Assessing the research capacity and culture of allied health workforce in a national private healthcare organisation.

Objective We set out to provide a benchmark assessment of allied health professionals' research capacity and culture in a national private health care organisation, including identifying barriers and facilitators to staff participation in research. Methods All allied health professionals across 16 sites were invited to participate in an online survey, using the research capacity and culture tool from 9 May to 17 June 2022. Descriptive analysis of each demographic variable was expressed in frequencies and percentages. Differences between organisation, team and individual domains were analysed as ordinal data (scale 1-9), and a mean score and standard deviation were calculated. Results The survey was completed by 182 allied health professionals across 16 sites, with an estimated response rate of 12%. Overall results identified low levels of research support or skills at organisational and team levels and moderate levels of skills at an individual level. Respondents were motivated to participate in research 'to develop skills', for 'improved job satisfaction' and 'career advancement'. Major barriers to participation in research were 'lack of time', 'lack of resources' and 'other work roles taking priority'. Conclusion The current study fills a knowledge gap by reporting the research capacity and culture among allied health professionals in a national private healthcare organisation in Australia. This study suggests that allied health professionals in private healthcare organisations perceive less than adequate levels of support at the team and organisational levels compared to their public counterparts. However, the barriers and motivators to participate in research activities were consistent with public hospitals.

Exercise adherence in trials of therapeutic exercise interventions for common musculoskeletal conditions: A scoping review.

OBJECTIVE: The aims of the scoping review were to: (1) evaluate how commonly trialists assess and report adherence to exercise intervention for common musculoskeletal conditions and (2) report the levels of adherence to exercise for musculoskeletal conditions and whether this was influenced by variables of interest. METHODS: Medline, Cinahl, Embase, Emcare, and SPORTDiscus databases were searched using predefined terms. Published randomised controlled trials were included. Trials were included if they investigated the effectiveness of an exercise intervention for low back pain, shoulder pain, Achilles tendinopathy and knee osteoarthritis (we selected a priori as indicative common musculoskeletal conditions). Data extraction was performed independently by teams of two reviewers. Descriptive consolidation and qualitative synthesis were performed. RESULTS: 321 trials were included; less than half (46.7%, 150/321) measured adherence. When adherence was assessed, 21% (31/150) of trials did not report the results. Adherence levels were greater when people were supervised. Reporting adherence was more common in registered trials. Adherence was measured most frequently via self-report (47.3%, 71/150) followed by supervised sessions (32.0%, 48/150) or combination of both (20.7%, 31/150). The majority of trials (97.0%, 97/100) reported the level of adherence in terms of a frequency. CONCLUSIONS: A majority of trials investigating exercise interventions for common musculoskeletal conditions do not assess exercise adherence. Trials that were registered reported exercise adherence more frequently. The majority of trials measure adherence via self-report with reliance on only one dimension of exercise adherence (frequency).

'He explains it in a way that I have confidence he knows what he is doing': A qualitative study of patients' experiences and perspectives of rotator-cuff-related shoulder pain education.

BACKGROUND: Patient education is recommended in clinical practice guidelines for rotator-cuff-related shoulder pain (RCRSP), yet there are no guidelines for clinicians. A gap in the current literature relates to patients' perspectives. AIMS: The aim of this study was to explore the experiences and perspectives of people with RCRSP about education for their condition. MATERIALS AND METHODS: An inductive qualitative design was adopted. Eight participants with RCRSP participated in individual telephone interviews that were audio-recorded, transcribed and de-identified. Four researchers completed inductive thematic analysis. Institutional ethics approval was obtained. RESULTS: Results are detailed as a thematic analysis from the interview responses. Three primary themes were identified: (1) a therapeutic alliance leads to trust of education; (2) education of RCRSP should be individualized and practical; and (3) delivery of educational interventions should be varied and multi-modal. DISCUSSION: The results demonstrated that trust in the health professional providing the education facilitates adherence and increases belief that the condition is being effectively treated. Participants believed imaging were necessary for an individual diagnosis despite clinical practice guidelines not recommending imaging for the first 6-12 weeks of initial presentation. There was a general caution about generic online information which may adversely impact the value of exclusively online educational intervention in the future. Participants preferred clear and practical education about RCRSP, including activity modification, timeframes for recovery and potential detriments to their recovery. There was consensus that education is best delivered early in the rehabilitation process, however there were mixed preferences for delivery method between written, video and face-to-face which perhaps reflects different learning styles and indicates that a 'one size fits all' approach is not effective in adult education in this condition. CONCLUSION: People with RCRSP believe education about their condition is important and is best delivered by a trusted source early in their rehabilitation. There is a belief that scans are necessary to provide an individualized diagnosis and assists in their understanding of the condition. There is an opportunity for online education; however, this may best be utilised as an adjunct method to face-to-face care.

A comparison of glenohumeral joint translation between young and older asymptomatic adults using ultrasonography: a secondary analysis.

Background: The rotator cuff muscles are subject to age-related changes, but the effect of aging on glenohumeral joint stability is poorly understood. Objectives: This study aimed to compare glenohumeral joint translation in asymptomatic young and older people. Methods: Twenty young (23.6 ± 5.3 years) and twenty older (66.5 ± 7.8 years) participants with no symptomatic shoulder pathology were recruited. Anterior and posterior glenohumeral joint translations were measured using real-time ultrasound in two positions: (1) shoulder neutral; and (2) shoulder at 90 degrees' abduction and four testing conditions: (1) rest; (2) passive accessory motion testing (PAMT) force alone; (3) PAMT with isometric internal rotation contraction; and (4) PAMT with external rotation contraction. Results: In both groups, there were significant differences between the amount of translation limited by anterior and posterior rotator cuff muscles in response to anterior and posterior PAMT force (p < 0.03), indicating rotator cuff activity-limited translation in a direction-specific manner. Young participants demonstrated increased passive posterior glenohumeral joint translation in the neutral shoulder position (p < 0.001) and their rotator cuff muscle contraction led to greater reductions in glenohumeral joint translation in the neutral shoulder position (p < 0.001), as compared with older participants. Conclusions: Rotator cuff contraction limits glenohumeral joint translation in a direction-specific manner in both young and older participants. However, younger age is associated with increased passive translation but greater ability to reduce glenohumeral joint translation with rotator cuff muscle contraction. Age-related changes should be considered when assessing and treating glenohumeral joint stability.

Glenohumeral joint translation and muscle activity in patients with symptomatic rotator cuff pathology: An ultrasonographic and electromyographic study with age-matched controls.

OBJECTIVES: To determine whether patients with symptomatic rotator cuff pathology had more glenohumeral joint translation and different patterns of rotator cuff muscle activity compared to controls. DESIGN: Repeated measurements of glenohumeral translation and muscle activity in two positions and six testing conditions in two groups. METHODS: Twenty participants with a symptomatic and diagnosed rotator cuff tear and 20 age, and gender matched controls were included. Neuromuscular activity was tested by inserting intramuscular electrodes in the rotator cuff muscles. Anterior and posterior glenohumeral translations were measured using real time ultrasound in testing conditions (with and without translation force, with and without isometric internal and external rotation), in two positions (shoulder neutral, 90° of abduction) and two force directions (anterior, posterior). RESULTS: Symptomatic pathology group demonstrated increased passive glenohumeral translation with posterior translation force (p<0.05). Overall, rotator cuff muscle contraction in the pathology group limited joint translation in a similar manner to the control group, but they did not show the normal direction specific pattern in the neutral posterior position (p<0.03). The pathology group demonstrated reduced EMG activity in the upper infraspinatus muscle relative to the reference position (p<0.02) with anterior translation force and in the supraspinatus (p<0.05) muscle with anterior and posterior translation force in the abducted position. CONCLUSIONS: Symptomatic pathology resulted in increased passive glenohumeral joint translation. Although there were some reductions in muscle activity with injury, their rotator cuff still controlled glenohumeral translation. These results highlight the need to consider joint translation in the assessment and management of patients with rotator cuff injury.

The upper and lower segments of subscapularis muscle have different roles in glenohumeral joint functioning.

Subscapularis muscle is divided into two independent segments, upper and lower (USUB and LSUB), but the role of each segment in glenohumeral functioning is unclear. We compared the electromyographic (EMG) activity of USUB and LSUB during a variety of shoulder movements, with and without an external translation force. Intramuscular electrodes were inserted in USUB and LSUB segments of 20 adults without pathology and EMG activity was measured in stabilization trials (with and without an anterior or posterior directed force at the humerus and isometric rotations) and two shoulder positions (shoulder neutral, abduction). Maximal voluntary isometric contraction (MVIC) trials were performed in abduction, internal and external rotation of the shoulder. In MVIC trials, USUB showed higher activity during internal rotation (p=0.03), whereas LSUB showed higher activity during external rotation (p<0.01). In stabilization trials, the interaction effects were significant for muscle segment×condition (p<0.01), and approached significance for muscle segment×position (p=0.06). In the neutral position, the pattern of activity for LSUB was similar to USUB. In the abducted position the LSUB, unlike USUB, was more active during external rotation (p=0.06) and also showed increased activity in response to the posterior directed force at the humerus (p=0.04). Our results suggest that USUB primarily acts asan agonist for internal rotation. In contrast LSUB was particularly active in external rotation in the abducted position and demonstrated increased EMG activity in response to the posteriorly directed force at the humerus in that position, suggesting more of a role in glenohumeral stabilization.

Measurement of glenohumeral joint translation using real-time ultrasound imaging: A physiotherapist and sonographer intra-rater and inter-rater reliability study.

BACKGROUND: Ultrasonography is an economical and non-invasive method for measuring real-time joint movements. Although physiotherapists are increasingly using ultrasound imaging for rotator cuff disorders, there is a lack of evidence on their reliability in using ultrasonography to measure glenohumeral translation. OBJECTIVE: The aim of this study was to evaluate the reliability of a physiotherapist in measuring anterior and posterior glenohumeral joint translation with ultrasound. METHODS: Study design: within day reliability. Anterior and posterior glenohumeral translations were measured at rest, in response to passive accessory motion testing force, and with isometric internal and external rotation in 12 young healthy adults. All the measurements were made in real time by a physiotherapist and an experienced sonographer in two positions (neutral and abducted) and in two views (anterior and posterior). Intra-rater and inter-rater reliability were expressed using intraclass correlation coefficients (ICC) and measurement error (mm). RESULTS: Intra-rater reliability was good for both raters (ICCP: 0.86-0.98; ICCS: 0.85-0.96). The inter-rater reliability between the physiotherapist and sonographer was moderate to good for posterior measurements (ICC 0.50-0.75) and poor to moderate for anterior measurements (ICC 0.31-0.53). For both intra-rater and inter-rater measurements, posterior translation was more reliable than the anterior translation with smaller measurement errors (posterior: 0.1-0.2 mm, anterior: 0.2-0.3 mm). CONCLUSION: A physiotherapist with minimal training was reliable in measuring glenohumeral joint translations. The ultrasound method was reliable for repeated measurement of both anterior and posterior glenohumeral translations with posterior measurements being more reliable than anterior. This method is recommended for future research to investigate the stabilising role of rotator cuff muscles.

The effect of in vivo rotator cuff muscle contraction on glenohumeral joint translation: An ultrasonographic and electromyographic study.

The proposed stabilizing mechanism of rotator cuff muscles is to limit excessive humeral head translation. However, an accurate measurement of glenohumeral joint translation in vivo has been challenging. We aimed to measure the effect of rotator cuff muscle contraction on glenohumeral joint translation using real time ultrasound (RTUS) and electromyography. Twenty healthy adults with no history of shoulder pathology were recruited. Six intramuscular electrodes were inserted in the rotator cuff muscles (supraspinatus, upper and lower infraspinatus, teres minor, upper and lower subscapularis). Anterior and posterior glenohumeral translations were measured in testing conditions (with and without translation force, with and without isometric internal and external rotation), in two positions (shoulder neutral, abduction) and views (anterior, posterior). There was reduced glenohumeral translation with rotator cuff muscle contraction in the neutral anterior (F2,38=17.8, p<0.01), neutral posterior (F1.6,31.0=44.3, p<0.01) and abducted posterior (F1.5,28.8=5.2, p<0.02) positions. There were also differences between the amount of translation limited by anterior and posterior rotator cuff muscles in response to anterior and posterior translation forces (p<0.05), indicating that their activity was, to a certain extent, direction specific. For example, in both neutral and abducted positions, contraction of the posterior rotator cuff muscles, infraspinatus and teres minor, appeared to tether anterior translation of the humeral head. Our results confirm that the rotator cuff functions as a stabilizer of the glenohumeral joint by limiting humeral head translation and this is likely to be in a direction-specific manner.

Verification of a standardized method for inserting intramuscular electromyography electrodes into teres minor using ultrasound.

The close proximity of the infraspinatus to the teres minor and their functional similarity in producing external rotation of the glenohumeral joint make accurate insertion of electromyographic (EMG) electrodes into the teres minor difficult and questionable even when published guidelines are followed. The primary aim of this study was to examine the anatomical support for the current guidelines for inserting intramuscular EMG electrodes into the teres minor muscle. The secondary aim was to provide a technical description for ultrasound-guided electrode insertion into the teres minor. Intramuscular electrodes were inserted into four cadaveric shoulders using markings based on the current guidelines. EMG electrodes were also inserted into the teres minor of four healthy male participants using real-time ultrasound (RTUS) guidance. Systematic dissections of the cadaver specimens revealed that the electrode had been successfully inserted into the teres minor muscle in only one out of the four. In the remaining three specimens, the needle lodged in the infraspinatus muscle belly at distances ranging from 3 to 17 mm medial to the teres minor. Using RTUS guidance, the electrodes were successfully inserted into the teres minor in all participants, as confirmed by visual inspection with RTUS. This study confirms that the current EMG electrode insertion guidelines for the teres minor are not accurate and RTUS ensures the placement of electrodes into the teres minor rather than the adjacent infraspinatus muscle.