Tuwhera Research Repository

The Tuwhera Research Repository provides sustainable open access and archiving to a broad range of AUT produced research - theses, research outputs and datasets.

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Access status: Open Access ,
Cleared But Not Ready? The Impact of Fatigue on Return-To-Sport Testing Post Anterior Cruciate Ligament Injury
(Auckland University of Technology, 2026) Robinson, James; Sheerin, Kelly; Belcher, Suzie
Anterior cruciate ligament (ACL) injury is associated with prolonged rehabilitation, substantial healthcare costs, reduced sports participation, and an elevated risk of reinjury after return to sport (RTS). Despite routine RTS testing to guide clinical decisions after ACL injury and reconstruction, reinjury rates remain high, suggesting current assessments may not adequately evaluate readiness for sport demands. Most RTS assessments are done in a rested state, although fatigue is an inherent feature of sport that alters neuromuscular control, movement quality, force production, and landing mechanics. These effects may be especially relevant in female athletes, who have higher rates of non-contact ACL injury and already exhibit higher-risk movement patterns that fatigue may further compromise. Consequently, athletes may meet RTS criteria when rested but show deficits under fatigue. This thesis investigated fatigue's influence on ACL RTS assessment and explored whether fatigue-informed testing identifies deficits missed during conventional rested evaluations. To address this aim, two studies were conducted. The first, a scoping review, evaluated fatigue protocols used in ACL RTS research regarding clinical relevance, feasibility, and translational potential. Twelve studies were identified, with protocols classified as localised neuromuscular (n = 7), whole-body sport-specific (n = 4), or isolated joint (n = 1). Fatigue consistently reduced absolute hop and jump performance, movement quality, and biomechanical variables linked to ACL injury risk. However, substantial heterogeneity existed across fatigue definitions, induction methods, verification criteria, and RTS assessment batteries. Notably, limb symmetry indices often remained unchanged despite reductions in absolute performance, suggesting symmetry-based measures may mask bilateral functional declines and underestimate fatigue-related deficits. The second study, a repeated-measures experiment, examined fatigue's acute effects on RTS outcomes in 15 recreationally active female athletes (23.1 ± 4.7 years). Healthy participants were recruited to isolate fatigue effects without the confounding influence of ACL injury or rehabilitation. Participants completed a standard RTS testing battery under rested and fatigued conditions. Fatigue was induced through repeated hopping, jumping, squatting, and step-down tasks until countermovement jump height dropped by at least 30%. After fatigue, quadriceps strength decreased by 9.8% (p < .001) and single-leg hop distance by 17.3% (p = .041). While most traditional RTS outcomes and limb symmetry measures remained unchanged, force-time-derived kinetic variables showed consistent reductions, including eccentric peak force, eccentric braking impulse, concentric impulse, and landing rate of force development. Collectively, these findings indicate fatigue can reveal neuromuscular and biomechanical impairments not detected by conventional RTS assessment done in a rested state. Traditional RTS measures retain clinical value but may not fully reflect functional capacity under physiological stress. Fatigue-informed assessment, especially through kinetic measures, can identify residual neuromuscular deficits concealed during conventional RTS testing. Further research is needed to establish clinically feasible fatigue protocols in ACL-reconstructed populations and determine whether fatigue-related RTS outcomes improve prediction of successful return to sport and reinjury risk.
Access status: Open Access ,
Anonymous Women? A Scoping Review of the Experiences of Women in Gamblers Anonymous (GA)
(Springer Science and Business Media LLC, 2019-06-18) Rogers, Jim; Landon, Jason; Sharman, Stephen; Roberts, Amanda
Women are participating in gambling at levels approaching those of men, and although levels of disordered gambling remain lower in women than in men, significant numbers are affected. Gamblers Anonymous (GA) is a mainstay of help to problem gamblers in many countries. A scoping review was conducted which specifically addressed the experiences of women who attend GA. Within the 25 identified relevant studies, only two reported empirical data on the specific numbers of women attending. A range of barriers still remain to the participation of women in these communities. These include ‘external’ barriers such as lack of referral and signposting, lack of accessible meetings, and costs of travel; ‘internal’ barriers such as shame, stigma, and fear of disclosure; and features of the GA meetings and discourse, such as a climate which is dismissive of women’s experiences.
Access status: Open Access ,
The Association of Gout Flare Resolution With Physical Activity and Sleep: A Prospective Remote‐monitoring Study
(Wiley, 2026-10-20) Stewart, Sarah; Girven, Boston; Clarke, Mia; Zeng, Irene; Gaffo, Angelo; Stamp, Lisa K; Edwards, N Lawrence; Rice, David; Ka'ai, Tania; Rudolph, Karl; Collis, Julie; Kayes, Nicola; Dalbeth, Nicola
Objectives This study aimed to determine whether gout flare resolution is associated with physical activity and sleep. These findings were intended to inform the future development of a definition for flare resolution. Methods Data from 81 participants with gout who experienced >1 flare during a 6-month prospective observational study were included. Daily activity (step count) and sleep (total sleep time and deep sleep percentage) were collected remotely using wrist-worn trackers. Daily flare occurrence was captured using smartphone diaries. Activity/sleep outcomes during each flare episode were compared to those during three resolution timeframes: T1: the first day following the flare; T2: the consecutive window immediately following the flare and equal in length to the flare; and T3: the consecutive window equal in length to the flare and immediately following a washout window (equal in length to the flare). Adjusted differences in medians between flare and resolution timeframes were estimated using linear quantile mixed models. Results Daily step count was lower during flares compared with all resolution timeframes (all P<0.033). T3 provided the best overall model fit, suggesting that resolution is most clearly distinguished from the flare when using this timeframe. No significant differences between flare and resolution were observed for the sleep outcomes for any resolution timeframe. Conclusions Physical activity improves soon after flare cessation, with the clearest distinction between flare and resolution observed over a longer post-flare recovery period, whereas sleep metrics do not differentiate flare from resolution states. These findings support physical activity as a useful objective domain for gout flare resolution.
Access status: Open Access ,
Perceptions of the Causes of Miscarriage Among Healthcare Providers and Women With a History of Miscarriage in Kerman: A Qualitative Exploration
(SAGE Publishing, 2026-10-13) Ashrafinia, Farzaneh; Crowther, Susan; Bahrampour, Niloufar; Heydari, Omolbanin
Background: Miscarriage is a common pregnancy outcome with emotional, psychological and social consequences for many women. Although several biomedical risk factors have been identified, many miscarriages remain unexplained. Perceptions of the causes of miscarriage are influenced by social, cultural and healthcare contexts; however, little is known about healthcare providers’ and women’s perceptions of the causes of miscarriage in the Iranian context. Objectives: To explore perceptions of the causes of miscarriage among healthcare providers and women with a history of miscarriage in south-eastern Iran. Design: A qualitative descriptive study informed by a feminist theoretical lens. Methods: Twenty-three participants, including six obstetricians–gynecologists, eleven midwives, and six women with history of miscarriage, were recruited using purposive sampling. Semi-structured interviews were conducted between August and October 2024 in Kerman, Iran. Data were analysed using reflexive thematic analysis supported by framework analysis. Results: Three themes were identified: (1) medical causes and risk factors, (2) lifestyle and environmental influences, and (3) emotional and psychological factors. Healthcare providers primarily attributed miscarriage to chromosomal abnormalities, chronic health conditions, and modifiable lifestyle risks. Women with a history of miscarriage also acknowledged biomedical explanations but described modifying their health behaviours and interpreted miscarriage through their personal experiences, emotional distress, and advice from family members and shared community beliefs. Conclusion: Healthcare providers and women with a history of miscarriage perceived its causes through different forms of knowledge and experience. While healthcare providers primarily emphasized biomedical explanations, women often interpreted miscarriage through their personal experiences and efforts to make sense of pregnancy loss. Both groups identified medical, lifestyle, environmental, and psychological factors as important perceived contributors, although some beliefs reflected cultural understandings rather than established scientific evidence. These findings highlight the importance of evidence-based, culturally sensitive communication and supportive miscarriage care that integrates clinical knowledge with women’s lived experiences.
Access status: Open Access ,
Mapping Teledentistry Encounters to Demographic and Diagnostic Groups: A Retrospective Evaluation of Claims Data in a U.S. Dental Institution
(SAGE Publications, 2026-10-21) Wammer, Emily; Ip, Ryan HL; Ingleshwar, Aparna Shivanand; Huang, Boyen
Introduction: Teledentistry expanded rapidly during COVID-19-related dental clinic closures, yet long-term utilization patterns, associated procedures, and patient characteristics remain insufficiently described. This study characterized teledentistry encounters by patient demographics and diagnoses and evaluated shifts in claim volumes and procedure patterns during and after clinic shutdown. Methods: A retrospective analysis evaluated 375 teledentistry claims from 288 patients at a university dental clinic (March 2020–April 2024). Change-point detection identified structural shifts in weekly claim volume. Independent t-tests and chi-squared tests compared demographics and procedure prevalence between periods. Encounters were linked to the most recent diagnoses within 90 days. Results: Most patients (83.7%) used teledentistry once. Claims peaked during shutdown (1.34/day) and declined thereafter (0.165/day). After the detected breakpoint in November 2020, average weekly claims decreased from 6.8 to 0.76. Limited oral evaluation was more common during shutdown than after (96.1% vs. 82.6%; p < 0.001). Post-shutdown patients were younger (mean age 37.8 vs. 42.7 years; p = 0.042), with no difference in sex (p = 0.28). Teledentistry services were more often covered by insurance post-shutdown (91.6% vs. 77.0%; p < 0.001). Common diagnoses included benign oral lesions and temporomandibular disorders. Conclusion: Teledentistry utilization surged during clinic closures but stabilized at low volumes post-reopening. While these findings specifically reflect United States health care billing and clinic environments, the predominant reliance on teledentistry for limited evaluations and select diagnostic groups highlights targeted opportunities for virtual care. As noted in the broader literature, future efforts to support sustainable integration will rely on continued technological advancements and educational initiatives for patients and health professionals.