This study aimed to review the literature describing and quantifying time lags in the health research translation process. Papers were included in the review if they quantified time lags in the development of health interventions. The study identified 23 papers. Few were comparable as different studies use different measures, of different things, at different time points. We concluded that the current state of knowledge of time lags is of limited use to those responsible for R&D and knowledge transfer who face difficulties in knowing what they should or can do to reduce time lags. This effectively ‘blindfolds’ investment decisions and risks wasting effort. The study concludes that understanding lags first requires agreeing models, definitions and measures, which can be applied in practice. A second task would be to develop a process by which to gather these data.

The Answer Is 17 Years, What Is the Question

Synopsis During the last decade, there has been a growing body of literature suggesting that proximal factors may play a contributory role with respect to knee injuries. A review of the biomechanical and clinical studies in this area indicates that impaired muscular control of the hip, pelvis, and trunk can affect tibiofemoral and patellofemoral joint kinematics and kinetics in multiple planes. In particular, there is evidence that motion impairments at the hip may underlie injuries such as anterior cruciate ligament tears, iliotibial band syndrome, and patellofemoral joint pain. In addition, the literature suggests that females may be more disposed to proximal influences than males. Based on the evidence presented as part of this clinical commentary, it can be argued that interventions which address proximal impairments may be beneficial for patients who present with various knee conditions. More specifically, a biomechanical argument can be made for the incorporation of pelvis and trunk stability, as we...

https://www.jospt.org/doi/pdf/10.2519/jospt.2010.3337

The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective

Foundations of Clinical Research: Applications to Practice, 2nd Edition, Leslie Gross Portney, Mary P. Watkins. Prentice Hall, Upper Saddle River, NJ (2000), 752 pages. $60

### Background

Youth sport participation offers many benefits including the development of self-esteem, peer socialisation and general fitness. However, an emphasis on competitive success, often driven by goals of elite-level travel team selection, collegiate scholarships, Olympic and National team membership and even professional contracts, has seemingly become widespread. This has resulted in an increased pressure to begin high-intensity training at young ages. Such an excessive focus on early intensive training and competition at young ages rather than skill development can lead to overuse injury and burnout.

### Purpose

To provide a systematic, evidenced-based review that will (1) assist clinicians in recognising young athletes at risk for overuse injuries and burnout; (2)delineate the risk factors and injuries that are unique to the skeletally immature young athlete; (3) describe specific high-risk overuse injuries that present management challenges and/or can lead to long-term health consequences; (4) summarise the risk factors and symptoms associated with burnout in young athletes; (5)provide recommendations on overuse injury prevention.

### Methodology

Medical Subject Headings (MeSHs) and text words were searched on 26 March 2012 from MEDLINE, CINAHL and PsycINFO. The search yielded 953 unique articles. Additional articles were found using cross-referencing. The process was repeated on 10 July 2013 to review any new articles since the original search. Screening by the authors yielded a total of 208 relevant sources that were used for this article. Recommendations were classified using the Strength of Recommendation Taxonomy (SORT) grading system.

### Definition of overuse injury

Overuse injuries occur due to repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place. Injury can involve the muscle-tendon unit, bone, bursa, neurovascular structures and the physis. Overuse injuries unique to young athletes include apophyseal injuries and physeal stress injuries.

### Epidemiology

It is estimated that 27 million US youth between 6 and 18 years of age participate in …

https://bjsm.bmj.com/content/bjsports/48/4/287.full.pdf

Overuse Injuries and Burnout in Youth Sports: APositionStatementfromtheAmericanMedicalSocietyfor Sports Medicine

Do you need to read published papers? Or are you a scientific paper non-reader or recluse? This book (very thoughtfully) starts off by asking whether you need to read this book—how many textbooks actually ask you whether you need to use/read/buy it? The need for such a book is certainly there, as this excellent little book is intended to help existing readers read, and actually interpret, medical papers better. Current non-readers and scientific recluses may even be encouraged to open medical journals for once! The book provides an excellent practical and pragmatic approach to critical analysis of much of the uninspiring and unread published literature (which often makes you wonder how it got into print in the first place!). There is a systematic discussion on evidence-based medicine and a thoughtful practical section on how to search the medical literature. Despite the age of the Internet and computerised databases, even the most experienced Medline surfer often only manages to find approximately a third of the published material on a particular subject—handy tips are provided to improve searches, to increase one’s gain and to reduce eye strain or repetitive strain injury from a long, tiring session at the Medline computer terminal. The book describes the various sections of a published paper, including appraisal of the nature of the study and statistics for the non-statistician. It then discusses what you would hope to gain from reading a particular paper, including papers that report drug trials, diagnostic screening tests, systematic reviews and guidelines. It also has information on economic analyses and qualitative research. Finally, it gives some examples of how to implement evidence-based findings. Since much of clinical medicine is still not evidence-based, perhaps this goes some way to rectify this appalling state of affairs. I also found the Appendix with a checklist for finding, appraising and implementing evidence fairly helpful. Readers of this excellent book who are like me — struggling to understand much of the published literature and also to produce an intelligible published paper every so often—this book not only helps you read a paper but tries to make you a better paper writer as well. Perhaps my understanding of evidence-based medicine will improve after reading this book, and make me a better teacher and researcher. Perhaps it will make me reject more of the papers submitted to the journal I help edit! At the cost of £14.95, this book is an absolute bargain and it fulfils its advertised aim of being a compressed introduction to the usefulness and potential applications of evidence-based medicine in the clinical setting. I recommend it wholeheartedly as an obligatory read.

How the Read a Paper: The Basics of Evidence Based Medicine

https://bjsm.bmj.com/content/bjsports/53/3/148.full.pdf

Infographic: Recommendations for running injuries

The Immediate Effects Of Foot Orthoses On Functional Performance In Individuals With Patellofemoral Pain Syndrome: 1071

BACKGROUND
Strategies are needed to improve referral into, and uptake of, osteoarthritis (OA) management programs. This survey investigated and compared patients' and medical professionals' views around hip and knee OA management and factors impacting implementation of an osteoarthritis management program.


METHODS
As part of a mixed-methods program of research, patients with hip or knee OA and medical professionals routinely involved in the management of OA, were invited to complete a comprehensive online survey. All data were analysed descriptively or using chi squared tests. Survey findings for factors perceived to impact implementation of an OA management programme were triangulated with previously reported qualitative data.


RESULTS
Fifty-three patients (38 females, 15 males) and 32 medical professionals (orthopaedic surgeons, sports physicians, rehabilitation physicians, rheumatologists and general practitioners) completed the survey. Twenty-eight patients (53%) had prior participation in the OA management programme (GLA:D® ) and 19 medical professionals (59%) had previously referred patients to the programme. Of the participants with prior exposure, 21 patients (75%) and 15 medical professionals (79%) agreed the programme was beneficial. A higher proportion of medical professionals, compared to patients, believed weight loss (100% vs. 67%), injection therapy (50% vs. 21%), hip replacement (100% vs. 62%) and knee replacement (97% vs. 62%) were effective treatments, with no differences for all other treatments. The barriers and enablers identified for referral into, and participation in, an OA management programme mostly aligned to factors identified in previous related qualitative research. Divergent factors in the survey included patients concerns about doing exercise-therapy with 81% (higher than expected) not reporting any concerns about exercising, and 19% (lower than expected) concerned about their OA joint, such as making their pain worse.


CONCLUSIONS
This study has extended our understanding of barriers and enablers for referral into, and participation in, an OA management programme with a lower than expected number of patients being concerned about exercising due to their OA joint. Patients and medical professionals had positive views relating to the quality of the programme delivery, patient satisfaction and programme effectiveness. Medical professionals were more likely than patients to consider weight loss, injections and joint replacement as effective treatment options.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/msc.1698

A survey of patient and medical professional perspectives on implementing osteoarthritis management programs for hip and knee osteoarthritis.

Background: At 2 to 3 years after anterior cruciate ligament reconstruction (ACLR), the relationship between known modifiable osteoarthritis (OA) risk factors and recurrent knee injury is unknown. This study aimed to determine the odds of new or recurrent traumatic knee injury in a cohort of young female athletes with ACLR 2 to 3 years postsurgery compared with healthy control participants. Secondary objectives were to explore the relationships of moderate and vigorous physical activity (MVPA) and body mass index (BMI) with knee injury, and to document self-reported MVPA satisfaction and beliefs about OA. Study Design: Prospective cohort. Level of Evidence: Level 2. Methods: A total of 51 female athletes with unilateral ACLR 1 to 2 years previously and 51 age and sport-matched control participants underwent assessment of MVPA (GT3X accelerometers) and BMI. One year later, participants self-reported knee injuries. Bivariable conditional logistic regression explored the association between knee injury, MVPA, and BMI in each group (injury/control). Results: At 1-year follow-up (n = 101), 19.6% of the injured cohort and 6.0% of control participants sustained a new or recurrent knee injury. The odds of knee injury for the injury group increased 7-fold over controls [odds ratio (OR) = 7.00 (95% CI = 0.86, 56.90)], although this was not statistically significant. The OR for MVPA was 0.98 (95% CI = 0.93, 1.03) and BMI was OR = 1.24 (95% CI = 0.85, 1.82). Half (56.0%) of injury participants and 66% of controls were satisfied with their MVPA; 81.6% of injury participants believed they had increased knee OA risk compared with someone who had never had a knee injury. Conclusion: In the 2 to 3 years after ACLR, 1 in 5 young female athletes had a new or recurrent knee injury. Based on the point estimate, injured participants were more likely to suffer a traumatic knee injury than matched control participants. MVPA and BMI were not associated with increased odds of knee injury. Clinical Relevance: Clinicians should be encouraged to have in-depth conversations with female athletes with previous ACLR regarding enjoyable and sustainable MVPA participation to promote long-term joint health.

New or Recurrent Knee Injury, Physical Activity, and Osteoarthritis Beliefs in a Cohort of Female Athletes 2 to 3 Years After ACL Reconstruction and Matched Healthy Peers

Abstract Objective Hip and knee osteoarthritis guidelines internationally provide consistent first‐line care recommendations. However, uptake of these recommendations remains suboptimal. This qualitative study explores factors influencing guideline‐based care from the perspectives of physiotherapists working in specialised osteoarthritis services across different models of care. Methods Nineteen semi‐structured interviews were conducted with physiotherapists working in specialist osteoarthritis services across three different Australian models of care (OsteoArthritis Hip and Knee Service n = 10; OsteoArthritis Chronic Care Programme n = 4; Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services n = 5). Interviews were audio recorded and transcribed verbatim. Data were coded and analysed inductively using thematic analysis. Results The overarching theme to emerge was that accessing first‐line osteoarthritis care is complex and difficult, regardless of model of care. Subthemes indicated that: (i) services are either unavailable or inadequately funded, (ii) referral pathways are labyrinthine and lengthy, (iii) patients and other health professionals often believe that surgery is the only/best option and (iv) managing patient co‐morbidities is challenging. Conclusion Physiotherapists working in specialised osteoarthritis services perceive multiple and complex factors influencing adherence to first‐line care. Barriers occur at various levels in all models of care, including patient and health professional beliefs, health service, and system levels. These results suggest improving healthcare for people with osteoarthritis requires urgent system reform.

Osteoarthritis management care pathways are complex and inefficient: A qualitative study of physiotherapist perspectives from specialised osteoarthritis services

Christian J Barton

Papers

Infographic: Recommendations for running injuries

The Immediate Effects Of Foot Orthoses On Functional Performance In Individuals With Patellofemoral Pain Syndrome: 1071

A survey of patient and medical professional perspectives on implementing osteoarthritis management programs for hip and knee osteoarthritis.

New or Recurrent Knee Injury, Physical Activity, and Osteoarthritis Beliefs in a Cohort of Female Athletes 2 to 3 Years After ACL Reconstruction and Matched Healthy Peers

Osteoarthritis management care pathways are complex and inefficient: A qualitative study of physiotherapist perspectives from specialised osteoarthritis services