Clinical Journal of Sport Medicine最新文献

Objective: Sport-related concussion (SRC) affects cognitive and oculomotor function. We evaluated recovery from SRC in athletes with cognitive symptoms and/or oculomotor impairments who were prescribed early aerobic exercise treatment.

Design: Secondary exploratory analysis of a randomized controlled trial.

Setting: Outpatient sports medicine clinics.

Participants: Male and female adolescents (13-18 years) within 10 days of SRC who were prescribed aerobic exercise and who reported either a low (<12 points) or high (≥12 points) burden of cognitive symptom scores on the Post-Concussion Symptom Inventory at initial assessment.

Interventions: Early aerobic exercise treatment.

Main outcome measures: Recovery time and incidence of persisting postconcussive symptoms beyond 1 month.

Results: Adolescents with a high burden of cognitive symptoms (n = 24, 16.0 ± 1.3 years old, 50% male, 5.3 ± 2.4 days since injury) took longer to recover (34.4 ± 37.1 vs 15.3 ± 7.6 days) than adolescents with a low burden (n = 32, 14.9 ± 1.4 years old, 69% male, 6.1 ± 2.3 days since injury) and had 6-fold higher odds of developing persisting postconcussive symptoms (odds ratio = 6.17 [1.15-33.15]). Abnormal repetitive saccades and vestibular ocular reflex were independently associated with longer recovery after controlling for multiple comparisons ( P < 0.0125), but only abnormal smooth pursuits were a significant effect modifier for the association between cognitive symptoms and recovery (interaction term hazard ratio = 0.133 [0.035-0.504], P = 0.003).

Conclusions: Individuals with impaired ability to smoothly track a moving target and whose cognitive symptoms are a significant burden are at substantial risk for delayed recovery from SRC. Early initiation of oculomotor rehabilitation may facilitate recovery in these patients.

Trials registration: Clinicaltrials.gov ID NCT02959216.

Objective: Evaluate the influence of sleep duration and concussion history on postconcussion symptoms in adolescent athletes.

Design: Observational retrospective study using the Immediate Post-Concussion Assessment and Cognitive Testing and Post-Concussion Symptom Scale (PCSS). Multivariable linear regression assessed sleep hours against 22 PCSS symptoms, controlling for demographic and health variables.

Setting: Urban concussion centers in Colorado and Florida, 2009 to 2019.

Participants: 11 564 student-athletes aged 12 to 22, categorized by concussion history.

Interventions: Analysis of sleep duration and concussion history in relation to neurocognitive and psychiatric symptom severity.

Main outcome measures: Primary outcomes included neurocognitive, psychiatric, and total symptom scores. Secondary outcomes were specific PCSS symptoms.

Results: Among 5349 student-athletes, 2671 (49.9%) had no prior concussions and 2678 (50.1%) had 1 or more. For those without prior concussions, sleep was negatively associated with age (β = -0.18, 95% confidence interval [CI], -0.22 to -0.13, P < 0.0001), vomiting (β = -0.22, 95% CI, -0.38 to -0.05, P = 0.012), and difficulty concentrating (β = -0.11, 95% CI, -0.19 to -0.35, P = 0.005). In athletes with a history of concussion, less sleep correlated with decreased age (β = -0.11, 95% CI, -0.14 to -0.07, P < 0.0001), headache (β = -0.065, 95% CI, -0.12 to -0.01, P = 0.031), irritability (β = -0.08, 95% CI, -0.15 to -0.01, P = 0.021), and difficulty concentrating (β = -0.08, 95% CI, -0.15 to -0.01, P = 0.031) but increased sensitivity to light (β = 0.10, 95% CI, 0.001-0.137, P = 0.048), numbness/tingling (β = 0.15, 95% CI, 0.04-0.26, P = 0.008), and feeling slowed down (β = 0.13, 95% CI, 0.05-0.21, P = 0.001).

Conclusion: Sleep duration and concussion history are associated with variations in postconcussion symptom severity among adolescent athletes. This data underscore the need for individualized management strategies based on sleep patterns and concussion history.

Objective: To examine the impact of the COVID-19 pandemic on the psychological health of key stakeholders within an elite UK sports organization.

Design: The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) was sent electronically to 500 employees, and 8 face-to-face interviews were conducted at an elite-level professional football club.

Setting: English Premier League (EPL) Football Club.

Participants: Office/stadium staff, coaching/backroom staff, players from the male U23, women's and men's senior teams.

Independent variables: Stakeholder groups that were invited to participate in the study: office/stadium staff, coaching/backroom staff, players from the U23, women's and men's senior teams, and variables of age and gender.

Main outcome measure: WEMWBS scores across the office/stadium staff, coaching/backroom staff, and player cohort.

Results: Of 122 responses (24% response rate) and 8 face-face interviews, the average WEMWBS score was 51.2 (SD ±8.4) and 14% of the cohort presented with scores suggestive of a higher risk of depression. The main findings were moderate effect size differences in WEMWBS scores with the players scoring higher than both the office/stadium staff (P = 0.01) and the coaching/backroom staff (P = 0.01).

Conclusions: Office/stadium staff experienced greater compromising mental health effects from the COVID-19 pandemic, as compared with the coaching/backroom staff and players, respectively, suggesting that elite sports organizations should also consider providing mental health education and signposting strategies for this area of the workforce.

Objective: To assess sports-related concussion (SRC) knowledge levels in US collegiate student-athletes (S-As) and athletic trainers (ATs) and identify factors that influence reporting of SRC by S-As.

Design: Cross-sectional, retrospective study.

Setting: University training room/clinic visits.

Participants: National Collegiate Athletics Association Division 1 S-As and ATs.

Interventions: A survey consisting of demographics, SRC knowledge, prior SRC history, and reporting habits.

Main outcome measures: Sports-related concussion knowledge scores, SRC reporting habits.

Results: Response rates were 67% (350/520) for S-As and 100% (11/11) for ATs. S-As represented 21 sports (mean age 20.3 years, range 18-24, 54% male). Sports-related concussion knowledge scores were lower in male S-As (median 73%; interquartile range [IQR] 55%-85%) than in female S-As (79%; 55%-88%) (P < 0.05). Sports-related concussion knowledge scores differed between collision/contact (C/C) sport (79%; 67%-86%) and noncontact (NC) sport (73%; 55%-83%) S-As (P < 0.05). Twenty-nine percent (n = 102) of the S-As experienced a prior SRC, of which 67% (n = 68) reported their injury to a medical/authority figure. Male and C/C S-As were significantly less likely to report SRC than female, limited-contact, or NC sport S-As. Sports-related concussion knowledge scores were higher in ATs (97%; 89%-99%) than in S-As (76%; 55%-85%) (P < 0.001).

Conclusions: S-As have variable levels of SRC knowledge, with female and C/C sport S-As scoring the highest. Most S-As with prior SRC reported these to a medical/authority figure, but male and C/C sport S-As were less likely to do so. As expected, ATs have higher SRC knowledge than S-As.

Objectives: The clinical consequences of coronavirus infection in elite judokas with exercise-induced bronchoconstriction (EIB) are unclear. We aimed to determine potential respiratory function abnormalities and recovery in athletes with and without EIB after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.

Design: Retrospective cohort study.

Setting: Türkiye Olympic Preparation Centre.

Participants: This retrospective study analyzed data collected from 25 consecutive elite judokas diagnosed with and without EIB and SARS-CoV-2 infection, routinely followed at an Olympic Sports Center between September 2020 and 2021.

Independent variables: Respiratory muscle strength and pulmonary function data were collected before and up to 90 days after SARS-CoV-2 infection.

Main outcome measures: Measurements included maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and peak expiratory flow (PEF).

Results: Infected athletes with EIB had more markedly reduced respiratory muscle strength and pulmonary function than those without EIB. Maximal inspiratory pressure was decreased by 14% and MEP by 8% from baseline in infected athletes with EIB during follow-up. Likewise, FEV1 and FVC decreased by 4%. Maximal inspiratory pressure, MEP, FEV1, and FVC remained abnormal after 90 days of SARS-CoV-2 infection in EIB athletes but normalized rapidly in non-EIB athletes. Peak expiratory flow seemed unaffected during follow-up. Exercise-induced bronchoconstriction severity was moderately correlated with the maximum fall in MEP during follow-up.

Conclusions: Severe acute respiratory syndrome coronavirus-2 infection notably decreases respiratory muscle strength and pulmonary function in judokas, especially those with pre-existing EIB, thereby prolonging spontaneous recovery time.

Objective: This study aimed to assess the experience of orofacial injuries and sports mouthguard use in German elite athletes.

Design: A questionnaire-based cross-sectional study was conducted.

Setting: The data were collected at the Institute of Applied Training Science (IAT, Leipzig, Germany) that provides regular primary care for elite athletes.

Participants: German elite athletes (18-35 years) from different disciplines with completed questionnaire on oral health in sports between May 2020 and April 2021 were included.

Interventions: N/A.

Main outcome measures: Number of dental, oral, and facial injuries during sports career and mouthguard use (received information, ownership, frequency) were assessed and compared between disciplines with different risks for orofacial trauma.

Results: In total, questionnaires of 337 athletes (23 ± 4 years, 50% female) were included. Disciplines were classified into high (HT, n = 20), medium (MT, n = 48), and low (LT, n = 269) risk for orofacial trauma. Substantial rates of injuries were identified; especially a lot of HT athletes reported orofacial injuries (HT: 55%, MT: 31%, LT: 17%; P ≤ 0.076) and dental injuries (HT: 30%, MT: 10%, LT: 7%; P ≤ 0.028). Mouthguards were rare (HT: 25%, MT: 0%, LT: 3%).

Conclusions: There is a need for more prevention of orofacial injuries in German elite sports for both HT and MT.

Abstract: In this case report, we encountered a pseudocyst as a complication of endoscopic lumbar discectomy in a high-level athlete within 3 months, which is atypical according to the literature. The recurrence of this pathology is even rarer, in this case, the patient presented a recurrence of the pseudocyst after resection. This case report outlines a review of the patient's clinical report, imaging, operative procedure, and complications, together with a literature review on pseudocysts after endoscopic lumbar discectomy.

Objectives: To determine whether history of traumatic brain injury (TBI) is associated with psychopathology, and, in particular, substance use disorder (SUD) in young adults with a history of athletic participation.

Design: Observational study.

Setting: University in the northeastern United States.

Participants: A large (n = 534) and mixed sex (57% female) sample of varsity and club sport athletes older than 18 years.

Interventions: None.

Main outcome measure: The Ohio State University Traumatic Brain Injury ID assessment and the Structured Clinical Interview for the diagnostic and statistical manual of mental disorders, fifth edition.

Results: Twenty-five percent of participants reported no history of head injuries, 32% reported 1 head injury, and 43% reported more than 1 head injury. Thirty-eight percent of participants had been diagnosed with 1 or more concussions. Twenty-eight percent of participants had a current psychiatric diagnosis and 49% had at least 1 lifetime diagnosis. Head injuries and concussions were significantly associated with the presence of lifetime psychiatric diagnosis and symptoms or diagnosis of alcohol or SUD. More head injuries were associated with symptoms of post-traumatic stress disorder.

Conclusions: Higher number of self-reported head injuries and diagnosed concussions were associated with a lifetime history of psychopathology, and specifically, with alcohol and substance use disorders. These relationships are similar to those seen in the general population of adults. The relationships also raise several interesting questions about recovery from head injuries in young adult athletes.

Objective: The purpose of this study was to examine the relationship between collegiate student-athletes' sleep and injury status.

Design: This study was a secondary analysis of observational survey data of student-athletes collected across 2 time periods, October 2020 and January 2021.

Setting: Data were collected as part of an ongoing national (USA) longitudinal survey investigating student-athletes' well-being in the aftermath of the COVID-19 pandemic.

Participants: Participants were made-up of a subsample of participants from the parent study. Data from 89 exact matched pairs (across 5 demographics) of injured and noninjured student-athletes (68.5% NCAA Division I, 82.0% women) were assessed.

Independent variables: Student-athletes' sleep disturbance levels were the primary independent variable of interest. Analytic models also covaried for gender, racial, and ethnic identities, sport in-seasons, and previous injury status.

Main outcome measures: Participant endorsed injury status was the main outcome measure of interest. Hypotheses were formulated during the data collection of the parent study.

Results: Student-athletes injured in January 2021 reported higher average sleep disturbances in both October 2020 and January 2021 than noninjured student-athletes but not student-athletes injured in October. In addition, October 2020 sleep disturbances were a significant predictor (P = 0.007) of injury, such that odds of student-athletes being injured increased 1.07 times for each unit increase in their sleep disturbances controlling for their identities, sport in-season, and previous injury status.

Conclusions: Findings signal support for the screening and targeting of student-athletes' sleep problems to reduce potential occurrences of sports-related injuries in student-athletes.

Objective: Exercise is a salient component in delaying disability progression in multiple sclerosis (MS). This study considers personal preferences regarding exercise program prescription and the resources needed to facilitate exercise.

Design: Cross-sectional study.

Setting: Community online, Australia.

Participants: Adults with MS.

Independent variables: Participants completed online questionnaires on current exercise and sport, and preferences toward exercise prescription variables, facilitative resource needs, and delivery method.

Main outcomes: We established preference responses for the entire sample, and separately, we used logistic regression and analysis of variance to compare preferences between participants stratified according to (1) geographical rurality (ie, metro vs rural and remote) and (2) current exercise engagement (ie, active, moderately active, and insufficiently active).

Results: Fifty people with a diagnosis of MS completed the survey. Participants had mild disability; most were metro-dwelling (74%) and physically active (58%). Preferences included a program of at least 6 months (70%), where exercise sessions are performed 5 d/wk (38%) at a moderate intensity (50%). Half (50%) of responders wanted to participate in sports for exercise. There was a significant difference in the preference toward higher-intensity exercise in active persons compared with inactive persons. Facilitative resources selected included a behavioral exercise coach (80%) who provides MS-specific information (46%) and behavioral change strategies (41%).

Conclusions: Persons with mild MS are interested in participating in various exercises and sports. Encouraging participation will have long-term benefits. We recommend that HCPs and researchers consider individual social factors, in addition to patient symptoms and disability, when designing exercise programs for an Australian MS population.