Prospective Assessment of Otologic Adverse Events due to Teprotumumab: Preliminary Results.

OBJECTIVE: To assess a series of patients receiving teprotumumab therapy and objectively quantify the rates of otologic adverse events. STUDY DESIGN: A prospective cohort study of adult patients receiving teprotumumab between May 2020 and January 2022. SETTING: Tertiary referral center. METHODS: Prior to treatment initiation, an ototoxicity-specific audiometric battery was completed, which included conventional audiometry (frequencies 250-8000 Hz), ultrahigh-frequency audiometry (9000-20,000 Hz), tympanometry, speech discrimination scores, and distortion product otoacoustic emissions (DPOAEs). Testing was then repeated after treatment completion. RESULTS: In total, 35 patients were recruited, with a median (range) age of 48.5 years (21-74), and 8 (22.8%) were male. The most common subjective symptom reported was a hearing decline (25.7%), followed by aural fullness (17.1%) and tinnitus (14.3%). Fourteen patients had both pre- and posttreatment audiometric data. Among them, 3 patients (21.4%) were found to have changes in standard frequency audiometry, and 10 (71.4%) had changes in high-frequency audiometry, with 2 patients having changes in both. Less than half (n = 5) of the 11 patients with changes in standard or high-frequency pure tone hearing noted subjective hearing decline. Changes in DPOAE were noted in 4 patients out of 13 (30.7%). Two patients discontinued treatment due to hearing decline. Finally, 3 patients (8.6%) were diagnosed with patulous eustachian tube (PET) by an otolaryngologist, and another 3 patients are suspected to have PET based on symptom description during ophthalmologic follow-up. CONCLUSION: In our cohort, a high incidence of otologic symptoms was found to be associated with teprotumumab usage. Subjective hearing decline, changes in ultrahigh-frequency hearing as well as eustachian tube dysfunction may be encountered and suggest the potential ototoxicity of teprotumumab.

Effects of sprint versus strength training on risk factors for hamstring injury in football players.

BACKGROUND: This study aimed to compare the effects of in-season sprint training vs. Nordic hamstring exercise (NHE) training on risk factors for hamstring strain injuries (HSI). METHODS: Eighteen male university football players (20.9±2.5 years; 181±7 cm; 75.8±9.1 kg; 15.2±3.5% of body fat) were randomly allocated to a sprint group or NHE group. They completed baseline isokinetic strength and sprint mechanics assessments prior to their assigned intervention performed twice weekly for 4-weeks, before post-testing. A mixed design ANOVA with repeated measures assessed time, group and interaction effects for all risk factors. RESULTS: There were significant increases in hamstring eccentric peak torque at 60°·s-1 (+8% - 9.9%), the torque produced at 20° (+15%) and 10° (+21% - 31%), as well as a rightward shift in angle of peak torque towards knee extension (-27% - -36%) in both groups (P<0.05). We also observed a significant increase (+24.5%) in hamstring eccentric peak torque at 180°·s-1 in the strength group only and significant improvements (+29.4%) in the rate of torque development of the dominant leg at 60°·s-1 in the sprint group only (P<0.05). No significant effect was noted on sprint performance or sprint mechanics (P>0.05). CONCLUSIONS: These findings suggest that both training programs can be effective to mitigate the risk of HSI, but through different mechanisms.

Healthcare professionals' perceptions and experiences of physiotherapy for people with mental illness: a protocol for a systematic review and meta-ethnography.

INTRODUCTION: There is a high global prevalence of patients presenting with physical and mental health comorbidities. Physiotherapeutic interventions, such as exercise, can have positive benefits for physical and mental health. However, poor accessibility and negative experiences of healthcare services for those with mental illness (MI) have been consistently observed within literature with recent research identifying poor experiences of physiotherapeutic interactions and processes such as referrals and discharges. One way to help improve physiotherapy services for this population is to understand the personal experiences and perceptions of healthcare professionals (HCPs) toward physiotherapy for patients with MI. Qualitative-based evidence syntheses are suited to bring this data together with the aim of improving physiotherapy services for patients with MI. This review will systematically search and synthesise existing evidence around HCP experiences and perceptions of physiotherapy for people with MI. METHODS AND ANALYSIS: A systematic search and seven-phase meta-ethnography will be undertaken. A comprehensive search of electronic databases (CINAHL plus, MEDLINE, Pubmed, Embase and Psycinfo) and search engines as well as grey literature (unpublished primary research such as theses) will be completed. Searches are planned to take place in July 2022. Eligibility criteria include: (a) qualitative data, (b) perceptions identified from HCP, including physiotherapists, assistants and HCP referring into physiotherapy, about physiotherapy for patients with MI and (c) are primary studies. ETHICS AND DISSEMINATION: This work is exempt from requiring ethical approval due to review methodology with data accessed from published works. This systematic review is expected to provide insight into experiences and perceptions of HCP around benefits and barriers to accessing physiotherapy for patients with mental health illness. Findings will be used to inform further research and co-develop recommendations to overcome barriers and optimise facilitators to care for this population. Findings will be disseminated via peer-reviewed journal, conference presentations and to key stakeholder groups. PROSPERO REGISTRATION NUMBER: CRD42021293035.

Physical Activity, Mental Health and Wellbeing of Adults within and during the Easing of COVID-19 Restrictions, in the United Kingdom and New Zealand.

Physical activity (PA) participation was substantially reduced at the start of the COVID-19 pandemic. The purpose of this study was to assess the association between PA, mental health, and wellbeing during and following the easing of COVID-19 restrictions in the United Kingdom (UK) and New Zealand (NZ). In this study, 3363 adults completed online surveys within 2-6 weeks of initial COVID-19 restrictions (April/May 2020) and once restrictions to human movement had been eased. Outcome measures included the International Physical Activity Questionnaire Short-Form, Depression Anxiety and Stress Scale-9 (mental health) and World Health Organisation-5 Wellbeing Index. There were no differences in PA, mental health or wellbeing between timepoints (p > 0.05). Individuals engaging in moderate or high volume of PA had significantly better mental health (-1.1 and -1.7 units, respectively) and wellbeing (11.4 and 18.6 units, respectively) than individuals who engaged in low PA (p < 0.001). Mental health was better once COVID-19 restrictions were eased (p < 0.001). NZ had better mental health and wellbeing than the UK (p < 0.001). Participation in moderate-to-high volumes of PA was associated with better mental health and wellbeing, both during and following periods of COVID-19 containment, compared to participation in low volumes of PA. Where applicable, during the current or future pandemic(s), moderate-to-high volumes of PA should be encouraged.

Physical activity, mental health and well-being of adults during initial COVID-19 containment strategies: A multi-country cross-sectional analysis.

OBJECTIVES: To assess physical activity (PA), mental health and well-being of adults in the United Kingdom (UK), Ireland, New Zealand and Australia during the initial stages of National governments' Coronavirus disease (COVID-19) containment responses. DESIGN: Observational, cross-sectional. METHODS: An online survey was disseminated to adults (n=8,425; 44.5±14.8y) residing in the UK, Ireland, New Zealand and Australia within the first 2-6 weeks of government-mandated COVID-19 restrictions. Main outcome measures included: Stages of Change scale for exercise behaviour change; International Physical Activity Questionnaire (short-form); World Health Organisation-5 Well-being Index; and the Depression Anxiety and Stress Scale-9. RESULTS: Participants who reported a negative change in exercise behaviour from before initial COVID-19 restrictions to during the initial COVID-19 restrictions demonstrated poorer mental health and well-being compared to those demonstrating either a positive-or no change in their exercise behaviour (p<0.001). Whilst women reported more positive changes in exercise behaviour, young people (18-29y) reported more negative changes (both p<0.001). Individuals who had more positive exercise behaviours reported better mental health and well-being (p<0.001). Although there were no differences in PA between countries, individuals in New Zealand reported better mental health and well-being (p<0.001). CONCLUSION: The initial COVID-19 restrictions have differentially impacted upon PA habits of individuals based upon their age and sex, and therefore have important implications for international policy and guideline recommendations. Public health interventions that encourage PA should target specific groups (e.g., men, young adults) who are most vulnerable to the negative effects of physical distancing and/or self-isolation.

Standing up for health - improving mental wellbeing during COVID-19 isolation by reducing sedentary behaviour.

The global COVID-19 outbreak and its management are disrupting ways of life and increasing the risk of poor mental and physical health for many. The restrictions on movement have made some forms of physical activity harder to achieve and increased the chances of more sedentary behaviour. Independent of exercise taken, sedentary behaviour can have a negative impact upon mental health, especially by lowering mood. We suggest evidence-based ways of reducing sedentary behaviour with commentary on how they may be adapted for life at home. These include: ways to use external cues, moving more frequently, maximising movement whilst waiting, reallocating time, workstation alternatives, restructuring the physical environment and recruiting help from others. At a time in which our mental and physical health needs are more critical than ever, the relationship between sedentary behaviour and low mood is of particular importance. The current situation represents a good opportunity for us all to change habits to implement a less sedentary lifestyle, for now and the future. This can start with changes we can make at home during lockdown.

The reliability and validity of the L-test in people with Parkinson's disease.

OBJECTIVE: To evaluate the test-retest and concurrent validity of the L-test in a group of participants with mild to moderate Parkinson's disease. The L-test is an extended version of the Timed up and Go test, incorporating a longer walking distance and turns in two directions. DESIGN: Cross-sectional. SETTING: Community. PARTICIPANTS: 16 participants (13 male), mean age 75 (SD 6.7) mean duration since diagnosis 7.1 years (±2.8). Disease severity was mild to moderate on the Hoehn and Yahr scale (mean 2.1; mode 2; range 1-3). 14 participants (12 male) completed the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A Bland and Altman plot examined the agreement between first and second testing occasion of the L-test. Intra-class correlation coefficients (ICC) assessed the test-retest reliability. Concurrent validity was established by correlating the L-test with the Timed up and Go test (TUG). The Minimal Detectable Change with 95% confidence interval (MDC95) was calculated to determine the true change not due to chance. RESULTS: The L-test showed excellent test-retest reliability on the Bland & Altman plot and the ICC. There was a high degree of agreement between measurements taken on days 1 and 2. The L-test correlated strongly with the Timed up and Go test on both measurement days with r=0.97 (p<0.001) and r=0.96 (p<0.001). The MDC95 was 5.31seconds. CONCLUSIONS: The L-test is a reliable and valid outcome measurement for the assessment of walking ability in participants with mild to moderate Parkinson's disease.

IMPACT SHOULDER ANGLES CORRELATE WITH IMPACT WRIST ANGLES IN STANDING BACK HANDSPRINGS IN PREADOLESCENT AND ADOLESCENT FEMALE GYMNASTS.

BACKGROUND AND PURPOSE: In gymnastics, the wrist is exposed to many different stresses including increased extension, especially during back handsprings. Currently a wrist extension angle during impact that places the wrist in danger has not been established. The purpose of this study was to: (1) determine the mean impact wrist angle during a standing back handspring in female preadolescent and adolescent gymnasts and (2) determine which factors predict impact wrist angles. METHODS: Fifty female gymnasts from six facilities, ages 8-15 were included in this study. Each gymnast completed a questionnaire about gymnastics participation and history of wrist pain. Active range of motion of the shoulder, elbow, wrist, hip, and ankle was measured. Each gymnast was asked to perform a standard back handspring, which was videotaped. The wrist and shoulder flexion angles, at maximum impact, were recorded and measured using motion analysis software. Two-sample t-test was used to assess the relationship between impact wrist angle and wrist pain. Multiple linear regression was used to determine the association between related variables and impact wrist angle. RESULTS: The mean back handspring impact wrist angle was 95°. Fifteen subjects (30%) reported wrist pain. Years of participation (p=0.02) and impact shoulder angle (p=0.04) were predictive of impact wrist angles. CONCLUSION: Shoulder angles and years of participation correlate with impact wrist angles during the performance of a standing back handspring. Future studies are necessary to determine if addressing these factors can affect the impact wrist angles. LEVEL OF EVIDENCE: 3.