Feasibility and acceptability of facilitated advance care planning in outpatient clinics: A qualitative study of health-care professionals experience.

OBJECTIVE: This study sought to determine the feasibility and acceptability of a facilitated advance care planning (ACP) intervention implemented in outpatient clinics, as perceived by health-care professionals (HCPs). METHODS: Data from seven focus groups (n = 27) and nine semi-structured interviews with HCPs recruited as part of a pragmatic, randomised controlled trial (RCT) were analysed using qualitative descriptive methodology. Components of the intervention included HCP education and training, tools to assist HCPs with patient selection, hardcopy information, and ACP documentation, and specialised nurse-facilitators to support HCPs to complete ACP conversations and documentation with patients and caregivers. RESULTS: Health-care professionals working in tertiary outpatient clinics perceived the facilitated ACP intervention as feasible and acceptable. Health-care professionals reported a high level of satisfaction with key elements of the intervention, including the specialised education and training, screening and assessment procedures and ongoing support from the nurse-facilitators. Health-care professionals reported this training and support increased their confidence and ACP knowledge, leading to more frequent ACP discussions with patients and their families. Health-care professionals noted their ability to conduct ACP screening and assessment in clinic was impeded by large clinical caseloads and patient-related factors (e.g., dementia diagnoses, and emotional distress). Additional barriers to ACP implementation identified by HCPs included poor collaboration, constrained time and clinical space, undefined roles and standardised recording procedures for HCPs. CONCLUSIONS: Facilitated ACP intervention in outpatient clinics is perceived by HCPs as feasible and acceptable. Addressing barriers and tailoring implementation strategies may improve the delivery of ACP as part of tertiary outpatient care.

Feasibility and Acceptability of Facilitated Advance Care Planning in Outpatient Clinics: A Qualitative Study of Patient and Caregivers Experiences.

Guidelines recommend advance care planning (ACP) for people with advanced illness; however, evidence supporting ACP as a component of outpatient care is lacking. We sought to establish the feasibility and acceptability of a facilitated ACP intervention for people attending tertiary outpatient clinics. Data from 20 semi-structured interviews with patient (M = 79.3 ± 7.7, 60% male) and caregiver (M = 68.1 ± 11.0, 60% female) participants recruited as part of a pragmatic, randomized controlled trial (RCT) were analyzed using qualitative descriptive methodology. Patients were randomized to intervention (e.g., facilitated support) or control (e.g., standard care). Intervention patients expressed high satisfaction, reporting the facilitated ACP session was clear, straightforward, and suited to their needs. Intervention caregivers did not report any significant concerns with the facilitated ACP process. Control participants reported greater difficulty completing ACP compared to intervention participants. Embedding facilitated ACP into tertiary outpatient care appears feasible and acceptable for people with advanced illnesses.

Effect of work boot shaft stiffness and sole flexibility on boot clearance and shank muscle activity when walking on simulated coal mining surfaces: implications for reducing trip risk.

Mining work boot shaft stiffness and sole flexibility variations are likely to affect how a miner moves their foot to clear the ground thus influencing their risk of tripping. Despite the potential negative consequences associated with tripping, limited research has investigated how these boot design features might contribute to a miner's trip risk. Therefore, this study aimed to investigate the effects of systematic variations to boot shaft stiffness and sole flexibility on lower limb alignment and shank muscle activity at toe off and boot clearance during initial swing when 20 males walked across two simulated coal mining surfaces. Although knee and hip alignment remained constant, changes to boot shaft stiffness and sole flexibility significantly interacted to influence the shank muscle activity and ankle alignment displayed at toe off. To reduce the risk of tripping, underground coal miners should avoid a boot with a stiff shaft, regardless of the sole flexibility.

Underground coal miners experience a high incidence of work-related lower limb injuries, with tripping a main cause. This study systematically investigated two boot design features that are likely to influence a miner's risk of tripping. To reduce trip risk, coal miners should avoid a boot with a stiff shaft.

Can we predict the landing performance of simulated aerials in surfing?

This study explored which technical and physical attributes could predict superior and/or safe landing performance when surfers performed variations of a simulated aerial task. Fourteen surfers (age 20.6 ± 5.7 years, height 178.1 ± 9.50 cm, mass 70.6 ± 10.8 kg) had their lower limb mobility, squat jump, countermovement jump, and drop-and-stick landing performance assessed. Performance of two aerial variations (Frontside Air (FA) and Frontside Air Reverse (FAR)) was also measured, with variables relating to technical performance (critical feature and subjective ratings) and potential injury risk (relative total peak landing force and loading rates) collected. Multiple linear regressions were used to predict performance of both aerial variations based on a subset of independent variables. Four models could predict performance. Predicted technical capability in the FAR was mostly influenced by lead limb hip extension and lead limb knee flexion range of motion. Potential injury risk when surfers perform an FA and FAR was predicted to be mitigated by increasing lead ankle dorsiflexion range of motion, as well as trail hip extensor mobility to reduce the relative total peak force experienced when landing the FA. These simple outcome measures could be routinely assessed to ensure successful and safe aerial landings in surfing.

Rate of loading, but not lower limb kinematics or muscle activity, is moderated by limb and aerial variation when surfers land aerials.

We aimed to determine whether there were any differences in how surfers used their lead and trail limbs when landing two variations of a simulated aerial manoeuvre, and whether technique affected the forces generated at landing. Fifteen competitive surfers (age 20.3 ± 5.6 years, height 178.2 ± 9.16 cm, mass 71.0 ± 10.5 kg) performed a Frontside Air (FA) and Frontside Air Reverse (FAR), while we collected the impact forces, ankle and knee muscle activity, and kinematic data. A principal component analysis (PCA) was used to reduce 41 dependent variables into 10 components. A two-way MANOVA revealed that although there were no limb x aerial variation interactions, surfers generated significantly higher relative loading rates at landing for the trail limb compared to the lead limb (+28.8 BW/s; F(1,303) = 20.660, p < 0.0001, η2 = 0.064). This was likely due to the surfers "slapping" the trail limb down when landing, rather than controlling placement of the limb. Similarly, higher relative loading rates were generated when landing the FA compared to the FAR (+23.6 BW/s; F(1,303) = 31.655, p < 0.0001, η2 = 0.095), due to less time over which the forces could be dissipated. No relationships between aerial variation or limb were found for any of the kinematic or muscle activity data. Practitioners should consider the higher relative loading rates generated by a surfer's trail limb and when surfers perform a FA when designing dry-land training to improve the aerial performance of surfing athletes.

Training for success: Do simulated aerial landings replicate successful aerial landings performed in the ocean?

PURPOSE: Physical preparation of competitive surfers includes substantial dry-land training. It is currently unknown, however, how closely these exercises replicate surfing maneuvers performed in the ocean. This study compared the technique features displayed by surfers when landing simulated aerial maneuvers on land to critical features previously established as necessary for surfers to successfully land aerials in the ocean during competition. METHODS: Fourteen competitive surfers (age 20.6 ± 5.7 years, height 178.1 ± 9.50 cm, mass 70.6 ± 10.8 kg) were recruited to perform two variations of a simulated aerial task, a Frontside Air (FA) and Frontside Air Reverse (FAR). Joint ranges of motion (ROM), center of pressure, and apparent gaze data were collected during the landing event. Paired t tests or Wilcoxon signed-rank tests were used to identify any significant differences in the outcome variables between the two aerial tasks. RESULTS: Participants displayed 100% and 60% of the critical features associated with successfully landing a FA and FAR, respectively. In both the simulated FA and FAR, participants landed in 1.0-3.7° of dorsiflexion, moving through significantly less ankle joint ROM in the lead limb during the FAR (P < .01). Participants also displayed significantly less knee and hip ROM (P = .002-.048) while landing the FAR compared to the FA. CONCLUSION: The simulated FA and FAR tasks are appropriate training tools for surfers to replicate most of the critical features that a surfer should display to successfully land aerial maneuvers in the ocean. These tasks therefore enable surfers to practice these complex movements in a controlled environment.

Effect of shaft stiffness and sole flexibility on perceived comfort and the plantar pressures generated when walking on a simulated underground coal mining surface.

The structural features of work boots worn by underground coal miners affect comfort, foot motion and, in turn, loading of the plantar surface of miners' feet. Although shaft stiffness and sole flexibility appear to be boot design features that could influence perceived comfort and plantar pressures, no study has systematically altered these boot design features to truly understand how they affect these parameters. This study aimed to systematically investigate the effect of changes to shaft stiffness and sole flexibility on perceived comfort and plantar pressures when 20 males walked on a simulated gravel coal mining surface under four different work boot conditions. There were no significant effects of shaft stiffness or sole flexibility on perceived comfort. However, shaft stiffness and sole flexibility each significantly affected the plantar pressures generated under the medial midfoot, heel, middle metatarsals and hallux and, in combination, affected plantar pressures generated beneath the lateral midfoot, medial and lateral metatarsals and lesser toes. Participants preferred a boot with a flexible shaft combined with a stiff sole, citing properties such as fit, moveability, walking effort and support to explain why they perceived one boot as more comfortable than another. We therefore recommend that underground coal mining work boots should be designed to incorporate different flexibility and stiffness between the shaft and sole of the boot to optimise foot movement and, in turn, walking efficiency.

Essential Skills for Superior Wave-Riding Performance: A Systematic Review.

Forsyth, JR, Riddiford-Harland, DL, Whitting, JW, Sheppard, JM, and Steele, JR. Essential skills for superior wave-riding performance: A systematic review. J Strength Cond Res 34(10): 3003-3011, 2020-To successfully and safely perform surfing maneuvers, surfers and their coaches need to know how to perform each maneuver correctly. Although some components of the sport are well understood, evidence-based recommendations in the scientific literature on how to perform surfing skills are sparse. The aim of this article was to systematically review the body of literature pertaining to discrete wave-riding skills and characteristics that are associated with the ability of surfers to successfully perform them. Searches of PubMed, SCOPUS, SPORTDiscus with Full-text, and Web of Science were undertaken in January 2019, to identify the most appropriate literature, with secondary searches of reference lists used to create a greater pool of possible articles. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). Ten studies deemed appropriate for review captured data from 299 surfers, who were predominantly competitive (78.3%) and male (58.2%). The average Down and Black Quality Index of the articles was 76.3 ± 8.4%, with these articles focusing on the "pop-up" and landing skills. Performance indicators, such as isometric push-up peak forces, force-plate derived and in-water time to pop-up, relative peak forces generated when landing and time-to-stabilization, were all shown to be related to the physical characteristics of surfers and could affect the ability of surfers to successfully ride a wave. Findings from the studies included in this review suggest that the pop-up and landing exhibit trainable qualities that coaches and athletes can use to improve surfing performance.

Effect of work boot shaft stiffness and sole flexibility on lower limb muscle activity and ankle alignment at initial foot-ground contact when walking on simulated coal mining surfaces: Implications for reducing slip risk.

Design features of safety work boots have the potential to influence how underground coal miners' feet interact with the challenging surfaces they walk on and, in turn, their risk of slipping. Despite the importance of work boot design in reducing the risk of miners slipping, limited research has investigated how boot design features, such as shaft stiffness and sole flexibility, affect the way miners walk. Therefore, this study aimed to investigate the effects of systematic variations to boot shaft stiffness and sole flexibility on lower limb muscle activity and ankle motion in preparation for initial foot-ground contact when 20 males walked across two simulated coal mining surfaces under four mining boot conditions. It was concluded that a boot which has different flexibility and stiffness between the shaft and sole is a better design option to reduce underground coal miners' slip risk than a boot that has a stiff shaft and stiff sole or flexible shaft and flexible sole.

How do we fit underground coal mining work boots?

Acceptable footwear fit, particularly width, is subjective and vaguely quantified. Proper shoe fit is important because it affects both comfort and the potential to prevent injury. Although mismatches between the feet of underground coal miners and their internal boot dimensions are known, no research has been undertaken to determine the impact of these mismatches on worker perceptions of fit, comfort and pain. This study aimed to quantitatively assess mining work boot fit relative to underground coal miners' subjectively rated work boot fit and comfort, reported foot problems, lower limb pain and lower back pain in order to develop evidence-based work boot fit recommendations. Traditional footwear fitting methods based predominantly on foot length are insufficient for underground coal mining-specific footwear. Instead, fit at the heel, instep and forefoot must be considered when fitting underground coal mining work boots, in conjunction with the traditional length measurement.Practitioner summary: Underground coal miners report their work boots fit but are uncomfortable. This study assessed actual fit relative to perceived fit, comfort, foot problems, lower limb pain and lower back pain of 197 miners. Fit at the heel, instep and forefoot must be considered when fitting mining work boots.

Are underground coal miners satisfied with their work boots?

Dissatisfaction with work boot design is common in the mining industry. Many underground coal miners believe their work boots contribute to the high incidence of lower limb injuries they experience. Despite this, the most recent research to examine underground coal mining work boot satisfaction was conducted over a decade ago. This present study aimed to address this gap in the literature by assessing current mining work boot satisfaction in relation to the work-related requirements for underground coal mining. 358 underground coal miners (355 men; mean age = 39.1 ± 10.7 years) completed a 54-question survey regarding their job details, work footwear habits, foot problems, lower limb and lower back pain history, and work footwear fit and comfort. Results revealed that underground coal miners were not satisfied with their current mining work boots. This was evident in the high incidence of reported foot problems (55.3%), lower back pain (44.5%), knee pain (21.5%), ankle pain (24.9%) and foot pain (42.3%). Over half of the underground coal miners surveyed believed their work boots contributed to their lower limb pain and reported their work boots were uncomfortable. Different working roles and environments resulted in differences in the incidence of foot problems, lower limb pain and comfort scores, confirming that one boot design cannot meet all the work-related requirements of underground coal mining. Further research examining the interaction of a variety of boot designs across the different underground surfaces and the different tasks miners perform is paramount to identify key boot design features that affect the way underground coal miners perform. Enhanced work boot design could improve worker comfort and productivity by reducing the high rates of reported foot problems and pain amongst underground coal miners.

Upper torso pain and musculoskeletal structure and function in women with and without large breasts: A cross sectional study.

BACKGROUND: Women with large breasts frequently experience upper torso pain secondary to their breast size. Evidence is lacking on the underlying causes of this pain. This study investigated whether upper torso pain and musculoskeletal structure and function differed between women with large breasts and women with small breasts. METHODS: A linear regression, adjusting for body mass, compared the upper torso pain, thoracic flexion torque due to breast mass, thoracic kyphosis, shoulder active range-of-motion, and scapular retraction muscle strength of 27 women with large breasts (bilateral breast volume>1200ml, age 45.9y SD 9.9y, BMI 29.0kg/m2 SD 3.8kg/m2) and 26 women with small breasts (bilateral breast volume <800ml, age 43.8y SD10.9y, BMI 23.3kg/m2 SD 2.9kg/m2). FINDINGS: Women with large breasts reported a higher upper torso pain score (46.6, 95%CI 33.3-58.0 versus 24.1, 95%CI 12.5-37.8), accompanied by a larger flexion torque (5.9Nm, 95%CI 4.5-5.8Nm versus 0.9Nm, 95%CI 0.8-2.4Nm), greater thoracic kyphosis (34°, 95%CI 31-38° versus 27°, 95% CI 24-31°), decreased shoulder elevation range-of-motion (160°, 95%CI 158-163° versus 169°, 95%CI 166-172°), and decreased scapular retraction endurance-strength (511.4s, 95%CI 362.2-691.3s versus 875.8s, 95%CI 691.5-1028.4s) compared to the women with small breasts. INTERPRETATION: Differences in the upper torso posture, range-of-motion, and muscle strength of women with large breasts provides insight into underlying causes of their musculoskeletal pain. This information can be used to develop evidence-based assessment and treatment strategies to relieve and prevent symptom progression.

The three-dimensional shapes of underground coal miners' feet do not match the internal dimensions of their work boots.

Mining work boots provide an interface between the foot and the ground, protecting and supporting miners' feet during lengthy coal mining shifts. Although underground coal miners report the fit of their work boots as reasonable to good, they frequently rate their boots as uncomfortable, suggesting that there is a mismatch between the shape of their feet and their boots. This study aimed to identify whether dimensions derived from the three-dimensional scans of 208 underground coal miners' feet (age 38.3 ± 9.8 years) differed from the internal dimensions of their work boots. The results revealed underground coal miners wore boots that were substantially longer than their feet, possibly because boots available in their correct length were too narrow. It is recommended boot manufacturers reassess the algorithms used to create boot lasts, focusing on adjusting boot circumference at the instep and heel relative to increases in foot length. Practitioner Summary: Fit and comfort ratings suggest a mismatch between the shape of underground coal miners' feet and their boots exists. This study examined whether three-dimensional scans of 208 miners' feet differed from their boot internal dimensions. Miners wore boots substantially longer than their feet, possibly due to inadequate width.

Analysis of Scoring of Maneuvers Performed in Elite Men's Professional Surfing Competitions.

PURPOSE: To investigate the influence of turns, tube rides, and aerial maneuvers on the scores awarded in elite men's professional surfing competitions. The successful completion rate and scores associated with different aerial variations were also investigated. METHODS: Video recordings from all 11 events of the 2015 World Surf League men's world championship tour were viewed to classify maneuvers performed by the competitors on each wave as turns, tube rides, and aerials. A 2-way ANOVA was used to determine any main effect or interaction of maneuver type or event location on the wave scores. A 1-way ANOVA was used to determine any main effect of aerial type on successful completion rate. RESULTS: Aerial maneuvers were scored significantly higher than tube rides and turns. A significant main effect existed for maneuver and completion rate. Aerial maneuvers had the lowest completion rate, 45.4%. During the finals series (quarterfinals, semifinals, and finals heats) aerial-maneuver completion rate was higher, 55.4%. The frontside air reverse was the most commonly performed maneuver and received an average score of 6.77 out of 10. CONCLUSION: Professional surfers can optimize their potential single-wave scores during competition by successfully completing aerial maneuvers. However, aerial maneuvers continue to be a high-risk maneuver with a significantly lower completion rate. Our findings suggest that surfers should aim to improve their aerial-maneuver completion rate via surf practice or land-based training drills.

Work boot design affects the way workers walk: A systematic review of the literature.

Safety boots are compulsory in many occupations to protect the feet of workers from undesirable external stimuli, particularly in harsh work environments. The unique environmental conditions and varying tasks performed in different occupations necessitate a variety of boot designs to match each worker's occupational safety and functional requirements. Unfortunately, safety boots are often designed more for occupational safety at the expense of functionality and comfort. In fact, there is a paucity of published research investigating the influence that specific variations in work boot design have on fundamental tasks common to many occupations, such as walking. This literature review aimed to collate and examine what is currently known about the influence of boot design on walking in order to identify gaps in the literature and develop evidence-based recommendations upon which to design future research studies investigating work boot design.

Effect of work boot type on work footwear habits, lower limb pain and perceptions of work boot fit and comfort in underground coal miners.

Lower limb injuries are highly prevalent in underground coal mining. Wearing gumboots with inadequate ankle support was thought to contribute to these injuries. Despite the uptake of leather lace-up boots, which provide more ankle support, no recent research could be found investigating the effect of this alternative work boot in underground coal mining. Consequently, this study aimed to determine whether boot type (gumboot, leather lace-up boot) influenced work footwear habits, foot problems, lower limb pain, lower back pain, or perceptions of work boot fit and comfort in underground coal miners. Chi-squared tests were applied to 358 surveys completed by underground coal miners to determine whether responses differed significantly (p < 0.05) according to boot-type. There were no significant between-boot differences in regards to the presence of foot problems, lower limb pain or lower back pain. However, the types of foot problems and locations of foot pain differed according to boot type. Gumboot wearers were also more likely to state that their work boot comfort was either 'uncomfortable' or 'indifferent', their work boot fit was 'poor' and their current boot did not provide enough support. The introduction of more structured leather lace-up boots appears to have positively influenced the support and fit provided by mining work boots, although foot problems, lower limb pain and lower back pain continue to be reported. Further investigation is recommended to identify which specific boot design features caused these observed differences in work boot fit, comfort and locations of foot pain and how these design features can be manipulated to create an underground coal mining work boot that is comfortable and reduces the high incidence of foot problems and lower limb pain suffered by underground coal miners.

Does participation in a physical activity program impact upon the feet of overweight and obese children?

OBJECTIVES: To investigate the effect of a weight-bearing physical activity program on foot structure and plantar pressures generated by overweight/obese children. DESIGN: Descriptive study. METHODS: Measurements were collected for a sample of children participating in an obesity treatment trial (mean±SD 8.5±1.1 y, 29.4% boys, 2.63±0.61 body mass index z-score). Children were randomised to physical activity (physical activity; n=24) and no physical activity (no physical activity; n=10) groups. Foot structure was characterised using anthropometry, an emed(®) AT-4 system quantified pressure distributions and Actigraph accelerometers objectively measured physical activity. RESULTS: After 6 months there was a significant decrease in body mass index z-score (physical activity: p=0.002, no physical activity: p<0.001), an increase in foot length (physical activity: p<0.001, no physical activity: p<0.001) and foot height (physical activity: p<0.001, no physical activity: p=0.008), although no change in physical activity. Pressure-time integrals increased after 6 months (lateral midfoot; physical activity: p=0.036, medial forefoot; physical activity: p=0.002, no physical activity: p=0.013, middle forefoot; physical activity: p=0.044, lateral forefoot; physical activity: p=0.043) but there were no between-group differences in plantar pressures after the physical activity program. CONCLUSIONS: Although changes to foot structure and function in overweight/obese children could not be attributed to participating in the physical activity program, their developing feet may still be at risk of pain and discomfort due to higher plantar pressures and pressure-time integrals. Further research investigating ways to reduce plantar pressures generated by overweight/obese children while they are physically active is warranted.

Effects of wearing gumboots and leather lace-up boots on lower limb muscle activity when walking on simulated underground coal mine surfaces.

This study aimed to investigate the effects of wearing two standard underground coal mining work boots (a gumboot and a leather lace-up boot) on lower limb muscle activity when participants walked across simulated underground coal mining surfaces. Quadriceps (rectus femoris, vastus medialis, vastus lateralis) and hamstring (biceps femoris, semitendinosus) muscle activity were recorded as twenty male participants walked at a self-selected pace around a circuit while wearing each boot type. The circuit consisted of level, inclined and declined surfaces composed of rocky gravel and hard dirt. Walking in a leather lace-up boot, compared to a gumboot, resulted in increased vastus lateralis and increased biceps femoris muscle activity when walking on sloped surfaces. Increased muscle activity appears to be acting as a slip and/or trip prevention strategy in response to challenging surfaces and changing boot features.

Lower activity levels are related to higher plantar pressures in overweight children.

PURPOSE: This study aimed to establish whether the peak plantar pressures generated by overweight and obese school-age children during walking were associated with their objectively measured physical activity. METHODS: Physical activity levels of a subset of 73 overweight/obese children from a randomized controlled trial (mean ± SD: age, 8.3 ± 1.1 yr; 47 girls; body mass index z-score, 2.7 ± 0.7) were objectively measured using accelerometers. Plantar pressure distributions were also quantified as the participants walked over a pressure platform. Pearson product moment correlation coefficients were calculated to determine the strength of the relations between the peak plantar pressures generated during walking and the physical activity levels for overweight/obese children. RESULTS: Peak pressures generated beneath the forefoot during walking were inversely correlated with time spent in different intensity levels of physical activity. Moderate-intensity (r = -0.321, P = 0.007), vigorous-intensity (r = -0.326, P = 0.006), and moderate- to vigorous-intensity (r = -0.342, P = 0.004) physical activity were significantly correlated with middle forefoot pressure and with lateral forefoot pressure (r = -0.248, P = 0.040; r = -0.264, P = 0.028; r = -0.267, P = 0.027, respectively). Lateral midfoot (r = -0.244, P = 0.044) and second toe (r = 0.227, P = 0.021) pressure were also significantly correlated with vigorous-intensity activity. CONCLUSIONS: Those children who generated higher pressures beneath their forefoot and midfoot during walking had lower levels of physical activity. Further research is required to determine the long-term effects of excessive body mass on participation in physical activity and whether the walking plantar pressure patterns associated with reduced physical activity are related to foot pain or discomfort.