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Aims: Gastrostomy feeding represents a vital component of supportive care provided to people with swallowing or feeding difficulties; however, the rate of specific long‐term complications is currently unknown in the adult population. This study aimed to determine the prevalence of specific long‐term gastrostomy‐related complications and unplanned replacements in adults. Methods: A prospective systematic review of Medline, CINAHL and Embase databases was performed. Key complications of hypergranulation, infection and displacement among studies relevant to percutaneous endoscopic gastrostomy tubes, radiologically inserted gastrostomy tubes and balloon replacement tubes were critically appraised by two independent reviewers. Results were synthesised quantitatively in a meta‐analysis using random effects where the population and condition were sufficiently homogeneous. Results: In total, 453 studies were identified, of which 17 met inclusion criteria. 8.5% of adults with a gastrostomy were found to have had an infection ≥42 days after initial tube insertion (p < 0.01), while 13% had hypergranulation (p < 0.01). Displacement occurred in 10.8% of adults (p < 0.01), with age (p < 0.001) and sex (p < 0.001) presenting as a risk factor (R2 = 75%) following meta‐regression. Conclusions: Approximately 1 in 10 people with a gastrostomy will experience a complication related to either hypergranulation, infection or dislodgement. Age, in combination with sex, may provide a guide for risk of displacement among adult female cohorts, though further studies reporting prevalence of gastrostomy‐related complications along with participant demographics are required. [ABSTRACT FROM AUTHOR]

Background: Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed. Purpose: In adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy. Methods: A comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures. Results: From 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference [SMD] 95% confidence interval [CI]): −4.05; −4.78 to −3.32), function (−2.81; −3.89 to −1.74), and QOL (−4.10; −4.43 to −3.77) were significantly poorer preoperatively. Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference [SPD] 1.35; 95% CI, 1.02–1.67) and 2 years postoperatively (1.35; 1.16–1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09–1.35) and 2 years (1.06; 0.9–1.22) and QOL at 1 year (1.36; 1.22–1.5) and 2 years (1.3; 1.1–1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia. Conclusions: Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants. Registration: PROSPERO (CRD42020144748) [ABSTRACT FROM AUTHOR]

Context: The gluteus minimus (GMin) muscle consists of 2 uniquely oriented segments that have potential for independent function and have different responses to pathology and aging. For healthy young adults, it is unknown that which rehabilitation exercises specifically target the individual segments. Objective: To quantify segmental GMin activity for 6 common lower-limb rehabilitation exercises in healthy young adults and determine if significant differences exist in segmental activity levels between the exercises. Method: Six common lower-limb rehabilitation exercises were performed by 10 healthy young adults with finewire electromyography (EMG) electrodes inserted into the anterior and posterior segments of the GMin muscle. Main Outcome Measures: Electromyography signals were recorded, and median normalized exercise activity levels were reported and compared for each GMin segment across the 6 exercises. Results: High activity levels were generated in the anterior segment by the resisted hip abduction-extension exercise (51 % maximum voluntary isometric contraction [MVIC]), whereas for the posterior segment, high activity levels were produced by the single-leg bridge (49% MVIC), the side-lie hip abduction (43% MVIC), the resisted hip abduction-extension exercise (43% MVIC), and the single-leg squat (40% MVIC). There were significant differences (P < .05) in the median electromyography activity levels for the anterior GMin segment but not for the posterior GMin segment across some of the exercises with large effect sizes. Conclusion: Targeted rehabilitation exercises graded by exercise intensity can be prescribed specifically for the anterior and posterior GMin segments to aid in restoration of hip function following injury or aging. [ABSTRACT FROM AUTHOR]

Objective: A new virtual ED service was introduced into a hospital network in the northern suburbs of Melbourne in response to changing needs during the COVID‐19 pandemic. The 'virtual ED' utilises a telehealth model as a means of assessment for appropriately selected patients to facilitate either complete care or navigation into streamlined pathways for ongoing care, in some cases bypassing the ED entirely where appropriate. The proposed study aims to evaluate the implementation of the model and identify future improvement opportunities, assess the impact on traditional health service delivery processes and patient experience, and determine the acceptability of the 'virtual ED' model of care. Methods: The present study will consist of a pre‐post‐ implementation evaluation using the RE‐AIM framework. Routine health service data will be collected for 6 months post‐implementation of the virtual ED model and compared to 24 months prior to implementation. Prospective data will be collected using routinely collected and survey data. Interviews and focus groups will be conducted to understand consumer and clinician perspectives on barriers and enablers to implementation and adoption of the virtual ED. Results: Descriptive statistics will be used to describe the study population and key outcomes, including changes in ED presentations and length of stay. Thematic analysis will be conducted on transcribed interviews and focus group data. This will be triangulated with data collected from patient feedback surveys. Conclusion: This project will support the delivery of care to ED patients by evaluating the 'virtual ED' model of care. [ABSTRACT FROM AUTHOR]

Proximal hamstring tendinopathy is a common cause of buttock pain in running based sports. A recent systematic review found outcome measures used in research studies on this condition were inconsistent, which impedes synthesis of evidence. To understand the impact tendinopathy has on patients an international collaboration (International Scientific Tendinopathy Symposium Consensus Group) agreed on nine core health domains that should be measured in research on tendinopathy. The aim of this study is to develop an outcome set for proximal hamstring tendinopathy that covers all nine tendinopathy core health domains. This protocol describes the steps taken to develop this core outcome set. This mixed method study will follow two key phases. Phase one: a systematic review will produce a comprehensive list of outcome measures that have been used in studies evaluating proximal hamstring tendinopathy. Outcome measures extracted will be matched to the tendinopathy core health domains by a steering committee of clinicians and researchers. Phase two: following a Delphi process, outcome measures will be considered by experienced clinicians, researchers, and patients. Within this study, outcome measures will be screened and selected using the Outcome Measures in Rheumatology filters of truth, feasibility, and discrimination, with a threshold of 70% agreement set for consensus. This project aims to provide and disseminate a core outcome set that can be recommended for use in future studies related to proximal hamstring tendinopathy. This will have the potential to improve research quality, allow pooling of studies in meta-analysis and assist in directing future research. Protocol registered with the Core Outcome Measures in Effectiveness Trials in May 2021 (). There is no agreed set of outcomes that are consistently used when researching proximal hamstring tendinopathy This protocol outlines the methods to derive a set of outcome measures to use when researching proximal hamstring tendinopathy Researchers, clinicians and patients will participate in a process of selecting outcome measures against the nine core health domains for tendinopathy Where core health domains do not have an outcome measure recommendations for future research will be provided Consistent use of outcome measures will allow pooling of data in meta-analysis and minimise research waste [ABSTRACT FROM AUTHOR]

The purpose of this exploratory analysis was to compare the impact of movement pattern training (MoveTrain) and standard strength and flexibility training (Standard) on muscle volume, strength and fatty infiltration in patients with hip‐related groin pain (HRGP). We completed a secondary analysis of data collected during an assessor‐blinded randomized control trial. Data were used from 27 patients with HRGP, 15–40 years, who were randomized into MoveTrain or Standard groups. Both groups participated in their training protocol (MoveTrain, n = 14 or Standard, n = 13) which included 10 supervised sessions over 12 weeks and a daily home exercise program. Outcome measures were collected at baseline and immediately after treatment. Magnetic resonance images data were used to determine muscle fat index (MFI) and muscle volume. A hand‐held dynamometer was used to assess isometric hip abductor and extensor strength. The Standard group demonstrated a significant posttreatment increase in gluteus medius muscle volume compared to the MoveTrain group. Both groups demonstrated an increase in hip abductor strength and reduction in gluteus minimus and gluteus maximus MFI. The magnitude of change for all outcomes were modest. Statement of Clinical Significance: Movement pattern training or a program of strength/flexibility training may be effective at improving hipabductor strength and reducing fatty infiltration in the gluteal musculature among those with HRGP. Further research is needed to betterunderstand etiology of strength changes and impact of muscle volume and MFI in HRGP and the effect of exercise on muscle structure andfunction. [ABSTRACT FROM AUTHOR]

Background: Although foot orthoses are often used in the management of lower limb musculoskeletal conditions, their effects on muscle activation is unclear, especially in more proximal segments of the lower limb.Research Question: Primary aim: Is there an immediate effect of foot orthoses on gluteal muscle activity during overground walking in healthy young adults? Secondary aim: Is there an immediate effect of foot orthoses on the activity of hamstring, quadriceps and calf muscles?Methods: In eighteen healthy young adults, muscle activity was recorded using fine wire electrodes for gluteus minimus (GMin; anterior, posterior) and gluteus medius (GMed; anterior, middle, posterior); and surface electrodes for gluteus maximus (GMax), hamstring, quadriceps and calf muscles. Participants completed six walking trials for two conditions; shoe and shoe with prefabricated foot orthoses. Muscle activity was normalised to the peak activity of the shoe condition and analysed using one-dimensional statistical non-parametric mapping to identify differences across the gait cycle.Results: Activity of GMed (anterior, middle, posterior) and GMin (posterior) was reduced in early stance phase when the orthosis was worn in the shoe (p < 0.05). GMin (anterior) activity was significantly reduced during swing (p < 0.05). Muscle activity was also significantly reduced during the orthoses condition for the lateral hamstrings and calf muscles (p < 0.05).Significance: Using foot orthoses may provide a strategy to reduce demand on GMin, GMed, lateral hamstring and calf muscles while walking. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Purpose: This study aimed to evaluate the differences in lower-limb biomechanics between adult subelite competitive football players with and without hip-related pain during two contrasting tasks—walking and single-leg drop jump (SLDJ)—and to determine whether potential differences, if present, are sex dependent. Methods: Eighty-eight football players with hip-related pain (23 women, 65 men) and 30 asymptomatic control football players (13 women, 17 men) who were currently participating in competitive sport were recruited. Biomechanical data were collected for the stance phase of walking and SLDJ. Pelvis, hip, knee, and ankle angles, as well as the impulse of the external joint moments, were calculated. Differences between groups and sex-specific effects were calculated using linear regression models. Results: Compared with their asymptomatic counterparts, football players with hip-related pain displayed a lower average pelvic drop angle during walking (P = 0.03) and a greater average pelvic hike angle during SLDJ (P < 0.05). Men with hip-related pain displayed a smaller total range of motion (excursion) for the transverse plane pelvis angle (P = 0.03) and a smaller impulse of the hip external rotation moment (P < 0.01) during walking compared with asymptomatic men. Women with hip-related pain displayed a greater total range of motion (excursion) for the sagittal plane knee angle (P = 0.01) during walking compared with asymptomatic women. Conclusion: Overall, few differences were observed in lower-limb biomechanics between football players with and without hip-related pain, irrespective of the task. This outcome suggests that, despite the presence of symptoms, impairments in lower-limb biomechanics during function do not appear to be a prominent feature of people with hip-related pain who are still participating in sport. [ABSTRACT FROM AUTHOR]

Background: There are few publications evaluating the research experience of hospital pharmacists in Australia. Aim: This study evaluated the research interest, confidence and experience of an Australian hospital pharmacist population. Methods: A cross‐sectional survey was undertaken in a health service. Demographic information was collected and study participants completed a validated questionnaire to evaluate their interest, confidence and experience in research. Differences between overall levels of interest, confidence and experience were evaluated using non‐parametric analysis of variance (ANOVA), whereas relationships of these with demographic variables were explored with multilinear regression. Participants listed the number of times they completed a range of research‐related tasks, as well as barriers to and support for participating in research. Results: Pharmacists exhibited high levels of interest in research but had comparatively lower levels of confidence and experience (p < 0.017 for all). Pharmacists undertook most of the research tasks less than five times in the past 5 years. Research interest was associated with qualifications and belief that research can influence practice (r2 = 0.175, p < 0.05); research confidence was associated with qualifications and gender (r2 = 0.405, p < 0.05); research experience was associated with years of experience and qualifications (r2 = 0.380, p < 0.01). Time was the most common barrier to participation in research. The level of departmental support was high, but one‐third of participants declined to answer this question. Conclusion: Research interest, confidence and experience were associated with possession of a postgraduate research qualification. Pharmacy professional organisations, pharmacy departments and educational institutions should consider ways to encourage pharmacists to complete a postgraduate qualification. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the current study was to determine the effects of education with targeted or sham exercise on pain and function in postmenopausal women with greater trochanteric pain syndrome (GTPS). Background: Conservative management of GTPS is poorly described, and to date, there have been no studies on education with exercise as an intervention for GTPS. Ninety-four postmenopausal women with GTPS were recruited to participate in this study. Materials and Methods: Participants were randomized to receive one of two 12-week exercise programs (GLoBE vs. sham). Participants received education on avoiding tendon compression with appropriate activity modification. The Victorian Institute of Sport Assessment-Gluteal tendon (VISA-G) was examined at baseline, 12, and 52 weeks. Secondary outcomes included hip pain and function questionnaires (Hip dysfunction and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), and Lateral Hip Pain questionnaire), a global rating of change in symptom questionnaire, and a quality of life measure (Assessment of Quality of Life [AQoL]-8D). Differences between groups were analyzed using intention to treat with analysis of covariance, per-protocol analysis, and responder analysis. Results: Responders to the GLoBE intervention had significantly better VISA-G, HOOS, OHS, and lateral hip pain questionnaire scores compared to responders in the sham group. However, intention to treat analyses showed no between-group differences for the GLoBE intervention and sham exercise groups. Significant improvement in VISA-G score was found for both programs at 12- and 52-weeks time points (p < 0.001). Conclusion: Lack of treatment effect was found with the addition of an exercise program to a comprehensive education on GTPS management. The improved outcomes of the responders in the GLoBE group indicate that there may be a subgroup of patients with a GTPS diagnosis that benefit from a GLoBE intervention program. [ABSTRACT FROM AUTHOR]

Running is a popular sport and recreational physical activity worldwide. Musculoskeletal injuries in runners are common and may be attributed to the inability to control pelvic equilibrium in the coronal plane. This lack of pelvic control in the frontal plane can stem from dysfunction of the gluteus medius. The aim of this systematic review was therefore to: (i) compile evidence of the activity profile of gluteus medius when running; (ii) identify how gluteus medius activity (electromyography) varies with speed, cadence and gender when running; (iii) compare gluteus medius activity in injured runners to matched controls. Seven electronic databases were searched from their earliest date until March 2015. Thirteen studies met our eligibility criteria. The activity profile was mono-phasic with a peak during initial loading (four studies). Gluteus medius amplitude increases with running speed; this is most evident in females. The muscles' activity has been recorded in injured runners with Achilles tendinopathy (two studies) and patellofemoral pain syndrome (three studies). The strongest evidence indicates a moderate and significant reduction in gluteus medius duration of activity when running in people with patellofemoral pain syndrome. This dysfunction can potentially be mediated with running retraining strategies. [ABSTRACT FROM AUTHOR]

Background: Greater trochanteric pain syndrome (GTPS) is pathology in the gluteus medius and minimus tendons and trochanteric bursa that causes debilitating tendon pain and dysfunction, particularly in post-menopausal women. Limited evidence in clinical studies suggests hormone changes after menopause may have a negative effect on tendon. This protocol describes a randomised controlled trial comparing the effectiveness of menopausal hormone therapy (MHT) and exercise therapy in reducing pain and dysfunction associated with GTPS in post-menopausal women.Method: One hundred and sixteen post-menopausal women will be recruited and randomised to receive one of two exercise programs (sham or targeted intervention exercise) and transdermal creams (MHT cream containing oestradiol 50mcg and norethisterone acetate 140mcg or placebo cream). Interventions will be 12-weeks in duration and outcomes will be examined at baseline, 12-weeks and 52-weeks. The primary outcome measure will be the VISA-G questionnaire and secondary outcomes measures will include three hip pain and function questionnaires (Hip dysfunction and Osteoarthritis Outcome Score, Oxford Hip Score, Lateral Hip Pain questionnaire), a global change in symptom questionnaire (using a 15-point Likert scale) and a quality of life measure (AQoL-8D questionnaire). Data will be analysed using the intention to treat principle.Discussion: This study is the first randomised controlled trial to compare the effectiveness of menopausal hormone therapy therapy alone, and with the combination of exercise therapy, to treat pain and dysfunction associated with GTPS. This study has been pragmatically designed to ensure that the interventions in this study can be integrated into policy and clinical practice if found to be effective in the treatment of GTPS in post-menopausal women. If successful, there is potential for this treatment regimen to be explored in future studies of other persistent tendon conditions in the post-menopausal population.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001157662 Registered 31 October 2014. [ABSTRACT FROM AUTHOR]

Dysfunction of hip stabilizing muscles such as quadratus femoris (QF) is identified as a potential source of lower extremity injury during functional tasks like running. Despite these assumptions, there are currently no electromyography (EMG) data that establish the burst activity profile of QF during any functional task like walking or running. The objectives of this study were to characterize and compare the EMG activity profile of QF while walking and running (primary aim) and describe the direction specific action of QF (secondary aim). A bipolar fine-wire intramuscular electrode was inserted via ultrasound guidance into the QF of 10 healthy participants (4 females). Ensemble curves were generated from four walking and running trials, and normalized to maximum voluntary isometric contractions (MVICs). Paired t -tests compared the temporal and amplitude EMG variables. The relative activity of QF in the MVICs was calculated. The QF displayed moderate to high amplitude activity in the stance phase of walking and very high activity during stance in running. During swing, there was minimal QF activity recorded during walking and high amplitudes were present while running (run vs walk effect size=4.23, P <0.001). For the MVICs, external rotation and clam produced the greatest QF activity, with the hip in the anatomical position. This study provides an understanding of the activity demands placed on QF while walking and running. The high activity in late swing during running may signify a synergistic role with other posterior thigh muscles to control deceleration of the limb in preparation for stance. [ABSTRACT FROM AUTHOR]

Introduction: Periacetabular osteotomy (PAO) is often performed in patients with hip dysplasia. The aim of this systematic review and meta-analysis was to evaluate the harms and benefits of PAO in patients with hip dysplasia in studies reporting both adverse events and patient-reported hip pain and function. Materials and methods: A systematic search combing PAO and patient-reported outcomes was performed in the databases MEDLINE, CINAHL, EMBASE, Sports Discuss and PsychINFO. Studies including both harms and benefits defined as adverse events and patient-reported hip pain and function were included. Risk of bias was assessed using The Cochrane Risk of Bias In Non-Randomized Studies – of Interventions. Results: Twenty-nine cohort studies were included, of which six studies included a comparison group. The majority of studies had serious risk of bias and the certainty of evidence was very low. The proportion of adverse events was 4.3 (95% CI 3.7; 4.9) for major adverse events and 14.0 (95% CI 13.0; 15.1) for minor adverse events. Peroneal nerve dysfunction was the most frequent adverse event among the major adverse events, followed by acetabular necrosis and delayed union or non-union. All patient-reported hip pain and function scores improved and exceeded the minimal clinically important differences after PAO. After 5 years, scores were still higher than the preoperative scores. Conclusion: PAO surgery has a 4% risk of major, and 14% risk of minor adverse events and a positive effect on patient-reported hip pain and function among patients with hip dysplasia. [ABSTRACT FROM AUTHOR]

Electromyographic (EMG) studies into gluteus medius (GMed) typically involve surface EMG electrodes. Previous comparisons of surface and fine wire electrode recordings in other muscles during high load isometric tasks suggest that recordings between electrodes are comparable when the muscle is contracting at a high intensity, however, surface electrodes record additional activity when the muscle is contracting at a low intensity. The purpose of this study was to compare surface and fine wire recordings of GMed at high and low intensities of muscle contractions, under high load conditions (maximum voluntary isometric contractions, MVICs). Mann–Whitney U tests compared median electrode recordings during three MVIC hip actions; abduction, internal rotation and external rotation, in nine healthy adults. There were no significant differences between electrode recordings in positions that evoked a high intensity contraction (internal rotation and abduction, fine wire activity >77% MVIC; effect size, ES < 0.42; p > 0.277). During external rotation, the intensity of muscle activity was low (4.2% MVIC), and surface electrodes recorded additional myoelectric activity (ES = 0.67, p = 0.002). At low levels of muscle activity during high load isometric tasks, the use of surface electrodes may result in additional myoelectric recordings of GMed, potentially reflective of cross-talk from surrounding muscles. [ABSTRACT FROM AUTHOR]

Background: People with hip osteoarthritis (OA) typically display altered gluteus minimus (GMin) and gluteus medius (GMed) activity during gait, in addition to reduced walking speed and stride length. It is unknown if current rehabilitation programs address changes in gluteal muscle activity in people with hip OA.Research Question: Can a targeted gluteal intervention restore normal gluteal muscle segment activity during gait in people with hip OA?Methods: This study presents secondary outcomes from a multi-site, double-blinded clinical trial in which participants with radiologically confirmed mild-moderate hip OA were randomised into a targeted gluteal or sham intervention for 12-weeks following baseline testing. Electromyography (EMG) outcomes were only conducted at a single site and data were collected from 22 participants. Intramuscular electrodes were inserted into two segments of GMin (anterior, posterior) and three segments of GMed (anterior, middle, posterior) to record average amplitude, peak amplitude and time to peak (TTP) during the first 60 % of the gait cycle (stance phase) at baseline and post-intervention.Results: Following the targeted gluteal intervention, posterior GMin displayed a decrease in average (P = 0.032, ES=1.04) and peak (P = 0.017, ES=1.17) muscle activity during late stance phase with a shift to an earlier TTP (P = 0.034, ES=1.02). There were no further significant changes between groups for other outcome measures. Similar trends for an earlier TTP were observed for the posterior segment of GMed following the targeted intervention (P = 0.095, ES=0.87). The earlier TTP in the posterior segments of both GMin and GMed post-intervention resembled patterns observed in a healthy young population.Significance: A targeted gluteal intervention can positively impact activity in posterior GMin during gait in people with hip OA when compared to a sham intervention. [ABSTRACT FROM AUTHOR]

Highlights: [•] Anterior and posterior segments of gluteus minimus were studied with fine wire EMG. [•] The EMG profile of each segment is illustrated across the gait cycle. [•] Each segment is capable of independent function. [•] We propose unique stabilising roles for each segment across the gait cycle. [•] This study paves the way for future EMG research on clinical populations. [Copyright &y& Elsevier]

Abstract: Previous electromyographic (EMG) studies of gluteus medius (GMed) have not accurately quantified the function of the three proposed structurally and functionally unique segments (anterior, middle and posterior). Therefore this study used anatomically verified locations for intramuscular electrode recordings in three segments of GMed to determine whether the segments are functionally independent. Bipolar fine wire electrodes were inserted into each segment of GMed in 15 healthy individuals. Participants completed a series of four walking trials, followed by maximum voluntary isometric contractions (MVICs) in five different positions. Temporal and amplitude variables for each segment were compared across the gait cycle using ANOVA. The relative contributions of each segment to the MVIC trials were compared with non-parametric tests. All segments showed a biphasic response during the stance phase of gait. There were no differences in amplitude variables (% MVIC) between segments, but the anterior segment had a later peak during both the first and second bursts.For the MVIC trials, there were significant differences in amplitude between segments in four of the five test positions. These data indicate that GMed is composed of three functionally independent segments. This study contributes to the theoretical understanding of the role of GMed. [Copyright &y& Elsevier]

Abstract: Our current theoretical understanding of gluteus minimus (GMin) and gluteus medius (GMed) function is primarily based on cadaveric studies and biomechanical modelling. There is an absence of electromyographic (EMG) research that aims to verify this understanding, particularly in relation to the potentially unique functional roles of structurally distinct segments within GMin (anterior and posterior) and GMed (anterior, middle and posterior). The aim of this paper is to provide a comprehensive technical description for inserting intramuscular EMG electrodes into uniquely oriented segments of GMin and GMed; and to report the levels of discomfort associated with gluteal intramuscular electrode insertions. Fifteen healthy volunteers took part in a series of walking trials after intramuscular EMG electrodes were inserted into segments of GMin (×2) and GMed (×3) according to previously verified guidelines. Visual analogue scores following walking trials at comfortable and fast speed indicate that discomfort levels associated with these insertions were low (2.4±1.4 and 1.6±0.7 respectively). The technical descriptions and illustrations provided in this paper will allow trained intramuscular electromyographers to insert electrodes into these muscle segments with confidence. [Copyright &y& Elsevier]

Background: People with hip osteoarthritis are typically offered a combination of education and exercise to address muscle atrophy and weakness. Limited evidence exists to assess the efficacy of exercise programs on muscle structure or function in this population. The aim of this study was to evaluate the effects of targeted resistance exercise on gluteal muscle hypertrophy and strength in people with mild-to-moderate hip osteoarthritis.Methods: Twenty-seven participants with radiologically confirmed hip osteoarthritis recruited from a single site of a multi-site, double-blind clinical trial were randomly allocated to receive a 12-week targeted gluteal intervention or sham intervention. Magnetic resonance imaging and hand-held dynamometry were used to determine change in gluteal muscle volume, fatty infiltration and hip muscle strength. For gluteal muscle volume and strength outcomes mixed model analyses of variance (ANOVA) were conducted. A general linear model (ANOVA) analysis with fixed effects parameter estimates was used to assess the impact of sex on gluteal muscle size and strength of the affected limb only. For muscle fat index a mixed method ANOVA was used to assess the differences between groups and over time.Results: In the targeted intervention group, gluteus minimus volume increased from baseline to post-intervention in both limbs (pooled mean difference: 0.06 cm3/kg, 95% confidence interval: 0.01 to 0.11) while no change occurred in the sham group (time x group effect: P = 0.025). Gluteus medius, gluteus maximus and tensor fascia lata volume did not change significantly over time. Hip strength (abduction, adduction, flexion, extension, external and internal rotation) improved similarly in both groups (time main effect: P ≤ 0.042). There was a consistent, albeit non-significant, pattern of reduced fatty infiltration after the targeted intervention.Conclusion: Targeted resistance exercise resulted in gluteus minimus hypertrophy, but improvements in hip strength occurred in both groups. Clinicians delivering hip osteoarthritis rehabilitation programs might consider implementing a targeted exercise program to attenuate disease associated changes within gluteal muscles.Trial Registration: Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347. Registered prospectively on 5 July 2017. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines recommend exercise as the first line of management for hip osteoarthritis, yet high-quality evidence from Cochrane reviews suggest only slight benefits for pain and physical function; and no benefit on quality of life (low-quality evidence). However, the scope of physical impairments identified in people with hip osteoarthritis may not have been adequately addressed with targeted rehabilitation options in previous randomised controlled trials (RCTs). Potential targeted options include gait retraining to address spatio-temporal impairments in walking; motor control training to address deep gluteal (gluteus minimus) dysfunction; and progressive, high-intensity resistance exercises to address atrophy of the gluteal muscles. The aim of this study is to investigate the effect of a targeted gluteal rehabilitation programme that incorporates gait retraining, motor control and progressive, high-intensity resistance-strength training, to address physical activity levels and self-reported physical function in people with mild to moderate disability from hip osteoarthritis.Methods: Ninety people diagnosed with mild to moderately disabling hip osteoarthritis will be recruited and randomised to receive one of two exercise programmes (sham or GHOst programme). Interventions will be 12 weeks in duration, with weekly, supervised physiotherapy sessions, and daily home exercises. Both groups will receive standardised education. Outcomes will be assessed at baseline, 7 weeks, 13 weeks (primary time-point) and 25 weeks. The primary outcome will be self-reported physical function measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes include physical activity measured with a tri-axial accelerometer, physical function tests, self-reported physical activity, isometric hip-muscle strength tests, hip-related patient-reported outcome measures, pain thoughts and depressive symptoms, quality of life, global rating of change, gluteal-muscle activity (electromyography (EMG)) and gluteal-muscle size and adiposity (magnetic resonance imaging (MRI)).Discussion: This will be the first study to compare a targeted gluteal rehabilitation programme to a sham exercise programme. The targeted GHOst programme includes exercises designed to address gait impairments as well as gluteal-muscle atrophy and dysfunction.Trial Registration: Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347 . Registered retrospectively on 5 July 2017. Protocol version 3.0. [ABSTRACT FROM AUTHOR]

Background: Foot orthoses and footwear interventions are advocated for the management of lower limb musculoskeletal conditions including the hip, but much of the research is focused on knee disorders. The aim of this systematic review was to synthesise the literature that investigates the use of foot orthoses or footwear in people with hip‐related pain. Methods: MEDLINE, EMBASE, CINAHL, AMED and SPORTDiscus were searched from inception to March 2023. Randomised controlled trials (RCT), cohort and pre‐post studies reporting on footwear and foot orthoses interventions, in participants with hip‐related pain, were eligible for inclusion. Outcomes included pain, physical function, and quality of life (QoL). Effect sizes were calculated where sufficient data were available. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Rob‐2) and the Joanna Briggs Institute Checklist. The overall quality of evidence was rated according to the Grading of Recommendations, Assessment, Development, and Evaluations framework. Results: Of the seven included studies (n = 266 participants), there was one RCT, one cohort and five single‐group pre‐post designs. Interventions included customised and non‐customised arch supports, heel lifts, and footwear modifications, used in the following hip conditions: trochanteric pain, non‐specific hip pain, hip osteoarthritis, and leg length dysfunction following total hip arthroplasty. Meta‐analysis was possible for outcomes in two studies, demonstrating moderate improvement in pain following foot orthoses use. Overall certainty of evidence ranged from very low to low. Conclusion: Single‐group pre‐post study designs describe positive relationships between foot orthoses and footwear use and improvements in hip pain, function, and QoL. However, these results were not supported by the only available RCT. Given this is a relatively inexpensive and non‐invasive treatment approach, further rigorous studies are warranted. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether participants with knee osteoarthritis classified as 'more' or 'less' physically active at baseline differ in characteristics and/or outcomes at baseline and at 3 and 12 months following the commencement of an education and exercise‐therapy program. Methods: Prospective cohort study using the GLA:D® Australia registry. The University of California, Los Angeles Physical Activity Scale (UCLA) participant data dichotomised as 'more' (≥7) or 'less' active (≤6). Groups were compared using chi‐square (obesity [baseline only], comorbidity prevalence, medication consumption, fear of damage from physical activity); and linear mixed model regression (12‐item Injury Osteoarthritis Outcome Score [KOOS‐12], pain [visual analogue scale], health‐related quality of life [QoL] [EQ‐5D‐5L]) statistics, adjusted for age, sex and baseline physical activity at 3 and 12 months. Results: We included 1059 participants (70% female). At baseline, 267 (25%) were classified as 'more' active, increasing to 29% and 30% at 3 and 12 months, respectively. At baseline, compared to the 'less' active group, the 'more' active group had a lower proportion of participants who were obese ('more' = 21% vs. 'less' = 44%), had comorbidities (58% vs. 74%) and consumed medications (71% vs. 85%); lower pain intensity (37 vs. 47); and higher KOOS‐12 (59 vs. 50), and health‐related QoL (0.738 vs. 0.665) scores. When accounting for age, sex and baseline physical activity, improvements seen in knee‐related burden and health‐related QoL were not different between groups at 3 or 12 months. Compared to the 'less' active group, the proportion of participants not consuming medication remained higher in the 'more' active group at 3 ('more' 45% vs. 'less' 28%) and 12 months (43% vs. 32%). Conclusion: 'More' active people with knee osteoarthritis were less likely to be obese, had fewer comorbidities, lower medication consumption, knee‐related burden and pain intensity, and higher health‐related QoL than 'less' active participants at all timepoints. [ABSTRACT FROM AUTHOR]

Background: Hip-related pain (HRP) is described as a movement-related disorder. However, little attention is given to the way people with HRP move, especially in populations still participating in sport. Thus, limiting our understanding of movementbased impairments in HRP and their potential relationships with pain/symptoms.Research Question: (1) What are the differences in absolute and relative amounts of positive and negative lower-limb joint work during walking and the single-leg drop jump (SLDJ) in football players with and without HRP? (2) What are the relationships between lower-limb joint work and HRP burden?Methods: 88 football players with HRP and 30 control football players were recruited. Positive and negative work done by the hip, knee, and ankle (and each joint's relative contribution to total work done) were calculated. The effect of sex on the relationship between HRP and work done, as well as the association between work done and International Hip Outcome Tool (iHOT33) scores, were assessed using linear and beta regressions models.Results: Walking: No joint work variables were significantly different between groups, nor were any relationships with iHOT33 scores evident. SLDJ: The knee's relative contribution to total lower-limb negative work done was 37.7 % and 42.4 % for women with and without HRP, respectively (P = 0.04). The iHOT33 was significantly associated with positive (P = 0.03 to <0.01) and negative (P = 0.02 to <0.01) work done by the hip as well as negative work done by the ankle (P = 0.03 to 0.01), independent of sex.Significance: Only one significant between-group comparison was revealed, involving the knee in female football players. In addition, football players with a greater selfreported burden of HRP tended to display lower hip joint work during the SLDJ. Rehabilitation programs could be targeted to address these impairments and normalize work done during high impact tasks in the management of HRP. [ABSTRACT FROM AUTHOR]

Background: Altered gluteus minimus (GMin) activity has been identified in people with hip osteoarthritis (OA) during gait with some evidence of altered gluteus medius (GMed) activity in patients with advanced OA. It is not known whether these muscles also exhibit altered activity during other functional tasks.Research Question: Does gluteal muscle activity during stepping tasks differ between people with hip OA and healthy older adults?Methods: Participants included 20 people with unilateral hip OA and 20 age-and sex-matched controls. Muscle activity in the three segments within GMed and two segments of GMin were examined using intramuscular electromyography during step-up, step-down and side-step tasks.Results: Participants in the OA group demonstrated reduced muscle activity early in the step-up task and a later time to peak activity in most muscle segments. Greater activity was identified in anterior GMin in people with hip OA during the side-step task. A delay in time to peak activity was identified in most muscle segments in people with OA during the side-step task.Significance: For participants with OA, reduced activity in most muscle segments and increased time spent in double limb stance during the step-up task could reflect the decreased strength and pain associated with single limb stance on the affected limb. This study provides further evidence of altered function of the deep gluteal muscles in people with hip OA and highlights the importance of addressing these muscles in rehabilitation. [ABSTRACT FROM AUTHOR]

• Unloader brace did not change co-contraction of agonist and antagonist muscles. • Unloader brace produced changes in gluteal and gastrocnemius timing and amplitude, however, the clinical relevance is unclear. • There were no differences between adjusted and unadjusted brace conditions. To determine the immediate effects of a varus unloader knee brace on lower-limb electromyographic activity in individuals with lateral knee osteoarthritis and valgus malalignment after anterior cruciate ligament reconstruction. Electromyographic data were recorded in 19 individuals with lateral knee osteoarthritis and valgus malalignment after anterior cruciate ligament reconstruction during walking under three conditions: (i) no brace, (ii) unadjusted brace (no varus adjustment), and adjusted brace (varus adjustment). Variables of interest were statistically analyzed using repeated measures analysis of variance. There were no significant differences in muscle co-contraction between the three test conditions. The adjusted brace resulted in delayed offset of gluteus maximus (mean difference [95% CI]: 72 ms [24, 119]), and earlier onset of gluteus medius (59 ms [21, 97]) compared to no brace. The adjusted brace delayed onset of lateral gastrocnemius compared to no brace (53 ms [28, 78]) and the unadjusted brace (39 ms [7, 71]) and reduced average activation amplitude of gluteus maximus (−4 mV [−6, −1]) and lateral gastrocnemius (−9 mV [−16, −2]) compared to no brace. The unloader brace did not produce significant changes in muscle co-contraction in individuals with lateral knee osteoarthritis and valgus malalignment after anterior cruciate ligament reconstruction. Significant changes in gluteal and gastrocnemius muscle activation timing and amplitude were observed, however, it is not clear whether these changes are of clinical importance. [ABSTRACT FROM AUTHOR]

Femoroacetabular impingement (FAI) syndrome is considered a motion-related condition. Little is known about the influence of symptom severity and cam morphology on hip biomechanics for individuals with FAI syndrome. Are hip biomechanics during running associated with symptom severity or cam morphology size in male football players with FAI syndrome? Forty-nine male, sub-elite football (soccer or Australian football) players (mean age= 26 years) with FAI syndrome completed the International Hip Outcome Tool-33 (iHOT-33) and Copenhagen Hip and Groin Outcome Score (HAGOS) and underwent radiographic evaluation. Biomechanical data were collected during overground running (3–3.5 m∙s−1) using three-dimensional motion capture technology and an embedded force plate. Various discrete hip angles and impulses of joint moments were analysed during the stance phase. Linear regression models investigated associations between running biomechanics data (dependent variables) and iHOT-33 and HAGOS scores and cam morphology size (independent variables). Hip joint angles during running were not associated with symptom severity in football players with FAI syndrome. A positive association was found between the impulse of the hip external rotation moment and HAGOS-Sport scores, such that a smaller impulse magnitude occurred with a lower HAGOS-Sport score (0.026 *10−2 [95%CI <0.001 *10−2 to 0.051 *10−2], P = 0.048). Larger cam morphology was associated with a greater peak hip adduction angle at midstance (0.073 [95%CI 0.002–0.145], P = 0.045). Hip biomechanics during running did not display strong associations with symptom severity or cam morphology size in male football players with FAI syndrome who were still participating in training and match play. Future studies might consider investigating associations during tasks that utilise end range hip joint motion or require greater muscle forces. • Bony morphology and symptom severity might impact biomechanics in FAI syndrome. • Running biomechanics, symptom severity, and hip radiographs were assessed. • Hip joint angles during running were not associated with symptom severity. • Larger cam morphology was weakly associated with a larger peak hip adduction angle. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the prevalence and factors associated with vestibular dysfunction in people who fall. Data Sources: All electronic records from MEDLINE, CINAHL, Embase and psycINFO databases were searched to 9 December 2022. Review Methods: Participants were adults with at least one fall within the previous year who were exposed to at least one vestibular function test. Any published peer reviewed trial designs were accepted. Included studies were assessed for risk of bias using a modified Epidemiological Appraisal Instrument. The quality of each meta-analysis was assessed using modified Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Ten trials (468 participants) were identified, six of which had high methodological quality. Vestibular dysfunction was found in 61% (48.01–72.32) I 2 = 78% of participants. The most prevalent type of dysfunction was from tests of vestibulo-ocular reflex at 61% (49.79 to 70.49) I 2 = 68%, followed by benign paroxysmal positional vertigo at 22% (10.30–40.32) I 2 = 87% and central dysfunction at 11% (2.24–37.76) I 2 = 50%. People who fall with vestibular dysfunction had reduced walking function compared to those without dysfunction −0.51 (−0.85 to −0.16) I 2 = 11%. Dizziness was not related to vestibular dysfunction in people who fall 0.25 (−0.10 to 0.60), I 2 = 0%. The quality of the body of evidence ranged from very low to high. Conclusion: More than one in two people who fall have vestibular dysfunction. Clinicians cannot rely on dizziness report to indicate need for vestibular screening in those who fall. A vestibular screen should be incorporated into a comprehensive falls assessment. [ABSTRACT FROM AUTHOR]

Background: High-frequency hospital users often present with chronic and complex health conditions and are at increased risk of serious morbidity and mortality if they contract COVID-19. Understanding where high-frequency hospital users are sourcing their information, whether they understand what they find, and how they apply the information to prevent the spread of COVID-19 is essential for health authorities to be able to target communication approaches. Methods: Cross-sectional survey of 200 frequent hospital users (115 with limited English proficiency) informed by the WHO's "Rapid, simple, flexible behavioral insights on COVID-19". Outcome measures were source of, and trust in information, and knowledge of symptoms, preventive strategies, restrictions, and identification of misinformation. Results: The most frequently cited source of information was television (n = 144, 72%) followed by the internet (n = 84, 42%). One in four television users sought their information from overseas news outlets from their country of origin, while for those using the internet, 56% relied on Facebook and other forms of social media including YouTube and WeChat. Overall, 41.2% of those surveyed had inadequate knowledge about symptoms, 35.8% had inadequate knowledge about preventative strategies, 30.2% had inadequate knowledge about government-imposed restrictions, and 69% believed in misinformation. Half of the respondents (50%) trusted all information, and only one in five (20%) were uncertain or untrusting. English-speaking participants were almost three times more likely to have adequate knowledge about symptoms (OR 2.69, 95%CI 1.47;4.91) and imposed restrictions (OR 2.10 95%CI 1.06; 4.19), and 11 times more likely to recognize misinformation (OR 11.52 95%CI 5.39; 24.60) than those with limited English. Conclusion: Within this population of high-frequency hospital users with complex and chronic conditions, many were sourcing their information from less trustworthy or locally relevant sources, including social media and overseas news outlets. Despite this, at least half were trusting all the information that they found. Speaking a language other than English was a much greater risk factor for having inadequate knowledge about COVID-19 and believing in misinformation. Health authorities must look for methods to engage diverse communities, and tailor health messaging and education in order to reduce disparities in health outcomes. [ABSTRACT FROM AUTHOR]

The gluteal muscles act as stabilizers of the hip joint and are important for the maintenance of hip function. Atrophy and weakness of the gluteal muscles have been identified in people with hip OA, but it is not known whether these muscles also exhibit altered activity patterns. The aim of this study was to compare gluteal muscle activity in people with hip OA and healthy older adults. Fine‐wire intramuscular electrodes were inserted into the three segments of gluteus medius (GMed) and two segments of gluteus minimus (GMin) in 20 participants with unilateral hip OA and 20 age‐ and gender‐matched controls. Electromyographic activity of these muscle segments was examined during walking along a 10 m walkway. Peak amplitude, average amplitude, and time to peak were compared between groups during the stance phase of the gait cycle. During early stance, the OA group demonstrated a higher burst of activity in posterior GMin (P = 0.02) and trends toward a higher peak in anterior GMin. Both groups displayed peak activity in anterior GMin in the early stance phase in contrast to previous reports in young adults. This early burst of muscle activity was more pronounced with increasing severity of OA. No differences were identified in GMed activity. While altered GMin activity is associated with aging, these changes were more pronounced in participants with hip OA. To reduce disability associated with hip OA, future rehabilitation programs should consider targeted gait strategies and exercises for GMin. [ABSTRACT FROM AUTHOR]

Background: High-frequency hospital users often present with chronic and complex health conditions and are at increased risk of serious morbidity and mortality if they contract COVID-19. Understanding where high-frequency hospital users are sourcing their information, whether they understand what they find, and how they apply the information to prevent the spread of COVID-19 is essential for health authorities to be able to target communication approaches. Methods: Cross-sectional survey of 200 frequent hospital users (115 with limited English proficiency) informed by the WHO's "Rapid, simple, flexible behavioral insights on COVID-19". Outcome measures were source of, and trust in information, and knowledge of symptoms, preventive strategies, restrictions, and identification of misinformation. Results: The most frequently cited source of information was television (n = 144, 72%) followed by the internet (n = 84, 42%). One in four television users sought their information from overseas news outlets from their country of origin, while for those using the internet, 56% relied on Facebook and other forms of social media including YouTube and WeChat. Overall, 41.2% of those surveyed had inadequate knowledge about symptoms, 35.8% had inadequate knowledge about preventative strategies, 30.2% had inadequate knowledge about government-imposed restrictions, and 69% believed in misinformation. Half of the respondents (50%) trusted all information, and only one in five (20%) were uncertain or untrusting. English-speaking participants were almost three times more likely to have adequate knowledge about symptoms (OR 2.69, 95%CI 1.47;4.91) and imposed restrictions (OR 2.10 95%CI 1.06; 4.19), and 11 times more likely to recognize misinformation (OR 11.52 95%CI 5.39; 24.60) than those with limited English. Conclusion: Within this population of high-frequency hospital users with complex and chronic conditions, many were sourcing their information from less trustworthy or locally relevant sources, including social media and overseas news outlets. Despite this, at least half were trusting all the information that they found. Speaking a language other than English was a much greater risk factor for having inadequate knowledge about COVID-19 and believing in misinformation. Health authorities must look for methods to engage diverse communities, and tailor health messaging and education in order to reduce disparities in health outcomes. [ABSTRACT FROM AUTHOR]

Background: High-frequency hospital users often present with chronic and complex health conditions and are at increased risk of serious morbidity and mortality if they contract COVID-19. Understanding where high-frequency hospital users are sourcing their information, whether they understand what they find, and how they apply the information to prevent the spread of COVID-19 is essential for health authorities to be able to target communication approaches. Methods: Cross-sectional survey of 200 frequent hospital users (115 with limited English proficiency) informed by the WHO's "Rapid, simple, flexible behavioral insights on COVID-19". Outcome measures were source of, and trust in information, and knowledge of symptoms, preventive strategies, restrictions, and identification of misinformation. Results: The most frequently cited source of information was television (n = 144, 72%) followed by the internet (n = 84, 42%). One in four television users sought their information from overseas news outlets from their country of origin, while for those using the internet, 56% relied on Facebook and other forms of social media including YouTube and WeChat. Overall, 41.2% of those surveyed had inadequate knowledge about symptoms, 35.8% had inadequate knowledge about preventative strategies, 30.2% had inadequate knowledge about government-imposed restrictions, and 69% believed in misinformation. Half of the respondents (50%) trusted all information, and only one in five (20%) were uncertain or untrusting. English-speaking participants were almost three times more likely to have adequate knowledge about symptoms (OR 2.69, 95%CI 1.47;4.91) and imposed restrictions (OR 2.10 95%CI 1.06; 4.19), and 11 times more likely to recognize misinformation (OR 11.52 95%CI 5.39; 24.60) than those with limited English. Conclusion: Within this population of high-frequency hospital users with complex and chronic conditions, many were sourcing their information from less trustworthy or locally relevant sources, including social media and overseas news outlets. Despite this, at least half were trusting all the information that they found. Speaking a language other than English was a much greater risk factor for having inadequate knowledge about COVID-19 and believing in misinformation. Health authorities must look for methods to engage diverse communities, and tailor health messaging and education in order to reduce disparities in health outcomes. [ABSTRACT FROM AUTHOR]

Background: High-frequency hospital users often present with chronic and complex health conditions and are at increased risk of serious morbidity and mortality if they contract COVID-19. Understanding where high-frequency hospital users are sourcing their information, whether they understand what they find, and how they apply the information to prevent the spread of COVID-19 is essential for health authorities to be able to target communication approaches. Methods: Cross-sectional survey of 200 frequent hospital users (115 with limited English proficiency) informed by the WHO's "Rapid, simple, flexible behavioral insights on COVID-19". Outcome measures were source of, and trust in information, and knowledge of symptoms, preventive strategies, restrictions, and identification of misinformation. Results: The most frequently cited source of information was television (n = 144, 72%) followed by the internet (n = 84, 42%). One in four television users sought their information from overseas news outlets from their country of origin, while for those using the internet, 56% relied on Facebook and other forms of social media including YouTube and WeChat. Overall, 41.2% of those surveyed had inadequate knowledge about symptoms, 35.8% had inadequate knowledge about preventative strategies, 30.2% had inadequate knowledge about government-imposed restrictions, and 69% believed in misinformation. Half of the respondents (50%) trusted all information, and only one in five (20%) were uncertain or untrusting. English-speaking participants were almost three times more likely to have adequate knowledge about symptoms (OR 2.69, 95%CI 1.47;4.91) and imposed restrictions (OR 2.10 95%CI 1.06; 4.19), and 11 times more likely to recognize misinformation (OR 11.52 95%CI 5.39; 24.60) than those with limited English. Conclusion: Within this population of high-frequency hospital users with complex and chronic conditions, many were sourcing their information from less trustworthy or locally relevant sources, including social media and overseas news outlets. Despite this, at least half were trusting all the information that they found. Speaking a language other than English was a much greater risk factor for having inadequate knowledge about COVID-19 and believing in misinformation. Health authorities must look for methods to engage diverse communities, and tailor health messaging and education in order to reduce disparities in health outcomes. [ABSTRACT FROM AUTHOR]

Context: Hip pain is associated with reduced hip muscle strength, range of movement (ROM), and decreased postural stability. Singleleg squat is a reliable and valid method to measure dynamic balance. Objective: To evaluate the influence of physical characteristics and use of a decline board on squat performance in a hip pain population. Design: Cross-sectional study setting. Clinical Patients: In total, 33 individuals scheduled for arthroscopic hip surgery were matched with 33 healthy controls. Interventions: Hip and ankle ROM, hip strength, and trunk endurance were assessed, along with knee and trunk kinematics during squat on flat and 25° decline surfaces. Main Outcome Measures: Between-group and surface differences in alignment, between-group strength and ROM, and associations between alignment and physical characteristics were assessed and determined using mixed model analysis of variance and Pearson R. Results: The hip pain group had significantly less strength and ROM for all directions except abduction strength and ankle dorsifiexion (P > .02). No differences existed between lire 2 groups for trunk (P < .70) or knee displacement (P < .46) during squat on either surface. When the 2 groups were combined (n = 66), decline squat significantly reduced knee medial displacement in both limbs by approximately 1 cm (P < .01). Decline squat reduced uxink lateral movement on 1 side only (P = .03). Reduced knee displacement during decline squat showed fair association with less hip-extension strength (r = -29), hip-flexion strength (r = -.25), and less dorsifiexion (r = -.24). Strength and range were not associated with trunk displacement. Conclusions: Decline squat reduced medial knee and lateral trunk displacement regardless of hip pain. Reductions may be greater in those with lesser hip muscle strength and dorsifiexion. Use of a decline board during squat for improving knee and trunk alignment should be considered as a goal of exercise intervention. [ABSTRACT FROM AUTHOR]

Objective. Clinical care ratios (CCRs) are a useful tool that can be used to quantify and benchmark the clinical and non-clinical workloads of allied health professionals. The purpose of this study was to determine if CCRs are influenced by level of seniority, type of role or profession. This will provide meaningful information for allied health service managers to better manage service demand and capacity. Method. Data was collected from 2036 allied health professionals from five professions across 11 Australian tertiary hospitals. Mean (95% confidence intervals) CCRs were calculated according to profession, seniority and role type. A two-way ANOVA was performed to assess the association of CCRs (dependent variable) with seniority level and profession (independent variables). Post-hoc pairwise comparisons identified where significant main or interaction effects occurred (a = 0.05). Results. Significant main effects for seniority level and profession were identified (P < 0.05), but there was no interaction effect. Post-hoc comparisons revealed significant differences between all tier combinations (P < 0.05) with more senior staff having the lowest CCRs. Conclusion. The direct and non-direct clinical components of the allied health professional's workload can be quantified and benchmarked with like roles and according to seniority. The benchmarked CCRs for predominantly clinical roles will enable managers to compare and evaluate like roles and modify non-direct clinical components according to seniority and discipline. [ABSTRACT FROM AUTHOR]

Background: Measures of hip muscle morphology and composition (e.g., muscle size and fatty infiltration) are possible with magnetic resonance imaging (MRI). Standardised protocols or guidelines do not exist for evaluation of hip muscle characteristics, hindering reliable and valid inter-study analysis. This scoping review aimed to collate and synthesise MRI methods for measuring lateral hip muscle size and fatty infiltration to inform the future development of standardised protocols. Methods: Five electronic databases (Medline, CINAHL, Embase, SportsDISCUS and AMED) were searched. Healthy or musculoskeletal pain populations that used MRI to assess lateral hip muscle size and fatty infiltration were included. Lateral hip muscles of interest included tensor fascia late (TFL), gluteus maximus, gluteus medius, and gluteus minimus. Data on MRI parameters, axial slice location, muscle size and fatty infiltrate measures were collected and analysed. Cross referencing for anatomical locations were made between MRI axial slice and E-12 anatomical plastinate sections. Results: From 2684 identified publications, 78 studies contributed data on volume (n = 31), cross sectional area (CSA) (n = 24), and fatty infiltration (n = 40). Heterogeneity was observed for MRI parameters and anatomical boundaries scrutinizing hip muscle size and fatty infiltration. Seven single level axial slices were identified that provided consistent CSA measurement, including three for both gluteus maximus and TFL, and four for both gluteus medius and minimus. For assessment of fatty infiltration, six axial slice locations were identified including two for TFL, and four for each of the gluteal muscles. Conclusions: Several consistent anatomical levels were identified for single axial MR slice to facilitate muscle size and fatty infiltration muscle measures at the hip, providing the basis for reliable and accurate data synthesis and improvements in the validity of future between studies analyses. This work establishes the platform for standardised methods for the MRI assessment of lateral hip musculature and will aid in the examination of musculoskeletal conditions around the hip joint. Further studies into whole muscle measures are required to further optimise methodological parameters for hip muscle assessment. [ABSTRACT FROM AUTHOR]

Background: Measures of hip muscle morphology and composition (e.g., muscle size and fatty infiltration) are possible with magnetic resonance imaging (MRI). Standardised protocols or guidelines do not exist for evaluation of hip muscle characteristics, hindering reliable and valid inter-study analysis. This scoping review aimed to collate and synthesise MRI methods for measuring lateral hip muscle size and fatty infiltration to inform the future development of standardised protocols.Methods: Five electronic databases (Medline, CINAHL, Embase, SportsDISCUS and AMED) were searched. Healthy or musculoskeletal pain populations that used MRI to assess lateral hip muscle size and fatty infiltration were included. Lateral hip muscles of interest included tensor fascia late (TFL), gluteus maximus, gluteus medius, and gluteus minimus. Data on MRI parameters, axial slice location, muscle size and fatty infiltrate measures were collected and analysed. Cross referencing for anatomical locations were made between MRI axial slice and E-12 anatomical plastinate sections.Results: From 2684 identified publications, 78 studies contributed data on volume (n = 31), cross sectional area (CSA) (n = 24), and fatty infiltration (n = 40). Heterogeneity was observed for MRI parameters and anatomical boundaries scrutinizing hip muscle size and fatty infiltration. Seven single level axial slices were identified that provided consistent CSA measurement, including three for both gluteus maximus and TFL, and four for both gluteus medius and minimus. For assessment of fatty infiltration, six axial slice locations were identified including two for TFL, and four for each of the gluteal muscles.Conclusions: Several consistent anatomical levels were identified for single axial MR slice to facilitate muscle size and fatty infiltration muscle measures at the hip, providing the basis for reliable and accurate data synthesis and improvements in the validity of future between studies analyses. This work establishes the platform for standardised methods for the MRI assessment of lateral hip musculature and will aid in the examination of musculoskeletal conditions around the hip joint. Further studies into whole muscle measures are required to further optimise methodological parameters for hip muscle assessment. [ABSTRACT FROM AUTHOR]

Hip pain is associated with impairments in postural control and balance. The Star Excursion Balance Test (SEBT) is a reliable and valid method for measuring dynamic postural control. To examine changes in dynamic postural control after hip arthroscopy and subsequent rehabilitation from baseline to 3 and 6 months postsurgery. Case series. Physiotherapy department. Sixty-seven individuals (47 men, 20 women; age = 31 ± 8 years, height = 1.78 ± 0.09 m, mass = 83 ± 15 kg) scheduled for hip arthroscopy to address chondrolabral conditions were matched with 67 healthy individuals serving as controls (47 men, 20 women; age = 31 ± 8 years, height = 1.77 ± 0.09 m, mass = 80 ± 16 kg). The hip arthroscopy group underwent postoperative rehabilitation including SEBT training. The SEBT reach normalized to limb length was collected before surgery (baseline) and at 3 and 6 months after arthroscopy and compared with that of the healthy matched control group. Repeated-measures analysis of variance was used to evaluate whether SEBT reach differed among the 3 time points, and t tests were used to evaluate between-limbs and between-groups differences. The SEBT reach in the hip arthroscopy group at baseline was less than that of the control group in all directions (P values <.001). At 3 months after arthroscopy, SEBT reach increased in the posteromedial (PM; P =.007), posterolateral (PL; P <.001), and anterolateral (AL; P <.001) directions from baseline. At 6 months after arthroscopy, all directions of reach had increased (P values <.001) from baseline. The anteromedial (mean difference [MD] = −2.9%, P =.02), PM (MD = −5.2%, P =.002), and AL (MD = −2.5%, P =.04) reach distances remained shorter at 6 months after surgery in the hip arthroscopy group than in the control group. No difference existed between the control and hip arthroscopy groups for reach in the PL direction (MD = −3.6%; P =.06). Dynamic balance control in the hip arthroscopy group at baseline was poorer than in a matched control group as measured using the SEBT. At 3 months after hip arthroscopy, we observed improvements in dynamic balance in the PM, PL, and AL SEBT directions. By 6 months after arthroscopy, all directions of SEBT reach had improved, but only the PL reach improved to the level of healthy control individuals. [ABSTRACT FROM AUTHOR]

Cam morphology size and location might affect the severity of reported burden in people with femoroacetabular impingement (FAI) syndrome. We investigated the relationship between cam morphology size (i.e., alpha angle) and self-reported hip/groin burden (i.e., scores for the International Hip Outcome Tool-33 (iHOT-33) and Copenhagen Hip and Groin Outcome Score (HAGOS)), examined separately for the anteroposterior pelvis (AP) and Dunn 45° radiographs in football players with FAI syndrome. In total, 118 (12 women) subelite football (soccer or Australian football) players with FAI syndrome with cam morphology (alpha angle ≥60°) participated. One blinded assessor quantified superior and anterosuperior cam morphology size by measuring alpha angles for the AP and Dunn 45° radiographs, respectively. Linear regression models investigated relationships between alpha angle (continuous independent variable, separately measured for the AP and Dunn 45° radiographs) and iHOT-33 and HAGOS scores (dependent variables). Larger anterosuperior cam morphology (seen on the Dunn 45° radiograph) was associated with lower (i.e., worse) scores for the iHOT-Total, iHOT-Symptoms, iHOT-Job, and iHOT-Social subscales (unadjusted estimate range −0.553 to −0.319 [95% confidence interval −0.900 to −0.037], p = 0.002 to 0.027), but not the iHOT-Sport (p = 0.459) nor any HAGOS scores (p = 0.110 to 0.802). Superior cam morphology size (measured using the AP radiograph) was not associated with any iHOT-33 or HAGOS scores (p = 0.085 to 0.975). Larger anterosuperior cam morphology may be more relevant to pain and symptoms in football players with FAI syndrome than superior cam morphology, warranting investigation of its effects on reported burden and hip disease over time. [ABSTRACT FROM AUTHOR]

Background: Greater trochanteric pain syndrome (GTPS) is a debilitating chronic condition, most prevalent in postmenopausal women. A positive association between high estrogen levels and tendon health may exist, and postmenopausal women have reduced estrogen. Menopausal hormone therapy (MHT) may reduce the incidence of tendon abnormality, particularly when combined with exercise. Purpose: To determine the effect of MHT and exercise on tendon pain and function in postmenopausal women with GTPS. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: Postmenopausal women (N = 132; n = 12, lost to follow-up) with GTPS were randomized into MHT and placebo transdermal cream groups combined with tendon-specific or sham exercise. All groups received education about avoiding gluteal tendon compression and load management throughout 12 weeks of intervention. The primary outcome was the Victorian Institute of Sport Assessment for gluteal tendinopathy (VISA-G), and secondary outcomes were measured at baseline and at 12 and 52 weeks. The Global Rating of Change was assessed at 12 and 52 weeks. A linear mixed-effects model was used to assess differences. Body mass index (BMI) was included as a covariate. Results: All participant groups improved over time (baseline vs 12 weeks, P <.001; baseline vs 52 weeks, P <.001). There was no difference among exercise groups measured by all outcomes (VISA-G: baseline, P =.97, mean difference [MD] = 0.10; 12 weeks, P =.49, MD = 2.15; 52 weeks, P =.32, MD = −3.08). There was a significant interaction effect between cream and BMI; therefore, the population was stratified by BMI levels (<25, <30, ≥30). The MHT groups (with exercise and education) had significantly better VISA-G outcomes (baseline, P =.04, MD = −11.20, 95% CI = −21.70 to −0.70; 12 weeks, P <.001, MD = −20.72, 95% CI = −31.22 to −10.22; 52 weeks, P =.002, MD = −16.71, 95% CI = −27.21 to −6.22) and secondary measure scores as compared with placebo at all time points when BMI was <25. Conclusion: MHT or placebo combined with tendon-specific or sham exercise plus education reduced pain and increased function for this population. For women with a BMI <25, MHT with any exercise plus education was better than placebo. A targeted exercise or sham exercise strategy is effective when prescribed with education about avoiding gluteal tendon compression and load management. Registration: ACTRN12614001157662 (Australian New Zealand Clinical Trials Registry). [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objective: A causal link between ballet, hip pain, and pathology has not been established. Change in ballet dancers' hip pain and cartilage defect scores were investigated over 5 years. Design: Longitudinal. Setting: Professional ballet company. Participants: Twenty-one professional ballet dancers (52% men). Independent Variables: Baseline and follow-up Copenhagen Hip and Groin Outcome Score (HAGOS—pain subscale); incidence of hip-related pain and levels of dance participation collected daily over 5 years; bony morphology measured on baseline 3T magnetic resonance imaging (MRI). Main Outcome Measure: Change in cartilage defect score on MRI between baseline and 5-year follow-up. Results: Cartilage scores did not increase in 19 (90%) dancers. There was one new cartilage defect and one progressed in severity. At follow-up, all 6 dancers with cartilage defects were men. Group HAGOS pain scores were high 97.5 (7.5) and not related to cartilage defects (P = 0.12). Five (83%) dancers with baseline cartilage defects reported HAGOS pain scores <100 at follow-up. There were no time-loss hip injuries over 5 years. Two (33%) dancers with cartilage defects recorded hip-related pain (one reported minor training modification). Femoral neck-shaft angles (NSAs) were lower in men with cartilage defects [129.3 degrees (3.4 degrees)] compared with those without cartilage defects [138.4 degrees (4.5 degrees); P = 0.004]. Conclusions: Elite level ballet did not negatively affect cartilage health over 5 years. Cartilage defects were related to low femoral NSAs. Most cartilage defects did not progress and there was minimal impact on dance participation and pain levels. Longer follow-up is required to determine the long-term sequelae for those with cartilage defects. Level of Evidence: 1b. [ABSTRACT FROM AUTHOR]

Background: The International Hip Outcome Tool–33 (iHOT-33) was developed to evaluate patients seeking surgery for hip and/or groin (hip/groin) pain and may not be appropriate for those seeking nonsurgical treatment. Purpose: To evaluate the psychometric properties of the iHOT-33 total (iHOT-Total) score and all subscale scores in adults with hip/groin pain who were not seeking surgery. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with hip/groin pain who were not seeking surgery were recruited from 2 ongoing studies in Australia. Semistructured one-on-one interviews assessed content validity. Construct validity was assessed by testing hypothesized correlations between iHOT-33 and Copenhagen Hip and Groin Outcome Score (HAGOS) subscale scores. Test-retest reliability was assessed in patients not undertaking treatment and who reported "no change" in their Global Rating of Change (GROC) score at 6-month follow-up. Scores were reliable at group and individual levels if intraclass correlation coefficients (ICCs) were ≥0.80 and ≥0.90, respectively. Scores were responsive if Spearman rank correlations (ρ) between the change in the iHOT-33 score and the GROC score were ≥0.40. Results: In total, 278 patients with hip/groin pain (93 women; mean age, 31 years) and 55 pain-free control participants (14 women; mean age, 29 years) were recruited. The iHOT-33 demonstrated acceptable content validity. Construct validity was acceptable, with all hypothesized strong positive correlations between iHOT-33 and HAGOS subscale scores confirmed (r range, 0.60-0.76; P <.001), except for one correlation between the iHOT-Sport and HAGOS-Sport (r =.058; P <.001). All scores were reliable at the group level, except for the iHOT-33 job subscale (iHOT-Job) (ICC range, 0.78-0.88 [95% CI, 0.60-0.93]). None of the subscales met the criteria for adequate reliability for use at the individual level (all ICCs <0.90). Minimal detectable change values (group level) ranged from 2.3 to 3.7 (95% CI, 1.7-5.0). All iHOT-33 subscale scores were responsive (ρ range, 0.40-0.58; P ≤.001), except for the iHOT-Job in patients not undertaking treatment (ρ = 0.27; P =.001). Conclusion: All iHOT-33 subscale scores were valid for use in patients with hip/groin pain who were not seeking surgery. Acceptable test-retest reliability was found for all subscale scores at the group level, except the iHOT-Job. All subscale scores, excluding the iHOT-Job, were responsive, regardless of undertaking physical therapist–led treatment or no treatment. [ABSTRACT FROM AUTHOR]

Background: Calf muscle strain injuries (CMSI) are prevalent in sport, but information about factors associated with time to return to play (RTP) and recurrence is limited. Purpose: To determine whether clinical and magnetic resonance imaging (MRI) data are associated with RTP and recurrence after CMSI. Study Design: Case-control study; Level of evidence, 3. Methods: Data of 149 CMSI reported to the Soft Tissue injury Registry of the Australian Football League were explored to evaluate the impact of clinical data and index injury MRI findings on RTP and recurrence. Clinical data included age, previous injury history, ethnicity, and the mechanism of injury. Results: Irrespective of the anatomical location, players with CMSI with severe aponeurotic disruption (AD) took longer to RTP than players with CMSI with no AD: 31.3 ± 12.6 days vs 19.4 ± 10.8 days (mean ± SD; P =.003). A running-related mechanism of injury was associated with a longer RTP period for CMSI overall (adjusted hazard ratio [AHR], 0.59; P =.02). The presence of AD was associated with a longer RTP period for soleus injuries (AHR, 0.6; P =.025). Early recurrence (ie, ≤2 months of the index injury) was associated with older age (AHR, 1.3; P =.001) and a history of ankle injury (AHR, 3.9; P =.032). Older age (AHR, 1.1; P =.013) and a history of CMSI (AHR, 6.7; P =.002) increased the risk of recurrence within 2 seasons. The index injury MRI findings were not associated with risk of recurrence. Conclusion: A running-related mechanism of injury and the presence of AD on MRI were associated with a longer RTP period. Clinical rather than MRI data best indicate the risk of recurrent CMSI. [ABSTRACT FROM AUTHOR]

Background: Hip abductor muscle function is associated with running-related injuries. Previous electromyography (EMG) studies that reporting gluteal muscle activity when running have failed to account for the multiple segments of the gluteals, and have used surface electrodes, which may be contaminated by cross-talk of surrounding muscles.Research Question: This study aimed to: (i) develop EMG profiles of gluteus medius (GMed - anterior, middle and posterior) and gluteus minimus (GMin - anterior and posterior) segments during running; (ii) compare the activation patterns of each gluteal segment between running and walking; and (iii) compare surface EMG signals of running and walking to fine wire EMG signals of middle GMed.Methods: Ten physically active and asymptomatic people participated. Gluteal segment activation was assessed during running and walking over 10 m. Muscle activation was assessed using bipolar fine wire intramuscular EMG electrodes and GMed activation was also assessed using surface EMG.Results: During running, all gluteal segments presented peak amplitude during the stance phase and anterior GMin presented additional second peak amplitude during the swing phase. All gluteal segments evaluated demonstrated consistently higher amplitudes during the stance and swing phases of running compared to walking. The mean amplitude assessed using surface EMG was 32-87% higher compared to fine wire during both phases for running and walking.Significance: Greater activation of GMed segments during the stance phase and the increased anterior GMin activity during the swing phase indicate a potentially important role for pelvis and hip stabilization, respectively, which should be considered during development of targeted rehabilitation for running populations. The overestimated activation using surface electrodes highlights a limitation of using surface EMG during running and walking. [ABSTRACT FROM AUTHOR]

Background: Calf muscle strain injuries (CMSI) show consistent rates of prevalence and re‐injury in elite Australian Football players. An epidemiological evaluation is warranted to better understand the clinical presentation and recovery of CMSI. Purpose: First, to describe the epidemiology of CMSI in elite Australian Football players. Second, to determine if recovery following injury is different according to: (a) injury type (index vs re‐injury); (b) muscle injured (soleus vs gastrocnemius); and (c) mechanism of injury (running‐related activity vs non running‐related activity). Study design: Descriptive epidemiological. Methods: Data retrieved from the Soft Tissue injury Registry of the Australian Football League were analyzed. Sixteen clubs submitted data on CMSI from 2014 to 2017. Data included: player characteristics, training and match history at the time of injury, MRI, and the time to reach recovery milestones. Results: One hundred and eighty‐four CMSI were included (149 index injuries; 35 re‐injuries). Soleus injuries were most prevalent (84.6%). Soleus injuries took 25.4 ± 16.2 days to return to play, whereas gastrocnemius injuries took 19.1 ± 14.1 days (P = .097). CMSI sustained during running‐related activities took approximately 12 days longer to recover than injuries sustained during non running‐related activities (P = .001). Compared to index injuries, re‐injuries involved older players (P = .03) and significantly more time was taken to run at >90% of maximum speed, return to full training, and return to play (P ≤ .001). Almost all of the observed re‐injuries involved soleus (91.4%). Conclusion: Soleus injuries are more prevalent than gastrocnemius injuries in elite Australian Football players. Prognosis appears to be influenced by clinical factors, with CMSI sustained during running‐related activities and re‐injuries needing more time to recover. [ABSTRACT FROM AUTHOR]

• Associations between type and severity of hip pathology with pre-operative patient reported outcome measures were investigated. • High prevalence of labral pathology and acetabular chondropathy were observed. • Severe femoral head chondropathy and large labral tears are often undetected with imaging. • Severe chondropathies are most associated with PROs; however only explain 22% of the variability. The relationship between hip pathology and patient reported outcome responses following hip surgery has been previously investigated. No studies have investigated the relationship between pathology and patient reported outcome responses prior to surgery. (1) Determine the prevalence of chondral and labral pathology identified during hip arthroscopy. (2) Determine the association between intra-articular findings and patient reported outcome scores in a pre-arthroscopy hip pain population. Sixty-seven (22 female) participants scheduled for hip arthroscopy after clinical examination and radiographic assessment completed a series of patient reported outcomes (Hip Disability and Osteoarthritis Outcome Score; International Hip Outcome Tool; Pain on Activity; Visual Analogue Scale). Pathology discovered/addressed during arthroscopy was classified. Univariable and multivariable linear regression models were used to assess the relationship between demographics, pathology and patient reported outcome responses. Ninety-one percent of participants had labral pathology; 76% had acetabular chondropathy and 31% had femoral head chondropathy. Across the ten patient reported outcome subscales, severe femoral head chondropathy and large labral tears had the greatest number of significant associations with patient reported outcome scores. The strongest association was with 'Hip Disability and Osteoarthritis Outcome Score symptoms and stiffness' subscale, where severe femoral head chondropathy explained 22% of variability in symptoms and stiffness, when adjusted for Body Mass Index and presence of pincer morphology (p = 0.002). Severe femoral head chondropathy and large labral tears along with a high prevalence of labral pathology and acetabular chondropathy were relatively common findings during hip arthroscopy. Severe femoral head chondropathy and large labral tears are most associated with patient reported outcome's, however, at best only explain 22% of the variability. [ABSTRACT FROM AUTHOR]

The effect of pain on lower limb biomechanics during walking has been found to be sex specific for certain joint diseases. However, it is not known if sex is an effect-modifier in people with hip pain. Therefore, the aim of the study was to determine the differences in lower limb biomechanics between men and women with hip-related groin pain during functional tasks. 65 male and 23 female football players with hip-related groin pain were recruited. Biomechanical data were recorded during walking and the single-leg drop jump. Hip, knee and ankle joint kinematics and kinetics were calculated. Differences between men and women were assessed using statistical parametric mapping. Walking: Men with hip-related groin pain walked with lower hip flexion and internal rotation angles during stance compared to women. During different sections of stance, men also displayed a lower hip adduction angle and 'external' adduction moment, a lower knee flexion angle and 'external' flexion moment, as well as greater 'external' dorsi-flexion moment and impulse. Single-leg drop jump: Men with hip-related groin pain displayed a lower hip flexion angle during early stance, and greater 'external' knee flexion and ankle dorsi-flexion moments. The impulse of the 'external' dorsi-flexion moment was also greater for men compared to women. Men and women with hip-related groin pain display differing lower limb biomechanics in both low and high impact tasks. Sex may therefore be a potential effect modifier in people with hip-related groin pain. Future research in this area should incorporate sex-specific analyses. NA. • Men and women with hip-related groin pain have differing lower limb biomechanics. • Ankle joint biomechanics were consistently different between groups across tasks. • Sex may be an effect modifier in hip-related groin pain biomechanics. [ABSTRACT FROM AUTHOR]

Altered hip and thigh muscle activity have been observed across a spectrum of articular hip pathologies, including hip osteoarthritis, femoroacetabular impingement syndrome, and labral pathology. No systematic reviews have examined muscle activity associated with hip pathology and hip-related pain across the life span. A greater understanding of impairments in hip and thigh muscle activity during functional tasks may assist in the development of targeted treatment strategies. We conducted a systematic review using the PRISMA guidelines. A literature search was performed in five databases (MEDLINE, CINAHL, EMBASE, Sports Discuss, and PsychINFO). Studies were included that (i) investigated people with hip-related pain (femoroacetabular impingement syndrome, labral tears) or hip osteoarthritis; and (ii) reported on muscle activity using electromyography of hip and thigh muscles during functional tasks such as walking, stepping, squatting, or lunging. Two independent reviewers performed data extraction and assessed risk of bias using a modified version of the Downs and Black checklist. Non-pooled data demonstrated a limited level of evidence. Overall, differences in muscle activity appeared to be more prevalent in people with more advanced hip pathology. We found that impairments in muscle activity in those with intra-articular hip pathology measured using electromyography were variable but appeared to be greater in severe hip pathology (e.g., hip OA). [ABSTRACT FROM AUTHOR]

Background: Hip pain is associated with reduced muscle strength, range of movement (ROM), and function. Hip arthroscopy is undertaken to address coexistent intra-articular pathologies with the aim of reducing pain and improving function. Purpose: To evaluate changes in strength and ROM in a cohort with chondrolabral pathology before surgery to 3 and 6 months after hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Sixty-seven individuals with hip pain who were scheduled for hip arthroscopy were matched with 67 healthy controls. Hip strength and ROM were collected preoperatively and at 3 and 6 months postoperatively. Repeated measures analysis of variance evaluated whether strength and ROM differed between limbs and among time points. Bonferroni post hoc tests determined differences in hip strength and ROM among testing times and between the hip pain group and matched controls. Results: Hip extension, internal rotation (IR), external rotation (ER), and adduction (P < .040) strength were greater at 3 months after surgery; all directions, including flexion, abduction, and squeeze, were greater at 6 months (P < .015). Hip flexion ROM was greater at 3 months after surgery (P = .013). Flexion, IR, and ER ROM was greater at 6 months (P < .041). At 6 months, IR ROM (P = .003) and flexion, IR, and ER strength (P < .005) remained less than matched controls. Conclusion: With the exception of squeeze and flexion, all directions of hip strength and hip flexion ROM are significantly improved 3 months after arthroscopy to address chondrolabral pathology. By 6 months after arthroscopy, strength in all directions and flexion and rotation ROM are significantly improved in both limbs, but hip flexion, IR, and ER strength and IR ROM remain significantly less than that of healthy matched controls in both limbs. [ABSTRACT FROM AUTHOR]

Background: Anterior pericapsular muscles potentially contribute to active hip joint stability in walking by controlling anterior femoral translation in peak extension. Alternatively, these muscles could flex the hip and tension the anterior capsule to aid initiation of swing. Although never investigated, the location of Iliocapsularis and its extensive anterior hip capsule attachment imply a potential role in these functions. We hypothesised if these muscles contribute to control of femoral head translation (rather than hip flexion), their activation would decrease when peak hip extension is reduced during shorter stride walking.Research Questions: To provide the first description of iliocapsularis activity during walking and challenge the hypothesised roles of the anterior pericapsular hip muscles in gait by walking with shortened strides.Methods: Fifteen healthy volunteers walked with self-selected and shortened stride lengths. Electromyographic recordings were made from iliocapsularis, iliacus and anterior gluteus minimus with intramuscular electrodes, and rectus femoris with surface electrodes. Stride characteristics were measured using force sensors and 3D motion capture. Ensembles of burst activity profiles for each stride length were compared.Results: Iliocapsularis displayed a consistent EMG burst around toe-off (terminal hip extension) that peaked during early swing phase with self-selected strides. In shortened strides, iliocapsularis EMG increased during mid to late stance (p = 0.03), with no difference in other muscles. Iliocapsularis, iliacus and rectus femoris activity decreased during early stance (p < 0.01) in short strides, whereas gluteus minimus EMG increased (p = 0.03).Significance: Iliocapsularis displayed an EMG burst around toe-off during walking, and greater EMG during mid-late stance in short stride walking, which was not seen in other pericapsular muscles. Shortened strides increase the demand for active tensioning of the hip joint capsule in initial swing, and suggests a role for iliocapsularis during active hip flexion in pain free young individuals. [ABSTRACT FROM AUTHOR]