Patient expectations and levels of satisfaction in chiropractic treatment for lumbar radiculopathy. A mixed methods study.

BACKGROUND: Chiropractic patients are generally satisfied with the care received. It is unclear if this also applies to Danish patients with lumbar radiculopathy included in a standardised chiropractic care package (SCCP). This study aimed to investigate patient satisfaction and explore perspectives on the SCCP for lumbar radiculopathy. METHODS: An explanatory sequential mixed methods design with three separate phases was used. Phase one was a quantitative analysis based on a survey in a prospective cohort of patients with lumbar radiculopathy in an SCCP from 2018 to 2020. Patients rated their satisfaction with the examination, information, treatment effect, and overall management of their problem on a 0-10 scale. In phase two, six semi-structured interviews conducted in 2021 were used to gain further explanatory insights into the findings from phase one. Data were analysed using systematic text condensation. In phase three, the quantitative and qualitative data were merged in a narrative joint display to obtain a deeper understanding of the overall results. RESULTS: Of 303 eligible patients, 238 responded to the survey. Of these, 80-90% were very satisfied (≥ 8) when asked about the examination, information, and overall management, whereas 50% were very satisfied with the treatment effect. The qualitative analysis led to the emergence of four themes: 'Understanding the standardised care packages', 'Expectations regarding consultation and treatment effect', 'Information about diagnosis and prognosis', and 'Interdisciplinary collaboration'. The joint display analysis showed that high patient satisfaction with the examination could be explained by the patients' feeling of being carefully and thoroughly examined by the chiropractor and by referrals to MRI. Advice and information given to patients on variations in symptoms and the expected prognosis were considered reassuring. Satisfaction with the chiropractor's coordination of care and with referral to other healthcare professionals was explained by the patients' positive experiences of coordinated care and their sense of alleviated responsibility. CONCLUSION: Overall, patients were satisfied with the SCCP for lumbar radiculopathy. From a patient's perspective, the consultation should include a thorough examination and a focus on communication and information relating to symptoms and prognosis, while expectations regarding the content and efficacy of the treatment should be addressed and aligned.

Game-induced fatigue patterns in elite female soccer.

The purpose was to examine the fatigue pattern of elite female soccer players after competitive games. Soccer players (n = 23) from the Danish women Premier League performed a countermovement vertical jump test, a repeated 30-m sprint test, and the Yo-Yo intermittent endurance level 2 (Yo-Yo IE2) test at rested state and after a competitive game. Average heart rate during the game was 86 +/- 1% of maximal heart rate with no differences between halves. Blood lactate was 5.1 +/- 0.5 mmol.L after the first half, which was higher (p < 0.05) than after the second half (2.7 +/- 0.4 mmol.L). Yo-Yo IE2 performance was 484 +/- 50 m after the game, which was 62% lower (p < 0.05) than at rested state (1,265 +/- 133 m). Average sprinting time of three 30-m sprints was 5.06 +/- 0.06 seconds after the game, which was 4% slower (p < 0.05) than at rest (4.86 +/- 0.06 seconds). No game-induced effect was observed on vertical jump performance. Significant inverse correlations were observed between Yo-Yo IE2 test performance and fatigue index during the repeated sprint test both at rest (r = -0.76, p < 0.05) and after the game (r = -0.66, p < 0.05). The study demonstrates that the type of fatigue that occurs after a female soccer game does cause marked impairment in intense intermittent exercise and repeated sprint performance but does not affect vertical jump performance. These findings support the notion that decrements in distance covered by sprinting and high-speed running toward the end of elite female games are caused by fatigue.

The Yo-Yo IR2 test: physiological response, reliability, and application to elite soccer.

PURPOSE: To examine the physiological response, reliability, and validity of the Yo-Yo intermittent recovery level 2 test (Yo-Yo IR2). METHODS: Thirteen normally trained male subjects carried out four Yo-Yo IR2 tests, an incremental treadmill test (ITT), and various sprint tests. Muscle biopsies and blood samples were obtained, and heart rate was measured before, during, and after the Yo-Yo IR2 test. Additionally, 119 Scandinavian elite soccer players carried out the Yo-Yo IR2 test on two to four occasions. RESULTS: Yo-Yo IR2 performance was 591 +/- 43 (320-920) m or 4.3 (2.6-7.9) min. Test-retest coefficient of variation in distance covered was 9.6% (N = 29). Heart rate (HR) at exhaustion was 191 +/- 3 bpm, or 98 +/- 1% HRmax. Muscle lactate was 41.7 +/- 5.4 and 68.5 +/- 7.6 mmol x kg(-1) d.w. at 85 and 100% of exhaustion time, respectively, with corresponding muscle CP values of 40.4 +/- 5.2 and 29.4 +/- 4.7 mmol x kg(-1) d.w. Peak blood lactate was 13.6 +/- 0.5 mM. Yo-Yo IR2 performance was correlated to ITT performance (r = 0.74, P < 0.05) and VO2max (r = 0.56, P < 0.05) but not to 30- and 50-m sprint performance. Yo-Yo IR2 performance was better (P < 0.05) for international elite soccer players than for moderate elite players (1059 +/- 35 vs 771 +/- 26 m) and better (P < 0.05) for central defenders (N = 21), fullbacks (N = 20), and midfielders (N = 48) than for goalkeepers (N = 6) and attackers (N = 24). Fifteen elite soccer players improved (P < 0.05) Yo-Yo IR2 performance by 42 +/- 8% during 8 wk of preseasonal training. CONCLUSION: This study demonstrates that the Yo-Yo IR2 test is reproducible and can be used to evaluate an athlete's ability to perform intense intermittent exercise with a high rate of aerobic and anaerobic energy turnover. Specifically, the Yo-Yo IR2 test was shown to be a sensitive tool to differentiate between intermittent exercise performance of soccer players in different seasonal periods and at different competitive levels and playing positions.

Evaluation of the ES-2re Dummy in Biofidelity, Component, and Full Vehicle Crash Tests.

This technical paper presents the results from tests conducted with the ES-2re, a version of the ES-2 side impact dummy that was modified by the National Highway Traffic Safety Administration (NHTSA) to improve its performance in crash tests. Through the series of biofidelity tests conducted on the ES-2re, described in International Standards Organization (ISO) Technical Report (TR)9790 (1999), the OSRP observed a final overall biofidelity ranking of 4.1 for the ES-2re, which corresponds to an ISO classification of "marginal." The biofidelity of the ES-2re is compared to that of the ES-2 and the WorldSID. Repeatability was also evaluated on the ES-2re based on the biofidelity test data. Additional pendulum tests were performed to assess the response of the dummy in oblique loading conditions, and results indicate that oblique loading from the front leads to significantly reduced rib deflections. To evaluate inconsistencies observed in the response of the ES-2, the OSRP analyzed the shoulder biofidelity via additional sled and drop tests. Due to the shoulder design of the ES-2 and ES-2re, the dummies appear to have significant sensitivity to initial conditions, potentially increasing variability in full vehicle tests. Finally, the responses of the ES-2re in full vehicle tests are compared to those of the ES-2 and the WorldSID.

ES-2 Dummy Biomechanical Responses.

This technical paper presents the results of biomechanical testing conducted on the ES-2 dummy by the Occupant Safety Research Partnership and Transport Canada. The ES-2 is a production dummy, based on the EuroSID-1 dummy, that was modified to further improve testing capabilities as recommended by users of the EuroSID-1 dummy. Biomechanical response data were obtained by completing a series of drop, pendulum, and sled tests that are outlined in the International Organization of Standardization Technical Report 9790 that describes biofidelity requirements for the midsize adult male side impact dummy. A few of the biofidelity tests were conducted on both sides of the dummy to evaluate the symmetry of its responses. Full vehicle crash tests were conducted to verify if the changes in the EuroSID-1, resulting in the ES-2 design, did improve the dummy's testing capability. In addition to the biofidelity testing, the ES-2 dummy repeatability, reproducibility and durability are discussed. Finally, this technical paper will compare the biofidelity ratings of the current adult side impact dummies with the ES-2 dummy, which received an overall dummy biofidelity rating of 4.6.