible and appropriate to their current physical abilities. These recommendations require further testing regarding impact on uptake and adherence in a controlled trial before incorporation into practice.
School shoes reduce children’s foot motion during walking & jogging compared to barefoot
228
D. O’Meara1*, R. Smith1, A. Hunt1 & B. Vanwanseele1 1 The University Of Sydney
Footwear influences adult foot mechanics and overall performance, however it is unclear whether this is true for a child’s developing foot. There is a need to quantify children’s shod foot mechanics. This study compares children’s 1stMTP, midfoot and ankle joint sagittal plane range of motion (ROM) while shod (school shoe) and barefoot during walking and jogging. Twelve children aged 6 to 13 years performed five walking and jogging trials while shod and barefoot. A motion analysis system (MAC) calculated 3D marker trajectories of the right toe, 1st & 5th MTP, navicular, calcaneus, malleoli and shank. In-shoe and barefoot rearfoot segment motion was measured with a wand marker cluster, which extended through a 10mm hole in the rear of the shoe. Motion at the 1stMTP joint was defined by the included angle between the first ray and the hallux. Midfoot and ankle motion were determined using embedded axis systems in the segments. Mean 1stMTP and midfoot ROM decreased during shod walking and jogging. While walking ROM decreased for the 1stMTP by 7˚, from 32˚ (p<0.001) and for the midfoot by 6˚, from 21˚ (p=0.016). While jogging ROM decreased for the 1stMTP by 14˚, from 39˚ (p<0.001) and for the midfoot by 11˚, from 29˚ (p=0.002). Mean ankle ROM remained at 25˚ during walking and 35˚ during jogging. School shoes restricted children’s foot motion during walking and jogging, compared to barefoot. The medium and long term implications of this change to a child’s foot motion remain to be discovered.
80