OBJECTIVE: Children and young people (CYP) with cancer undergo painful and distressing procedures. We aimed to systematically review the effectiveness of nonpharmacological interventions to reduce procedural anxiety in CYP. METHODS: Extensive literature searches sought randomised controlled trials that quantified the effect of any nonpharmacological intervention for procedural anxiety in CYP with cancer aged 0 to 25. Study selection involved independent title and abstract screening and full text screening by two reviewers. Anxiety, distress, fear, and pain outcomes were extracted from included studies. Where similar intervention, comparator, and outcomes presented, meta-analysis was performed, producing pooled effect sizes (Cohen's d) and 95% confidence intervals (95% CI). All other data were narratively described. Quality and risk of bias appraisal was performed, based on the Cochrane risk of bias tool. RESULTS: Screening of 11 727 records yielded 56 relevant full texts. There were 15 included studies, eight trialling hypnosis, and seven nonhypnosis interventions. There were large, statistically significant reductions in anxiety and pain for hypnosis, particularly compared with treatment as usual (anxiety: d = 2.30; 95% CI, 1.30-3.30; P 

© 2018 Objectives: This prospective study investigated anatomical and biomechanical risk factors for second and third metatarsal stress fractures in military recruits during training. Design: Prospective cohort study. Methods: Anatomical and biomechanical measures were taken for 1065 Royal Marines recruits at the start of training when injury-free. Data included passive range of ankle dorsi-flexion, dynamic peak ankle dorsi-flexion and plantar pressures during barefoot running. Separate univariate regression models were developed to identify differences between recruits who developed second (n = 7) or third (n = 14) metatarsal stress fracture and a cohort of recruits completing training with no injury (n = 150) (p < 0.05). A multinomial logistic regression model was developed to predict the risk of injury for the two sites compared with the injury-free group. Multinomial logistic regression results were back transformed from log scale and presented in Relative Risk Ratios (RRR) with 95% confidence intervals (CI). Results: Lower dynamic arch index (high arch) (RRR: 0.75, CI: 0.63–0.89, p < 0.01) and lower foot abduction (RRR: 0.87, CI: 0.80–0.96, p < 0.01) were identified as increasing risk for second metatarsal stress fracture, while younger age (RRR: 0.78, CI: 0.61–0.99, p < 0.05) and later peak pressure at the second metatarsal head area (RRR: 1.19, CI: 1.04–1.35, p < 0.01) were identified as risk factors for third metatarsal stress fracture. Conclusions: for second metatarsal stress fracture, aspects of foot type have been identified as influencing injury risk. For third metatarsal stress fracture, a delayed forefoot loading increases injury risk. Identification of these different injury mechanisms can inform development of interventions for treatment and prevention.

© 2017 Informa UK Limited, trading as Taylor. &. Francis Group. Background: Third metatarsal stress fractures are relatively common during Royal Marines recruit training; however, their aetiology is poorly understood. Mathematical modelling of the third metatarsal may aid in understanding risk factors for stress fracture, particularly if the influence of footwear on peak bending stresses can be determined. This study built on previous models of metatarsal bending stress by integrating individual metatarsal geometry and gait data. Methods: Data from five males with size 11 (UK) feet were acquired. MRI images were digitised to determine cross-sectional bone parameters. Gait variables included vertical ground reaction forces, plantar pressure and foot orientation. The magnitude and location of peak bending stresses were calculated for barefoot running, before standard issue combat boots and trainers were compared. Findings: Estimated peak compressive, tensile and torsional stresses were greater in combat assault boots than in trainers (p < 0.05) with medium effect sizes but wide confidence intervals. However, differences in bone geometry between individuals had a much greater influence on estimated peak stresses. Interpretation: Results suggest that bone geometry has a greater influence on third metatarsal stress fracture risk than footwear. Future bone stress simulations should account for bone geometry. Further development of the model in a variety of participants should proceed to verify these suggestions.

Background/Aims: Analogy learning is a motor learning strategy that uses biomechanical metaphors to chunk together explicit rules of a to-be-learned motor skill. This proof-of-concept study aims to establish the feasibility and potential benefits of analogy learning in enhancing stride length regulation in people with Parkinson’s.
Methods: Walking performance of thirteen individuals with Parkinson’s was analysed using a Codamotion analysis system. An analogy instruction; “following footprints in the sand” was practiced over 8 walking trials. Single- and dual- (motor and cognitive) task conditions were measured before training, immediately after training and 4-weeks post training. Finally, an evaluation form was completed to examine the interventions feasibility.
Findings: Data from 12 individuals (6 females and 6 males, mean age 70, Hoehn and Yahr I-III) were analysed, one person withdrew due to back problems. In the single task condition, statistically and clinically relevant improvements were obtained. A positive trend towards reducing dual task costs after the intervention was demonstrated, supporting the relatively implicit nature of the analogy. Participants reported that the analogy was simple to use and became easier over time.
Conclusions: Analogy learning is a feasible and potentially implicit (i.e. reduced working memory demands) intervention to facilitate walking performance in people with Parkinson’s.

Plantar loading may influence comfort, performance and injury risk in soccer boots. This study investigated the effect of cleat configuration and insole cushioning levels on perception of comfort and in-shoe plantar pressures at the heel and fifth metatarsal head region. Nine soccer academy players (age 15.7 ± 1.6 years; height 1.80 ± 0.40 m; body mass 71.9 ± 6.1 kg) took part in the study. Two boot models (8 and 6 cleats) and two insoles (Poron and Poron/gel) provided four footwear combinations assessed using pressure insoles during running and 180° turning. Mechanical and comfort perception tests differentiated boot and insole conditions. During biomechanical testing, the Poron insole generally provided lower peak pressures than the Poron/gel insole, particularly during the braking step of the turn. The boot model did not independently influence peak pressures at the fifth metatarsal, and had minimal influence on heel loads. Specific boot-insole combinations performed differently (P 

Background: Tibial stress fractures cause a significant burden to Royal Marines recruits. No prospective running gait analyses have previously been performed in military settings.
Aim: We aimed to identify biomechanical gait factors and anthropometric variables associated with increased risk of TSF.
Methods: 1065 Royal Marines recruits were assessed in week-2 of training. Bilateral plantar pressure and 3D lower limb kinematics were obtained for barefoot running at 3.6 m.s-1, providing dynamic arch index, peak heel pressure and lower limb joint angles. Age, bimalleolar breadth, calf girth, passive hip internal/external range of motion and body mass index (BMI) were also recorded. Ten recruits who sustained a TSF during training were compared with 120 recruits who completed training injury-free using a binary logistic regression model to identify injury risk factors.
Results: Four variables significantly (p

Barefoot running has increased in popularity over recent years, with suggested injury risk and performance benefits. However, despite many anecdotal descriptions of barefoot running styles, there is insufficient evidence regarding the specific characteristics of barefoot running. The present study provided reference data for four footstrike modalities adopted across a large cohort of habitually shod male runners while running barefoot: heel strikers (HS), midfoot strikers (MS), forefoot strikers (FS) and a newly defined group, toe runners (TR - contact made only with the forefoot), compared with the three modalities previously reported. Plantar pressure analysis was used for the classification of footstrike modality, with clearly distinguishable pressure patterns for different modalities. In the present study, the distribution of footstrike types was similar to that previously observed in shod populations. The absence of differences in ground contact time and stride length suggest that potential performance benefits of a non-HS style are more likely to be a function of the act of running barefoot, rather than of footstrike type. Kinematic data for the knee and ankle indicate that FS and TR require a stiffer leg than HS or MS, while ankle moment and plantar pressure data suggest that a TR style may put greater strain on the plantar-flexors, Achilles tendon and metatarsal heads. TR style should therefore only be adopted with caution by recreational runners. These findings indicate the importance of considering footstrike modality in research investigating barefoot running, and support the use of four footstrike modalities to categorise running styles.

Background: Ankle inversion injury is common in military populations but associated biomechanical risk factors are largely unknown. This prospective study examined the association between pressure and kinematic variables, and ankle inversion injury risk in Royal Marine (RM) recruits. It was hypothesised that a more medially concentrated pressure at the heel-off phase of stance, greater impulse and peak pressure at the first metatarsal head, greater peak rearfoot eversion angle and greater eversion excursion would be associated with ankle inversion injury. Methods: Data from 145 male, injury-free RM recruits were recorded in week-2 of a 32-week military training programme. Each recruit completed five running trials at 3.6ms-1, along a 2m pressure plate. Kinematic data were simultaneously recorded. Injuries sustained during the training programme were prospectively recorded. Findings: Data from eleven recruits who had suffered an ankle inversion injury during RM training were compared with 20 uninjured controls. The injury group displayed a higher (P < 0.05) peak first metatarsal pressure, peak metatarsal impulse and more medially concentrated pressure at heel-off than control recruits. There were no differences in kinematic variables between groups. The injury group had a lower body mass than controls (P < 0.05). Interpretations: the findings from this study support existing literature, providing evidence that high medial concentration of vertical forces when running are associated with increased ankle inversion injury risk. This may be due to the lateral ankle ligaments being less accustomed to loading, resulting in relatively weak lateral ligaments, or ligaments less able to deal with fatigue than those of the control group. © 2013.

BACKGROUND: Ankle inversion injury is common in military populations but associated biomechanical risk factors are largely unknown. This prospective study examined the association between pressure and kinematic variables, and ankle inversion injury risk in Royal Marine (RM) recruits. It was hypothesised that a more medially concentrated pressure at the heel-off phase of stance, greater impulse and peak pressure at the first metatarsal head, greater peak rearfoot eversion angle and greater eversion excursion would be associated with ankle inversion injury. METHODS: Data from 145 male, injury-free RM recruits were recorded in week-2 of a 32-week military training programme. Each recruit completed five running trials at 3.6 ms(-1), along a 2m pressure plate. Kinematic data were simultaneously recorded. Injuries sustained during the training programme were prospectively recorded. FINDINGS: Data from eleven recruits who had suffered an ankle inversion injury during RM training were compared with 20 uninjured controls. The injury group displayed a higher (P

Purpose: the relatively high incidence rate of third metatarsal (MT3) stress fractures in Royal Marine (RM) recruits may be linked to the footwear worn during training. The present study investigated the effect of standard issue RM recruit footwear on biomechanical variables linked with MT3 stress fracture risk. Methods: Seven male volunteers (age 18.3±0.4 years, mass 81.1±8.2 kg) ran at 3.6ms-1in a laboratory while wearing a combat assault boot (CAB) and a neutral gym trainer (GT). In-shoe plantar pressure was assessed using pressure insoles (RSScan, 500 Hz). Two-dimensional ankle kinematics and kinetics were assessed at 120 Hz (Peak Motus). Horizontal ground reaction force characteristics were investigated using an AMTI force plate (960 Hz). Results: Peak plantar pressure, impulse and loading rate were significantly greater at the MT3 head in the CAB (P