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Test-Retest Reliability and Reliable Change Estimates for Sensorimotor Concussion Assessments in Healthy Young Adults. 健康青年感觉运动脑震荡评估的重测信度和可靠变化估计。
IF 1.3 4区 医学 Q3 REHABILITATION Pub Date : 2025-01-20 DOI: 10.1123/jsr.2024-0275
Gregory C Edwards, Alex E Bruggeman, Nick Fogt, James A Onate, Rebecca A Bliss, Catherine C Quatman-Yates, Jaclyn B Caccese

Context: Sensorimotor impairments are common sequela following concussion, but recovery following a concussion is often determined through examiner scored clinical testing. There are emerging technologies that provide objective methods to determine physiological impairment after concussion, but the psychometrics of these tools are lacking and must be established for use in clinical practice.

Objective: The purpose of this study was to examine the test-retest reliability and provide reliable change estimates in healthy young adults for outcomes from 3 emerging technologies providing objective assessments of sensorimotor function in healthy young adults.

Design: Test-retest reliability design in a laboratory setting.

Methods: Healthy, young adults completed testing at 2 time points 4 weeks apart on the Bertec Vision Trainer, the Concussion Balance Test (COBALT), and the Neurolign Dx-100 eye-tracking system. We determined test-retest reliability using intraclass correlation coefficients with a 2-way mixed-effects model absolute agreement. Reliable change estimates were calculated for 70%, 80%, 90%, and 95% CIs.

Results: Participants included 30 healthy young adults (age = 25 [5] y, interquartile range = 20-29; range = 18-38; 17% [57%] women). Test-retest reliability for the Bertec Vision Trainer outcomes ranged from 0.56 to 0.88, with 45% of the outcomes being classified as clinically acceptable (>.70 intraclass correlation coefficients ); for COBALT conditions, sway velocity ranged from 0.50 to 0.95, 95% ellipse area ranged from -0.22 to 0.88, and Sway Score ranged from 0.07 to 0.85, with 50% of COBALT metrics being clinically acceptable; and for the Dx-100, outcomes ranged from -0.20 to 0.89, with 52% being clinically acceptable.

Conclusions: Overall, test-retest reliability was moderate-to-good for the Bertec Vision Trainer assessment outcomes but were highly variable for outcomes of postural control using the COBALT and eye-tracking metrics using the Dx-100. This study adds clinically relevant test-retest reliability and reliable change estimates in healthy adults for 3 commercially available sensorimotor assessments.

背景:感觉运动障碍是脑震荡后常见的后遗症,但脑震荡后的恢复通常是通过考官评分的临床测试来确定的。有一些新兴的技术可以提供客观的方法来确定脑震荡后的生理损伤,但是这些工具的心理测量学是缺乏的,必须建立在临床实践中使用。目的:本研究的目的是检验三种新兴技术对健康年轻人感觉运动功能的客观评估结果的重测信度,并提供可靠的变化估计。设计:实验室环境下的重测可靠性设计。方法:健康的年轻人在间隔4周的2个时间点完成Bertec视力训练器、脑震荡平衡测试(COBALT)和Neurolign Dx-100眼动追踪系统的测试。我们使用类内相关系数和双向混合效应模型确定重测信度。为70%、80%、90%和95% ci计算可靠的变更估计。结果:参与者包括30名健康的年轻人(年龄= 25岁,四分位数范围= 20-29;范围= 18-38;17%[57%]女性)。Bertec视力训练器结果的重测信度范围为0.56至0.88,45%的结果被归类为临床可接受(>)。70个类内相关系数);对于钴条件,摇摆速度范围为0.50至0.95,95%椭圆面积范围为-0.22至0.88,摇摆评分范围为0.07至0.85,其中50%的钴指标临床可接受;Dx-100的结果范围为-0.20 - 0.89,52%临床可接受。结论:总体而言,Bertec Vision Trainer评估结果的重测信度为中等至良好,但使用COBALT的姿势控制结果和使用Dx-100的眼动追踪指标的结果变化很大。本研究为3种市售的感觉运动评估增加了临床相关的重测信度和健康成人的可靠变化估计。
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引用次数: 0
The Effect of Myofascial Release Applied to Thoracolumbar Fascia on Flexibility, Muscular Endurance, and Balance in Healthy Young Adults: A Single-Blind Randomized Controlled Trial. 肌筋膜释放对健康年轻人胸腰筋膜柔韧性、肌肉耐力和平衡的影响:一项单盲随机对照试验
IF 1.3 4区 医学 Q3 REHABILITATION Pub Date : 2025-01-20 DOI: 10.1123/jsr.2024-0102
Hatice Ozdemir, Ummuhan Bas Aslan, Hasan Atacan Tonak, Ibrahim Cagda Kal

Context: Although cranial distant effects occur in self-myofascial release interventions for lower-extremity muscles and fascia, the results of caudal distant effects are still unclear. The aim of this study was to examine the distant effects of myofascial release applied to the thoracolumbar fascia together with exercise training on balance, lower-extremity flexibility, and muscular endurance in healthy young adults.

Design: Single-blinded randomized control trial design.

Methods: Thirty-six healthy participants aged 18-35 years were randomly divided into 3 groups: myofascial release and exercise group (group 1, n = 12), exercise group (group 2, n = 12), and control group (group 3, n = 12). Three days a week for 4 weeks, group 1 applied the thoracolumbar fascia foam roller massage together with the warm-up, muscular endurance, balance, and stretching exercise program, and group 2 applied the same exercise program except for the foam roller massage. No intervention was made in group 3. Flexibility was assessed with sit and reach test, muscular endurance with the 1-minute sit to stand test, and balance with star excursion balance test before the intervention and at the end of the fourth week.

Results: Flexibility, muscular endurance, and dynamic balance values increased significantly in groups 1 and 2 after the intervention (P < .05). When the difference values (Δ) of groups 1 and 2 were compared, there was a difference in favor of group 1 for flexibility, muscular endurance, and dynamic balance (P < .05).

Conclusions: The results of the study showed that the effect of the distant myofascial release technique added to the exercise training on flexibility, muscular endurance, and dynamic balance was greater than the exercise training alone.

背景:尽管在下肢肌肉和筋膜的自我肌筋膜释放干预中会出现颅端远端效应,但尾端远端效应的结果仍不清楚。本研究的目的是研究将肌筋膜释放法应用于胸腰筋膜,并结合运动训练对健康年轻人的平衡、下肢柔韧性和肌肉耐力的远期影响。设计:单盲随机对照试验设计。方法:将36例18 ~ 35岁的健康受试者随机分为肌筋膜松解运动组(1组,n = 12)、运动组(2组,n = 12)和对照组(3组,n = 12)。每周3天,连续4周,组1应用胸腰筋膜泡沫滚轮按摩配合热身、肌肉耐力、平衡、拉伸等锻炼方案,组2应用除泡沫滚轮按摩外的相同锻炼方案。第三组不进行干预。在干预前和第四周结束时,用坐伸测试评估柔韧性,用1分钟坐立测试评估肌肉耐力,用星形偏移平衡测试评估平衡。结果:干预后1、2组的柔韧性、肌肉耐力、动态平衡值均显著升高(P < 0.05)。比较1组和2组的差异值(Δ), 1组在柔韧性、肌肉耐力和动态平衡方面有明显优势(P < 0.05)。结论:本研究结果表明,在运动训练中加入远端肌筋膜释放技术对柔韧性、肌肉耐力和动态平衡的影响大于单纯的运动训练。
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引用次数: 0
The Effects of Floor Isometric Trunk Extension Exercise on Muscle Thickness and Activation Vary Between Different Combinations of Duration and Repetition Number. 地板等长躯干伸展运动对肌肉厚度和激活的影响在不同的持续时间和重复次数组合中有所不同。
IF 1.3 4区 医学 Q3 REHABILITATION Pub Date : 2025-01-20 DOI: 10.1123/jsr.2024-0054
Eleftherios Kellis, Athanasios Konstantopoulos, Athanasios Ellinoudis

Context: Intermittent floor trunk extensions are popular exercises in group fitness programs. The aim of this study was to investigate whether fewer repetitions of longer isometric trunk extension efforts compared with more repetitions of shorter isometric contractions have different acute effects on muscle thickness and activation as well as perceived exertion.

Design: This study followed a cross-sectional design.

Methods: Twenty healthy young males performed floor prone trunk extension exercises using 3 different exercise protocols of repetition and duration: 10 × 5 seconds (D10 × 5), 2 × 25 seconds (D2 × 25), and 5 × 10 seconds (D5 × 10). Ultrasound multifidus thickness and rate of perceived exertion on a 10-point scale were measured immediately after each protocol. Electromyographic activation from the erector spinae, multifidus, and gluteus maximum during each protocol was measured using bipolar surface electrodes.

Results: The longer duration (D2 × 25) protocol showed a significant greater rate of perceived exertion (6.22 [0.73]) and rest multifidus thickness change (median: 8.04%) compared with the other protocols (P < .05). Within each protocol, root mean square of all muscles increased from trial to trial in the D2 × 25 and D5 × 10 (P < .05), but not during the D10 × 5 protocol (P > .05). The maximum root mean square was achieved in the shorter duration (D10 × 5) protocol compared with the other ones (P < .05).

Conclusion: If trunk extension exercises on the floor are used in a training setting, then using exercises with long duration and fewer repetitions may elicit a greater metabolic response.

背景:间歇地板躯干伸展是团体健身项目中流行的运动。本研究的目的是探讨较短的等距收缩与较短的等距收缩相比,较短的等距收缩与较短的等距收缩相比,较短的等距伸展是否对肌肉厚度和激活有不同的急性影响。设计:本研究采用横断面设计。方法:20名健康青年男性采用3种不同的重复和持续时间:10 × 5秒(D10 × 5)、2 × 25秒(D2 × 25)和5 × 10秒(D5 × 10)进行地板俯卧躯干伸展练习。每次治疗后立即测量超声多裂肌厚度和感知用力率(10分制)。使用双极表面电极测量每个方案中竖脊肌、多裂肌和臀大肌的肌电激活。结果:较长时间(D2 × 25)方案与其他方案相比,感知劳累率(6.22[0.73])和休息时多裂肌厚度变化(中位数:8.04%)显著高于其他方案(P < 0.05)。在每个方案中,D2 × 25和D5 × 10组所有肌肉的均方根均随试验而增加(P < 0.05),但在D10 × 5方案中没有增加(P < 0.05)。与其他方案相比,时间较短的方案(D10 × 5)获得最大均方根(P < 0.05)。结论:如果在训练中使用地板上的躯干伸展练习,那么使用长时间和较少重复的练习可能会引起更大的代谢反应。
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引用次数: 0
Validity of Lower-Extremity Strength Between Push- and Pull-Based Handheld Dynamometers: A Technical Report. 基于推和拉的手持式测力仪的下肢强度有效性:一份技术报告。
IF 1.3 4区 医学 Q3 REHABILITATION Pub Date : 2025-01-20 DOI: 10.1123/jsr.2024-0108
Neal R Glaviano, Emma F Zuk, Lauren Sheldon, Michael DiStefano, Laurie Devaney

Context: Handheld dynamometers provide clinicians an objective measure of lower-extremity force production at the hip and knee. While push-based dynamometers are common in clinical practice, they can be associated with patient discomfort, and standardization of methods is challenging when patient forces can exceed the ability of the rater. Development of novel, pull-based dynamometers allow for better patient comfort, but validity between dynamometers must be established before integration into clinical practice. Therefore, the purpose of this study was to compare measurement of lower-extremity force between push- and pull-based handheld dynamometers.

Design: Descriptive laboratory study.

Methods: Twenty-one healthy triathletes performed isometric hip abduction, hip external rotation, and knee extension testing against 2 separate handheld dynamometers. Pearson product correlations were calculated for the relationship between devices, while Bland-Altman plots were used to measure agreement with limit of agreement to assess systematic bias.

Results: Correlations between devices were strong for hip abduction and knee extension (r = .743-.767, P < .001) and moderate for hip external rotation (r = .429, P = .052). Additionally, there was good agreement between the 2 devices, with acceptable limits of agreement across the 3 force tasks. The pull-based dynamometer resulted in greater torque values for knee-extension and hip external rotation, with a mean difference of -0.37 and -0.19 N·m/kg, but there was no difference in hip abduction with a mean difference of 0.03 N·m/kg.

Conclusion: The results demonstrate that pull-based dynamometers are an acceptable alternative to push-based dynamometers for hip abduction and knee extension, but some caution may exist for hip external rotation. Clinicians should be aware of differences in lower-extremity force across multiple handheld dynamometers when assessing muscle function in practice.

背景:手持式测功机为临床医生提供了髋关节和膝关节下肢力量产生的客观测量。虽然基于推力的测力计在临床实践中很常见,但它们可能与患者不适有关,当患者的力量可能超过测力计的能力时,方法的标准化是具有挑战性的。新型拉力式测力仪的开发可以提高患者的舒适度,但在应用于临床实践之前,必须确定测力仪之间的有效性。因此,本研究的目的是比较基于推和拉的手持式测力仪对下肢力的测量。设计:描述性实验室研究。方法:21名健康的铁人三项运动员在2台独立的手持式测功机上进行髋外展、髋外旋和膝关节伸展测试。皮尔逊产品相关性计算设备之间的关系,而Bland-Altman图用于测量一致性与一致性限制,以评估系统偏倚。结果:髋关节外展和膝关节外展的器械相关性强(r = .743-)。767, P < 0.001)和中度髋外旋(r = .429, P = .052)。此外,两个设备之间有很好的一致性,在3个force任务之间有可接受的一致性限制。拉力测功仪在膝关节伸展和髋关节外旋时的扭矩值更大,平均差值分别为-0.37和-0.19 N·m/kg,但在髋关节外展时无差异,平均差值为0.03 N·m/kg。结论:结果表明,在髋关节外展和膝关节伸展时,基于拉力的测功机是一种可接受的替代基于推力的测功机,但在髋关节外旋时可能存在一些谨慎。临床医生在实践中评估肌肉功能时,应该意识到多个手持式测功机在下肢力方面的差异。
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引用次数: 0
A Dynamic Warm-Up Improves Titleist Performance Institute Screen Scores in Adult Golfers. 动态热身提高成人高尔夫球手的头衔表表现研究所屏幕分数。
IF 1.3 4区 医学 Q3 REHABILITATION Pub Date : 2025-01-17 DOI: 10.1123/jsr.2024-0193
Andrew Skibski, Pradeep Vanguri, Jeffrey R Stout, Christopher D Ingersoll, L Colby Mangum

Context: Guidelines for various movement assessments often instruct clinicians to conduct testing without a warm-up. Warm-ups are commonly performed to increase heart rate, decrease stiffness, and prepare for sport-specific demands. Since athletes typically complete a warm-up prior to sport participation, evaluating biomechanics in this condition may provide a better indication of their bodies' physical capabilities. The primary purpose of this study was to compare scores on the Titleist Performance Institute (TPI) screen before and after a dynamic warm-up in adult golfers.

Design: Twenty-four adult golfers (19 male/5 female, age 44.0 [15.4] y, height 171.3 [8.6] cm, weight 82.5 [16.3] kg, average 18-hole score 90.7 [10.3] strokes) completed a single-session crossover laboratory study.

Methods: Participants completed the TPI screen, which included 15 simple tests scored based on their ability to properly complete the movement. Following a rest and washout period, participants performed a brief dynamic warm-up including exercises for the extremities and trunk, followed by 30 seconds of practice golf swings. Participants immediately retested the TPI screen, following the same procedures. Composite and individual test scores were compared before and after the warm-up with Wilcoxon signed-rank tests and r effect sizes at a significance of P ≤ .05.

Results: TPI composite scores were significantly higher following the warm-up (median: 36, interquartile range 31/40) than before the warm-up (median: 33, interquartile range 28/36) (P < .001), with a large effect size (r = .81).

Conclusions: Our findings suggest a warm-up leads to higher scores on the TPI screen, and that an athlete's warm-up condition should be considered when interpreting their performance.

背景:各种运动评估指南经常指导临床医生在没有热身的情况下进行测试。热身通常是为了提高心率,减少僵硬,为特定的运动要求做准备。由于运动员通常在参加运动前完成热身,在这种情况下评估生物力学可以更好地表明他们的身体能力。本研究的主要目的是比较成年高尔夫球手在动态热身前后在Titleist Performance Institute (TPI)屏幕上的得分。设计:24名成年高尔夫球手(男19名,女5名,年龄44.0[15.4]岁,身高171.3 [8.6]cm,体重82.5 [16.3]kg,平均18洞杆数90.7[10.3]杆数)完成单期交叉实验室研究。方法:参与者完成TPI筛选,其中包括15个简单的测试,根据他们正确完成运动的能力进行评分。在休息和洗脱期之后,参与者进行了一个简短的动态热身,包括四肢和躯干的锻炼,然后是30秒的高尔夫挥杆练习。参与者立即按照相同的程序重新测试TPI筛选。采用Wilcoxon符号秩检验比较热身前后的综合和单项测试成绩,r效应量P≤0.05。结果:热身后TPI综合评分(中位数:36,四分位范围为31/40)显著高于热身前(中位数:33,四分位范围为28/36)(P < 0.001),且效应量较大(r = 0.81)。结论:我们的研究结果表明,热身会导致更高的TPI屏幕得分,并且在解释运动员的表现时应考虑运动员的热身情况。
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引用次数: 0
Return to Sport After Partum in Patients With Diastasis of the Rectus Abdominis Muscles: Ultrasound Evaluation and Rehabilitation Protocol. 腹直肌分离患者产后恢复运动:超声评估和康复方案。
IF 1.3 4区 医学 Q3 REHABILITATION Pub Date : 2025-01-17 DOI: 10.1123/jsr.2024-0252
Fabio Vita, Danilo Donati, Vincenza Amouso, Salvatore Massimo Stella, Marta Fantini, Roberto Tedeschi, Marco Miceli, Stefano Galletti, Cesare Faldini

Background: Diastasis rectus abdominis is a condition in which the rectus abdominis muscles separate and move laterally, causing stretching of the linea alba tissue with weakness of the abdominal wall. Although it can lead to hernia of the abdominal viscera, diastasis rectus abdominis is not a hernia in itself. This condition is common among women during pregnancy and the postpartum period and can significantly affect their quality of life and their return to sports activity. Unfortunately, information on the incidence, risk factors, prevention, and treatment of diastasis rectus abdominis are limited.

Methods: We conducted a pilot prospective observational study on 37 patients who practiced sports at high levels (at least 3 times a week with amateur/competitive competitions) who underwent ultrasound measurements of the distance between the rectus abdominis muscles at the level of the xiphoid process, supraumbilical, umbilical, and subumbilical at time (T0), after 2 months from the rehabilitation protocol (T1), and then after 4 months of rehabilitation protocol (T2) from approximately 3 months after giving birth, and we saw an early return to sport.

Results: Our data analysis reveals that there is an initial decrease in diastasis during the first 2 months with 3 weekly physiotherapy activity sessions in all 4 measurements. One session takes place on site with physiotherapists, while the other 2 are carried out at home using the rehabilitation protocol provided by the medical staff. At the 4-month follow-up, the improvement was similar to the previous follow-up.

Conclusion: Of the 37 women analyzed, 6 were referred to the surgeon; 2 for hernias and 4 for diastases greater than 4 cm. The remaining women benefited from a conservative approach. Patients undergoing the rehabilitation protocol showed improvements in all 4 measures, as well as their early return to sport.

背景:腹直肌移位是指腹直肌分离并向外侧运动,引起白线组织拉伸,腹壁无力。虽然它可以导致腹部脏器疝,但腹直肌移位本身并不是疝。这种情况在怀孕和产后期间的妇女中很常见,并会严重影响她们的生活质量和重返体育活动。不幸的是,关于腹直肌转移的发病率、危险因素、预防和治疗的信息有限。方法:我们对37例进行高水平运动(每周至少3次业余/竞技比赛)的患者进行了一项前瞻性先导观察研究,这些患者在康复方案(T1)后2个月(T0)接受超声测量剑突、脐上、脐上和脐下水平的腹直肌之间的距离。然后在产后大约3个月进行了4个月的康复治疗(T2)之后,我们看到她们很早就恢复了运动。结果:我们的数据分析显示,在所有4项测量中,在前2个月内,每周进行3次物理治疗活动,转移率初步下降。其中一次在现场由物理治疗师进行,另外两次在家中根据医务人员提供的康复方案进行。在4个月的随访中,改善与前一次随访相似。结论:在分析的37名妇女中,6名转介到外科医生;疝2例,病变大于4cm 4例。其余的女性则受益于保守疗法。接受康复方案的患者在所有4项措施中均有所改善,并且他们可以早期恢复运动。
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引用次数: 0
Early Surgical Treatment of Posttraumatic Myositis Ossificans of the Vastus Intermedius Muscle. 外伤性股中间肌骨化性肌炎的早期手术治疗。
IF 1.3 4区 医学 Q3 REHABILITATION Pub Date : 2025-01-17 DOI: 10.1123/jsr.2024-0114
Pave Kalebić, Silvije Šegulja, Bojan Miletić, Hrvoje Vlahović, Gordana Starčević-Klasan

Context: This case study demonstrates the effectiveness of early surgical excision of the traumatic myositis ossificans of the vastus intermedius muscle in an elite football player and return to sports activity within 3 months from the initial injury.

Case presentation: A 27-year-old male professional football player presented with progressive pain and loss of range of motion after sustaining a severe, right quadriceps contusion 4 weeks earlier. After unsuccessful conservative therapy, the differential diagnosis of myositis ossificans was suspected and confirmed on radiographic examination. MRI revealed significant edema encompassing a substantial portion of the vastus intermedius muscle.

Management and outcomes: Surgical treatment was considered for the right thigh mass, being symptomatic 1 month after the onset and refractory to conservative treatment and rehabilitation program. At 2 months postsurgery, the patient was asymptomatic and had completed a rehabilitation program.

Conclusion: Early surgical treatment followed-up with a rehabilitation program results with a complete recovery of muscle strength and range of motion. At 3 months postinitial injury, the patient was considered fully recovered and had returned to the match without reporting pain or other symptoms.

背景:本病例研究证明了一名优秀足球运动员早期手术切除外伤性股中间肌骨化性肌炎的有效性,并在初始损伤后3个月内恢复体育活动。病例介绍:一名27岁的男性职业足球运动员,在4周前右股四头肌严重挫伤后出现进行性疼痛和活动范围丧失。保守治疗不成功后,怀疑骨化性肌炎的鉴别诊断,并通过影像学检查证实。MRI显示明显的水肿包围了相当一部分股中间肌。处理和结果:考虑对右大腿肿块进行手术治疗,发病1个月后出现症状,保守治疗和康复方案难以治愈。术后2个月,患者无症状并完成了康复计划。结论:早期手术治疗和康复治疗可使肌肉力量和活动范围完全恢复。在初次受伤后3个月,患者被认为完全康复,并返回比赛,没有报告疼痛或其他症状。
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引用次数: 0
Immediate and Short-Term Effect of Scapula Retraction Exercises on Subacromial Space: Do We Have Enough Evidence in Patients With Subacromial Pain? 肩胛骨收缩运动对肩峰下间隙的即时和短期影响:我们有足够的证据证明肩峰下疼痛患者吗?
IF 1.3 4区 医学 Q3 REHABILITATION Pub Date : 2025-01-11 DOI: 10.1123/jsr.2024-0195
Leyla Eraslan, Ozan Yar, Gazi Huri, Irem Duzgun

Context: Limited information exists regarding the immediate and short-term effects of scapula retraction exercises (SREs) on acromiohumeral distance (AHD) in subacromial pain syndrome (SPS). This study's 2 main objectives were to investigate (1) the immediate effect of the SRE on AHD at varying shoulder abduction angles in patients with SPS and healthy controls and (2) the effect of the 8-week SRE program on AHD in patients with SPS.

Design: Cross-sectional and pre-post intervention designs were utilized on this study.

Methods: Twenty-one patients with SPS and age-matched healthy controls were included. First, AHD at 0°, 30°, 45°, 60°, and 90° of active shoulder abductions were recorded during (1) resting upper quadrant posture and (2) while participants were performing SREs. Patients then underwent an 8-week progressive SRE program. AHD measures, pain intensity (visual analog scale), and disability (Shoulder Pain and Disability Index) were recorded at baseline and 8 weeks. AHD were analyzed using mixed-model analyses of variance. Pain and disability were analyzed using paired samples t test.

Results: The immediate effect of the SREs revealed a significant angle-by-exercise-by-group interaction for the AHD values (F3,155 = 3.956, P = .009, ηp2=.175). Pairwise comparisons yielded that the SRE increased AHD values in patients with SPS (P < .05), yet it did not affect healthy controls (P > .05). Besides, the SRE program revealed a significant angle-by-time interaction for the AHD values (F3,054 = 9.476, P < .001, ηp2=.195). AHD increased at all elevation angles, and pain and disability improved over time (P < .05).

Conclusion: SREs immediately affect AHD in patients with SPS but not in healthy populations. Moreover, SREs applied in progressive abduction angles improve pain, functionality, and AHD values in patients with SPS.

背景:关于肩峰下疼痛综合征(SPS)患者肩胛骨牵伸练习(SREs)对肩肱骨距离(AHD)的即时和短期影响的信息有限。本研究的两个主要目的是调查(1)SRE对SPS患者和健康对照者不同肩部外展角度下AHD的直接影响,以及(2)8周SRE计划对SPS患者AHD的影响。设计:本研究采用横断面设计和干预前后设计。方法:选取21例SPS患者和年龄相匹配的健康对照。首先,在(1)休息上象限姿势和(2)参与者进行SREs时,记录主动肩外展0°、30°、45°、60°和90°的AHD。然后,患者接受了为期8周的渐进式SRE计划。在基线和8周时记录AHD测量、疼痛强度(视觉模拟量表)和残疾(肩痛和残疾指数)。AHD分析采用混合模型方差分析。疼痛和残疾的分析采用配对样本t检验。结果:SREs对AHD值的直接影响显示,不同运动角度与不同组之间存在显著的相互作用(f3155 = 3.956, P = 0.009, ηp2= 0.175)。两两比较发现,SRE增加了SPS患者的AHD值(P < 0.05),但对健康对照组没有影响(P < 0.05)。此外,SRE程序显示AHD值具有显著的角度-时间交互作用(f3054 = 9.476, P < 0.001, ηp2= 0.195)。AHD在所有仰角均增加,疼痛和残疾随时间改善(P < 0.05)。结论:SREs会立即影响SPS患者的AHD,但对健康人群没有影响。此外,SREs应用于渐进式外展角度可改善SPS患者的疼痛、功能和AHD值。
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引用次数: 0
A Concussion Management Policy Change Promoted Earlier Initiation of Rehabilitation Services and Improved Clinical Recovery Outcomes in Concussion. 脑震荡管理政策的改变促进了脑震荡患者早期康复服务的开展,并改善了脑震荡患者的临床康复结果。
IF 1.3 4区 医学 Q3 REHABILITATION Pub Date : 2025-01-11 Print Date: 2025-03-01 DOI: 10.1123/jsr.2024-0097
Elizabeth F Teel, Danielle Dobney, Deborah Friedman, Lisa Grilli, Christine Beaulieu, Isabelle J Gagnon

Context: In line with emerging research, an interprofessional specialty concussion clinic instituted a policy change permitting earlier physiotherapy-based treatment entry. Our objective was to determine the effect of this policy change on concussion recovery outcomes.

Design: Secondary analysis of prospectively collected clinical data.

Methods: 600 youth with concussion were included. Active rehabilitation was initiated ≥4 weeks (prepolicy) or ≥2 weeks (postpolicy) postconcussion based on institutional policy. Cox proportional hazard models, linear mixed models, and chi-square analyses were conducted.

Results: The postpolicy group (median = 22 d [interquartile range: 17-27]) started treatment earlier than the prepolicy group (median = 26 d [interquartile range: 24-30], P < .001). Length of episode of care (χ2(1) = 11.55, P < .001, odds ratios = 1.49; 95% confidence interval, 1.19-1.88); rehabilitation (χ2(1) = 9.47, P = .002, odds ratios = 1.73, 95% confidence interval, 1.22-2.45]); and total recovery (χ2(1) = 11.53, P < .001, odds ratios = 1.49; 95% confidence interval, 1.18-1.88) were reduced in patients postpolicy change. A significant interaction effect was found for total postinjury symptom (F2,320 = 3.59, P = .03) and symptom change scores (F2,315 = 5.17, P = .006), with the postpolicy group having faster symptom resolution over time. No group differences were observed for persisting symptoms.

Conclusions: Earlier rehabilitation initiation occurred as intended following an institutional policy change, which had small, but significant, effects on recovery outcomes in youth with concussion. Health care providers should adopt policies to encourage early active rehabilitation services after concussion.

背景:根据新兴的研究,一个跨专业的专业脑震荡诊所制定了一项政策改变,允许早期的基于物理治疗的治疗进入。我们的目的是确定这一政策变化对脑震荡恢复结果的影响。设计:对前瞻性临床资料进行二次分析。方法:选取青年脑震荡患者600例。根据机构政策,在脑震荡后≥4周(政策前)或≥2周(政策后)开始积极康复。采用Cox比例风险模型、线性混合模型和卡方分析。结果:政策后组(中位数= 22 d[四分位数范围:17-27])比政策前组(中位数= 26 d[四分位数范围:24-30],P < .001)更早开始治疗。护理时间(χ2(1) = 11.55, P < 0.001,优势比= 1.49;95%置信区间,1.19-1.88);康复(χ2(1) = 9.47, P = 0.002,优势比= 1.73,95%可信区间为1.22 ~ 2.45);总回收率(χ2(1) = 11.53, P < 0.001,优势比= 1.49;95%可信区间(1.18-1.88),政策改变后患者的死亡率降低。损伤后总症状(f2320 = 3.59, P = .03)与症状改变评分(f2315 = 5.17, P = .006)之间存在显著的交互作用,且损伤后组随时间的推移症状消退更快。在持续症状方面没有观察到组间差异。结论:在制度政策改变后,早期的康复开始如期发生,这对青年脑震荡患者的康复结果有小但显著的影响。卫生保健提供者应采取政策,鼓励脑震荡后早期主动康复服务。
{"title":"A Concussion Management Policy Change Promoted Earlier Initiation of Rehabilitation Services and Improved Clinical Recovery Outcomes in Concussion.","authors":"Elizabeth F Teel, Danielle Dobney, Deborah Friedman, Lisa Grilli, Christine Beaulieu, Isabelle J Gagnon","doi":"10.1123/jsr.2024-0097","DOIUrl":"10.1123/jsr.2024-0097","url":null,"abstract":"<p><strong>Context: </strong>In line with emerging research, an interprofessional specialty concussion clinic instituted a policy change permitting earlier physiotherapy-based treatment entry. Our objective was to determine the effect of this policy change on concussion recovery outcomes.</p><p><strong>Design: </strong>Secondary analysis of prospectively collected clinical data.</p><p><strong>Methods: </strong>600 youth with concussion were included. Active rehabilitation was initiated ≥4 weeks (prepolicy) or ≥2 weeks (postpolicy) postconcussion based on institutional policy. Cox proportional hazard models, linear mixed models, and chi-square analyses were conducted.</p><p><strong>Results: </strong>The postpolicy group (median = 22 d [interquartile range: 17-27]) started treatment earlier than the prepolicy group (median = 26 d [interquartile range: 24-30], P < .001). Length of episode of care (χ2(1) = 11.55, P < .001, odds ratios = 1.49; 95% confidence interval, 1.19-1.88); rehabilitation (χ2(1) = 9.47, P = .002, odds ratios = 1.73, 95% confidence interval, 1.22-2.45]); and total recovery (χ2(1) = 11.53, P < .001, odds ratios = 1.49; 95% confidence interval, 1.18-1.88) were reduced in patients postpolicy change. A significant interaction effect was found for total postinjury symptom (F2,320 = 3.59, P = .03) and symptom change scores (F2,315 = 5.17, P = .006), with the postpolicy group having faster symptom resolution over time. No group differences were observed for persisting symptoms.</p><p><strong>Conclusions: </strong>Earlier rehabilitation initiation occurred as intended following an institutional policy change, which had small, but significant, effects on recovery outcomes in youth with concussion. Health care providers should adopt policies to encourage early active rehabilitation services after concussion.</p>","PeriodicalId":50041,"journal":{"name":"Journal of Sport Rehabilitation","volume":" ","pages":"308-316"},"PeriodicalIF":1.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Loaded Open Kinetic Chain Exercises Caused More Anterior Tibial Translation and Anteromedial Graft Elongation Than Closed Kinetic Chain Following Double-Bundle Anterior Cruciate Ligament Reconstruction. 双束前交叉韧带重建后,负荷开放动力链运动比封闭动力链运动能增加胫骨前平移和前内侧移植物伸长。
IF 1.3 4区 医学 Q3 REHABILITATION Pub Date : 2025-01-11 DOI: 10.1123/jsr.2024-0188
Ling Zhang, Yangyang Yang, Chunjie Xia, Cong Wang, Jiayu Qiu, Jiebo Chen, Tsung-Yuan Tsai, Jinzhong Zhao, Shaobai Wang

Context: To further improve rehabilitation programs while preventing overstretching the anterior cruciate ligament (ACL), a thorough understanding of the knee kinematics and ACL length change during closed kinetic chain and open kinetic chain (OKC) exercises is essential. The measurement of ACL graft length relates to the changes in strain experienced by the ACL graft during different types of exercises rather than simple physical length.

Objective: This study aimed to determine the effects of closed kinetic chain and OKC exercises on tibiofemoral kinematics and ACL graft length changes following double-bundle ACL reconstruction.

Design: Cohort study (diagnosis); level of evidence, 3.

Setting: Laboratory.

Patients: Fifteen patients who underwent double-bundle ACL reconstruction were asked to perform 10-kg loaded seated knee extension (OKC-10) and single-leg lunge. During the seated knee extension, patients were instructed to extend and flex the knee within a range of 0° to 90° of flexion, with a 10-kg load applied to the ankle. For the lunge, patients began in a natural standing position and were instructed to flex the ACL-reconstructed knee to approximately 90°.

Interventions: The 3-dimensional tibiofemoral kinematics under different weight-bearing conditions were determined using a dual-fluoroscopic imaging system.

Main outcome measures: The tibiofemoral kinematics in 6 degrees-of-freedom were measured. And 3-dimensional ligament simulation technique was used to quantify length changes of the anteromedial bundle and posterolateral bundle.

Results: The tibia exhibited significantly more external rotation during the OKC-10 motion than during the single-leg lunge from 35° to 70° of knee flexion (P ≤ .028). Beyond 30° of knee flexion, the tibia exhibited significantly more varus during the OKC-10 motion than during the single-leg lunge (P ≤ .028). And a significantly more anterior tibial translation was observed during the OKC-10 motion than during the lunge from 0° to 15° of flexion (P ≤ .018). The anteromedial bundle length was significantly longer during the OKC-10 motion than during the lunge between 0° and 25° of knee flexion (P ≤ .028).

Conclusions: The effects of OKC exercises with loads on knee rotational stability should be considered in making rehabilitation programs for patients after ACL reconstruction. Since some degree of anterior tibial translation is physiological, it is important to note that increased translation alone does not necessarily indicate danger or instability.

背景:为了进一步改善康复计划,同时防止前交叉韧带(ACL)过度拉伸,在闭合动力链和开放动力链(OKC)训练中,全面了解膝关节运动学和ACL长度的变化是必不可少的。ACL移植物长度的测量与ACL移植物在不同类型的运动中所经历的应变变化有关,而不是简单的物理长度。目的:本研究旨在确定闭合动力链和OKC运动对双束ACL重建后胫股运动学和ACL移植长度变化的影响。设计:队列研究(诊断);证据水平,3。设置:实验室。患者:15例接受双束前交叉韧带重建的患者被要求进行10kg负重坐式膝关节伸展(OKC-10)和单腿弓步。在坐位膝关节伸展期间,患者被指示在0°至90°的屈曲范围内伸展和弯曲膝关节,脚踝施加10kg的负荷。对于弓步,患者以自然站立姿势开始,并指示将acl重建的膝关节弯曲约90°。干预措施:采用双透视成像系统测定不同负重条件下的三维胫股运动学。主要观察指标:测量6个自由度的胫股运动学。采用三维韧带模拟技术量化前内侧束和后外侧束的长度变化。结果:在OKC-10运动中,胫骨的外旋明显大于单腿弓步,膝关节屈曲35°至70°(P≤0.028)。膝关节屈曲超过30°时,OKC-10运动中胫骨内翻明显多于单腿弓步运动(P≤0.028)。在OKC-10运动期间观察到的胫骨前移位明显多于在0°至15°屈曲期间观察到的胫骨前移位(P≤0.018)。在OKC-10运动期间,前内侧束长度明显长于膝关节屈曲0°至25°之间的弓步运动期间(P≤0.028)。结论:在制定前交叉韧带重建患者的康复方案时,应考虑负重负重OKC运动对膝关节旋转稳定性的影响。由于某种程度的胫骨前移位是生理性的,因此需要注意的是,单纯的移位增加并不一定意味着危险或不稳定。
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引用次数: 0
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Journal of Sport Rehabilitation
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