• Systematic review of effects of current transtibial prosthetic socket designs—Part 1: Qualitative outcomes

      Safari, Reza; Meier, Margrit Regula; University Of Social Welfare and Rehabilitation Sciences; Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran;; Department for Occupational Therapy, Prosthetics, and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway (PLOS, 2015)
      This review is an attempt to untangle the complexity of transtibial prosthetic socket fit, determine the most important characteristic for a successful fitting, and perhaps find some indication of whether a particular prosthetic socket type might be best for a given situation. Further, it is intended to provide directions for future research. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used medical subject headings and standard key words to search for articles in relevant databases. No restrictions were made on study design or type of outcome measure. From the obtained search results (n = 1,863), 35 articles were included. The relevant data were entered into a predefined data form that incorporated the Downs and Black risk of bias assessment checklist. Results for the qualitative outcomes (n = 19 articles) are synthesized. Total surface bearing sockets lead to greater activity levels and satisfaction in active persons with amputation, those with a traumatic cause of amputation, and younger persons with amputation than patellar tendon bearing sockets. Evidence on vacuum-assisted suction and hydrostatic sockets is inadequate, and further studies are much needed. To improve the scientific basis for prescription, comparison of and correlation between mechanical properties of interface material, socket designs, user characteristics, and outcome measures should be conducted and reported in future studies.
    • Systematic review of effects of current transtibial prosthetic socket designs—Part 2: Quantitative outcomes

      Safari, Reza; Meier, Margrit Regula; University of Social Welfare and Rehabilitation Sciences; Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran;; Department for Occupational Therapy, Prosthetics, and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway (PLOS, 2015)
      This review is an attempt to untangle the complexity of transtibial prosthetic socket fit and perhaps find some indication of whether a particular prosthetic socket type might be best for a given situation. In addition, we identified knowledge gaps, thus providing direction for possible future research. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using medical subject headings and standard key words to search for articles in relevant databases. No restrictions were made on study design and type of outcome measure used. From the obtained search results (n = 1,863), 35 articles were included. The relevant data were entered into a predefined data form that included the Downs and Black risk of bias assessment checklist. This article presents the results from the systematic review of the quantitative outcomes (n = 27 articles). Trends indicate that vacuum-assisted suction sockets improve gait symmetry, volume control, and residual limb health more than other socket designs. Hydrostatic sockets seem to create less inconsistent socket fittings, reducing a problem that greatly influences outcome measures. Knowledge gaps exist in the understanding of clinically meaningful changes in socket fit and its effect on biomechanical outcomes. Further, safe and comfortable pressure thresholds under various conditions should be determined through a systematic approach.
    • A systematic review of evidence about the role of alexithymia in chronic back pain

      Elander, James; Kapadi, Romaana; Bateman, Antony H.; University of Derby; Royal Derby Spinal Centre, University Hospitals of Derby and Burton NHS Foundation Trust (British Psychological Society, 2021-02-01)
      Individuals with alexithymia struggle to make sense of their emotions. Alexithymia has been associated with a range of physical illnesses, but may influence different illnesses differently, so to understand the role of alexithymia in illness it is important to focus on specific conditions. This article reviews evidence from ten reports published between 2000 and 2018 of studies with samples of adults with chronic back pain that used the Toronto Alexithymia Scale (TAS). The studies were conducted in Germany, Israel, Italy, Russia, Turkey and the USA. Eight studies involved clinical samples and two involved public transit workers. Studies that compared participants with high and low alexithymia consistently found associations with measures of pain. The findings show that more severe alexithymia plays a role in the experience of chronic back pain, and support the incorporation of alexithymia-related elements in interventions to help people with chronic back pain improve their emotional regulation and reduce their pain-related distress.
    • A systematic review of variables used to assess clinically acceptable alignment of unilateral transtibial amputees in the literature.

      Tafti, Nahid; Hemmati, Fatemeh; Safari, Reza; Karimi, Mohammad Taghi; Farmani, Farzad; Khalaf, Ali; Mardani, Mohammad Ali; University of Derby; University of Social Welfare and Rehabilitation Sciences; Shiraz University of Medical Sciences; et al. (Sage, 2018-08-08)
      Prosthetic alignment is a subjective concept which lacks reliability. The outcome responsiveness to prosthetic alignment quality could help to improve subjective and instrument assisted prosthetic alignment. This study was aimed to review variables used to assess clinically acceptable alignment in the literature. The search was done in some databases including: Google Scholar, PubMed, EBSCO, EMBASE, ISI Web of Knowledge and Scopus. The first selection criterion was based on abstracts and titles to address the research questions of interest. The American Academy of Orthotics and Prosthetics checklists were used for paper risk of bias assessment. A total of 25 studies were included in this study. Twenty-four studies revealed the critics of standing position or walking to locate clinically acceptable alignment, only one study measured outcomes in both situations. A total of 253 adults with transtibial amputations and mean age of 48.71 years participated in included studies. The confidence level of included studies was low to moderate, and before-after trial was the most common study design (n = 19). The joint angle, load line location with respect to joints and center of pressure-related parameters were reported as sensitive outcomes to prosthetic alignment quality in standing posture. The amount of forces at various parts of gait cycle and time of events were sensitive to prosthetic alignment quality during walking. Standing balance and posture and temporal parameters of walking could help to locate clinically acceptable alignment.
    • A systematic review on the effects of group singing on persistent pain in people with long‐term health conditions

      Irons, J. Yoon; Sheffield, David; Ballington, Freddie; Stewart, Donald E; Health and Social Care Research Centre, University of Derby (Wiley, 2019-09-23)
      Singing can have a range of health benefits; this paper reviews the evidence of the effects of group singing for chronic pain in people with long‐term health conditions. We searched for published peer‐reviewed singing studies reporting pain measures (intensity, interference and depression) using major electronic databases (last search date 31 July 2018). After screening 123 full texts, 13 studies met the inclusion criteria: five randomized controlled trials (RCTs), seven non‐RCTs and one qualitative study. Included studies were appraised using Downs and Black and the Critical Appraisals Skills Programme quality assessments. Included studies reported differences in the type of singing intervention, long‐term condition and pain measures. Due to the high heterogeneity, we conducted a narrative review. Singing interventions were found to reduce pain intensity in most studies, but there was more equivocal support for reducing pain interference and depression. Additionally, qualitative data synthesis identified three key linked and complementary themes: physical, psychological and social benefits. Group singing appears to have the potential to reduce pain intensity, pain interference and depression; however, we conclude that there is only partial support for singing on some pain outcomes based on the limited available evidence of varied quality. Given the positive findings of qualitative studies, this review recommends that practitioners are encouraged to continue this work. More studies of better quality are needed. Future studies should adopt more robust methodology and report their singing intervention in details. Group singing may be an effective and safe approach for reducing persistent pain and depression in people with long‐term health conditions.
    • Temperature measurement and control system for transtibial prostheses: functional evaluation.

      Ghoseiri, Kamiar; Zheng, Yong Ping; Leung, Aaron K L; Rahgozar, Mehdi; Aminian, Gholamreza; Lee, Tat Hing; Safari, Reza; University of Social Welfare and Rehabilitation Sciences (Taylor & Francis, 2016-11-14)
      The accumulation of heat inside the prosthetic socket increases skin temperature and fosters perspiration, which consequently leads to high tissue stress, friction blister, discomfort, unpleasant odor, and decreased prosthesis suspension and use. In the present study, the prototype of a temperature measurement and control (TM&C) system was designed, fabricated, and functionally evaluated in a phantom model of the transtibial prosthetic socket. The TM&C system was comprised of 12 thermistors divided equally into two groups that arranged internal and external to a prosthetic silicone liner. Its control system was programmed to select the required heating or cooling function of a thermal pump to provide thermal equilibrium based on the amount of temperature difference from a defined set temperature, or the amount of difference between the mean temperature recorded by inside and outside thermistors. A thin layer of aluminum was used for thermal conduction between the thermal pump and different sites around the silicone liner. The results showed functionality of the TM&C system for thermoregulation inside the prosthetic socket. However, enhancing the structure of this TM&C system, increasing its thermal power, and decreasing its weight and cost are main priorities before further development.
    • Temperature measurement and control system for transtibial prostheses: single subject clinical evaluation.

      Ghoseiri, Kamiar; Zheng, Yong Ping; Leung, Aaron K L; Rahgozar, Mehdi; Aminian, Gholamreza; Masoumi, Mehdi; Safari, Reza; University of Social Welfare and Rehabilitation Sciences (Taylor & Francis, 2016-11-14)
      The snug fit of a prosthetic socket over the residual limb can disturb thermal balance and put skin integrity in jeopardy by providing an unpleasant and infectious environment. The prototype of a temperature measurement and control (TM&C) system was previously introduced to resolve thermal problems related to prostheses. This study evaluates its clinical application in a setting with reversal, single subject design. The TM&C system was installed on a fabricated prosthetic socket of a man with unilateral transtibial amputation. Skin temperature of the residual limb without prosthesis at baseline and with prosthesis during rest and walking was evaluated. The thermal sense and thermal comfort of the participant were also evaluated. The results showed different skin temperature around the residual limb with a temperature decrease tendency from proximal to distal. The TM&C system decreased skin temperature rise after prosthesis wearing. The same situation occurred during walking, but the thermal power of the TM&C system was insufficient to overcome heat build-up in some regions of the residual limb. The participant reported no significant change of thermal sense and thermal comfort. Further investigations are warranted to examine thermography pattern of the residual limb, thermal sense, and thermal comfort in people with amputation.
    • The extent, variability, and attitudes towards volunteering among undergraduate nursing students: implications for pedagogy in nurse education.

      Dyson, Sue E.; Liu, Liang Q.; van den Akker, Olga; O'Driscoll, Mike (Elsevier, 2017-03-01)
      In the aftermath of the Francis Report nurses are being called to account for an apparent lack of care and compassion, leading to debate around pedagogy in nurse education. Absent from this debate is a consideration of student volunteering within undergraduate nursing programmes and its potential to promote student nurses self-esteem and to enhance the development of critical thinking skills. The aim of this study was therefore to understand the extent of and attitudes towards volunteering among nursing students. A mixed methods approach using a specifically developed questionnaire, followed by in-depth interviews to ascertain extent, variability, and attitudes towards volunteering revealed low levels of volunteering among nursing students. Limited time, limited access, and lack of academic support were cited as reasons. Nevertheless, students displayed positive attitudes towards volunteering. While volunteering has been shown to impact upon students abilities to think critically, to develop personal values and respond to the needs of others, volunteering within the UK undergraduate nursing programme considered is neither structured nor formalized. Nurse educators should pay attention to the positive benefits of volunteering for nursing students and consider ways in which volunteering might be incorporated into the curriculum.
    • The politics of health services research: health professionals as hired hands in a commissioned research project in England.

      Dyson, Simon M.; Dyson, Sue E. (British Sociological Association, SAGE Publications & the Universities of Surrey and Stirling, 2014-08-15)
      Previous health services research has failed to account for the role played by clinical staff in the collection of data. In this paper we use the work of Roth on hired hand research to examine the politics of evidence production within health services research. Sociologies of work predict lack of engagement in the research tasks by subordinated groups of workers. We examine the role of midwives in researching ante-natal screening for sickle cell and thalassaemia in England, and construct three ideal types: repairers, refractors, and resisters to account for the variable engagement of health staff with research. We find some features of the hired hand phenomenon predicted by Roth to be in evidence, and suggest that the context of our project is similar to much health services research. We conclude that without concerted attempts (1) to change the social relations of research production; (2) to mitigate hired hand effects; (3) to assess the impact of the hired hand effect on the validity and reliability of findings, and (4) to report on these limitations, that health services research involving large teams of subordinated clinical staff as data collectors will be prone to produce evidence that is of limited trustworthiness. Keywords: evidence-based research; health services research; hired hands; politics of evidence; screening; midwives; research methodology; work and employment.
    • Trigeminal neuralgia: Imaging and the patient experience of Magnetic Resonance Imaging (MRI) of the brain: Findings from an on-line survey of patient experience of MRI imaging.

      de Witt, Julie T; Gallagher, S; University of Derby (2018-10-06)
      Background This is the first study to explore the experience of this group of patients and their experience of having an MRI brain scan. It is also unique in specifically focusing on MRI brain scan alone. This gives a new perspective on the nature of patient-centred service we should be delivering, not only to patients with this rare condition, but perhaps when scanning anyone with a pain condition – or indeed in personalizing an examination for any patient. Aims/Objectives To understand the patient’s lived experience of having an MRI brain scan, to understand what made a positive difference and what the patient would like or expect the radiographer to know about their condition. Methods Qualitative method utilized an online survey (Lime survey) with free text responses and some limited demographic data. Survey was advertised on closed social media group and on National charity website (Trigeminal Neuralgia Association UK). 96 responses were received, with 50 free text responses to the open questions. These were analysed using thematic analysis. Results Five themes emerged, with a number of subthemes within each. These are that there are some good stories, there are some not so good experiences, that care and communication makes a difference, that Trigeminal neuralgia (TN) pain is more than just a headache and finally that we need to be involving our patients in their scan. In describing the experience of having an MRI brain scan it was striking that narratives seemed to be clear cut in terms of ‘good or bad’ , but an interesting key difference seemed to be the perceived ‘kindness’ of the staff. Conclusions A recommendation is given in terms of working with a TN patient and their pain triggers, this is for everyone’s benefit as this is also more likely to result in a timely scan with minimal blur artefacts if the patient’s pain is minimized.
    • True cowmen and commercial farmers: Exploring vets’ and dairy farmers’ contrasting views of ‘good farming’ in relation to biosecurity.

      Shortall, Orla; Sutherland, Lee-Ann; Ruston, Annmarie; Kaler, Jasmeet; University of Nottingham; The James Hutton Institute; University of Derby; Social, Economic and Geographical Sciences, The James Hutton Institute; Craigiebuckler Aberdeen AB15 8QH Scotland, UK; Social, Economic and Geographical Sciences, The James Hutton Institute; Craigiebuckler Aberdeen AB15 8QH UK; College of Health and Social Care; University of Derby, Kedleston Road; Derby DE22 1GB UK; et al. (Wiley, 2017-11-30)
      Responsibility for biosecurity in UK farming is being devolved from government to industry, with a greater emphasis on the veterinarian (vet)‐farmer relationship. Although social science has shown that care for animals is part of ‘good farming’, the British dairy sector sees a need to improve biosecurity. This research uses the good farmer concept to compare how vets and dairy farmers define good farming for biosecurity based on qualitative interviews with 28 vets and 15 dairy farmers in England. The results revealed two conflicting ‘good farmer’ identities: the large, commercial farmer who has the economic capital to invest in biosecurity and veterinary services; and the self‐sufficient stock keeper whose cultural and social capital lead them to manage herd health independently. These identities reflect changing ‘rules of the game’, following Bourdieu's use of the term, and increasing penetration of vets’ cultural capital into the sector. They involve different constructions of risk which need to be recognised within debates about good biosecurity.
    • Unnatural women: reflections on discourses on child murder and selective mortal neglect

      Hogan, Susan; University of Derby (Demeter Press, 2020-01)
      While the existence of maternal ambivalence has been evident for centuries, it has only recently been recognized as central to the lived experience of mothering. This accessible, yet intellectually rigorous, interdisciplinary collection demonstrates its presence and meaning in relation to numerous topics such as pregnancy, birth, Caesarean sections, sleep, self-estrangement, helicopter parenting, poverty, environmental degradation, depression, anxiety, queer mothering, disability, neglect, filicide and war rape. Its authors deny the assumption that mothers who experience ambivalence are bad, evil, unnatural, or insane. Moreover, historical records and cross-cultural narratives indicate that maternal ambivalence appears in a wide range of circumstances; but that it becomes unmanageable in circumstances of inequity, deprivation and violence. From this premise, the authors in this collection raise imperative ethical, social, and political questions, suggesting possibilities for vital cultural transformations. These candid explorations demand we rethink our basic assumptions about how mothering is experienced in everyday life.
    • Using a research-informed interprofessional curriculum framework to guide reflection and future planning of interprofessional education in a multi-site context

      Moran, Monica Catherine; Steketee, Carole; Forman, Dawn; Dunston, Roger; University of Curtin (Canadian Institute for Studies in Publishing Press, 2015-03)
      Background: Over the past two years health educators in Australia have benefited from funding made available from national organizations such as the Office of Learning and Teaching (OLT) and Health Workforce Australia (HWA). Funded research has been conducted into educational activities across the country that aim to promote integrated and sustainable interprofessional learning. Methods and Findings: A collaboration between multiple stakeholders led to the establishment of a consortium of nine universities and interprofessional organizations. This collaboration resulted in a series of research studies and the development of a conceptual framework to guide the planning and review of interprofessional health curricula. A case study of the development of a suite of health education programs at a regional university in Australia is used to demonstrate how the framework can be used to guide curricular reflection and to plan for the future. Shedding a light on interprofessional health education activities across multiple sites provides a rich picture of current practices and future trends. Commonalities, gaps, and challenges become much more obvious and allow for the development of shared opportunities and solutions. Conclusions: The production of a shared conceptual framework to facilitate interprofessional curriculum development provides valuable strategies for curricular reflection, review, and forward planning.
    • Using a research-informed interprofessional curriculum framework to guide reflection and future planning of Interprofessional Education in a Multi-site Context

      Moran, Monica Catherine; Steketee, Carole; Forman, Dawn; Dunston, Roger; University of Derby (2015-03)
      Abstract Background: Over the past two years health educators in Australia have benefited from funding made available from national organizations such as the Office of Learning and Teaching (OLT) and Health Workforce Australia (HWA). Funded research has been conducted into educational activities across the country that aim to promote integrated and sustainable interprofessional learning. Methods and Findings: A collaboration between multiple stakeholders led to the establishment of a consortium of nine universities and interprofessional organizations. This collaboration resulted in a series of research studies and the development of a conceptual framework to guide the planning and review of interprofessional health curricula. A case study of the development of a suite of health education programs at a regional university in Australia is used to demonstrate how the framework can be used to guide curricular reflection and to plan for the future. Shedding a light on interprofessional health education activities across multiple sites provides a rich picture of current practices and future trends. Commonalities, gaps, and challenges become much more obvious and allow for the development of shared opportunities and solutions. Conclusions: The production of a shared conceptual framework to facilitate interprofessional curriculum development provides valuable strategies for curricular reflection, review, and forward planning.
    • Using behavioural insights to improve the healthiness of children’s packed lunches.

      Jackson, Jessica; Ward, Derek; Giles, David; Bunten, Amanda; Howell-Jones, Rebecca; Burgess-Allen, Jilla; University of Derby; Public Health England (Oxford University Press, 2017-10-20)
      Background Childhood obesity continues to rise in the UK from 9.3% in children aged 4-5 years to 19.8% by age 10-11. Only 1 in 100 school packed lunches meet national recommendations for school meals in England with 82% containing unhealthy snacks and 61% sugar sweetened drinks. Encouraging parents to identify healthier choices could reduce added sugar content and improve the healthiness of school lunches. Methods A cluster randomised controlled trial was implemented in 17 primary schools (8 intervention, 9 control) in England. The intervention comprised of 3 packs of materials delivered to parents who make children lunches (7-11 years). Materials were designed using behavioural-insights to raise awareness of added sugar and offer healthier options. The materials were delivered over a 4-week period in intervention schools. Photographs of the contents of the packed lunches were taken at 3 time points; 1719 pre-intervention, 1745 post-intervention & 1725 at 3 month follow-up. Visible items in each photograph were coded for nutritional content. A parental survey was conducted at post follow up to explore parental knowledge, attitudes and beliefs about healthier packed lunches. Results The coding and analysis is underway and findings will be presented in November. Presented data will describe group differences pre-intervention, post-intervention and follow up from the >5000 lunch boxes for 1) the number lunch boxes that contain surgery food; 2) the average number of sugary food items; 3) the average grams of sugar in lunch boxes; and 4) the proportion of lunch boxes that contain fruit or vegetables. Conclusions This study was funded by Public Health England to explore whether low cost, low intensive interventions can have a significant impact on changing health behaviours. There is a lack of evidence on improving the nutritional quality of packed lunches and if improvements are identified there are potential implications for child health, nutrition and obesity rates. Key messages: •The study aims to ascertain the effectiveness of a behavioural-insight informed intervention in changing the healthiness of packed lunches provided by parents of primary school aged children. •This low cost, low intensity intervention has the potential to improve the healthiness of primary school age children’s diets.
    • Using behavioural insights to reduce sugar in primary school children's packed lunches in derby; A cluster randomised controlled trial

      Bunten, Amanda; Porter, Lucy; Burgess-Allen, Jilla; Howell-Jones, Rebecca; Jackson, Jessica; Ward, Derek; Staples, Vicki; Staples, Paul; Rowthorn, Harriet; Saei, Ayoub; et al. (Elsevier BV, 2020-10-08)
      Children's packed lunches contain more sugar than school-provided meals. Interventions to improve the provision of healthier packed lunches have modest effects on lunch contents. This cluster randomised controlled trial tested an intervention to encourage healthier provision of packed lunches by parents of primary school children in Derby. Schools were randomised to intervention (n = 8) or control (n = 9) using blocked random allocation. In the intervention group, parents of children who brought packed lunches to school in years 3–6 (age 7–11 years) received three bundles of materials (including packed lunch planner, shopping list, information on sugar content of popular lunchbox items and suggestions for healthier swap alternatives) in bookbags/lunchboxes over a 4-week period. Control parents received no materials. Photos of lunchbox contents were taken at baseline, immediately post-intervention and at three-month follow-up. A parental survey aimed to assess capability, opportunity and motivation for packing a healthier lunchbox. No intervention effects were observed for primary outcomes (presence and number of sugary snacks or chilled sugary desserts). The intervention had a significant impact on one secondary outcome (increased number of healthier “swap” items suggested in intervention materials) immediately post-intervention, but this effect had disappeared at three-month follow-up. No intervention effects were found on survey variables. Parent comments revealed that materials were either received positively (as they reinforced existing behaviours) or negatively (as they were not perceived to be helpful or appropriate). The results of this study suggest that providing educational materials and resources to parents of primary school children in Derby was not sufficient to increase provision of healthier packed lunches. Future research should investigate how behavioural science can support families to improve the nutritional content of primary school children's lunchboxes.
    • Using figured worlds to explore parents' attitudes and influences for choosing the content of primary school packed lunches

      Jackson, Jessica; Giles, David; Gerrard, Clarabelle; University of Derby (MAG Online Library, 2019-09-30)
      This study aimed to explore parents' attitudes toward the content of their child's packed lunch, school healthy eating policies, and their child's wishes. Furthermore, in this context, it also aimed to explore perceptions of health promotional materials and how these interventions interplayed with issues parents felt were important. The ideology of ‘figured worlds’ was used as a stance to consider the relationship between bounding structures within society and the individual positional identity. Focus groups interviews obtained qualitative data of parents' multiple viewpoints. Iterative categorisation was employed as a method of analysis to observed findings in the data in relation to the individuals as intersubjective beings and their behaviour influenced by environmental conditions. A cross selection of local schools and parenting network were approached. Snowballing techniques were implemented highlighting the inclusion criteria. Participants were required to have a child attending primary school who they provided a packed lunch for on a regular basis. Three umbrella themes were identified: ‘The parents ideal’, ‘The child's desires’, and ‘Inconsistencies of the governing school’. A fourth theme, ‘The health promotional intrusion’ provides insight into the parents' reality when being presented with health promotional materials. This study has highlighted the complex, conflicting interplay between parents' ideal for their child's diet, their child's desires and the governing approaches to encouraging healthier choices. This understanding is vital when designing specific interventions to meet the needs of individuals, which prevent, protect and promote a healthy lifestyle for children and their families.
    • Values and ethics in CBT

      Kingdon, David; Maguire, Nick; Stalmeisters, Dzintra; Townend, Michael; University of Derby (Sage, 2017-03-17)
      This book covers the values and ethics in the field of CBT.
    • Ventilatory muscle strength, diaphragm thickness and pulmonary function in world-class powerlifters.

      Brown, Peter I.; Venables, Heather; Liu, Hymsuen; de Witt, Julie T.; Brown, Michelle R.; Faghy, Mark; University of Derby (Springer, 2013)
      Resistance training activates the ventilatory muscles providing a stimulus similar to ventilatory muscle training. We examined the effects of elite powerlifting training upon ventilatory muscle strength, pulmonary function and diaphragm thickness in world-class powerlifters (POWER) and a control group (CON) with no history of endurance or resistance training, matched for age, height and body mass.