Explore the vast range of titles available.

Introduction Many inconsistencies have been identified in the translation of evidence‐based treatment recommendations for musculoskeletal shoulder pain into healthcare services, with little known about factors influencing decision‐making. The objective of this study was to explore the views and experiences of healthcare providers (HCPs) and people living with shoulder pain on treatment decision‐making. Methods Adopting a qualitative design, purposeful sampling was employed to recruit 13 individuals with nonspecific musculoskeletal shoulder pain and 30 HCPs. Data were collected through 1:1 semi‐structured interviews and analysed using an approach informed by Constructivist Grounded Theory. To facilitate analysis, two patient and public involvement (PPI) meetings were conducted. Results Most participants (69%) had shoulder pain of ≥1‐year duration. Biomechanical beliefs about shoulder pain predominated and were heavily influential in decision‐making for both patients and HCPs. Despite a consensus that therapeutic alliance facilitated decision‐making, the extent of collaboration between HCPs and patients in treatment decision‐making was rather limited. In addition to condition‐specific factors, Individual patient characteristics and resources also influenced treatment decisions. Conclusion Findings revealed the complexity of the decision‐making process for both patients and HCPs, exposing substantial gaps between the reported views and experiences of participants and the principles of client‐centred and evidence‐based practice. There is a pressing need to enhance the translation of evidence‐based knowledge into practice in this clinical area. Patient or Public Contribution In line with a consultative approach to collaborative data analysis, a subgroup of participants attended two PPI meetings to provide commentary and feedback on preliminary findings.

Virtual Reality (VR) is an immersive computer-generated environment that provides a multi-sensory experience for the user. Modern technology allows the user to explore and interact with the virtual environment, offering opportunities for rehabilitation. The use of immersive VR in the management of musculoskeletal shoulder pain is relatively new and research is required to demonstrate its feasibility and effectiveness in this field. The aims of this study were, firstly, to explore physiotherapists' beliefs and perspectives of immersive VR as a platform for rehabilitation in patients with musculoskeletal shoulder pain, secondly, to identify potential barriers and facilitators to using VR in a musculoskeletal setting and thirdly, to gain insight from clinicians that would inform the development of a VR intervention for the rehabilitation of musculoskeletal shoulder pain. This study used qualitative descriptive design methodology. A series of three focus group interviews were carried out, via Microsoft Teams. Physiotherapists received an Oculus Quest™ headset to use at home prior to the focus group interviews. A six-phase process of reflexive thematic analysis was carried out to identify themes within the data. Atlas Ti Qualitative Data Analysis software was used to facilitate thematic analysis. Five themes were identified within the data. They reflected physiotherapists beliefs that VR provides novel opportunities for shoulder rehabilitation and may offer new avenues for managing movement-related fear and improving concordance with rehabilitation. However, barriers related to safety and practical considerations associated with using VR were also identified in the final themes. These findings provide valuable insight into clinician acceptability of immersive VR as a platform for rehabilitation and the need for further research to answer the questions posed by physiotherapists in the current study. This research will contribute to human-centered design of VR-supported interventions for managing musculoskeletal shoulder pain.

Knee pain is estimated to affect at least 25% of people older than 50 years. In Ireland, knee pain accounts for the greatest number of new consultations seen in publicly funded orthopaedic clinics and meniscal pathology is the most common knee diagnosis after osteoarthritis. Exercise therapy is recommended as first line treatment for degenerative meniscal tears (DMT), while clinical practice recommendations advise against surgery. Nonetheless, arthroscopy rates remain high internationally for menisectomy in middle aged and older adults. While Irish knee arthroscopy figures are not available, referral in substantial numbers to orthopaedic clinics suggests surgery may be considered a treatment option for patients with DMTs by some primary care practitioners. This warrants further investigation with the GPs themselves; therefore, the aim of this qualitative study is to explore GPs' views on managing DMT and factors influencing their clinical decision making. Ethical approval was granted by the Irish College of General Practitioners. Semi-structured interviews were conducted online with 17 GPs. Question topics included assessment and management approach, role of imaging and factors influencing referral to orthopaedics, and future supports that would enhance management of this type of knee pain. Transcribed interviews are being analysed using an inductive approach to thematic analysis guided by the research aim and Braun and Clarke's six-step approach. Data analysis underway. Results available for WONCA in June 2022Discussion: These results will contribute to the development of a knowledge translation and exercise intervention for the management of DMT in primary care.

Training load monitoring is employed to quantify training demands, to determine individual physiological adaptions and to examine the dose–response relationship, ultimately reducing the likelihood of injury and making a meaningful impact on performance. The purpose of this study is to explore the relationship between training load and injury in competitive swimmers, using the session rate of perceived exertion (sRPE) method. Data were collected using a prospective, longitudinal study design across 104 weeks. Data were collected from 34 athletes centralised in two of Swim Ireland’s National Centres. Bayesian mixed effects logistic regression models were used to analyse the relationship between sRPE-TL and medical attention injuries. The average weekly swim volume was 33.5 ± 12.9 km. The weekly total training load (AU) averaged 3838 ± 1616.1. A total of 58 medical attention injury events were recorded. The probability of an association between training load and injury ranged from 70% to 98%; however, evidence for these relationships was deemed weak or highly uncertain. The findings suggest that using a single training load metric in isolation cannot decisively inform when an injury will occur. Instead, coaches should utilise monitoring tools to ensure that the athletes are exposed to an appropriate training load to optimise physiological adaptation. Future research should strive to investigate the relationship between additional risk factors (e.g., wellbeing, lifestyle factors or previous injury history), in combination with training load and injury, in competitive swimmers.

Background In response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability. Methods This was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, XMercy University Hospital, Cork, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% ( n =36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study. Results Those that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3–8 days) compared to those that opted for usual care (median 35 days; 19–39 days) ( p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction. Conclusion A telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.

Background Exercise is the recommended first-line therapy for a degenerative meniscal tear (DMT). Despite this, knee pain attributed to DMTs are a common presentation to specialist orthopaedic clinics. In the primary care setting, the general practitioner (GP) plays a central role in managing patients with knee pain, but to date their perspective has not been explored in relation to DMTs. This study explored GPs’ experiences of managing people with knee pain attributed to a DMT. Methods A qualitative research design was adopted and practices in the South and Mid-West of Ireland were contacted via recruitment emails circulated through professional and research networks. Interested GPs contacted the researchers via email, and purposive and snowball sampling was used for recruitment. Semi-structured interviews were conducted online or over the telephone. Interviews were digitally recorded and transcribed. Data was analysed using an inductive approach to thematic analysis. Ethical approval was granted by the Irish College of General Practitioners (ICGP_REC_21_0031). Results Seventeen semi-structured one-on-one interviews were conducted. Three main themes were identified with related subthemes: (1) GPs’ experiences of relational aspects of care, (2) GP beliefs about what constitutes best care for patients with a DMT, and (3) how GP practice is enacted within the current healthcare setting. GPs described the challenge of maintaining a strong clinical alliance, while managing perceived patient expectations of a ‘quick fix’ and advanced imaging. They reported slowing down clinical decisions and feeling ‘stuck’ with limited options when conservative treatment had failed. GPs believed that exercise should be the core treatment for DMTs and emphasised engaging patients in an active approach to recovery. Some GPs believed arthroscopy had a role in circumstances where patients didn’t improve with physiotherapy. Limited access to public physiotherapy and orthopaedic services hampered GPs’ management plans and negatively impacted patient outcomes. Conclusions GP beliefs around what constitutes best care for a DMT generally aligned with the evidence base. Nonetheless, there was sometimes tension between these beliefs and the patient’s own treatment expectations. The ability to enact their beliefs was hampered by limited access to conservative management options, sometimes leading to early escalation of care.

Background/aimExercise imparts a load on tendon tissue that leads to changes in tendon properties. Studies suggest that loading immediately reduces tendon thickness, with a loss of this response in symptomatic tendinopathy. No studies investigating the response of tendon dimensions to load for the rotator cuff tendons exist. This study aimed to examine the short-term effect of loading on the thickness of the supraspinatus tendon and acromiohumeral distance those with and without rotator cuff tendinopathy.MethodsParticipants were 20 painfree controls, and 23 people with painful rotator cuff tendinopathy. Supraspinatus tendon thickness and acromiohumeral distance were measured using ultrasound scans before, and at three time points after loading (1, 6 and 24 hours). Loading involved isokinetic eccentric and concentric external rotation and abduction.ResultsThere was a significant increase in supraspinatus tendon thickness in the pain group at 1 (7%, ∆=0.38, 95% CI 0.19 to 0.57) and 6 hours (11%, ∆=0.53, 95% CI 0.34 to 0.71), although only the 6 hours difference exceeded minimal detectable difference. In contrast, there was a small non-significant reduction in thickness in controls. The acromiohumeral distance reduced significantly in both groups at 1 hour (controls: ∆=0.64, 95% CI 0.38 to 0.90; pain: ∆=1.1, 95% CI 0.85 to 1.33), with a larger change from baseline in the pain group.ConclusionThose diagnosed with painful supraspinatus tendinopathy demonstrated increased thickening with delayed return to baseline following loading. Rehabilitation professionals may need to take into account the impact of loading to fatigue when planning rehabilitation programmes.

ObjectivesRotator cuff tendinopathies are the most common shoulder disorders. As persistent symptoms lasting more than 3 months have been shown to be a strong indicator of poor outcomes, it is important to have successful interventions in the acute stage. However, there is no evidence yet to guide clinical interventions in an acute pain context. The objective of this study was to compare the short-term effect of a 2-week gradual reloading exercises programme with the use of cryotherapy on symptoms and function for acute rotator cuff tendinopathy.MethodsThis simple-blind, randomised controlled trial included 44 participants with acute rotator cuff tendinopathy who were randomly allocated to either the exercises or cryotherapy group. Symptoms and functional limitations were evaluated at weeks 0, 2 and 6 using self-reported questionnaires (Disabilities of the Arm, Shoulder and Hand, Western Ontario Rotator Cuff, and Brief Pain Inventory), while acromiohumeral distance, shoulder strength and active range of motion were evaluated at weeks 0 and 2.ResultsFollowing interventions, both groups showed statistically significant improvements on symptoms and function at week 2 and week 6 compared with baseline. However, there was no significant group × time interaction. There was no time effect on acromiohumeral distance, shoulder strength and active range of motion, as well as no time × group interaction.ConclusionThe results showed a statistically significant improvement in symptoms and function in both groups, but there was no difference between the short-term effect of a cryotherapy based-approach and a gradual reloading exercises programme.Trial registration numberNCT02813304.

Abstract Background: Knowledge of normal muscle characteristics is crucial in planning rehabilitation programmes for injured athletes. There is a high incidence of ankle and anterior tibial symptoms in football players, however little is known about the effect of limb dominance on the anterior tibial muscle group (ATMG). The purpose of this study was to assess the effect of limb dominance and sports-specific activity on ATMG thickness in Gaelic footballers and non-football playing controls using ultrasound measurements, and to compare results from transverse and longitudinal scans. Methods: Bilateral ultrasound scans were taken to assess the ATMG size in 10 Gaelic footballers and 10 sedentary controls (age range 18-25 yrs), using a previously published protocol. Both transverse and longitudinal images were taken. Muscle thickness measurements were carried out blind to group and side of dominance, using the Image-J programme. Results: Muscle thickness on the dominant leg was significantly greater than the non-dominant leg in the footballers with a mean difference of 7.3%, while there was no significant dominance effect in the controls (p < 0.05). There was no significant difference between the measurements from transverse or longitudinal scans. Conclusions: A significant dominance effect exists in ATMG size in this group of Gaelic footballers, likely attributable to the kicking action involved in the sport. This should be taken into account when rehabilitating footballers with anterior tibial pathology. Ultrasound is a reliable tool to measure ATMG thickness, and measurement may be taken in transverse or longitudinal section.

BackgroundUltrasound (US) imaging is commonly used to visualise tendon structure. It is not clear whether the presence of structural abnormalities in asymptomatic tendons predicts the development of future tendon symptoms in the Achilles or patellar tendon.AimTo perform a systematic review and meta-analysis investigating the ability of US imaging to predict future symptoms of patellar or Achilles tendinopathy.MethodsProspective studies that performed US imaging of Achilles OR patellar tendon structure among asymptomatic patients at baseline and a clinical measure of pain and/or function at follow-up were included. Study quality was assessed using the Critical Appraisal Skills Programme tool by two independent reviewers, and predictive ability of US was assessed using meta-analyses.ResultsThe majority of participants in the review were from sporting populations. Meta-analysis revealed that tendon abnormalities on US are associated with future symptoms of both patellar and Achilles tendinopathy (RR=4.97, 95% CI 3.20 to 7.73). Subgroup analysis indicated that tendon abnormalities at baseline were associated with an increased risk of both Achilles (RR=7.33, 95% CI 2.95 to 18.24) and patellar (RR=4.35, 95% CI 2.62 to 7.23) tendinopathy.ConclusionsThis systematic review and meta-analysis indicates that tendon abnormalities visualised using US in asymptomatic tendons are predictive of future tendinopathy and are associated with at least a fourfold increased risk.ImplicationsIdentification of at-risk athletes using screening tools such as US may allow preventative programmes to be implemented. However, it is clear that other factors beyond tissue structure are involved in the development of lower limb tendinopathy.