A randomised controlled trial of SAFMEDS to improve musculoskeletal radiology interpretation.

INTRODUCTION: This study examined the impact of a Say-All-Fast-Minute-Everyday-Shuffled (SAFMEDS) intervention on musculoskeletal radiology interpretation ability. It addressed two research questions: 1) what degree of performance improvement in musculoskeletal radiology interpretation does SAFMEDS engender beyond usual teaching? and; 2) does the degree of improvement differ for participants who achieve behavioural fluency and those who do not? MATERIALS AND METHODS: This study used a pragmatic randomised controlled trial design. Third-year medical students were randomised to either an intervention group (n = 22), who received SAFMEDS and usual teaching, or a control group (n = 20), who received usual teaching only. Eleven participants (5 intervention group, 6 control group) did not complete participation. RESULTS: A large effect size of the SAFMEDS intervention was identified (partial η2 = 0.672; M = 38.5 min practice). When controlling for baseline performance, intervention group participants' performance on the post-test was significantly higher (M = 77.4%) than that of control group participants (M = 49.6%). Intervention group participants who achieved fluency performed significantly better at post-test (M = 82.4%) than intervention group participants who did not (M = 72.9%). CONCLUSIONS: SAFMEDS constitutes a powerful adjunct to usual teaching that produces significant improvement with a short duration of engagement, particularly when students achieve fluency in the target behaviour. Future research should consider the application of SAFMEDS, and other fluency training interventions, more widely within musculoskeletal education and orthopaedic surgery training.

Bone Density and Cross-sectional Geometry of the Proximal Femur Are Bilaterally Elevated in Elite Cricket Fast Bowlers.

The skeleton of a cricket fast bowler is exposed to a unique combination of gravitational and torsional loading in the form of substantial ground reaction forces delivered through the front landing foot, and anterior-posterior shear forces mediated by regional muscle contractions across the lumbo-pelvic region. The objectives of this study were to compare the hip structural characteristics of elite fast bowlers with recreationally active age-matched controls, and to examine unilateral bone properties in fast bowlers. Dual-energy X-ray absorptiometry of the proximal femur was performed in 26 elite male fast bowlers and 26 normally active controls. Hip structural analysis (GE Lunar; enCORE version 15.0) determined areal bone mineral density (BMD) of the proximal femur, and cross-sectional area, section modulus (Z), cross-sectional moment of inertia, and femoral strength index at the narrow region of the femoral neck. Mean femoral neck and trochanter BMD were greater in fast bowlers than in controls (p <0.001). All bone geometry properties, except for cross-sectional moment of inertia, were superior in fast bowlers (p <0.05) following adjustment for height and lean mass. There were no asymmetries in BMD or bone geometry when considering leg dominance of the fast bowlers (p > 0.05). Elite fast bowlers have superior bone characteristics of the proximal femur, with results inferring enhanced resistance to axial compression (cross-sectional area), and bending (Z) forces, and enhanced strength to withstand a fall impact as indicated by their higher femoral strength index. No asymmetries in hip bone properties were identified, suggesting that both torsional and gravitational loading offer significant osteogenic potential.

Insights into relationships between body mass, composition and bone: findings in elite rugby players.

Recent reports indicate that bone strength is not proportional to body weight in obese populations. Elite rugby players have a similar body mass index (BMI) to obese individuals but differ markedly with low body fat, high lean mass, and frequent skeletal exposure to loading through weight-bearing exercise. The purpose of this study was to determine relationships between body weight, composition, and bone strength in male rugby players characterized by high BMI and high lean mass. Fifty-two elite male rugby players and 32 nonathletic, age-matched controls differing in BMI (30.2 ± 3.2 vs 24.1 ± 2.1 kg/m²; p = 0.02) received 1 total body and one total hip dual-energy X-ray absorptiometry scan. Hip structural analysis of the proximal femur was used to determine bone mineral density (BMD) and cross-sectional bone geometry. Multiple linear regression was computed to identify independent variables associated with total hip and femoral neck BMD and hip structural analysis-derived bone geometry parameters. Analysis of covariance was used to explore differences between groups. Further comparisons between groups were performed after normalizing parameters to body weight and to lean mass. There was a trend for a positive fat-bone relationship in rugby players, and a negative relationship in controls, although neither reached statistical significance. Correlations with lean mass were stronger for bone geometry (r(2): 0.408-0.520) than for BMD (r(2): 0.267-0.293). Relative to body weight, BMD was 6.7% lower in rugby players than controls (p < 0.05). Rugby players were heavier than controls, with greater lean mass and BMD (p < 0.01). Relative to lean mass, BMD was 10%-14.3% lower in rugby players (p < 0.001). All bone geometry measures except cross-sectional area were proportional to body weight and lean mass. To conclude, BMD in elite rugby players was reduced in proportion to body weight and lean mass. However, their superior bone geometry suggests that overall bone strength may be adequate for loading demands. Fat-bone interactions in athletes engaged in high-impact sports require further exploration.

Bone cross-sectional geometry in male runners, gymnasts, swimmers and non-athletic controls: a hip-structural analysis study.

Loading of the skeleton is important for the development of a functionally and mechanically appropriate bone structure, and can be achieved through impact exercise. Proximal femur cross-sectional geometry was assessed in the male athletes (n = 55) representing gymnastics, endurance running and swimming, and non-athletic controls (n = 22). Dual energy X-ray absorptiometry (iDXA, GE Healthcare, UK) measurements of the total body (for body composition) and the left proximal femur were obtained. Advanced hip structural analysis (AHA) was utilised to determine the areal bone mineral density (aBMD), hip axis length (HAL), cross-sectional area (CSA), cross-sectional moment of inertia (CSMI) and the femoral strength index (FSI). Gymnasts and runners had greater age, height and weight adjusted aBMD than in swimmers and controls (p < 0.05). Gymnasts and runners had greater resistance to axial loads (CSA) and the runners had increased resistance against bending forces (CSMI) compared to swimmers and controls (p < 0.01). Controls had a lower FSI compared to gymnasts and runners (1.4 vs. 1.8 and 2.1, respectively, p < 0.005). Lean mass correlated with aBMD, CSA and FSI (r = 0.365-0.457, p < 0.01), particularly in controls (r = 0.657-0.759, p < 0.005). Skeletal loading through the gymnastics and running appears to confer a superior bone geometrical advantage in the young adult men. The importance of lean body mass appears to be of particular significance for non-athletes. Further characterisation of the bone structural advantages associated with different sports would be of value to inform the strategies directed at maximising bone strength and thus, preventing fracture.

Sexual dimorphism of femoral neck cross-sectional bone geometry in athletes and non-athletes: a hip structural analysis study.

The characterisation of bone geometry in male and female athletes may increase our understanding of how physical loading may enhance bone strength in both sexes. This study investigated sexual dimorphism in hip geometry of athletes and age- and sex-matched non-athletes. Dual energy X-ray absorptiometry of the left proximal femur was performed in 62 male (n = 31; 30.2 ± 4.6 years) and female (n = 31; 27.9 ± 5.2 years) competitive endurance runners, and 36 male (n = 18; 28.7 ± 5.8 years) and female (n = 18; 29.1 ± 5.3 years) non-athletes. The hip structural analysis programme determined areal bone mineral density (aBMD), bone area (BA), hip axis length, cross-sectional area (CSA), and cross-sectional moment of inertia (CSMI) of the femoral neck. Strength indices were derived from the femoral strength index (FSI) (Yoshikawa et al., J Bone Miner Res 9:1053-1064, 1994). Despite similar size-adjusted aBMD, sexual dimorphism was apparent for BA, CSA and CSMI, with superior values in men compared to women (P < 0.01). FSI was greater in male and female athletes than non-athletes (P < 0.01). From all groups, results in male athletes inferred greatest resistance to axial (CSA) and bending loads (FSI). Estimates of bone strength (FSI) were greater in female athletes than male and female non-athletes, supporting the osteogenic value of regular loading of the hip.