OSCE Papers

Milanese et al. 2014

P:

• 6 Patients

I/C:

• Measured accuracy of Smartphone app vs goniometer - 18 positions in knee flexion measured

O:

• Both methods had high inter + intra relater reliability + Validity + No difference in accuracy between experience levels of physio, Phone app even slightly more accurate (marginal)

Limitations:

• Only used R knee joint + healthy subjects

Tell me about a paper for Goniometry testing reliability

Bohannon 2008

P:

• Systematic Review of strides - 45

I/C:

• Grip Strength as outcome predictor +can predict mortality, disability + hospital LOS

O: 

• Low grip strength = high frailtty + Strength loss = all the otther issues

Limitations:

• Lack of standardised protocols

• Different studies gave different str. cutoff points (Benton et al. 2022)

Tell me about a paper for HGD testing - why is HGD useful?

Baghari et al. 2025

P:

• 60 Overweight/ obese men

I/C:

• Measures taken: Body comp / strength/ power? / blood/ inflammatory markers

• Randomly assigned to one of 4 groups: No exercise vs upper vs lower vs combined - 12 weeks 3x per week

O:

• Combined - most effective for body comp + muscular performance + inflammatory marker reduction

Limitations:

• Only male,

• non blinded,

• no comorbidities

Treatment for symptoms of Obeisity - Study

Bohannon 2001

P:

• 128 acute rehab patients (Stroke, surgery or cancer)

I/C: 

• MMT Compared to HHD scores - Grading MMT 0-5 - HHD Oxford 0-12

• Knee Extensor

O:

• Good concurrent validity, Highly correlated

Limitations:

• Measurements less concurrent on lower grades

Paper for reliability of MMT

Singla + Vequar 2014

P:

• Narrative review on postural assessment for sports people

O:

• Visual observation: No equipment + subjective

• Goniometry: Objective + high reliability

• X-ray: GOLD standard + costly + invasive

• Photogrammetry: Highly reliable + costly

Limitations:

• Sports people only

• Narrative review

Paper to support postural assessment

ACSM, 2011

O:
- 1. CV exercise (aerobic): 30 mins 5d/wk (150 min moderate

or

• Or at least 3 days of 75 mins vigorous.

• + muscle straighten 2+ dpw

3. Flexibility: 2-3d/wk

4. Neuromotor training (balance, agility + co-ordination, proprioception): 2-3 d/wk,

Guidelines for exercise prescription for adults of all ages

Fragala et al. 2019

O:

• Position statement National strength and conditioning association - 50+ year olds

I/C:

Healthy:

• 2-3 sets of 1-2 multijoint compound exercises 2-3x per week - 70-85% of 1RM

Frail:

• 1 set of 12-15 reps of 1-2 multijoint 2-3x per week, low intensity 20-30% 1RM

OA:

• 2-3 sets, 6-8 reps 65-75% 1RM

OP:

• 2-3 sets, 8-12 reps - low intensity

Benefits:

• Strength, muscle mass reduced inflammation + mobility, gait speed and reduced falls risk reduced depression and anxiety, improved QOL.

• NB = 2-3x per week, large muscle groups.. Start at 55% 1RM progress to 80% RT Balance + Functional is best

Paper for exercise in Elderly

Harradine et al 2018

P:

• Systematic Review of 143 papers

I/C:

• Searching for standardized protocol for LL gait assessment

• Only 4 studies met inclusion criteria of: Adults with no instrument aids + Only MSK injuries

O:

• Evidence was low quality Outlines the need for standardised protocol for RTCGA, or else could lead to misdiagnosis

Limitations:

• Injured pop w msk issues only

• Nil studies with video recording

Gait Analysis - Paper!

Sherrington et al. 2019

P:

• Cochrane Review - 208 RCT’s on fall prevention programmes

O:

• Found over ½ of fall prevention programmes have insignificant fall reduction

Required for reduction:

• Balance + functional movement + resistance exercisem- reduces by 34%

• Tai chi reduces falls by 19%

• Str alone ineffective (as is walking or dance alone)

Limitations:

• Barely any

• Didn’t account for ADL’s influence outside of programmes

Falls Prevention programme paper

NICE Guidelines

P:

• For adults 65+ or 50+ with comorbidities

I/C:

• Assessment: Frailty, gait, medication

• Exercise (focus): Balance, co-irdination, strength, functional

O:

• Reduction in fear is NB

• Exercise - recommend the OTAGO program.

• Walking aids, environment changes (railings) + Education on falls risk prevention, walking frames if needed

Guidelines for Fall reduction + what programmes could be encouraged?

Bertrand et al. 2017

P:

• Systematic review of 13 Studies (canes, rollators,multiple types of walking aids)

• Qual + Quant = crossover

I/C:

• How walking aids enable PA and participation among adults with physical disabiliies

• Noted: Attitudes, perception, activity participation

O:

• Increasing the users BOS

• Wider and more stable platform.

• Somatosensory information: Increasing the feedback your body gets from the ground through the device.

• Reduces the load on the legs -> increases the users confidence and stability. Negatives:

• Social Stigma, makes some ADL's difficult.

• Positives:

• Increased Mobility, can speak while using - critical to address stigma

Limitations:

• Research quality issue: Most studies consisted of Low to moderate levels of evidence, with small sample sizes

• Focused more on canes and rollators than other aids 

• Lack of peer reviews in studies analysed

Discussing Walking aids - Cite a paper

Bartels et al. 2016

P:

• Systematic review of 13 RCTs

• Average BMI overweight

I/C:

• Px in hip or knee / OA

• 12 weeks of aqua therapy in 32-26 deg. pool

O:

• Pain scores decreased

• QOL up 13%

• No adverse effects!

Factors Involved:

• Boyancy, viscosity, hydrostatic pressure, water temp.

Limitations:
- Moderate evidence quality

• Short term outcomes

• Mostly females involved

Aqua Therapy relevant - Cite a paper

Beamish et al. 2024

P:

• Systematic review of 65 studies

I/C:

• post partum exercise vs none

O:

• Post-partum exercise reduced rates if urinary incontinence by 37%

• Pelvic floor muscle (PFM) training reduced pelvic organ prolapse by 56%

• Abdominal Exercise reduced rec. ab. Distance post partum.

Limitations:

• High heterogeneity between studies (different populations etc.)

Pregnancy Exercise Prescription - Cite a paper

Hoare et al. 2017

P:

• Qalitative - Survey

• P = 894 Ages 25-54

O:

Barriers:

• Lack of time

• Didn’t enjoy

• No friend to do with

• Prefer doing other things

Motivators:

• Weight loss

• Mental health

• Athletic Performance

Limitations:

• Self reported data

• High age range

Barriers to exercise/ Help in achieving buy in - Cite a paper

WHO Guidelines

I:

• Limit sedentary behaviour

O:

• Adults need 150-300 minutes of moderate aerobic exercise per week

• Or 75-150 mins of vigorous

• + 2 strength sessions

Older adults:

• As much as able in 10 minute bouts

• Focusing on functional balance + strength 3x per week

Post partum or Pregnant:

• 150 minutes moderate

General guidelines for activity levels that should be achieved? 

SMART Goal Guidelines

Specific

Measurable

Achievable

Relevant

Time Bound

E.g. - short term:

• Strength training 2x per week for 1 month

• + SLS for 10 seconds in 2 weeks

• Aerobic exercise 2x per week

Long term:

• Achieving WHO guidelines

• + Functional test outcomes

General paper for Goal setting? Cite a paper

Royal Osteoporosis society - Strong, Steady and Straight PA guidelines for OP

Strong: 3 x 8-12, 2-3x per week RT

Low or moderate - impact 20 mins

Most days = Jog, Jump, Stamp

Steady: Challenging Balance 2-3x per week

SLS, tandem walk

Straight: Back Strength - 2-3x week Hip Hinge, Pilates, Swim Avoid loaded flex + rotation

Osteoperosis Guidelines for exercise?

Canadian Guidelines for Physical Activity throughout Pregnancy 2019

• 150 Minutes of moderate intesity PA per week

• Should include aerobic, strength + yoga

• Should take place over 3 days min.

• Pelvic Floor Exercise advised

• High heat + humidity + Physical contact sport - avoid!

Individuals with higher exercise tolerance before pregnancy can have increased exercise allowances

Pregnancy Physical Activity Guidelines

Serra et al. 2015

P:

• 130 Healthy Adults

I/C:

6 Minute walk test vs. SF-36 Health survey PROM

How predictive has the survey for 6 min walk?

O:

Good 6 min walk test = Higher health QOL + Increased function

Limitations:

• QOL improvements in women with better 6 min walk test was higher/ present

• Very strict inclusion cirteria, non smoker, non obeise, non drinker, independant

6 Minute walk test justification

Khuna et al. 2024 - Corss sectional

P:

60 Patients - 60+ years old - Knee OA

I:

5x STS and 30s STS

C:

Knee muscle strength with HHD

O:

Good recurrent validity, re-test reliability, inter-rater + Intra-rater for both!

Significantly correlated with knee flexor and extensor strength

Limitations:

Only Knees

No grading of the OA

Sit to stand justification

5 warmup exercises

5 strength

12 Balance

Do for 6 months minimum 3x per week

• 2 walks a week 30 mins

Aligns with NICE guidelines of high dosage

Doesnt adhere to WHO aerobic guidelines

Fall programme for very frail individual

FAME Guidelines:

• 7 components

• Tai chi, floor strength, chair strength, Flexibility, Seated + standing strength, education, aerobic capacity

• Many supports - Peer support, professional support

Guidelines for mild fall risks

Mathiassen 2006

• Review Article/ Narrative Review

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Mathiassen defines variation as change in exposure across time and diversity as the extent that exposure entities differ, then reviews evidence and measurement approaches showing that jobs with little variation (long periods of similar postures/loads) are plausibly linked to increased risk of overuse and musculoskeletal disorders. He explains why promoting task variation or rotation should reduce continuous loading of the same tissues (and thereby reduce fatigue and injury risk), while also discussing methodological challenges in quantifying beneficial vs. harmful variability.

Paper For overuse injuries/prevention