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The purpose of this transaction log analysis was to evaluate university students’ engagement behaviours with a catalogue of multimedia lectures. These lectures incorporated selected instructional design principles from the cognitive theory of multimedia learning (CTML). Specifically, thirty-two multimedia lectures which differentially employed the signalling, segmenting and embodiment principles from the CTML were delivered to a cohort of 92 students throughout an academic trimester. Engagement with each multimedia lecture was measured in three domains: affective engagement was measured using a Likert-style survey that accompanied each multimedia lecture; behavioural engagement was measured using the web logs provided by YouTube Studio analytics (average watch time); cognitive engagement was measured using students’ average score on a quiz that accompanied each multimedia lecture. Separate multiple linear regression analyses for measures of affective, behavioural and cognitive engagement revealed that multimedia lectures that ‘stacked’ the instructional design principles of embodiment (whereby the lecture was interspersed with clips of an enthusiastic onscreen instructor), segmenting (where lectures were divided into shorter, user-paced segments) and signalling (where onscreen labels highlighted important material) increased measures of engagement, including overall watch time, number of survey submission and number of quiz attempts ( P < 0.05). There was no association between any of the tested principles and students’ quiz scores or their responses on the Likert-style survey. This study adds to the available literature demonstrating the effectiveness of the signalling, segmenting and embodiment principles for increasing learner engagement with multimedia lectures.

The objective of this study was to utilise web log analysis to evaluate the relationship between University students’ engagement (e.g., watch time) and the characteristics of a catalogue of multimedia lectures, including their duration, the speaking rate of the narrator and the extent to which they implemented certain principles from Mayer’s Cognitive Theory of Multimedia Learning (CTML). Fifty-six multimedia lectures covering topics related to healthcare (e.g., anatomy, physiology and clinical assessment) were developed to differentially employ the image/embodiment, redundancy, segmentation and signalling principles from the CTML. These lectures were delivered to multiple cohorts of students throughout an academic semester. Student watch time was evaluated using the meta-usage data provided by YouTube studio. The multimedia lectures were viewed 4338 times (mean = 35 views per lecture; 27 unique viewers per lecture). Generalised estimating equations revealed that videos that were segmented into shorter chunks, that incorporated signals to highlight important information for students and during which captions were toggled ‘off’ by students were associated with longer watch times (P < 0.05). Additionally, watch time diminished for videos placed later in a sequence based on the audience retention metric. When designing multimedia lectures, instructors should be encouraged to use on screen labels to highlight important information, segment learning material into shorter ‘chunks’ and incorporate a dynamic instructor on screen at regular intervals displaying high embodiment. If several videos are to be delivered to students as part of a learning ‘unit’, educators should consider placing the most important learning material earlier in the sequence.

Background Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist. Objective Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity. Methods We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields. Results One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with high-quality studies (0.54 vs 11.55 per 1,000 exposures). Ankle sprain prevalence period estimates were similar across sub-groups. Lateral ankle sprain was the most commonly observed type of ankle sprain. Conclusions Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity. Studies at a greater risk of bias were more likely to underestimate the risk of ankle sprain. Participants were at a significantly higher risk of sustaining a lateral ankle sprain compared with syndesmotic and medial ankle sprains.

Triple-masked three-armed feasibility parallel randomized controlled trial. Multimedia patient education materials are increasingly used in healthcare. While much research focuses on optimising their scientific content, research is equally needed to optimise design and implementation. This study aims to determine the feasibility of a study examining how the implementation of scientific advice on design affects patient outcomes. Participants aged 10–18 with radiographically confirmed adolescent idiopathic scoliosis will be recruited from community settings in Ireland and randomized into usual care or receiving multimedia educational videos with or without evidence-informed design principles. Participants will be masked in the two video intervention arms, as will the therapist sending the educational videos. Outcomes will include the number of participants recruited and randomized, the number analysed post-intervention and at week eight, and the outcomes for baseline, post-intervention, and week 8. Adverse events will also be reported. This feasibility randomized controlled trial will offer insight into the feasibility of implementing advice from the literature in designing a trial of multimedia patient education materials for a population with adolescent idiopathic scoliosis. Trial registration : Clinical Trail : Trial is registered on ClinicalTrials.gov as NCT06090344 .

Heart rate variability (HRV), particularly the root mean square of successive differences (RMSSD), is widely used as a non-invasive indicator of autonomic nervous system activity and physiological recovery. This study examined whether daily short-term HRV, measured under standardised morning conditions, was associated with self-reported wellness in a non-clinical adult population. Over a 14-day period, 41 participants completed daily five-minute HRV recordings using a Polar H10 chest sensor and the Kubios mobile app, followed by ratings of sleep quality, fatigue, stress, and physical recovery. Bayesian ordinal mixed-effects models revealed that higher RMSSD values were associated with better self-reported sleep (β = 0.510, 95% HDI: 0.239 to 0.779), lower fatigue (β = 0.281, 95% HDI: 0.020 to 0.562), and reduced stress (β = 0.353, 95% HDI: 0.059 to 0.606), even after adjusting for covariates. No association was found between RMSSD and perceived muscle soreness. These findings support the interpretability of RMSSD as a physiological marker of daily recovery and stress in real-world settings. While the effect sizes were modest and individual variability remained substantial, results suggest that consistent HRV monitoring may offer meaningful insight into subjective wellness—particularly when contextualised and tracked over time.

VO 2 max is a measure of cardiorespiratory fitness and a key indicator of overall health. It is predictive of cardiovascular events and shows a strong inverse association with all-cause mortality. Increased cardiorespiratory fitness is associated with reductions in coronary artery disease, diabetes and cancer. Apple Watch offers a less resource-intensive and more feasible alternative to the gold standard assessment for VO 2 max, indirect calorimetry, but the accuracy of its measurements remains uncertain. This study aimed to assess the validity of VO 2 max estimates from Apple Watch in comparison to indirect calorimetry. Thirty participants wore an Apple Watch for 5-10 days to generate a VO 2 max estimate. Subsequently, they underwent a maximal exercise treadmill test in accordance with the modified Åstrand protocol. The agreement between measurements from Apple Watch and indirect calorimetry was assessed using Bland-Altman analysis, mean absolute percentage error (MAPE), and mean absolute error (MAE). Overall, Apple Watch underestimated VO 2 max, with a mean difference of 6.07 mL/kg/min (95% CI 3.77–8.38). Limits of agreement indicated variability between measurement methods (lower -6.11 mL/kg/min; upper 18.26 mL/kg/min). MAPE was calculated as 13.31% (95% CI 10.01–16.61), and MAE was 6.92 mL/kg/min (95% CI 4.89–8.94). These findings indicate that Apple Watch VO 2 max estimates require further refinement prior to clinical implementation. However, further consideration of Apple Watch as an alternative to conventional VO 2 max prediction from submaximal exercise is warranted, given its practical utility.

The widespread use of wearable devices has enabled continuous monitoring of biometric data, including heart rate variability (HRV) and resting heart rate (RHR). However, the validity of these measurements, particularly from consumer devices like Apple Watch, remains underexplored. This study aimed to validate HRV measurements obtained from Apple Watch Series 9 and Ultra 2 against the Polar H10 chest strap paired with the Kubios HRV software, which together served as the reference standard. A prospective cohort of 39 healthy adults provided 316 HRV measurements over a 14-day period. Generalized Estimating Equations were used to assess the difference in HRV between devices, accounting for repeated measures. Apple Watch tended to underestimate HRV by an average of 8.31 ms compared to the Polar H10 (p = 0.025), with a mean absolute percentage error (MAPE) of 28.88% and a mean absolute error (MAE) of 20.46 ms. The study found no significant impact of RHR discrepancies on HRV differences (p = 0.156), with RHR showing a mean difference of −0.08 bpm, an MAPE of 5.91%, and an MAE of 3.73 bpm. Equivalence testing indicated that the HRV measurements from Apple Watch did not fall within the pre-specified equivalence margin of ±10 ms. Despite accurate RHR measurements, these findings underscore the need for improved HRV algorithms in consumer wearables and caution in interpreting HRV data for clinical or performance monitoring.

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries.

Total Knee Arthroplasty (TKA) is one of the most frequently performed elective surgical procedures worldwide. In the United States, annual procedure volumes are projected to exceed 3.5 million by 2030, while demand in Ireland is expected to rise by 49% by 2036. Despite its overall effectiveness, up to 20% of patients remain dissatisfied post-operatively. Conventional follow-up methods rely on intermittent Patient-Reported Outcome Measures (PROMs) and clinic-based performance tests, which provide only a partial view of recovery. Wearable-derived mobility data offers the opportunity to capture daily activity patterns in free-living conditions, complementing PROMs and clinical assessments to refine understanding of recovery trajectories following TKA. This prospective observational cohort study will recruit up to 160 participants scheduled for unilateral TKA at the Beacon Hospital (Dublin, Ireland). Participants will wear a Garmin Vivosmart 5 continuously from up to four weeks pre-operatively to 6 months post-operatively. Continuous, minute-level wearable data will be collected including daily step count. PROMs will be collected using the Labfront Companion mobile application and will include weekly numeric ratings of pain, fatigue, stiffness and sleep quality; the Oxford Knee Score (OKS) at 30-day intervals; and the EQ-5D-5L at 60-day intervals. Clinical indicators and measures will be abstracted from the electronic health record (Meditech). Clinical and demographic measures include age, sex, height, weight, body mass index (BMI), and participation in prehabilitation exercise classes. Primary statistical analysis will evaluate longitudinal trend analysis of step count and PROMs over time after surgery, while covariate-adjusted Spearman-type correlations will evaluate cross-sectional associations between daily step count, OKS, EQ-5D-5L and pain. This study will characterise wearable-derived mobility metrics across early and mid-stage recovery following TKA, and evaluate their associations with PROMs. Integrating continuous wearable data with PROMs and clinical information may refine post-operative monitoring and support personalised rehabilitation following TKA.

The widespread adoption of consumer wearable devices has enabled continuous biometric data collection at an unprecedented scale, raising important questions about data privacy, security, and user rights. In this study, we systematically evaluated the privacy policies of 17 leading wearable technology manufacturers using a novel rubric comprising 24 criteria across seven dimensions: transparency, data collection purposes, data minimization, user control and rights, third-party data sharing, data security, and breach notification. High Risk ratings were most frequent for transparency reporting (76%) and vulnerability disclosure (65%), while Low Risk ratings were common for identity policy (94%) and data access (71%). Xiaomi, Wyze, and Huawei had the highest cumulative risk scores, whereas Google, Apple, and Polar ranked lowest. Our findings highlight inconsistencies in data governance across the industry and underscore the need for stronger, sector-specific privacy standards. This living review will track ongoing policy changes and promote accountability in this rapidly evolving domain.