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This book argues that narrative people and place are inseparable and pursues the ­consequences of this insight through the design of narrative environments. This is a new and distinct area of practice that weaves together and extends narrative theory, spatial theory and design theory. Examples of narrative spaces, such as exhibitions, brand experiences, urban design and socially engaged participatory interventions in the public realm, are explored to show how space acts as a medium of communication through a synthesis of materials, structures and technologies, and how particular social behaviours are reproduced or critiqued through spatial narratives. This book will be of interest to scholars in design studies, urban studies, architecture, new materialism and design practitioners in the creative industries. Cover image adapted from a photograph of Making Beauty by Elpida Hadzi-Vasileva at the Djanogly Gallery, Nottingham University 2016. Photo and adaption: Tricia Austin.

Evidence-based practice (EBP) is an important paradigm in health care. Physical therapists report lack of knowledge and time constraints as barriers to EBP. The purpose of this technical report is to illustrate how Medical Subject Headings (MeSH), a controlled vocabulary thesaurus of indexing terms, is used to efficiently search MEDLINE, the largest component of PubMed. Using clinical questions, this report illustrates how search terms common to physical therapist practice do or do not map to appropriate MeSH terms. A PubMed search strategy that takes advantage of text words and MeSH terms is provided. A search of 139 terms and 13 acronyms was conducted to determine whether they appropriately mapped to a MeSH term. The search results were categorized into 1 of 5 outcomes. Nearly half (66/139) of the search terms mapped to an appropriate MeSH term (outcome 1). When a search term did not appropriately map to a MeSH term, it was entered into the MeSH database to search for an appropriate MeSH term. Twenty-one appropriate MeSH terms were found (outcomes 2 and 4), and there were 52 search terms for which an appropriate MeSH term was not found (outcomes 3 and 5). Nearly half of the acronyms did not map to an appropriate MeSH term, and an appropriate MeSH term was not found in the database. The results are based on a limited number of search terms and acronyms. Understanding how search terms map to MeSH terms and using the PubMed search strategy can enable physical therapists to take full advantage of available MeSH terms and should result in more-efficient and better-informed searches.

Prevention of exercise-related leg pain (ERLP) has not been successful because ERLP risk factors are not well known. To determine the percentage of high school cross-country (XC) athletes who reported a history of ERLP in their running careers, to identify the percentage of athletes who reported an occurrence of ERLP during 1 XC season, and to investigate the association of selected factors (age, high school year, years of high school running, sex, ERLP history, body mass index [BMI], foot type, and training distance) and the occurrence of ERLP. Prospective cohort study. Six local high schools. One hundred twenty-five high school XC athletes (62 females, 63 males). All athletes completed an initial ERLP questionnaire, and foot type was visually assessed. After the season, athletes were asked to complete a Web-based questionnaire regarding the seasonal occurrence of ERLP. Statistical analyses of differences (t tests) and associations (chi(2), relative risk) were conducted. A total of 103 of the 125 athletes (82.4%) reported a history of ERLP, with 81 athletes reporting ERLP occurrence within the month preceding completion of the initial questionnaire. Bilateral medial leg pain was the most common ERLP presentation. More than half of the athletes (58.4%) with an ERLP history reported that the pain had interfered with XC participation. Ninety-three athletes responded to the postseason questionnaire, and 45 (48.0%) reported ERLP seasonal occurrence. Most athletes (97.8%) who experienced the seasonal occurrence of ERLP had a history of ERLP. No associations were noted between ERLP history or seasonal occurrence and age, high school year, years of high school running, sex, BMI, foot type, or training distance. Both a history of ERLP and the seasonal occurrence of ERLP were common among these XC athletes. The only risk factor identified for ERLP season occurrence was ERLP history.

Background and Purpose: As of October 1, 2002, physical therapy continuing education (CE) in Illinois was mandated. Research examining the recent mandate for physical therapists to engage in CE is limited. The purposes of this study were to examine the perceptions of physical therapist clinicians and managers concerning the barriers to and facilitators of CE and to identify how physical therapists perceive the role of their department in the CE process. Subjects: Participants were 23 physical therapists at 6 hospitals. Methods: Qualitative methodology was used to analyze data. Results: Four themes were identified: negotiating and managing the variables associated with CE, providing and promoting opportunities that meet physical therapists’ CE needs, identifying the elements of employment environments that foster CE, and perceived implications of mandating CE. Discussion and Conclusion: This investigation highlights the need to identify the core set of variables associated with engaging in CE and to promote the elements of employment environments that foster CE.

Collins N, Bisset L, McPoil T, Vicenzino B. Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis. Foot Ankle Int. 2007;28(3):396-412. Among patients with or at risk for musculoskeletal overuse conditions, (1) do foot orthoses provide clinically meaningful improvements, and (2) are foot orthoses cost-effective? Studies published through September 28, 2005, were identified by using MEDLINE, EMBASE, CINAHL and Pre-CINAHL, Physiotherapy Evidence Database (PEDro), PubMed, SPORTDiscus, Biological Abstracts, Web of Science, Allied Health and Complementary Medicine Database, and the full Cochrane Library. The authors did not provide the search strategy used. Reference lists of included randomized controlled trials (RCTs) and identified systematic reviews were searched by hand. Studies were included if (1) they were RCTs that included the use of foot orthoses (either custom or prefabricated) in 1 of the intervention groups, (2) the clinical problem was an overuse condition as defined by the American College of Foot and Ankle Orthopedics and Medicine guidelines for which foot orthoses were recommended, and (3) at least 1 clinically relevant outcome was measured for a minimum of 1 week. Limits were not placed on year of publication, status of publication, or language. The journal, authors, and author affiliations of included RCTs were masked from 2 of the reviewers who independently assessed the included RCTs for methodologic quality using a modified PEDro scale plus 3 additional items (justification of sample size, use of outcome measures with known validity and reliability, and reporting of adverse or side effects). Disagreements on methodologic quality were resolved with consensus or by a third reviewer. The effect sizes for the included RCTs were represented by relative risk (RR) for dichotomous outcomes and standardized mean difference (SMD) for continuous data. Confidence intervals (CIs) were reported for RR and SMD. Study data were extracted directly from each of the included studies. If provided, data from intention-to-treat analysis were extracted. Study authors were contacted when insufficient data were reported. A meta-analysis (random-effects model) was conducted using Review Manager (version 4.2; The Nordic Cochrane Centre, Copenhagen, Denmark). The search identified 3192 potentially relevant studies. Full articles were retrieved for 327 studies. Twenty-two of the 327 studies met the inclusion criteria. Because the authors of 1 study used the same methods to report on 2 populations, a total of 23 RCTs were included in the systematic review. Prevention of lower limb overuse conditions with the use of foot orthoses was reported in 8 RCTs (7 studies). The effect of foot orthoses in the treatment of lower limb overuse conditions was reported in 15 RCTs. Of the 23 RCTs, the cost-effectiveness of foot orthoses was reported in 2 and the adverse effects of foot orthoses were reported in 8. Across the prevention RCTs, data were available for analysis for a range of 47 to 417 participants with 8 to 16 weeks of follow-up. Based on 4 RCTs in which the researchers examined prevention of lower limb overuse conditions with foot orthoses versus control in military personnel, the RR was 1.49 (95% CI  =  1.07, 2.08). A clinically beneficial effect size was set a priori at 1.5 or greater for the foot-orthoses group or at 0.7 or less for the comparison group. Based on 2 RCTs reported in 1 study of the use of custom versus prefabricated foot orthoses for prevention of lower limb overuse conditions, no significant difference in risk was found (RR  =  1.14, 95% CI  =  0.90, 1.44). In their calculating and reporting of RR, the authors do not appear to have followed convention. Across the treatment RCTs, data were available for analysis for a range of 18 to 133 participants with 8 to 52 weeks of follow-up. The authors of the treatment RCTs reported a variety of outcome measures. Two of these, patient-perceived treatment effect (PPE) and pain on the visual analog scale (VAS), were used to calculate an overall treatment effect (PPE as RR and VAS as SMD). Based on 2 RCTs examining foot orthoses versus control, no significant difference in PPE was found (RR  =  1.01, 95% CI  =  0.61, 1.68). Based on 2 RCTs in which custom versus prefabricated foot orthoses were examined, no significant difference in PPE was found (RR  =  0.88, 95% CI  =  0.42, 1.81). The VAS data reported in the text appear to contradict the VAS data reported in Figure 2 for foot orthoses versus control for the treatment of lower limb overuse conditions. Specifically, the lower limit of the CI in the text was negative (-0.28) and in Figure 2 was positive. Because of this apparent contradiction, we did not interpret these data. Authors of 2 RCTs reported cost-effectiveness, but the data could not be pooled. Adverse events were reported in 8 of the 22 studies. The most common adverse effect reported was discomfort, which was the main reason for discontinuing foot-orthoses use in 2 studies. The evidence supports the use of foot orthoses to prevent a first occurrence of lower limb overuse conditions and shows no difference between custom and prefabricated foot orthoses. The evidence was insufficient to recommend foot orthoses (custom or prefabricated) for the treatment of lower limb overuse conditions.

BackgroundThere is limited evidence describing the relationship between calcaneal bone mineral density (cBMD) and activity level or lower extremity overuse bone injury (LEOBI).ObjectiveThe purposes of this study were to: 1) compare cBMD of intercollegiate athletes (ICA) and non-intercollegiate athlete (NA) college students, 2) examine the influence of physical activity on cBMD in NA, and 3) determine if there is an association between cBMD and the development of LEOBI.DesignProspective, cohort study.SettingNCAA Division I University.Participants84 ICA and 103 NA college students.AssessmentICAs provided injury and menstrual history, were measured for cBMD at the beginning and end of the year, and were followed for occurrence of LEOBI. NA college students provided injury and menstrual history and were measured for cBMD.Main Outcome MeasuresDescriptive statistics, statistical analyses of relationships, logistic regression, and t-tests were used in the statistical analyses.ResultsEight ICAs were diagnosed with a LEOBI over the year. There was no difference in initial cBMD between ICAs with and without LEOBI; right (p=.05) and left cBMD (p=.07) were lower in those ICAs with LEOBI at the end of the season. The NAs had significantly lower cBMD and speed of sound (SOS) than the ICAs. There were no significant differences in cBMD and SOS values between the 8 ICAs with LEOBI and the 103 NAs. For the NAs, there was no significant correlation between cBMD and activity, however, age of onset of menstruation and cBMD were found to be significantly correlated (p<.05).Conclusions cBMD was significantly lower in NAs as compared to ICAs. The ICAs with LEOBI did not have significantly different cBMD than the NAs. The difference in cBMD between ICAs and NAs may be activity related, but differences in cBMD among the NAs was not related to activity level.

Practice guidelines (guidelines) have an increasing role in health care delivery and are being published more frequently. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is an approach for guideline development. The GRADE approach has been adopted by multiple national and international organizations producing guidelines related to physical therapist care. The purpose of this article is to introduce physical therapists to the GRADE approach for guideline development. GRADE provides a consistent approach for guideline development and transparency in the communication of how the guidelines were developed and how the recommendations were reached, leading to informed choices by patients, clinicians, and policy makers in health care. GRADE leads to a clear distinction between the strength of the evidence and the recommendation. Both the direction (for or against) and the strength (weak or strong) of the recommendation are considered. For determining the strength of the recommendation, GRADE takes into account the quality of evidence, the balance of benefit and harm, uncertainty about or variability in patients' values and preferences, and uncertainty about whether the intervention is a wise use of resources. The GRADE approach has been used primarily with interventions and clinical questions and less often with questions related to diagnosis and prognosis. The frequency of publication of guidelines is increasing. To make informed choices in the health care system, physical therapists should understand how guidelines are developed. The GRADE approach has been adopted by national and international organizations that produce guidelines relevant to physical therapist practice. Understanding the GRADE approach will enable physical therapists to make informed clinical choices.

BackgroundThere is limited evidence describing the relationship between calcaneal bone mineral density (cBMD) and activity level or lower extremity overuse bone injury (LEOBI).ObjectiveThe purposes of this study were to: 1) compare cBMD of intercollegiate athletes (ICA) and non-intercollegiate athlete (NA) college students, 2) examine the influence of physical activity on cBMD in NA, and 3) determine if there is an association between cBMD and the development of LEOBI.DesignProspective, cohort study.SettingNCAA Division I University.Participants84 ICA and 103 NA college students.AssessmentICAs provided injury and menstrual history, were measured for cBMD at the beginning and end of the year, and were followed for occurrence of LEOBI. NA college students provided injury and menstrual history and were measured for cBMD.Main outcome measuresDescriptive statistics, statistical analyses of relationships, logistic regression, and t-tests were used in the statistical analyses.ResultsEight ICAs were diagnosed with a LEOBI over the year. There was no difference in initial cBMD between ICAs with and without LEOBI; right (p=0.05) and left cBMD (p=0.07) were lower in those ICAs with LEOBI at the end of the season. The NAs had significantly lower cBMD and speed of sound (SOS) than the ICAs. There were no significant differences in cBMD and SOS values between the 8 ICAs with LEOBI and the 103 NAs. For the NAs, there was no significant correlation between cBMD and activity, however, age of onset of menstruation and cBMD were found to be significantly correlated (p<0.05).ConclusionscBMD was significantly lower in NAs as compared to ICAs. The ICAs with LEOBI did not have significantly different cBMD than the NAs. The difference in cBMD between ICAs and NAs may be activity related, but differences in cBMD among the NAs was not related to activity level.

The purposes of this research were to (1) investigate the effect of foot orthotic use on exercise related leg pain (ERLP) in cross-country (XC) athletes, and (2) determine if an association between foot type and foot orthotic use exists. Prospective cohort design. High schools and colleges in a Midwestern metropolitan region. 213 high school and college XC athletes (107 male, 106 female). Participants were seen before the fall XC season for classification of foot type, visual orthotic inspection, and questionnaire completion regarding foot orthotic use and ERLP. Statistical analysis of relationships (chi-square) was conducted. 37 of the 213 XC athletes (17.4%) used foot orthotics; 31 of the 37 athletes using foot orthotics (83.8%) reported a history of ERLP. Of these 31 athletes, 17 (54.8%) were using orthotics for ERLP and 15 reported a decrease in ERLP with orthotic use. Fourteen athletes were using orthotics for a reason other than ERLP and only 2 reported a decrease in ERLP with orthotic use. Athletes using orthotics included all three foot types (pronated, neutral, supinated) with no relationship between orthotic use and foot type. One-sixth of the XC athletes used foot orthotics and most using orthotics for ERLP reported a decrease in ERLP symptoms. The majority of athletes using orthotics for reasons other than ERLP reported no change in ERLP symptoms. There was no association between foot type and orthotic use.

This chapter examines the impact of the narrative and the environment nodes on the people node of the narrative environments tripartite network, that is to say, how narrative environments engage people. It shows how storyworlds are prompted by multimodal means in the spatial context of narrative environments. The chapter analyses examples of how modes of address in explicit and implicit communications are materialised in space, and also shows how cognitive and emotional engagement can be achieved through a synthesis of physical and digital interaction in narrative environments. The importance of engagement is accompanied by a recognition of the value of narrative. Stories attract and sustain people's attention, both crucial aspects of engagement. A useful starting point for examining spatial modes of address is Louis Althusser's theory of interpellation, in which addressees are called and recruited, as subjects, for specific ideological horizons.