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Aims Neck pain is a common complaint and accounts for a significant proportion of individuals seeking physiotherapy. Assessment for patients with neck pain normally involves a judgment of head posture. Head posture is considered important as deviations from ‘normal’ may have detrimental biomechanical and physiological implications and provide clues as to optimal interventions. However, studies comparing head posture between patients with neck pain and asymptomatic individuals have shown conflicting results. This article critically appraises the role of head posture assessment for patients with neck pain. Methods The rationale for a relationship between head posture and neck pain is discussed; clinical assessment of head posture—including issues around surrogate measures, validity and reliability—is explored, and studies comparing patients with neck pain and asymptomatic individuals are examined. Finally, studies investigating techniques to correct head posture are appraised. Findings and conclusions It is unclear whether the assessment of head posture through observation is valid and/or reliable and whether therapeutic interventions to improve head posture result in gains for the patient. There is a need for further research exploring the links between these factors, and practitioners should be encouraged to re-appraise the value of assessing head posture for patients with neck pain.

Background: Head posture (HP) assessment of patients with neck pain (NP) is claimed to be useful in aiding diagnosis, determining treatment strategies and monitoring patient progress. It is assumed that patients with NP have poorer HP than asymptomatic individuals. Objectives: To determine whether there are differences in angles or linear distances between anatomical landmarks used as surrogates for HP between individuals with and without NP. Methods: Studies were sought from PubMed, CINAHL, Physiotherapy Evidence Database, Sports Discus, Web of Science, Academic Search Premier and The Cochrane Library. Two reviewers screened titles and abstracts, and assessed full reports for potentially eligible studies. Data extraction and synthesis: Two reviewers independently extracted information on participants' characteristics, study methods and study quality. Discrepancies were resolved using a third reviewer as arbiter. Study heterogeneity prevented meta-analysis so a tally of study outcome was performed. Results: Seven of 13 included studies found no statistically significant differences in measurements of components of HP between participants with NP and asymptomatic participants. When compared to asymptomatic individuals NP patients were found to have greater forward HP in 4 of 19 comparisons (11 studies), greater head extension/flexion in two of nine comparisons (six studies) and less side-flexion and less rotation in one of one comparison (one study). Conclusion: There is insufficient good quality evidence to determine whether forward HP, head extension, side-flexion and rotation differ between participants with NP and asymptomatic participants.

Background: Palliative care trials have higher rates of attrition. The MORECare guidance recommends applying classifications of attrition to report attrition to help interpret trial results. The guidance separates attrition into three categories: attrition due to death, illness or at random. The aim of our study is to apply the MORECare classifications on reported attrition rates in trials. Methods: A systematic review was conducted and attrition classifications retrospectively applied. Four databases, EMBASE; Medline, CINHAL and PsychINFO, were searched for randomised controlled trials of palliative care populations from 01.01.2010 to 08.10.2016. This systematic review is part of a larger review looking at recruitment to randomised controlled trials in palliative care, from January 1990 to early October 2016. We ran random-effect models with and without moderators and descriptive statistics to calculate rates of missing data. Results: One hundred nineteen trials showed a total attrition of 29% (95% CI 28 to 30%). We applied the MORECare classifications of attrition to the 91 papers that contained sufficient information. The main reason for attrition was attrition due to death with a weighted mean of 31.6% (SD 27.4) of attrition cases. Attrition due to illness was cited as the reason for 17.6% (SD 24.5) of participants. In 50.8% (SD 26.5) of cases, the attrition was at random. We did not observe significant differences in missing data between total attrition in non-cancer patients (26%; 95% CI 18-34%) and cancer patients (24%; 95% CI 20-29%). There was significantly more missing data in outpatients (29%; 95% CI 22-36%) than inpatients (16%; 95% CI 10-23%). We noted increased attrition in trials with longer durations. Conclusion: Reporting the cause of attrition is useful in helping to understand trial results. Prospective reporting using the MORECare classifications should improve our understanding of future trials.

BackgroundClimbing is an increasingly popular sport worldwide. However relatively little is known about the mechanisms of injury sustained by climbers.ObjectiveTo investigate mechanisms of injury in a representative sample of British climbers.DesignRetrospective cross-sectional study.SettingOnline survey of active climbers.Patients (or Participants)369 active climbers (men n=307, mean±SD, age=37.66 ±14.38 years; Women n=62, mean ±SD, age=34.63 ±12.19 years).Interventions (or Assessment of Risk Factors)Epidemiological incidence proportion (IP) and mechanism of injury.Main Outcome MeasurementsInjuries that resulted in medical intervention and/or withdrawal from participation for ≥1 day.ResultsOf 369 climbers surveyed, 299 sustained at least 1 injury in the last 12 months resulting from climbing. The IP was 0.810 (95% CI: 0.770–0.850). Thus the average probability of sustaining at least one injury was 81% (95% CI: 77–85). The total number of injuries sustained was 1088 providing a clinical incidence of 2.95 injuries per climber. 94 climbers sustained an acute injury as a result of impact with the climbing surface and/or ground, 212 climbers sustained an injury resulting from chronic overuse and 166 climbers sustained injuries resulting from a non-impact acute trauma. The average probabilities of sustaining injury per mechanism were: impact injury 25.5% (95% CI: 23.2–27.8); acute non-impact injury 45.1% (95% CI: 42.5–47.7) and chronic overuse injury 57.5% (95% CI: 54.9–60.1). Injury from chronic overuse was positively associated with indoor lead operating standard (P=0.007), bouldering operating standard (P< 0.001) and bouldering frequency (P< 0.001). The most common injury site was the fingers with 180 participants (60%) sustaining at least one finger injury. 85 participants sustained at least 1 chronic overuse reinjury.ConclusionsThe most commonly reported injury mechanism was chronic overuse. The most common site was the fingers. Chronic overuse injuries due to repetitive loading may have been historically preceded by a non-impact acute trauma.