Journal of Sport Rehabilitation最新文献

Context: Athletes with a history of concussion (CON) have been demonstrated to have heightened levels of anxiety and depression that may continue well beyond the resolution of concussion symptoms. The global events of 2020 resulted in elevated levels of anxiety and depression in the general population, which may have unequally presented in collegiate athletes with (CON) than those without a history of concussion (NoCON). Using a deception design, our survey-based study compared levels of anxiety and depression in CON and NoCON collegiate athletes in response to the pandemic and social injustices. We hypothesized that the CON group would have significantly elevated anxiety and depression as compared to the NoCON group in response to events of 2020.

Design and methods: Collegiate athletes (N = 106) during the academic 2020-2021 academic year were divided into CON and NoCON groups based on their preinjury (baseline) concussion assessment. Participants completed the Social Readjustment Rating Scale (SSRS), Center for Epidemiologic Studies Depression Scale (CES-D), and Generalized Anxiety Disorder Scale-7 (GAD-7) via an electronic survey pertaining to the events of 2020. The term "concussion" was not used in any study materials which was the basis for our deception-based design. An analysis of covariance was used to compare group CES-D and GAD-7 outcome scores while controlling for the SSRS outcome score.

Results: Our survey response rate was 14.2% (48/337 [77.1% female]) and 10.1% (58/580 [67.2% female]), for the NoCON and CON groups, respectively. The NoCON group had significantly (F1 = 5.82, P = .018, ηp2=.06) higher anxiety (8.3 [5.89]) as compared to the CON group (5.5 [2.85]). The NoCON group also had significantly (F1 = 13.7, P < .001, ηp2=.12) higher levels of depression (21.0 [12.52]) as compared to the CON group (16.07 [9.10]).

Discussion: Our deception-based study revealed NoCON participants had elevated and clinically relevant mood states as compared to CON participants in response to the events of 2020.

Context: Targeted and directed rehabilitation with a healthcare provider can be an effective approach in the treatment of concussion, particularly for patients with protracted recovery, high symptom reporting, cervicogenic dysfunction, musculoskeletal involvement, and/or vestibular/oculomotor dysfunction. While many environmental and intrinsic medical history factors may influence concussion recovery, little is known about whether an individual's recovery trajectory can be influenced by the amount of time taken to receive rehabilitation. The purpose of this study was to evaluate recovery trajectories of concussion patients requiring targeted multimodal rehabilitation after a specialty concussion clinic visit within ≤3 days, 4 to 7 days, and >7 days. We also sought to evaluate risk factors for protracted recovery.

Design and methods: The study involved a retrospective chart review of 103 patients (mean age = 13.78 [2.89]; 55% female) who, after their initial specialty concussion clinic visit, received rehabilitation in ≤3 days, 4 to 7 days, and >7 days. Patients were evaluated at a pediatric specialty concussion clinic between April 2021 and December 2023, and diagnosed with concussion by a specialist (primary care sports medicine physician, nurse practitioner, and/or neuropsychologist), referred for rehabilitation via physical therapy services, completed more than one rehabilitation session, and received medical clearance to initiate the return-to-sport protocol. Groups were compared based on relevant clinical factors, Vestibular Ocular Motor Screening, neurocognitive testing (Trails B-A), Post-Concussion Symptom Scale, days from injury to concussion evaluation, days from concussion evaluation to rehabilitation, number of rehabilitation sessions, recovery days after rehabilitation, and total recovery days (ie, days from injury to medical clearance to initiate return-to-sport protocol). Data analysis included chi-square, correlations, 1-way analysis of variance, and general linear regression. Adjusted odds ratios for protracted recovery were derived from a logistic regression model.

Discussion: Days from injury to concussion evaluation (P < .001), days from concussion evaluation to rehabilitation (P = .006), and Trails B-A (P = .009), were significant predictors of total recovery time among pediatric concussion patients who required multimodal rehabilitation. Risk of protracted recovery increased by 34% each day from injury to concussion evaluation a patient did not receive treatment (Nagelkerke Pseudo R2 = .45; P < .001). Previous studies have also shown that time to concussion evaluation is an important prognostic indicator of recovery. Correspondingly, prompt referral to concussion care and rehabilitation for patients with a need for multimodal rehabilitation can improve recovery outcomes.

Although concussion management and return to play/learn decision making focuses on reducing symptoms, there is growing interest in objective physiological approaches to treatment. Clinical and technological advancements have aided concussion management; however, the scientific study of the neurophysiology of concussion has not translated into its standard of care. This expert commentary is motivated by novel clinical applications of electroencephalographic-based neurofeedback approaches (eg, quantitative electroencephalography [QEEG]) for treating traumatic brain injury and emerging research interest in its translation for treating concussion. QEEG's low-cost relative to other brain recording/imaging techniques and precedent in clinical and medical care makes it a potential tool for concussion rehabilitation. Although uncommon, licensed and certified clinicians and medical professionals are implementing QEEG neurofeedback for concussion management within their score of practice. These approaches are not widely adopted nor recommended by professional medical societies, likely because of a limited evidence base of well-designed studies with available standard protocols. Thus, the potential efficacy of QEEG neurofeedback for treating persistent symptoms or cognitive dysfunction after sports-related concussion is unknown. This commentary will update the concussion clinician-scientist on the emerging research, techniques, and disagreements pertaining to the translation of QEEG neurofeedback for concussion management, particularly in the treatment of persistent cognitive difficulties. This commentary will also introduce to readers the fundamentals of how the electroencephalogram may be acquired, measured, and implemented during QEEG neurofeedback. An evidence base of supportive findings from well-designed studies, including those that are retrospective, outcomes-based, and, ultimately, placebo/sham-controlled is recommended prior to considering more widespread adoption of QEEG neurofeedback approaches for treating persistent symptoms or cognitive deficits after sports-related concussion. We review the considerable barriers to this research and clinical implementation, and conclude with opportunities for future research, which will be necessary for establishing the quality and efficacy of QEEG neurofeedback for concussion care.

Clinical scenario: Individuals with patellofemoral pain (PFP) present with a variety of neuromuscular and psychological deficits, with the "gold-standard" for treatment being rehabilitation programs with strengthening-based exercises. While such interventions primarily target pain and function measures, it is unknown whether psychological measures such as fear-avoidance beliefs (FABs) are also affected.

Clinical question: Is rehabilitation including strengthening exercises effective in improving FABs in individuals with PFP?

Summary of key findings: Three studies met the inclusion criteria and were included in the appraisal. All studies found that rehabilitation including strengthening exercises was effective in improving FABs for physical activity, though such improvements were modest. One study found that supplementing a one-time psychological intervention to rehabilitation including strengthening exercises resulted in greater improvements in FABs than with rehabilitation including strengthening exercises alone. Two studies found associations between changes in FABs and changes in pain and/or function outcomes.

Clinical bottom line: There is consistent evidence that the incorporation of rehabilitation with strengthening exercises is effective in improving FABs in individuals with PFP, though such improvements are modest. Furthermore, supplementation with psychological interventions to rehabilitation including strengthening exercises may produce larger improvements in FABs, particularly in patients with an elevated FABs phenotype. As a result of improving FABs, patient outcomes of pain and function may be improved, though future research is needed. Therefore, at this time, we recommend that rehabilitation, including strengthening exercises with supplemental psychological interventions be prescribed for the treatment of PFP particularly in subgroups with elevated FABs, to improve patient outcomes.

Strength of recommendation: Collectively, the body of evidence included to answer the clinical question aligns with the strength of recommendation of A based on the Strength of Recommendation Taxonomy.

Context: The Buffalo Concussion Treadmill Test (BCTT) for exercise intolerance following concussion may highlight underlying autonomic dysfunction. Autonomic function at rest and with exertion may be predictive of neurocognitive performance for individuals with sports-related concussion. The purpose of this study is to explore the feasibility and utility of combining multimodal assessments with heart rate variability (HRV) measures during the BCTT for individuals with a remote history of concussion.

Design: Prospective cohort study design, pretest/posttest.

Methods: Participants included 5 males and 5 females (N = 10, age: 25.2 [3.3] y old, height: 173.2 [11.2] cm, mass: 73.4 [13.7] kg, body mass index: 24.5 [3.9], time since last concussion of 6.3 [4.5] y). All participants completed the multimodal assessment battery including: Concentration Reverse Digits (6 digits), Stroop Incongruent, and King-Devick Test under single- (seated) and dual-task conditions (walking on treadmill at 2.0 mph, 0% incline). Heart rate and HRV was collected at rest, during the BCTT, and during postexercise recovery. HRV data were processed and analyzed based on established protocols. Paired t tests were performed for pre- and postmeasurements separately for single- and dual-task tests of the multimodal assessment battery and HRV indices.

Results: During the BCTT, HRV indices reflective of peripheral nervous system activity demonstrated a significant reduction with concomitant increase in HRV indices of sympathetic nervous system activity (P < .05). Recovery in these HRV indices toward baseline was observed during postexercise recovery. Neurocognitive performance on the Stroop task significantly improved with exercise (P < .05).

Conclusion: Implementation of multimodal assessments to evaluate physiological and neurocognitive responses to exercise in individuals with history of sports-related concussion is feasible. Addition of these objective measures may decrease reliance on self-reporting of exercise-induced symptom exacerbation, enabling clinicians to identify individuals whose neurocognitive performance or physiologic response to exercise on the BCTT deviates from the expected.

Clinical scenario: The Functional Movement Screen (FMS) is used to assess movement patterns and the risk of injury of active individuals. Current studies have found positive relationships with core training and injury prevention as well as lower limb stability, which can help improve FMS scores.

Clinical question: Does the implementation of a core training program have an impact on FMS scores in healthy active adults who participate in sport?

Summary of key findings: Literature was searched for articles that included core-focused exercises and implementation of the FMS. This resulted in 25 studies being returned, only 23 of which were published in the last 10 years. Only 7 focused on the change in FMS scores after implementation of core training. Three of these studies were included in the analysis due to the specialized athlete population. All 3 studies found that using a core training program led to significantly higher FMS scores postintervention.

Clinical bottom line: There is clear evidence that core training increases FMS scores in athletes. It is important for health care providers treating athletes to consider core training to improve functional movement patterns or FMS scores in sport-specific populations.

Strength of recommendation: Overall, there are moderate to high levels of evidence that support a grade B recommendation for core training improvements on FMS scores in athletes.

Context: The single-leg hop is based solely on performance with no measure of movement quality. The purpose of this study was to (1) develop a real-time screening tool to capture single-leg functional performance and movement quality and (2) to provide preliminary validation (criterion validity) of a trained clinician's real-time movement quality assessment with 3D kinematics.

Study design: Cross-sectional.

Methods: Fifty-nine adolescent athletes volunteered (15.2 [1.1] y, 165.8 [9.2] cm, and 61.5 [13.9] kg, 51 females and 8 males). Each participant performed 3 trials of the single-leg hop on their dominant leg. A 3-dimensional inertial measurement system was used to capture knee joint kinematics. A movement quality checklist for use during a single-leg hop (movement quality single-leg hop) was developed to score biomechanical errors based on lower-extremity injury risk factors. Four criteria were developed for the checklist: (1) knee valgus, (2) foot rotation, (3) lateral trunk flexion, and (4) erect posture. An independent t test was conducted for each dependent variable (knee flexion displacement and knee abduction displacement) by each independent variable (movement category presence of (1) lateral trunk flexion, (2) knee valgus, (3) foot rotation, and (4) erect posture/sound during landing [yes or no]). The alpha level was set at α < .05 for all analyses.

Results: Knee flexion displacement was significantly decreased (P < .001, mean difference 9.40 [1.88]) and knee abduction displacement was significantly increased (P < .001, mean difference 9.41 [0.47]) for those who had knee valgus documented by the clinician. In additional, for those with visually documented erect posture/sound of landing, there was a significant decrease in knee flexion displacement (P < .001, mean difference 10.13 [2.34]).

Conclusion: The movement quality single-leg hop checklist has shown promising preliminary validation (criterion validity) for clinicians to assess movement quality. Increased knee abduction and decreased knee flexion are common risk factors associated with knee injuries and this clinician friendly real-time checklist may highlight individuals who are at risk of sustaining a knee injury.

Context: Advancements in portable load-cell technology have enabled high-quality assessment of shoulder internal (IR) and external rotation (ER) peak force (Fmax) and rate of force development (RFD). This study's purpose was to explore the reliability and differences between IR and ER Fmax and RFD in different testing positions using a novel load-cell device.

Design: A within-subjects repeated-measures design was employed to compare the intersession values and reliability of Fmax and RFD for both shoulder IR and ER across 3 positions: seated-0°, supine-0° and supine-90°.

Methods: National-level swimmers (n = 19; age = 16.8 [1.0] y) completed 3 testing occasions of each condition (combination of arm, rotation, and test position) separated by 7 to 14 days.

Results: IR superseded ER in all testing positions. The association between these positions across IR and ER was typically strong for both Fmax and RFD (r > .85, P < .001) except for IR RFD (r = .56-.73, P < .05). For sessions 2 to 3, Fmax intraclass correlation coefficient and CV (intraclass correlation coefficient = .89-.96, CV = 5.2%-8.8%) were typically within acceptable ranges, whereas RFD (intraclass correlation coefficient = .74-.90, CV = 11.5%-18.1%) often exhibited inflated error.

Conclusion: The supine (90°) position was the most consistent position across both measures. Load-cell technology can be confidently used to assess shoulder rotation Fmax in 3 different positions, whereas RFD should be used with caution without protocol refinement.

Context: In shoulder rehabilitation, exercises that reduce upper trapezius (UT) activity and optimize the trapezius muscle activation rate reduce the symptoms of shoulder pathologies. One such exercise, the lawn-mower (LM) exercise, is frequently used in scapular rehabilitation protocols due to its multijoint, multiplanar, and kinetic chain-based nature. Design/Objective: This study aimed to compare trapezius muscle activation levels and ratios during the LM exercise in standing and quadruped positions through a randomized controlled trial.

Methods: Eighteen healthy volunteers (mean age [SD] = 25 [5] y, 10 women and 8 men, mean body mass index [SD] = 22.91 [2.59] kg/m2) participated in the study, and surface electromyography was employed to measure trapezius muscle activity during quadruped LM (QLM) and standing LM (SLM) exercises. The data were normalized as a percentage of maximal voluntary contraction.

Results: The study revealed significantly lower UT activity (percentage of maximal voluntary contraction) during QLM compared with SLM (P < .05) in concentric and isometric phases. Conversely, QLM exhibited significantly higher activation of the middle trapezius (MT) and lower trapezius (LT) in all phases when compared with SLM (P < .05). UT/MT and UT/LT ratios were also significantly lower in all QLM phases compared with SLM (P < .05).

Conclusion: Study findings suggest that quadruped exercises reduce UT activation while promoting more balanced MT and LT muscle activation. This balance is essential for shoulder rehabilitation, especially in cases requiring minimal UT activation and maximal MT and LT activation. In cases where a balanced trapezius muscle activation pattern is required, including QLM exercises rather than SLM exercises may be more efficient.