Use of the International IFOMPT Cervical Framework to inform clinical reasoning in postgraduate level physiotherapy students: a qualitative study using think aloud methodology.

BACKGROUND: Vascular pathologies of the head and neck are rare but can present as musculoskeletal problems. The International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) Cervical Framework (Framework) aims to assist evidence-based clinical reasoning for safe assessment and management of the cervical spine considering potential for vascular pathology. Clinical reasoning is critical to physiotherapy, and developing high-level clinical reasoning is a priority for postgraduate (post-licensure) educational programs. OBJECTIVE: To explore the influence of the Framework on clinical reasoning processes in postgraduate physiotherapy students. METHODS: Qualitative case study design using think aloud methodology and interpretive description, informed by COnsolidated criteria for REporting Qualitative research. Participants were postgraduate musculoskeletal physiotherapy students who learned about the Framework through standardized delivery. Two cervical spine cases explored clinical reasoning processes. Coding and analysis of transcripts were guided by Elstein's diagnostic reasoning components and the Postgraduate Musculoskeletal Physiotherapy Practice model. Data were analyzed using thematic analysis (inductive and deductive) for individuals and then across participants, enabling analysis of key steps in clinical reasoning processes and use of the Framework. Trustworthiness was enhanced with multiple strategies (e.g., second researcher challenged codes). RESULTS: For all participants (n = 8), the Framework supported clinical reasoning using primarily hypothetico-deductive processes. It informed vascular hypothesis generation in the patient history and testing the vascular hypothesis through patient history questions and selection of physical examination tests, to inform clarity and support for diagnosis and management. Most participant's clinical reasoning processes were characterized by high-level features (e.g., prioritization), however there was a continuum of proficiency. Clinical reasoning processes were informed by deep knowledge of the Framework integrated with a breadth of wider knowledge and supported by a range of personal characteristics (e.g., reflection). CONCLUSIONS: Findings support use of the Framework as an educational resource in postgraduate physiotherapy programs to inform clinical reasoning processes for safe and effective assessment and management of cervical spine presentations considering potential for vascular pathology. Individualized approaches may be required to support students, owing to a continuum of clinical reasoning proficiency. Future research is required to explore use of the Framework to inform clinical reasoning processes in learners at different levels.

Physical functioning outcome measures in the lumbar spinal surgery population and measurement properties of the physical outcome measures: protocol for a systematic review.

INTRODUCTION: Low back pain can lead to substantial decline in physical functioning. For disabling pain not responsive to conservative management, surgical intervention can enhance physical functioning. Measurements of physical functioning include patient-reported outcome measures and physical outcome measures using evaluations of impairments, performance on a standardised task or activity in a natural environment. Selecting outcome measures with adequate measurement properties is fundamental to evaluating effectiveness of interventions. The purpose of this systematic review is to identify outcome measures (patient reported and physical) used to evaluate physical functioning (stage 1) and assess the measurement properties of physical outcome measures of physical functioning (stage 2) in the lumbar spinal surgery population. METHODS AND ANALYSIS: This protocol aligns with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Using a two-staged approach, searches will be performed in MEDLINE, EMBASE, Health and Psychosocial Instruments, CINAHL, Web of Science, Scopus, PEDro and the grey literature from inception until 15 December 2021. Stage 1 will identify studies evaluating physical functioning with patient-reported or physical outcome measures in the lumbar spinal surgery population. Stage 2 will search for studies evaluating measurement properties (validity, reliability, responsiveness) of the physical outcome measures identified in stage 1 in the lumbar spinal surgery population. Two independent reviewers will evaluate studies for inclusion, extract data, assess risk of bias (COSMIN risk of bias tool and checklist) and quality of evidence (modified Grading of Recommendations Assessment, Development and Evaluation approach). Results for each measurement property per physical outcome measure will be quantitatively pooled if there is adequate clinical and methodological homogeneity or qualitatively synthesised if there is high heterogeneity in studies. ETHICS AND DISSEMINATION: Ethics approval is not required. Results will be disseminated through peer-reviewed journal publication and conference presentation. PROSPERO REGISTRATION NUMBER: CRD42021293880.

Shoulder electromyography activity during push-up variations: a scoping review.

Background: Push-ups (PU) are a common closed chain exercise used to enhance shoulder girdle stability, with variations that alter the difficulty or target specific muscles. To appropriately select and prescribe PU exercises, an understanding of muscle activity during variations of the PU is needed. The purpose of this scoping review was to identify common PU variations and describe their muscle activation levels. Methods: Databases searched included PubMed, CINAHL, Scopus, and SPORTDiscus for articles published between January 2000 and November 2019. Results: Three hundred three articles were screened for eligibility with 30 articles included in the analysis. Six PU types and five muscles met the criteria for analysis. Weighted mean electromyography (EMG) amplitude was calculated for each muscle across PU types and for each PU type as a measure of global muscle activity. Triceps and pectoralis major had the highest EMG amplitude during unstable, suspension, incline with hands on a ball and the standard PU. Serratus anterior had the highest EMG amplitude during PU plus and incline PU. The greatest global EMG amplitude occurred during unstable surface PU. Discussion: These results provide clinicians with a framework for prescribing PU to target specific muscles and scale exercise difficulty to facilitate rehabilitation outcomes.

How is recovery defined and measured in patients with low back pain? Protocol for a mixed study systematic review.

INTRODUCTION: This protocol describes the methods for a mixed study systematic review aiming to explore the definitions and measurements of recovery in patients with low back pain, and how perspectives of recovery differ between patients and providers. This review will be the first to review the concept of recovery in patients with low back pain across both quantitative and qualitative literature. METHODS AND ANALYSIS: This protocol has been designed and reported in line with Preferred Reporting Items of Systematic Reviews and Meta-Analyses Protocols. The following databases will be electronically searched from database inception until 30 November 2021: Medline, EMBASE, CINAHL, Cochrane, PEDro. Grey literature will be searched for through targeted searching of ProQuest Dissertations and Theses and handsearching of the references of all included studies. Studies will be included if they include a patient population of >50% with low back pain (with or without leg pain), and mention the concept of recovery within the abstract, methods or results. The Mixed Methods Appraisal Tool will be used for quality assessment of both quantitative and qualitative included studies. Two independent reviewers will conduct the search, screen titles/abstracts and extract relevant data from full texts. Discrepancies between reviewers will be settled by a third reviewer with spinal pain expertise. For syntheses, thematic analysis will be used to analyse both qualitative and quantitative investigations to explore meanings, measurement and perspectives of recovery from a diverse evidence base. There is no clinical trial associated with this protocol. ETHICS AND DISSEMINATION: There are no ethical issues associated with this systematic review, and ethics approval was not required. Once completed, the results of this review will be published in a peer-reviewed journal within the realm of spinal pain to help guide future research inquiries. PROSPERO REGISTRATION NUMBER: CRD42022295804.

Mental fatigue does not substantially alter neuromuscular function in young, healthy males and females.

The neuromuscular mechanisms leading to impaired motor performance after mental fatigue (MF) are not well-understood and little is known of sex-specific differences in the neuromuscular response to MF. The purpose of this study was to investigate sex-related differences in the impact of MF on neuromuscular function. Thirty young, healthy adults (15F, 15M) performed the Psychomotor Vigilance Task (PVT) to induce MF and watched the Earth documentary (control) for 30 min in a random and counterbalanced order. Before and after each task, measurements of neuromuscular function during submaximal dorsiflexion contractions were obtained. At the end of the PVT, females and males had a slower reaction time (p<0.001, η2p=0.41) and reported higher fatigue (p<0.001, η2p=0.50), suggesting the PVT induced MF. After the PVT, females and males demonstrated a decline in force during 10% maximum voluntary contractions (MVC) (p=0.006, η2p=0.24), slower motor unit firing rate during 20% MVC (p=0.04, η2p=0.15) and a longer cortical silent period (p=0.01, η2p=0.22). However, similar changes were observed in the control condition suggesting MF is unlikely to substantially alter neuromuscular function during submaximal isometric contractions in young, healthy adults. Results also suggest neuromuscular function after a MF task is similar between young, healthy females and males. Further research is required to investigate populations with higher fatigue, such as multiple sclerosis or chronic fatigue syndrome.

Sex differences in the impact of state and trait fatigue on gait variability.

Conditions requiring greater attention or cognitive control, such as fatigue, lead to changes in the motor performance of a task. Perceived fatigue refers to subjective feelings of fatigue, can be expressed as a state variable or trait characteristic and is influenced by demographic factors, such as sex. The purpose of this study was to determine how sex interacts with state and trait physical fatigue (PF) and mental fatigue (MF) to influence gait variability. METHODS: 123 healthy adults (77 female, 46 male), aged 18-36 years, completed the Mental and Physical State and Trait Energy and Fatigue Scale. Using a median split for each fatigue variable, participants were placed into "low" or "high" fatigue categories. Gait variability was defined as the asymmetry of lateral step variability (ALSV) and coefficient of variation (CV) of gait speed, stride length and double limb (DL) support during overground walking. RESULTS: Males with low state PF had greater ALSV than females with low state PF (p = 0.05, η2p = 0.07) and males with high state PF (p = 0.007, η2p = 0.15). Females with high trait MF had greater CV of gait speed than females with low trait mental fatigue (p = 0.02, η2p = 0.08). Males with low trait MF had greater CV of gait speed (p = 0.01, η2p = 0.10) and stride length (p = 0.002, η2p = 0.17) than females with low trait MF. CV of DL support did not vary based on fatigue level or sex (p ≥ 0.11). CONCLUSIONS: There are sex-specific differences in the impact of state PF on asymmetry of lateral step variability and trait MF on the variability of gait speed and stride length.

State and Trait Fatigue and Energy Predictors of Postural Control and Gait.

Compromised attentional resources during perceived fatigue has been suggested to alter motor control. The authors determined if measures of postural control and gait are predicted by state and trait physical and mental fatigue and energy, and how these relationships are modified by sex, sleep quality, and physical activity. Young adults (n = 119) completed the Modified Clinical Test of Sensory Integration, overground walking, and questionnaires to quantify fatigue and energy, sleep quality, and physical activity. Regression models indicated that trait fatigue, trait energy, and sleep quality were predictors of postural control (p ≤ .02, R2 ≥ .04). State fatigue, state energy, and sex were predictors of gait (p ≤ .05, R2 ≥ .03). While the variance explained was low (3-13%), the results demonstrate perceptions of fatigue and energy may influence posture and gait.

Force Control and Motor Unit Firing Behavior Following Mental Fatigue in Young Female and Male Adults.

Purpose: The neuromuscular mechanisms leading to impaired motor performance in the presence of mental fatigue remain unclear. It is also unknown if mental fatigue differentially impacts motor performance in males and females. The purpose of this study was to assess the impact of mental fatigue on force production and motor unit (MU) firing behavior in males and females. Methods: Nineteen participants performed 10-s isometric dorsiflexion (DF) contractions at 20 and 50% maximum voluntary contraction (MVC) before, during, and after completing 22 min of the psychomotor vigilance task (PVT), to induce mental fatigue. The DF force and indwelling MU firing behavior of the tibialis anterior (TA) was measured before and immediately following the PVT and within the first and final minutes of the PVT. Results: Force steadiness and motor unit firing rate (MUFR) variability did not change during or following the PVT at either contraction intensity (p ≥ 0.16). Overall, females had more variability than males in MUFR during the 20% MVCs (15.98 ± 2.19 vs. 13.64 ± 2.19%, p = 0.03), though no sex differences were identified during the 50% MVCs (p = 0.20). Mean MUFR decreased following mental fatigue in both sexes in the 20% MVC condition (14.79 ± 3.20 vs. 12.92 ± 2.53 Hz, p = 0.02), but only in males during the 50% MVC condition (18.65 ± 5.21 vs. 15.03 ± 2.60 Hz, p = 0.01). Conclusions: These results suggest possible sex and contraction intensity-specific neuromuscular changes in the presence of mental fatigue.