Musculoskeletal (MSK) and Sport and Exercise Medicine (SEM) in General Practice (GP): A Novel GP-based MSK and SEM Clinic for Managing Musculoskeletal symptoms in a GP

Musculoskeletal (MSK) complaints are common within primary care (1) (2) (3) but some General Practitioners (GPs)/family physicians do not feel comfortable managing these symptoms (3), preferring to refer onto hospital specialists or Integrated Clinical Assessment and Treatment Services (ICATs). Long waiting times for hospital outpatient reviews are a major cause of patient inconvenience and complaints (4). We therefore aimed to establish a GP-ran MSK and sport and exercise medicine (SEM) clinic based within a Belfast GP surgery that would contribute to a sustainable improvement in managing these common conditions within primary care as well as reducing waiting times for patients with these conditions to see a specialist. This shift from hospital-based to community-based management is in-keeping with recent policy changes within the UK health-system, including Transforming Your Care within Northern Ireland (NI) (5). The GP-ran MSK and SEM clinic was held monthly within a Belfast GP practice, staffed by one GP with a specialist interest in MSK and SEM conditions and its performance was reviewed over a three month period. Parameters audited included cases seen, orthopaedic and x-ray referral rates and secondary care referrals comparing the GP practice’s performance to the same time period in the previous year as well as patient satisfaction questionnaires.

Musculoskeletal (MSK) and Sport and Exercise Medicine (SEM) in General Practice (GP): A Novel GP-based clinic

The problem-Musculoskeletal (MSK) symptoms are common within primary care but some GPs are not comfortable managing these; waiting times for hospital appointments are a major cause of patients’ complaints. Current UK healthcare policies emphasise a need for more community-based management. We aimed to pilot an innovative general practice-based clinic to improve the management of MSK and Sport and Exercise Medicine (SEM) symptoms within general practice.

The approach-This project was conducted in an inner-city practice of approximately 9,000 patients and 5 GP partners. The practice commissioned a novel monthly 4-hour clinic staffed by one GP with a specialist interest in MSK and SEM conditions. Each patient was allocated a 20-minute appointment. All primary care staff within the practice could refer any patient for whom they considered hospital referral appropriate, with no specific exclusion criteria. Management plans included injection therapy, exercise prescription and onward referral. After three months (August-October 2014) numbers of consultations, sources of referral, reasons for referral and management outcomes were described; patient satisfaction was assessed by questionnaire, offered to 10 randomly selected patients by reception staff and self-completed by patients. Costs of the clinic were compared to current options.

Findings- All patients (14 males; 21 females; aged 35-77 years), were seen within four weeks of referral (one third of orthopaedic referrals in 2013 waited over 9 weeks for appointment). Most were referred from other GPs; some came from physiotherapy and podiatry. Shoulder problems were the most frequent reason for referral. The commonest management option was steroid injection, with most patients being given advice regarding exercise and analgesia; there were 3 onward referrals (2 physiotherapy; 1 rheumatology).

Comparing August-October data in 2014 and 2013, total, orthopaedic and rheumatology referrals were reduced by 147, 2 and 3, respectively; within the practice MSK presentations and physiotherapy and x-ray referrals were 60, 47 and 90 fewer, respectively.

The cost per attendance at the clinic was £61; initial orthopaedic-ICAT assessments cost £82 and a consultant appointment £213.

Satisfaction questionnaires were returned by all 10 selected participants and provided positive feedback, expressing preference for community-based, rather than hospital, management.

Consequence- Our pilot study indicates that this novel service model has potential for efficient and effective management of MSK and SEM complaints in primary care, reducing the need for hospital referral and the clinical burden on general practices. The innovation deserves further evaluation in a full-scale trial to determine its generalisability to other practice settings and populations.

BTEC level 3 National sport and exercise sciences.

El programa BTEC es un programa de estudios que permite obtener una cualificación profesional o laboral. Este recurso está preparado para ayudar al alumno en el curso BTEC National, nivel 3, especificación de deporte y ciencias del ejercicio. Incluye unidades obligatorias y unidades opcionales y conocimientos y actividades que permiten obtener los grados de aprobado, notable y sobresaliente.

Sport and exercise sciences. Level 3. BTEC National.

Este recurso ha sido escrito para ayudar a los alumnos a superar las pruebas para el nivel 3 del curso Edexcel BTEC National en la especificación de 2010 de deporte y ciencias del ejercicio. Incluye veintitrés unidades, además de actividades de evaluación en cada unidad que cubren todos los criterios de ésta para ofrecer a los estudiantes la oportunidad de practicar sus tareas y profundizar en el conocimiento y la comprensión de la materia y obtener los grados de aprobado, notable y sobresaliente. También, hay un capítulo dedicado a la enseñanza superior que ayuda a los candidatos a prepararse para la vida universitaria y el aprendizaje.

Sport psychology and indigenous performing artists

A group of students from the Aboriginal Centre for the Performing Arts participated in a mental skills training program that focused on goal setting, self-confidence development, and team building. There were 13 two-hour sessions held over a 20-week period. The participants, cultural issues, and the basic structure of the program are described. The author's observations regarding competition, displays of affection, collective values, and the importance of family and nature are provided. The participants qualitatively evaluated the program. Conclusions related to group process, program structure, and diversity are presented. These conclusions should be of value in terms of shaping future group mental skills training programs.

Insights from ecological psychology and dynamical systems theory can underpin a philosophy of coaching

The aim of this paper is to show how principles of ecological psychology and dynamical systems theory can underpin a philosophy of coaching practice in a nonlinear pedagogy. Nonlinear pedagogy is based on a view of the human movement system as a nonlinear dynamical system. We demonstrate how this perspective of the human movement system can aid understanding of skill acquisition processes and underpin practice for sports coaches. We provide a description of nonlinear pedagogy followed by a consideration of some of the fundamental principles of ecological psychology and dynamical systems theory that underpin it as a coaching philosophy. We illustrate how each principle impacts on nonlinear pedagogical coaching practice, demonstrating how each principle can substantiate a framework for the coaching process.

Representative learning design and functionality of research and practice in sport

Egon Brunswik proposed the concept of “representative design” for psychological experimentation, which has historically been overlooked or confused with another of Brunswik’s terms, ecological validity. In this article, we reiterate the distinc­tion between these two important concepts and highlight the relevance of the term representative design for sports psychology, practice, and experimental design. We draw links with ideas on learning design in the constraints-led approach to motor learning and nonlinear pedagogy. We propose the adoption of a new term, repre­sentative learning design, to help sport scientists, experimental psychologists, and pedagogues recognize the potential application of Brunswik’s original concepts, and to ensure functionality and action fidelity in training and learning environments.

Principles of motor learning in ecological dynamics : a comment on functions of learning and the acquisition of motor skills (with reference to sport)

This paper provides a commentary on the contribution by Dr Chow who questioned whether the functions of learning are general across all categories of tasks or whether there are some task-particular aspects to the functions of learning in relation to task type. Specifically, they queried whether principles and practice for the acquisition of sport skills are different than what they are for musical, industrial, military and human factors skills. In this commentary we argue that ecological dynamics contains general principles of motor learning that can be instantiated in specific performance contexts to underpin learning design. In this proposal, we highlight the importance of conducting skill acquisition research in sport, rather than relying on empirical outcomes of research from a variety of different performance contexts. Here we discuss how task constraints of different performance contexts (sport, industry, military, music) provide different specific information sources that individuals use to couple their actions when performing and acquiring skills. We conclude by suggesting that his relationship between performance task constraints and learning processes might help explain the traditional emphasis on performance curves and performance outcomes to infer motor learning.

The need for ‘representative task design’ in evaluating efficacy of skills tests in sport : a comment on Russell, Benton and Kingsley (2010)

Russell, Benton and Kingsley (2010) recently suggested a new association football test comprising three different tasks for the evaluation of players' passing, dribbling and shooting skills. Their stated intention was to enhance ‘ecological validity’ of current association football skills tests allowing generalisation of results from the new protocols to performance constraints that were ‘representative’ of experiences during competitive game situations. However, in this comment we raise some concerns with their use of the term ‘ecological validity’ to allude to aspects of ‘representative task design’. We propose that in their paper the authors confused understanding of environmental properties, performance achievement and generalisability of the test and its outcomes. Here, we argue that the tests designed by Russell and colleagues did not include critical sources of environmental information, such as the active role of opponents, which players typically use to organise their actions during performance. Static tasks which are not representative of the competitive performance environment may lead to different emerging patterns of movement organisation and performance outcomes, failing to effectively evaluate skills performance in sport.

Managing teams: Comparing organizational and sport psychological approaches to teamwork

This paper examines how teams and teamwork research have been conceptualised in the fields of sport psychology and organizational psychology. Specifically, it provides a close inspection of the general theoretical assumptions that inhere in the two disciplines. The results of a discursive analysis of research literature suggest that the fields have significantly different ways of conceptualising teams and teamwork and that conceptual borrowing may prove fruitful. A key argument is however, that in order for meaningful cross-fertilisation to take place a sound understanding of these differences is necessary. Working from this premise, the essential differences between sport and organizational approaches to teams are outlined. The paper is concluded with a discussion of contributions that organizational psychology can make to understandings of sport-oriented teams.