risk primary ankle sprains pose, the development of a UK evidence-based guideline for this common problem may be appropriate. Stratification of care may also aid in identification of patients at higher risk of recurrence and chronicity. This in turn may facilitate selection of the most appropriate treatment methods. The Norwich Patellar Instability score: Validity, internal consistency and responsiveness Smith TO, Chester R, Hunt N, Cross JL, Clark A, Donell ST firstname.lastname@example.org Background/Aims: This study assessed the validity, internal consistency, responsiveness and floor-ceiling effects of the Norwich Patellar Instability (NPI) score for a cohort of conservatively managed people following first-time patellar dislocation (FTPD). Methods: Fifty patients were recruited, providing 130 completed datasets over 12 months. Patient NPI score, Lysholm Knee score, Tegner Level of Activity score and isometric knee extension strength were assessed at baseline, 6 weeks, 6 and 12 months post-injury. Results: There was high convergent validity with a statistically significant correlation between NPI and Lysholm Knee score (p<0.001), Tegner Level of Activity score (p<0.001) and isometric knee extension strength (p<0.002). Principal component analysis revealed the NPI demonstrated good concurrent validity, with four components accounting for 70.4% of the variability. While the NPI demonstrated a floor effect for 13 of the 19 items, no ceiling effect was reported. There was high internal consistency, with a Cronbach a value of 0.93 (95% CI 0.91–0.93). NPI score was responsive to change over the 12-month period, with an effect size of 1.04 from baseline to 12 months post-injury. Conclusions: The NPI can be considered a valid and responsive outcome measure to assess patellar instability symptoms for people conservatively managed following FTPD. The high floor effects reported in this study need further exploration to improve the ability of the NPI to detect people with lower perceived instability symptoms. S4 Clinicians’ perceptions and experiences of using dynamic elastomeric fibre orthoses with patients with neurological disorders Hassan A, Snowdon N email@example.com Background/Aims: Dynamic elastomeric fibre orthoses (DEFOs) or Lycra garments are used to help control movement and posture in people with neurological conditions. The effectiveness of these garments has been investigated previously in small, low-quality studies. No previous qualitative research has been conducted on user experiences or clinicians’ reasoning. The objective of this study was to understand clinical reasoning behind the prescription of Lycra garments for adults with neurological disorders. Methods: Qualitative, semi-structured interviews were conducted with therapists (n=7) who had used DEFOs with at least five adults with neurological pathologies. Data were analysed using thematic analysis. Results: Four themes were identified: i) what DEFOs might work for; ii) how to assess its potential; iii) how to fund the garments, and iv) practicalities around their use. DEFOs were felt to be helpful for conditions such as ataxia, low tone and spasticity, and improving posture, balance and upper limb function. The concept of dynamic control was important, in that the garments can provide support without restricting movement and proprioception. The impact of DEFOs was assessed using standardised outcome measures, patient feedback and quality of movement. Conclusions: There appears to be potential use for DEFOs, however, a key challenge lies in determining which patients are likely to benefit. This study suggests a protocol for prescribing Lycra garments. It is recommended that this be applied and evaluated in clinical practice. Identifying and evaluating evidence of adverse events and contraindications of manual therapy for low back pain Shipley J firstname.lastname@example.org Background: Sign up to Safety, an NHS initiative, encourages the reporting of incidences within health care and reduction of all avoidable harms. Manual therapy is offered as a treatment choice for low back pain by physiotherapists; however, there appears no definitive answer of who this option is safe for. Methods: A systematic search and review of the literature was carried out to explore the classification and frequency of adverse events from manual therapy for low back pain. Six databases were searched using a range of synonyms for the population, intervention and outcome, using controlled terms and MeSH indexing. Results: Twenty studies were selected through a priori inclusion and exclusion criteria. These represented a variety of study designs and a narrative synthesis was conducted. Using the best current classification system for adverse events of manual therapy revealed the majority of adverse events reported should be classified as ‘not adverse’. Moderate events were less frequent and major events were rare. The quality of the selected studies was assessed according to relevance and rigour. Relevance of the studies was not demonstrated and confidence in the studies’ rigour was low. A quarter of the studies listed contraindications to manual therapy but these were poorly referenced and were of expert opinion without explicit critical appraisal at best. Conclusions: There is no clear message from the literature identifying which subgroups should be excluded from manual therapy. There is a lack of consensus as to what constitutes an adverse event, how these should be graded and difficulty attributing adverse events to specific manual therapy technique due to mixed methods of manipulation and mobilisation. Implications: Future studies are needed to develop reliable and validated standardised outcome measures of adverse events from manual therapy. A standardised national reporting system for adverse events from manual therapy is needed. Formulation of a consensus group to consider relative risk ratio alongside defined adverse events and current understanding of mechanism of effect of manual therapy would assist in establishing the safety of manual therapy for different low back pain subgroups. © 2015 MA Healthcare Ltd PRS Conference abstracts International Journal of Therapy and Rehabilitation, August 2015, Vol 22, No 8 © MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 203.002.032.208 on October 25, 2017. Use for licensed purposes only. No other uses without permission. All rights reserved.