What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands: Background, design and conceptual model of FINALE Brain activation during working memory 1 month after mild traumatic brain injury Job task and psychosocial risk factors for work-related musculoskeletal disorders among newspaper employees. A Randomized Controlled Trial to Prevent Patient Lift and Transfer Injuries of Health Care Workers Balance performance with a cognitive task: a dual-task testing paradigm. A randomised controlled trial on whether a participatory ergonomics intervention could prevent musculoskeletal disorders Review article: Methodology for the ‘rapid review’ series on musculoskeletal injuries in the emergency department Individually tailored treatment targeting activity, motor behavior, and cognition reduces pain-related disability: a randomized controlled trial in patients with musculoskeletal pain. Epidemiological patterns of musculoskeletal injuries and physical training. Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: A randomized controlled clinical trial Lower extremity stiffness: implications for performance and injury. Effects of Physical-Cognitive Dual Task Training on Executive Function and Gait Performance in Older Adults: A Randomized Controlled Trial A comprehensive work injury prevention program with clerical and office workers: phase I. Technology-adaptable interventions for treating depression in adults with cognitive impairments: protocol for a systematic review Effect of Individually Tailored Biopsychosocial Workplace Interventions on Chronic Musculoskeletal Pain and Stress Among Laboratory Technicians: Randomized Controlled Trial. The influence of exercise and BMI on injuries and illnesses in overweight and obese individuals: a randomized control trial Rehabilitation of divided attention after severe traumatic brain injury: A randomised trial Injuries in sedentary individuals enrolled in a 12-month, randomized, controlled, exercise trial. Pupillary responses index cognitive resource limitations. Closed head injury-related information processing deficits: an event-related potential analysis. Association of the Functional Movement Screen with injuries in division I athletes. Short-term motor learning through non-immersive virtual reality task in individuals with down syndrome
Background Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy . Underst and ing intrinsic risk factors that may place an elite soldier at risk of musculoskeletal injury may be beneficial in preventing musculoskeletal injury and maintaining operational military readiness . Findings from this population may also be useful as hypothesis-generating work for particular civilian setting s such as law enforcement officers ( SWAT teams ) , firefighters ( smoke jumpers ) , or others in physically dem and ing professions . Questions / purpose sThe purpose s of this study were ( 1 ) to examine whether using baseline measures of self-report and physical performance can identify musculoskeletal injury risk ; and ( 2 ) to determine whether a combination of predictors would enhance the accuracy for determining future musculoskeletal injury risk in US Army Rangers . Methods Our study was a planned secondary analysis from a prospect i ve cohort examining how baseline factors predict musculoskeletal injury . Baseline predictors associated with musculoskeletal injury were collected using surveys and physical performance measures . Survey data included demographic variables , injury history , and biopsychosocial questions . Physical performance measures included  ankle dorsiflexion , Functional Movement Screen , lower and upper quarter Y-balance test , hop testing , pain provocation , and the Army Physical Fitness Test ( consisting of a 2-mile run and 2 minutes of sit-ups and push-ups ) . A total of 320 Rangers were invited to enroll and 211 participated ( 66 % ) . Occurrence of musculoskeletal injury was tracked for 1 year using monthly injury surveillance surveys , medical record review s , and a query of the Department of Defense healthcare utilization data base . Injury surveillance data were available on 100 % of the subjects . Receiver operator characteristic curves and accuracy statistics were calculated to identify predictors of interest . A logistic regression equation was then calculated to find the most pertinent set of predictors . Of the 188 Rangers ( age , 23.3 ± 3.7 years ; body mass index , 26.0 ± 2.4 kg/m2 ) remaining in the cohort , 85 ( 45.2 % ) sustained a musculoskeletal injury of interest .  Results Smoking , prior surgery , recurrent prior musculoskeletal injury , limited-duty days in the prior year for musculoskeletal injury , asymmetrical ankle dorsiflexion , pain with Functional Movement Screen clearing tests , and decreased performance on the 2-mile run and 2-minute sit-up test were associated with increased injury risk . Presenting with one or fewer predictors result ed in a sensitivity of 0.90 ( 95 % confidence interval [ CI ] , 0.83–0.95 ) , and having three or more predictors result ed in a specificity of 0.98 ( 95 % CI , 0.93–0.99 ) . The combined factors that contribute to the final multivariable logistic regression equation yielded an odds ratio of 4.3 ( 95 % CI , 2.0–9.2 ) , relative risk of 1.9 ( 95 % CI , 1.4–2.6 ) , and an area under the curve of 0.64 . Conclusions Multiple factors ( musculoskeletal injury history , smoking , pain provocation , movement tests , and lower scores on physical performance measures ) were associated with individuals at risk for musculoskeletal injury . The summation of the number of risk factors produced a highly sensitive ( one or less factor ) and specific ( three or more factors ) model that could potentially be used to effectively identify and intervene in those persons with elevated risk for musculoskeletal injury . Future research should establish if screening and intervening can improve musculoskeletal health and if our findings among US Army Rangers translate to other occupations or athletes . Level of Evidence Level II , prognostic study Background A mismatch between individual physical capacities and physical work dem and s enhance the risk for musculoskeletal disorders , poor work ability and sickness absence , termed physical deterioration . However , effective intervention strategies for preventing physical deterioration in job groups with high physical dem and s remains to be established . This paper describes the background , design and conceptual model of the FINALE programme , a framework for health promoting interventions at 4 Danish job groups ( i.e. cleaners , health-care workers , construction workers and industrial workers ) characterized by high physical work dem and s , musculoskeletal disorders , poor work ability and sickness absence . Methods / Design A novel approach of the FINALE programme is that the interventions , i.e. 3 r and omized controlled trials ( RCT ) and 1 exploratory case-control study are tailored to the physical work dem and s , physical capacities and health profile of workers in each job-group . The RCT among cleaners , characterized by repetitive work tasks and musculoskeletal disorders , aims at making the cleaners less susceptible to musculoskeletal disorders by physical coordination training or cognitive behavioral theory based training ( CBTr ) . Because health-care workers are reported to have high prevalence of overweight and heavy lifts , the aim of the RCT is long-term weight-loss by combined physical exercise training , CBTr and diet . Construction work , characterized by heavy lifting , pushing and pulling , the RCT aims at improving physical capacity and promoting musculoskeletal and cardiovascular health . At the industrial work-place characterized by repetitive work tasks , the intervention aims at reducing physical exertion and musculoskeletal disorders by combined physical exercise training , CBTr and participatory ergonomics . The overall aim of the FINALE programme is to improve the safety margin between individual re sources ( i.e. physical capacities , and cognitive and behavioral skills ) and physical work dem and s , and thereby reduce the physical deterioration in a long term perspective by interventions tailored for each respective job-group . Discussion The FINALE programme has the potential to provide evidence -based knowledge of significant importance for public health policy and health promotion strategies for employees at high risk for physical deterioration . Trial registration sIS RCT N96241850 , NCT01015716 and Objective : To assess patterns of regional brain activation in response to varying working memory loads shortly after mild traumatic brain injury ( MTBI ) . Background : Many individuals complain of memory difficulty shortly after MTBI . Memory performance in these individuals can be normal despite these complaints . Methods : Brain activation patterns in response to a working memory task ( auditory n-back ) were assessed with functional MRI in 12 MTBI patients within 1 month of their injury and in 11 healthy control subjects . Results : Brain activation patterns differed between MTBI patients and control subjects in response to increasing working memory processing loads . Maximum intensity projections of statistical parametric maps in control subjects showed bifrontal and biparietal activation in response to a low processing load , with little additional increase in activation associated with the high load task . MTBI patients showed some activation during the low processing load task but significantly increased activation during the high load condition , particularly in the right parietal and right dorsolateral frontal regions . Task performance did not differ significantly between groups . Conclusion : MTBI patients differed from control subjects in activation pattern of working memory circuitry in response to different processing loads , despite similar task performance . This suggests that injury-related changes in ability to activate or to modulate working memory processing re sources may underlie some of the memory complaints after MTBI OBJECTIVES A cross-sectional study was conducted to assess the association of upper extremity musculoskeletal disorders and work-related factors among employees using video display terminals at a large metropolitan newspaper . METHODS The study included 1050 r and omly selected workers from four departments . The workers were asked to complete question naires on symptoms , job tasks , and psychosocial and work organization conditions . Musculoskeletal disorders of the upper extremities were defined by frequency , duration , and intensity of symptoms not attributable to acute injury . Data were analyzed with the use of logistic regression . RESULTS A total of 973 workers completed the survey . The one-year period prevalence rate for any musculoskeletal disorder of the upper extremities was 41 % . Neck symptoms ( 26 % ) were the most frequently reported , followed by h and or wrist ( 22 % ) , shoulder ( 17 % ) , and elbow ( 10 % ) symptoms . Greater time working at the video display station was associated with increased h and or wrist symptoms in a dose-response relationship . In addition , variables corresponding to increased work-load dem and s ( eg , increased time working under deadline and increased job pressure ) were associated with increased neck , shoulder , and h and or wrist disorders . Women were more likely to report symptoms in several areas , but this finding may reflect the concentration of women in jobs involving more risk factors . CONCLUSIONS The results suggest a high prevalence of musculoskeletal disorders of the upper extremities among newspaper employees , and they provide additional evidence that increased work load , time pressure , and greater hours of computer use are related to the occurrence of work-related musculoskeletal disorders among these workers , particularly for disorders in the h and or wrist area Study Design . R and omized controlled trial ( RCT ) . Objectives . To compare the effectiveness of training and equipment to reduce musculoskeletal injuries , increase comfort , and reduce physical dem and s on staff performing patient lifts and transfers at a large acute care hospital . Summary of Background Data . Back injury to nursing staff during patient h and ling tasks is a major issue in health care . The value of mechanical assistive devices in reducing injuries to these workers is unclear . Methods . This three-armed RCT consisted of a “ control arm , ” a “ safe lifting ” arm , and a “ no strenuous lifting ” arm .  A medical , surgical , and rehabilitation ward were each r and omly assigned to each arm . Both intervention arms received intensive training in back care , patient assessment , and h and ling techniques . Hence , the “ safe lifting ” arm used improved patient h and ling techniques using manual equipment , whereas the “ no strenuous lifting ” arm aim ed to eliminate manual patient h and ling through use of additional mechanical and other assistive equipment . Results . Frequency of manual patient h and ling tasks was significantly decreased on the “ no strenuous lifting ” arm . Self-perceived work fatigue , back and shoulder pain , safety , and frequency and intensity of physical discomfort associated with patient h and ling tasks were improved on both intervention arms , but staff on the mechanical equipment arm showed greater improvements . Musculoskeletal injury rates were not significantly altered . Conclusions . The “ no strenuous lifting ” program , which combined training with assured availability of mechanical and other assistive patient h and ling equipment , most effectively improved comfort with patient h and ling , decreased staff fatigue , and decreased physical dem and s. The fact that injury rates were not statistically significantly reduced may reflect the less sensitive nature of this indicator compared with the subjective indicators PURPOSE Athletic performance dem and s simultaneous use of cognitive and postural control capabilities . Decrements to both systems have been observed following concussion . This study evaluated a dual-task methodology to establish the tenability of using this testing model in concussed athletes . METHODS Nonconcussed subjects were assessed over 2 d. Subjects were introduced to the task-switching cognitive assessment test and a NeuroCom Smart Balance Master postural control assessment protocol on day 1 . In the following session , subjects were evaluated on  postural control and cognitive function tests independently ( single task ) , and then concurrently ( dual task ) . RESULTS Significant improvements were seen in three of the four balance conditions and in three of the four reaction times when the cognitive and balance task were performed simultaneously ( P<0.05 ) . No significant balance by cognitive task interaction was revealed ( P>0.05 ) ; however , significant differences existed in reaction time based on stimulus position and increasing balance dem and s ( P<0.05 ) . CONCLUSION Combining the cognitive and balance assessment s result ed in healthy subjects showing improved performance when compared with individual task performance . The dual-task methodology brought about systematic changes to reaction time in relation to increasing balance dem and s. The ability of this protocol to detect changes in postural control or cognitive function following concussive injury requires further study Objectives : To examine the efficacy of a participatory ergonomics intervention in preventing musculoskeletal disorders among kitchen workers .  Participatory ergonomics is commonly recommended to reduce musculoskeletal disorders , but evidence for its effectiveness is sparse . Methods : A cluster r and omised controlled trial among the 504 workers of 119 kitchens in Finl and was conducted during 2002–2005 . Kitchens were r and omised to an intervention ( n = 59 ) and control ( n = 60 ) group . The duration of the intervention that guided the workers to identify strenuous work tasks and to seek solutions for decreasing physical and mental workload , was 11 to 14 months . In total , 402 ergonomic changes were implemented . The main outcome measures were the occurrence of and trouble caused by musculoskeletal pain in seven anatomical sites , local fatigue after work , and sick leave due to musculoskeletal disorders . Individual level data were collected by a question naire at baseline and every 3 months during the intervention and 1-year follow-up period . All response rates exceeded 92 % . Results : No systematic differences in any outcome variable were found between the intervention and control groups during the intervention or during the 1-year follow-up . Conclusions : The intervention did not reduce perceived physical work load and no evidence was found for the efficacy of the intervention in preventing musculoskeletal disorders among kitchen workers . It may be that a more comprehensive re design of work organisation and processes is needed , taking more account of workers ’ physical and mental re sources Musculoskeletal injuries are a common presentation to the ED , with significant costs involved in the management of these injuries , variances in care within the ED and associated morbidity . A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED . This paper presents the methodology used across the rapid review s. PubMed , CINAHL , EMBASE , TRIP and the grey literature , including relevant organisational websites , were search ed in 2015 . The search was repeated consistently for each topic area ( injuries of the foot and ankle , knee , h and and wrist , elbow , shoulder , lumbar spine and cervical spine ) . English- language primary studies , systematic review s and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion . Data extraction of each included article was conducted , followed by a quality appraisal . The extracted data from each article was synthesis ed to group similar evidence together . For each rapid review , the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED , such as the assessment , diagnostic tests , management and follow-up considerations from ED . The series of rapid review s are design ed to foster evidence -based practice within the ED , targeting the injuries most commonly presenting . The review s provide clinicians in EDs with rapid access to the best current evidence , which has been synthesis ed and organised to assist decision-making UNLABELLED This study compares the outcomes of an individually tailored behavioral medicine intervention ( experimental ) with physical exercise therapy ( control ) . The experimental intervention was systematic ally individualized according to each participant 's behavioral treatment goals and functional behavioral analyses . One hundred twenty-two patients seeking care at 3 primary health care clinics because of musculoskeletal pain were r and omized . Ninety-seven completed the trial . Data were collected at baseline , immediately after treatment , and at a 3-month follow-up . Analyses of data from completers , as well as intention-to-treat analyses , showed that the experimental group experienced lower levels of disability ( P = .01 ) , lower maximum pain intensity ( P = .02 ) , higher levels of pain control ( P = .001 ) , and lower fear of movement ( P = .022 ) as a result of treatment condition . Self-efficacy ( P = .0001 ) and physical performance ( P = .0001 ) increased over time for both groups . Participants in the experimental group generally reported more positive effects after treatment . Treatment fidelity was maintained during the course of the study . Activity can be resumed and pain might be managed by the patients themselves if treatment incorporates the biopsychosocial explanatory model of pain and strategies are tailored according to individual 's priorities of everyday life activities and empirically derived determinants of pain-related disability . PERSPECTIVE This study shows that the biomedical and the psychosocial perspectives of the experiences and consequences of pain complement rather than contradict each other . Primary health care patients with persistent musculoskeletal pain benefit more from a systematic tailoring of treatments according to biopsychosocial factors than from a physically based exercise intervention PURPOSE The purpose of this study was to identify rates of diagnosis-specific musculoskeletal injuries in U.S. Marine Corps recruits and to examine the association between patterns of physical training and these injuries . METHODS Subjects were 1,296 r and omly selected male Marine recruits , ages 17 to 28 yr , who reported to Marine Corps Recruit Depot San Diego for boot camp training between January 12 and September 14 , 1993 . Recruits were followed prospect ively through 12 wk of training for injury outcomes . Injury patterns were examined in relation to weekly volumes and types of vigorous physical training . RESULTS The overall injury rate was 39.6 % ( number of recruits injured/ population at risk ) , with 82 % of injuries occurring in the lower extremities . Overuse injuries accounted for 78 % of the diagnoses . The most frequent site of injury was the ankle/foot region ( 34.3 % of injuries ) , followed by the knee ( 28.1 % ) . Ankle sprains ( 6.2 % , N = 1,143 ) , iliotibial b and syndrome ( 5.3 % , N = 1,143 ) , and stress fractures ( 4.0 % , N = 1,296 ) were the most common diagnoses . Injury rates were highest during the weeks with high total volumes of vigorous physical training and the most hours of running and marching . Weekly injury rates were significantly correlated with hours of vigorous physical training ( overuse injuries r = 0.667 , P = 0.018 ; acute injuries r = 0.633 , P = 0.027 ) . CONCLUSIONS The results of this controlled epidemiological investigation indicate that volume of vigorous physical training may be an etiologic factor for exercise-related injuries . The findings also suggest that type of training , particularly running , and abrupt increases in training volume may further contribute to injury risk & NA ; Psychological treatments for chronic pain , particularly those based upon cognitive behavioural principles , have generally been shown to be efficacious . Recently , a treatment has been developed based upon the fear‐avoidance model of chronic musculoskeletal pain , which suggests chronic pain can be relieved by exposing the individual to movements and tasks that have been avoided due to fear of (re)injury . This grade d in vivo exposure treatment has been found to be beneficial in case studies . The present investigation utilized a r and omized controlled trial method to assess the effectiveness of grade d in vivo exposure relative to other conditions . Forty‐four chronic low back pain patients were r and omly assigned to grade d in vivo exposure , grade d activity , or a wait‐list condition . While only trend differences were observed for pain‐related disability , patients in the grade d in vivo exposure condition demonstrated ( a ) significantly greater improvements on measures of fear of pain/movement , fear avoidance beliefs , pain‐related anxiety , and pain self‐efficacy when compared to those in the grade d activity condition , and ( b ) significantly greater improvements on measures of fear‐avoidance beliefs , fear of pain/movement , pain‐related anxiety , pain catastrophising , pain experience , and anxiety and depression when compared to those in the wait‐list control condition . Additionally , patients in the grade d in vivo exposure condition maintained improvements in these areas at one month follow‐up . Implication s of these findings for the treatment of individuals with chronic low back and other pain conditions are discussed BACKGROUND Lower extremity stiffness is thought to be an important factor in musculoskeletal performance . However , too little or too much stiffness is believed to increase the risk of musculoskeletal injury . PURPOSE To provide a current up date of the lower extremity stiffness literature as it pertains to both performance and injury . SUMMARY It appears that increased stiffness is beneficial to performance . As well it appears that there may be an optimal amount of stiffness that allows for injury-free performance . There is some evidence that increased stiffness may be related to bony injuries and decreased stiffness may be associated with soft tissue injuries . Further investigations should evaluate the relationship between stiffness and injury prospect ively . Initial reports suggest that stiffness can be modified in response to the external environment or verbal cues . RELEVANCE A greater underst and ing of the role of stiffness in both performance and injury will provide a stronger foundation for the development of optimal training intervention programs Physical and cognitive training seem to counteract age-related decline in physical and mental function . Recently , the possibility of integrating cognitive dem and s into physical training has attracted attention . The purpose of this study was to evaluate the effects of twelve weeks of design ed physical-cognitive training on executive cognitive function and gait performance in older adults . Thirty-six healthy , active individuals aged 72.30 ± 5.84 years were assigned to two types of physical training with major focus on physical single task ( ST ) training ( n = 16 ) and physical-cognitive dual task ( DT ) training ( n = 20 ) , respectively . They were tested before and after the intervention for executive function ( inhibition , working memory ) through R and om Number Generation and for gait ( walking with/without negotiating hurdles ) under both single and dual task ( ST , DT ) conditions . Gait performance improved in both groups , while inhibitory performance decreased after exercise training with ST focus but tended to increase after training with physical-cognitive DT focus . Changes in inhibition performance were correlated with changes in DT walking performance with group differences as a function of motor task complexity ( with/without hurdling ) . The study supports the effectiveness of group exercise classes for older individuals to improve gait performance  , with physical-cognitive DT training selectively counteracting the age-related decline in a core executive function essential for daily living The risk for the development of musculoskeletal disorders and associated conditions in clerical and office workers is well documented . The majority of work injury prevention programs for this population were single-faceted ( education , workstation re design , or task modification ) and yielded both positive and negative findings . This pilot study was conducted with 16 full-time clerical and office workers at a small private college . In a r and omized control trial , the intervention group received four hours of individualized training through a multi-faceted injury prevention program . Between group differences in musculoskeletal symptom frequency and intensity and perceived stress and energy levels existed , although were statistically insignificant . There was a statistically significant decrease in Lower Back ache/pain from pre to post measures for the intervention group Background Depression is a common comorbidity in individuals with cognitive impairment . Those with cognitive impairments face unique challenges in receiving the benefits of many conventional therapies for depression , and may have poorer outcomes in areas such as recovery and quality of life . However , the stigmatization of mental health disorders , cost barriers and physical disabilities may prevent these individuals from seeking mental health care . An online , self-help intervention specifically developed for adults with cognitive deficits and depression may be particularly beneficial to this population . We aim to inform the design of such an intervention through a systematic review by answering the following research question : among adults with cognitive impairment ( including those with acquired brain injuries or neurodegenerative diseases ) , which technology-amenable interventions have been shown to effectively decrease symptoms of depression ? Specifically , psychotherapeutic and /or behavioural interventions that could be delivered in a self-guided , online system will be included . Methods Comprehensive electronic search es will be conducted in MEDLINE , EMBASE , PsycINFO and CINAHL . Additional studies will be obtained through manually search ing the references of relevant systematic review s , contacting primary authors of select articles and tracking conference proceedings and trial registries . Article titles and abstract s will be screened using predefined eligibility criteria , and then judged for their amenability to the proposed self-help , technology-based intervention . The full text of those articles with selected interventions will then be screened to determine final eligibility for inclusion . Included articles will be categorized by intervention type and assessed for risk of bias using the Cochrane Effective Practice and Organization of Care Risk of Bias tool for non-r and omized trials , controlled before-after studies and interrupted time series . The primary outcome will be a change in score on a vali date d depression scale , and adverse events will be documented as a secondary outcome . After data extraction from selected articles , pooling of data and meta- analysis will be conducted if a sufficient pool of studies with comparable methodology and quality are identified . Alternatively , plain language summaries will be developed . The quality of evidence will be assessed using the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) system . Systematic review registration PROSPERO BACKGROUND Chronic musculoskeletal pain is prevalent among laboratory technicians and work-related stress may aggravate the problem . OBJECTIVES This study investigated the effect of a multifaceted worksite intervention on pain and stress among laboratory technicians with chronic musculoskeletal pain using individually tailored physical and cognitive elements . STUDY DESIGN This trial uses a single-blind r and omized controlled design with allocation concealment in a 2-armed parallel group format among laboratory technicians . The trial " Implementation of physical exercise at the Workplace (IRMA09)--Laboratory technicians " was registered at Clinical Trials.gov prior to participant enrolment . SETTING The study was conducted at the head division of a large private pharmaceutical company 's research and development department in Denmark . The study duration was March 2014 ( baseline ) to July 2014 ( follow-up ) . METHODS Participants ( n = 112 ) were allocated to receive either physical , cognitive , and mindfulness group-based training ( PCMT group ) or a reference group ( REF ) for 10 weeks at the worksite . PCMT consisted of 4 major elements : 1 ) resistance training individually tailored to the pain affected area , 2 ) motor control training , 3 ) mindfulness , and 4 ) cognitive and behavioral therapy/education . Participants of the REF group were encouraged to follow ongoing company health initiatives . The predefined primary outcome measure was pain intensity ( VAS scale 0 - 10 ) in average of the regions : neck , shoulder , lower and upper back , elbow , and h and at 10 week follow-up . The secondary outcome measure was stress assessed by Cohen´s perceived stress question naire . In addition , an explorative dose-response analysis was performed on the adherence to PCMT with pain and stress , respectively , as outcome measures . RESULTS A significant ( P < 0.0001 ) treatment by time interaction in pain intensity was observed with a between-group difference at follow-up of -1.0 ( 95%CI : -1.4 to -0.6 ) . No significant effect on stress was observed ( treatment by time P = 0.16 ) . Exploratory analyses for each body region separately showed significant pain reductions of the neck , shoulders , upper back and lower back , as well as a tendency for h and pain . Within the PCMT group , general linear models adjusted for age , baseline pain , and stress levels showed significant associations for the change in pain with the number of physical-cognitive training sessions per week ( -0.60 [ 95%CI -0.95 to -0.25 ] ) and the number of mindfulness sessions ( 0.15 [ 95%CI 0.02 to 0.18 ] ) . No such associations were found with the change in stress as outcome . LIMITATIONS Limitations of behavioral interventions include the inability to blind participants to which intervention they receive . Self-reported outcomes are a limitation as they may be influenced by placebo effects and outcome expectations . CONCLUSIONS We observed significant reductions in chronic musculoskeletal pain following a 10-week individually adjusted multifaceted intervention with physical training emphasizing dynamic joint mobility and mindfulness coupled with fear-avoidance and de-catastrophizing behavioral therapy compared to a reference group encouraged to follow on-going company health initiatives . A higher dose of physical-cognitive training appears to facilitate pain reduction , whereas a higher dose of mindfulness appears to increase pain . Hence , combining physical training with mindfulness may not be an optimal strategy for pain reduction . TRIAL REGISTRATION NCT02047669 Background Medically treated injuries have been shown to increase with increasing body mass index ( BMI ) . Information is lacking on the frequency and type of injuries and illnesses among overweight and obese adults who engage in regular physical activities as part of weight loss or weight gain prevention programs . Methods Sedentary adults with BMI s between 25 and 40 kg/m2 ( n = 397 ) enrolled in one of two r and omized clinical trials that emphasized exercise as part of a weight loss or weight gain prevention program . Interventions differed by duration of the exercise goal ( 150 , 200 , or 300 minutes/week or control group ) . Walking was prescribed as the primary mode of exercise . At six month intervals , participants were asked , " During the past six months , did you have any injury or illness that affected your ability to exercise ? " Longitudinal models were used to assess the effects of exercise and BMI on the pattern of injuries/illnesses attributed to exercise over time ; censored linear regression was used to identify predictors of time to first injury/illness attributed to exercise . Results During the 18-month study , 46 % reported at least one injury/illness , and 32 % reported at least one injury that was attributed to exercise .  Lower-body musculoskeletal injuries ( 21 % ) were the most commonly reported injury followed by cold/flu/respiratory infections ( 18 % ) and back pain/injury ( 10 % ) . Knee injuries comprised one-third of the lower-body musculoskeletal injuries . Only 7 % of the injuries were attributed to exercise alone , and 59 % of the injuries did not involve exercise . BMI ( p ≤ 0.01 ) but not exercise ( p ≥ 0.41 ) was significantly associated with time to first injury and injuries over time . Participants with higher BMI s were injured earlier or had increased odds of injury over time than participants with lower BMI s. Due to the linear dose-response relationship between BMI and injury/illness , any weight loss and reduction in BMI was associated with a decrease risk of injury/illness and delay in time to injury/illness . Conclusions Overweight and obese adults who were prescribed exercise as part of weight loss or weight gain prevention intervention were not at increased risk of injury compared to overweight adults r and omized not to participate in prescribed exercise . Since onset of injury/illness and pattern of injuries over time in overweight and obese individuals were attributed to BMI , weight reduction may be an avenue to reduce the risk of injury/illness in sedentary and previously sedentary overweight and obese adults . Trial Registration Clinical trials.gov NCT00177502 and Patients with severe traumatic brain injury ( TBI ) frequently suffer from a difficulty in dealing with two tasks simultaneously . However , there has been little research on the rehabilitation of divided attention . The objective of the present study was to assess the effectiveness of a rehabilitation programme for divided attention after severe TBI . Twelve patients at a subacute/chronic stage after a severe TBI were included . A r and omised AB vs. BA cross-over design was used . Training lasted six weeks , with four one-hour sessions per week . It was compared to a non-specific ( control ) cognitive training . During experimental treatment , patients were trained to perform two concurrent tasks simultaneously . Each one of the two tasks was first trained as a single task , then both tasks were given simultaneously . A progressive hierarchical order of difficulty was used , by progressively increasing task difficulty following each patient 's individual improvement . Patients were r and omised in two groups : one starting with dual-task training , the other with control training . Outcome measures included target dual-task measures , executive and working memory tasks , non-target tasks , and the Rating Scale of Attentional Behaviour addressing attentional problems in everyday life . Assessment was not blind to treatment condition . A significant training-related effect was found on dual-task measures and on the divided attention item of the Rating Scale of Attentional Behaviour . There was only little effect on executive measures , and no significant effect on non-target measures . These results suggest that training had specific effects on divided attention and helped patients to deal more rapidly and more accurately with dual-task situations BACKGROUND The risk of musculoskeletal injury with the introduction of moderate-to-vigorous exercise in sedentary adults is not well established . The purpose of this report is to examine the effect of a 12-month exercise intervention on musculoskeletal injury and bodily pain in predominately overweight , sedentary men ( n = 102 ) and women ( n = 100 ) , ages 40 to 75 years . METHODS Participants were r and omized to a moderate-to-vigorous aerobic exercise intervention ( EX )  ( 6 d/wk , 60 min/d , 60 % to 85 % max . heart rate ) or usual lifestyle control ( CON ) . Participants completed a self-report of musculoskeletal injury and body pain at baseline and 12-months . RESULTS The number of individuals reporting an injury ( CON ; 28 % vs. EX ; 28 % , P = .95 ) did not differ by group . The most commonly injured site was lower leg/ankle/foot . The most common causes of injury were sports/physical activity , home maintenance , or " other . " In the control group , bodily pain increased over the 12 months compared with the exercise group ( CON -7.9 , EX -1.4 , P = .05 ) . Baseline demographics and volume of exercise were not associated with injury risk . CONCLUSIONS Previously sedentary men and women r and omized to a 12-month aerobic exercise intervention with a goal of 360 min/wk reported the same number of injuries as those in the control group and less bodily pain Cognitive task-evoked pupillary responses reliably index information-processing loads . However , previous studies have reported inconsistent findings regarding the nature of the pupillary response when processing dem and s approach or exceed available processing re sources . This condition was examined in 22 normal undergraduates by using pupillometric recordings during a digit span recall task , with 5 ( low load ) , 9 ( moderate load ) , and 13 ( excessive load ) digits per string .  Pupillary responses increased systematic ally with increased processing load ( to-be-recalled digits ) until the limit of available re sources ( memory capacity of 7 + /- 2 digits ) , when they reached asymptote and then declined with re source overload ( > 9 digits ) . These findings suggest that pupillary responses increase systematic ally with increased processing dem and s that are below re source limits , change little during active processing at or near re source limits , and begin to decline when processing dem and s exceed available re sources Event-related  potentials ( ERPs )  can eluci date aspects of sensory and cognitive processing that have been compromised due to closed head injury . We present the results of two investigations , one previously unreported , in which we used ERPs to evaluate information processing in head-injury survivors . In the first study , we used visual and auditory reaction time tasks differing in attentional dem and s to assess processing after head trauma . We found numerous changes in auditory processing in survivors : longer reaction times ( but normal accuracy ) , longer N200 and P300 latencies , and reduced N100 and N200 amplitudes . In contrast , on visual tasks , only reduced N200 amplitude distinguished survivors and controls . To increase attentional dem and s , in a second study , we administered the continuous performance test ( CPT ) . Survivors performed with lower accuracy than controls on visual and auditory tasks , and their ERPs were characterized by smaller visual and auditory N200s and P300s and smaller auditory N100s . We also present a synthesis , derived from a review of the literature , of closed head-injury effects on ERPs . Our own findings are in agreement with that synthesis . Namely , cognitive ERP components are more sensitive than sensory components to the effects of trauma . Specifically , in survivors , the amplitudes of N200 and P300 are often reduced , and their latencies prolonged . In general , as compared with visual ERPs , auditory ERPs may be more susceptible to the effects of closed head injury , suggesting that the auditory processing system is more vulnerable than the visual system . We conclude by discussing the potential use of  ERPs  to monitor clinical course and recovery in survivors of closed head injury CONTEXT The Functional Movement Screen ( FMS ) evaluates performance in 7 fundamental movement patterns using a 4-point scale . Previous studies have reported increased injury risk with a composite score ( CS ) of 14/21 or less ; these studies were limited to specific sports and injury definition . OBJECTIVE To examine the association between  FMS CS and movement pattern scores and acute noncontact and overuse musculoskeletal injuries in division I college athletes . An exploratory objective was to assess the association between injury and FMS movement pattern asymmetry . DESIGN Prospect i ve cohort . SETTING College athletic facilities . PARTICIPANTS 167 injury-free , college basketball , football , volleyball , cross country , track and field , swimming/ diving , soccer , golf , and tennis athletes ( males = 89 ) . INTERVENTION The FMS was administered during pre-participation examination . MAIN OUTCOME MEASURE Noncontact or overuse injuries that required intervention from the athletic trainer during the sport season . RESULTS FMS CS was not different between those injured ( n = 74 ; 14.3 ± 2.5 ) and those not ( 14.1 ± 2.4 ; P = .57 ) . No point on the ROC curve maximized sensitivity and specificity ; therefore previously published cut-point was used for analysis with injury ( ≤ 14 [ n = 92 ] ) . After adjustment , no statistically significant association between FMS CS and injury ( odds ratio [ OR ] = 1.01 , 95 % CI 0.53 - 1.91 ) existed . Lunge was the only movement pattern that was associated with injury ; those scoring 2 were less likely to have an injury vs those who scored 3 ( OR = 0.21 , 95 % CI 0.08 - 0.59 ) . There was also no association between FMS movement pattern asymmetry and injury .  CONCLUSION FMS CS , movement patterns , and asymmetry were poor predictors of noncontact and overuse injury in this cohort of division I athletes Background Down syndrome ( DS ) has unique physical , motor and cognitive characteristics . Despite cognitive and motor difficulties , there is a possibility of intervention based on the knowledge of motor learning  . However , it is important to study the motor learning process in individuals with DS during a virtual reality task to justify the use of virtual reality to organize intervention programs . The aim of this study was to analyze the motor learning process in individuals with DS during a virtual reality task . Methods A total of 40 individuals participated in this study , 20 of whom had DS ( 24 males and 8 females , mean age of 19 years , ranging between 14 and 30 yrs . ) and 20 typically developing individuals ( TD ) who were matched by age and gender to the individuals with DS . To examine this issue , we used software that uses 3D images and reproduced a coincidence-timing task . Results The results showed that all individuals improved performance in the virtual task , but the individuals with DS that started the task with worse performance showed higher difference from the beginning . Besides that , they were able to retain and transfer the performance with increase of speed of the task . Conclusion Individuals with DS are able to learn movements from virtual tasks , even though the movement time was higher compared to the TD individuals . The results showed that individuals with DS who started with low performance improved coincidence- timing task with virtual objects , but were less accurate than typically developing individuals . Trial registration Clinical Trials.gov Identifier : NCT02719600
Conclusion The results of this systematic review indicate that motor performance is further impaired by placing a cognitive load on individuals in population s with musculoskeletal injury .
More dem and ing tasks such as gait appear to be more affected in injured individuals than simple balance tasks .
Background Research suggests that individuals with musculoskeletal injury may have difficulty negotiating physical tasks when they are combined with cognitive loads .
Objective Our objective was to conduct a systematic review to underst and the effects of increased cognitive dem and on movement patterns among individuals with musculoskeletal injuries .