Objectives: To observe the prevalence of lumbar intervertebral disc degeneration in elite athletes as compared with published literature of changes seen in non-athletes-that is, normal population. Methods: The lumbar spines of 31 Olympic athletes who presented to the Olympic Polyclinic with low back pain and/or sciatica were examined using magnetic resonance imaging. Three criteria were looked at: (a) the loss of disc signal intensity; (b) the loss of disc height; (c) the presence of disc displacement. The results were then recorded and correlated with the lumbar levels. Results: The disc signal intensity was progressively reduced the more caudal the disc space. It was most common at the L5/S1 level, and, of the abnormal group, 36% (n = 11) showed the most degenerative change. Disc height reduction was also found to be most common at the L5/S1 level. However, the most common height reduction was only mild. A similar trend of increased prevalence of disc herniation was noted with more caudal levels. At the L5/S1 level, 58% were found to have an element of disc displacement, most of which were disc bulges. Compared with changes seen in the normal population (non-athletes) as described in the literature, disc degeneration defined by the above criteria was found to be significantly more severe in these Olympic athletes. Conclusions: Although the study was limited, the results suggest that elite athletes have a greater prevalence and greater degree of lumbar disc degeneration than the normal population. A more detailed follow up study should be considered to investigate which particular training activities have the most impact on the lumbar spine, and how to modify training methods so as to avoid the long term sequelae of degenerative disc disease of the lumbar spine.B ack pain appears to be more common in elite athletes than the normal population. It has been reported that up to 75% have had one or more episodes of back pain.

Background There are 6000‐7000 stroke survivors yearly in Singapore with about 40% being at risk for post‐stroke cognitive impairment (PSCI). Stroke Memory Rehabilitation (SMaRT) programme was designed to reduce the incidence of PSCI, facilitate transition back to the community, improve the mood and quality of life of patients with mild ischemic strokes. We report the preliminary outcomes of the program. Method Participants who attended the programme from April 2018 to Dec 2019 were included in this study. Each patient attended 8 two‐hour sessions over 8 weeks, focusing on cognitive processes (episodic memory, executive function and visuospatial function); healthy lifestyle habits, relaxation techniques and goal setting. All patients were administered neuropsychological assessments and questionnaires pre‐programme, 8 weeks and 6 months post‐programme. Paired sample t‐tests were applied to evaluate the changes in scores over the four time points on each outcome measure, subject to Bonferroni correction for family‐wise errors. Result 156 participants (mean age=63.53 years, SD=9.63; mean education=9.95 years SD=4.18, 65.4 % male). Significant improvements in all outcome measures were observed from pre‐programme to all other time points. Cognitive scores significantly improved from pre to post‐programme and pre to 6 months post‐programme on the Montreal Cognitive Assessment (24.52 to 25.36; p<.001 and 25.05 to 25.98; p<.001 respectively); Visual Cognitive Assessment Test (VCAT) Score (22.67 to 24.14; p<.001 and 22.63 to 24.92; p<.001). Scores for Trail Making Test‐A only significantly shortened from pre‐ to 6 months post‐programme (52.00 to 45.52; p<.001). Depression levels significantly reduced on the Geriatric Depression Scale (4.01 to 3.29; p=.001 and 3.46 to 2.33; p<.001). Activities of daily living measured on the NEADL significantly improved (52.24 to 55.15; p<.001 and 52.48 to 56.27; p<.001). Quality of life (DemQOL) also significantly improved (88.77 to 91.88; p=.006 and 91.83 to 95.52; p<.001). Conclusion Preliminary findings demonstrate encouraging improvement in global cognition, executive function, quality of life, depression and activities of daily living from pre‐programme to 8 weeks and 6 months post‐programme. A multi‐approach structured cognitive rehabilitation programme for stroke survivors may thus be useful in preventing post‐stroke dementia.

BackgroundPersons with mild stroke experience minimal functional difficulties; nonetheless, they are at elevated risk for post-stroke cognitive impairment (PSCI) and cognitive decline. AimsWe report outcomes from an observational cohort study of a structured, multidomain intervention for persons with mild strokes. MethodsThe Stroke Memory RehabiliTation (SMaRT) program comprises weekly two-hour group sessions for six weeks on cognitive strategies, lifestyle and relaxation. Participants were recruited from a tertiary hospital between June 2018 to September 2019. They had MRI-confirmed ischemic strokes with mild functional difficulties (modified Rankin Scale score ≤3). Participants underwent assessments and questionnaires at baseline, 1-week post-program, 3 months post-program, and 6 months post-program. Results Participants (N=108, mean age=63.54±9.22, 31.5% female) demonstrated significant improvement in cognition, mood, activities of daily living (ADL) and quality of life (QOL) (ps<0.05) across timepoints. Participants performed significantly better at 6 months post-program compared to baseline on cognitive tests (MoCA 24.47±3.22 vs. 25.80±2.83, Beta=1.26, 95% CI(0.78,1.74)), p<.001; Visual Cognitive Assessment Test (22.74±3.98 vs. 24.76±3.68, Beta=2.04, 95% CI(1.44,2.65), p<.001); 87% of participants maintained or improved in performance. At 6 months post-program, participants reported greater functional independence (Nottingham Extended ADLs Questionnaire Beta=4.20, 95% CI(2.63,5.77), p<.001); fewer depressive symptoms (Geriatric Depression Scale Beta=-1.44, 95% CI(-1.94, -0.94), p<.001); and improved QOL (Dementia-QOL Questionnaire Beta=5.28, 95% CI(1.09, 2.57), p<.001). ConclusionsThe SMaRT program is a cost-effective, scalable, structured program for PSCI. Findings suggest its potential effectiveness in reducing cognitive decline and improving other domains of well-being, with carry-over benefits after 6 months.

Urinary incontinence (UI) is a common but often under-reported medical condition that laid a significant impact in one's quality of life (QoL). Studies have highlighted that there is strong association between UI and lower back pain (LBP). However, there is limited evidence on clinician incorporating UI assessment and treatment as a part of LBP management. Therefore, the aim of this study is to evaluate physiotherapy knowledge in understanding the association of lower back pain and urinary incontinence. A cross sectional study design was adopted to a randomly selected sample. A self-administered questionnaire was used to obtained detailed information on the awareness of risk factor of LBP, understanding the associated problem of LBP, common LBP management and evaluating knowledge level of LBP and UI. A total of 60 participants has participated in this survey. The results demonstrate almost more than 50% of physiotherapist is not fully aware of the association between lower back pain and urinary incontinence. About 57% of physiotherapist did not incorporate bladder management as part of LBP care. However, when compared between genders, female populations had better knowledge and understanding of the association of LBP and UI. The results show there is still a lack of knowledge on the association of lower back pain and urinary incontinence among Physiotherapists. In the future, more of education talk about the association between lower back pain and urinary incontinence would help in increasing the knowledge level of Physiotherapist thus incorporating UI assessment and treatment as a part of lower back care.