Background: Backpacks are essential in the daily lives of children. Carrying a heavy backpack affects trunk posture during standing. It remains unclear, whether this effect is also observed during gait. Research question: How do different backpack weights affect trunk kinematics during walking in children? Methods: Sixteen children stood and walked on a 5 m walkway with a custom load-carrying-system simulating unloaded and loaded backpacks (10 %;20 %;30 % of body mass (BM). A marker-based 3D motion analysis system captured whole-body kinematics (Rizzoli model). During walking, the primary outcomes were the maximum ranges of motion (RoM;[°]) of thoracic and lumbar trunk segmental angles in three planes. During standing, the average angles over 5 s were measured in three planes. Secondary measures included stride length, stride time, and velocity during walking. The children's own backpacks' weights were measured and expressed as a percentage of body mass. Statistical analysis was performed using repeated-measures ANOVA (α=0.05) and Tukey-Kramer post hoc test. Results: The average weight of the children’s own backpack was 15.4 ± 7.4 %BM. For the experimental conditions, the average weights added to the load-carrying system were 3.3 ± 0.8 kg (10 %BM), 6.5 ± 1.7 kg (20 %BM), and 9.8 ± 2.5 kg (30 %BM). During standing, the average trunk flexion angles (sagittal plane) of the lumbar trunk segment significantly increased with increased backpack weight (p = 0.002). During walking, no changes in sagittal plane RoM but significant decreases in lumbar and thoracic transversal and frontal plane RoM (p < 0.001), stride length (p = 0.047) and velocity (p = 0.041) were observed with additional weight. No significant differences were observed for stride time between the conditions. Significance: Added backpack weight led to a more flexed trunk posture during standing and reduced transversal and frontal plane trunk movement, stride length, and gait velocity during walking. These adjustments likely compensate for the dorsally displaced center of mass and minimize energy expenditure by reducing trunk-backpack-angular momentum during walking.

Staphylococcus aureus (S. aureus) is one of the bacterial species capable of forming multilayered biofilms on implants. Such biofilms formed on implanted medical devices often require the removal of the implant in order to avoid sepsis or, in the worst case, even the death of the patient. To address the problem of unwanted S. aureus biofilm formation, its first step, i.e., adhesion, must be understood and prevented. Thus, the development of adhesion-reducing surface coatings for implant materials is of utmost importance. In this work, we used single-cell force spectroscopy to analyze the adhesion of the biofilm-forming S. aureus strain SA113 on naive and protein-coated silicon surfaces (SiO2). In addition to the wild type, we used the SA113 ΔdltA knockout mutant to further investigate the effect of d-alanylation of lipoteichoic acids of the cell wall. In order to examine how the surface charge affects adhesion, we coated silanized SiO2 surfaces with amphiphilic class II hydrophobins. The naturally occurring hydrophobin HFBI was used as well as the HFBI variant D40Q/D43N, which is less negatively charged at physiological pH due to the exchange of two acidic aspartate residues. These two types of hydrophobin-coated surfaces resemble each other in roughness and wettability but differ only in charge. By measurement of the forces with which each S. aureus strain binds to hydrophobin-coated surfaces, we show that the adhesion of S. aureus at surfaces can be influenced by the charges exposed by the target surfaces. Therefore, in addition to hydrogen bonding, electrostatic interactions between the cell and the hydrophilic surface govern adhesion on these surfaces. Moreover, we found that for both HFBI coatings, the adhesion strength of S. aureus is reduced by nearly a factor of 30 compared to silanized SiO2 surfaces. Therefore, hydrophobin coatings are of great interest for further use in the field of biomedical surface coating.

Background: Traditional bone setting (TBS) remains a prevalent healthcare practice in Nigeria, offering complementary treatments for musculoskeletal conditions such as low back pain (LBP). This study explores the perspectives of both patients and physiotherapists regarding TBS and its implications for the management of LBP. Methods: A qualitative research approach was employed, utilizing semi-structured interviews with 25 participants (13 patients who had utilized TBS services for LBP, and 12 physiotherapists). Theoretical sampling was employed in participant recruitment until saturation. Recordings were transcribed and thematic analysis was conducted as a secondary analysis. Reporting was informed by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Eleven (11) participants were female and 14 were male; with a mean age of 35 years. Five themes were identified from this study: driving impetus for TBS, influencing perceptions with information, turning to TBS as a final recourse, exploring the primary alternative, and integrating TBS. The shift towards TBS for LBP stems from deficiencies in prevailing healthcare practices in Nigeria. Patients and physiotherapists hold varying perspectives regarding cultural significance, and effectiveness and safety of TBS compared to professional physiotherapy interventions. Accessibility, affordability, and perceived efficacy are common facilitators for the patronage of TBS among patients, while others were hesitant and viewed it as a last resort. Negative perception of physiotherapists about TBS for LBP were based on concerns regarding the lack of scientific evidence, standardized practices, and potential complications associated with the procedures. Conclusion: Participants consider TBS viable when professional physiotherapy fails, citing expectations for therapist-guided techniques, affordability, and cultural factors. Physiotherapists remain cautious, stressing the need for evidence-based care and noting severe TBS complications. Some participants advocate for integrating TBS with professional healthcare through collaboration and better communication. This study, supported by literature, highlights the potential for TBS integration, with open communication and training fostering collaboration. Future studies could investigate the practicality of this integration, prioritizing culturally appropriate, safe, and effective approaches to LBP management.

Background and aim: Clinical prediction rules (CPRs) are mathematical tools that are intended to guide clinicians in clinical decision making or predict a future outcome, but they seem rather unknown, under-utilized, or avoided by clinicians. This study aimed to assess knowledge, attitude, and practice of CPRs in low-back pain (LBP) among physiotherapists. Methods: A cross-sectional study involving 45 consenting specialist musculoskeletal physiotherapists from three public-funded teaching hospitals in Nigeria was carried out. An adapted validated questionnaire on facilitators and barriers to CPRs utilization, and a socio-demographic proforma were used to collect data. Descriptive and inferential statistics were employed to analyze data. Alpha level was set at p < 0.05. Results: Respondents were mostly males (71.1%), married (64.4%) and first-degree holders (55.6%). Twenty-eight (62.2%) of the respondents had above-average knowledge of CPRs in LBP. Rates for positive attitude towards, and utilization of CPRs were 37.8% and 15.6%. Knowledge and attitude about CPRs in LBP were not significantly influenced by socio-demographic factors (p > 0.05). However, there was a significant association between the utilization of CPRs and years of experience (χ2 = 10.339 p = 0.016). Conclusion: Most Nigerian physiotherapists had above-average knowledge, but a negative attitude and low utilization of CPRs in LBP. Clinicians’ years of clinical experience influence the usage of CPR. There is a need to incorporate training in CPRs into undergraduate and continuous professional development programmes.

Introduction: The Evidence-Based Practice Confidence (EPIC) Scale measures health professionals’ self-efficacy associated with evidence-based practice activities. The scale has been cross-culturally translated into German together with physical therapists. To support its use in German-speaking countries, the measurement properties of the scale need to be determined. Therefore, the primary objective of this study was to assess the measurement properties of the German EPIC scale. In a preparatory step, we aimed to evaluate the comprehensibility of the scale among German-speaking occupational therapists, speech and language therapists, and nurses. Methods: First, semi-structured cognitive interviews were used to evaluate the comprehensibility of the EPIC scale. Second, a longitudinal online survey with repeated measures (baseline and retest survey) was conducted. The target group included physical therapists, occupational therapists, speech and language therapists, and nurses from Germany, Austria, and Switzerland. Reliability, responsiveness, and validity were evaluated using internal consistency, test-retest reliability, standard error of measurement, known-groups method, exploratory factor analysis and the minimal detectable change, respectively. Results: Comprehensibility of the German EPIC scale was confirmed by eleven health care professionals (four occupational therapists, two speech and language therapists, five nurses). The baseline and the retest surveys were completed by 708 and 222 participants, respectively. The measure demonstrated an internal consistency of .930, with an intraclass correlation coefficient (ICC) for test-retest reliability of .936 (95% CI: .917 to .951). The standard error of measurement was 4.92, and the minimal detectable change at the 95% confidence level was 6.02. All hypotheses in the known-groups method were confirmed, and construct validity was acceptable. Factor analysis revealed two main factors affecting the results of the scale. Conclusion: The findings provide evidence that supports the use of the German EPIC scale among health professionals. For instance, it can be used to evaluate self-efficacy during EBP training.