Physician and Sportsmedicine最新文献

Objectives: A multifaceted assessment battery is recommended for testing suspected concussed athletes; however, the individual tests have limitations and potentially may lead to false positive outcomes. Therefore, the purpose of this study was to psychometrically evaluate concussion assessment tools used for intercollegiate student-athletes, with a focus on the time interval between baseline and subsequent assessments.

Methods: Ninety-two collegiate student-athletes matched between concussion (N = 46. F32/M14) and non-concussion (N = 46, 32F/14 M) completed the standard assessment of concussion, balance error scoring system, symptom questionnaire, and computerized neurocognitive tests at baseline and acutely (<48 h) following a concussion. Test outcomes were compared between time points with three approaches: 1) vs baseline, 2) reliable change scores (RCI), and 3) vs American College of Rehabilitation Medicine (ACRM). Concussion assessment sensitivity, specificity, likelihood ratios, predictive values, and diagnostic odds ratio were calculated. A receiver operator characteristic compared area under the curve (AUC) for the overall battery as well as between academic years.

Results: The sensitivity of the battery was high (78.3-95.7%), but specificity was low to moderate (6.5-52.2%) with comparison to the RCI typically performing best. The three approaches yielded AUC values between 0.51 and 0.63 which is below the discriminatory threshold (0.70) with comparison to RCI performing best. By academic year, Juniors was the only year in which the ROC exceeded the threshold (0.75). The number of tests failed did not improve any AUC values (0.51-0.69) to exceed the threshold.

Conclusions: The outcomes of this study support the premise that concussion must be evaluated using a comprehensive clinical examination including a variety of assessments to evaluate each clinical domain. Clinicians need to recognize that the multifaceted assessment battery has high sensitivity, but the overall psychometrics do not exceed the threshold for group discrimination and caution must be used in their interpretation.

Objectives: Players in the National Basketball Association (NBA) are at high risk for ACL tears which are detrimental to their career due to the months of rehabilitation. The authors hypothesize that after anterior crucial ligament (ACL) injury, older players will be less likely to return to the NBA, players that do return will have a lower performance efficiency rating (PER), and the decrease in PER will be associated with a lower salary.

Methods: This case-control study utilized the publicly available database maintained by the NBA, professional basketball players from 2002 to 2022 who suffered an ACL tear were identified. Controls, without ACL tears, were matched by age, BMI, position, race, and average minutes played before the injury date to uninjured controls. Return to NBA, pre-injury and post-return player efficiency ratings (PER), and salary change after injury were analyzed by multivariate analyses.

Results: A total of 67 players suffered an ACL tear. Fifty-six (83.6%) players returned to the NBA at some point after their injury, while 11 (16.4%) did not. Multivariate logistic regression showed that older age and the presence of multi-ligament injury predicted retiring from the NBA (ß = 1.4 and 10.7). Older age and greater minutes played before surgery to be the only significant predictors of decreased PER after return to the NBA (ß = -0.5 and -0.2). Players with a multiyear contract and with improvements in PER after injury tended to have greater salary increases (ß = 6.5 and 0.7). All p < 0.05. PER in players with ACL tears decreased by about 3 points (13.1 to 9.9) compared to controls without ACL tears (13.2 to 12.9).

Conclusion: Older age and multiligament injuries are associated with retiring for the NBA; older and increased minutes played are associated with a decreased PER upon return; and, PER decreases are associated with decreased salary. Players with ACL tears, even when case-control matched, showed decreased PER upon return. These results can be attributed to age-related changes in athleticism and health.

Background: Dancesport is performed in high-heeled shoes. Dancesport athletes may have a higher prevalence and incidence of ankle sprains, which can affect their performance. However, the occurrence of ankle sprains among dancesport athletes remains unclear. This study aimed to determine the prevalence and incidence of ankle sprains among elite dancesport athletes and to investigate the related information.

Method: We conducted a mixed descriptive epidemiological study (cross-sectional and longitudinal) involving 198 elite adolescent dancesport athletes, using past medical records and questionnaires administered to the participants. Data on the occurrence of ankle sprains among all participants were compiled using medical records and information on injury mechanisms, missed days, severity types, and countermeasures for ankle sprains were collected. The prevalence of chronic ankle instability (CAI) among the participants was assessed using a questionnaire. Following the initial survey, we conducted a one-year follow-up study to investigate the incidence of ankle sprains, incidence rate per 1000 exposure hours, and recurrence of ankle sprains.

Result: The cross-sectional study and longitudinal study included 198 participants and 92 elite dancesport athletes, respectively. The prevalence of ankle sprains and CAI was 49.5% and 45.1%, respectively. Of all ankle sprains, 88% were medial injuries. The most common injury mechanisms were turning (46.9%) and jumping (46.9%). The average number of missed days due to ankle sprains was 11.2 days. Most injuries were managed with rest, and only one male athlete underwent surgery due to an ankle sprain sustained during dancing. During the one-year follow-up, the incidence of ankle sprains, incidence rate per 1000 exposure hours, and recurrence rate of ankle sprains were 46.6% (male, 41.2%; female, 48.8%), 0.65 ankle sprains/1000 h, and 35.3%, respectively. No sex-related differences were observed.

Conclusion: It is crucial to focus on the occurrence of ankle sprains and CAI in dancesport athletes with high heels. Future research should clarify the impact of ankle sprains on dancesport performance and develop preventive measures to reduce the incidence and recurrence of these associated injuries.

Purpose: This systematic review aims to synthesize the current research on doping in combat sports, examining the prevalence, detection methods, prevention strategies, and overall impact on combat sports.

Design/methodology/approach: Of the 21 identified articles, six met the inclusion criteria. A systematic approach was used, including content analysis based on specific criteria: articles in English, original research, and relevance to sport and doping.

Findings: The review reveals an unsettling prevalence of doping across combat sports, suggesting that current detection and prevention efforts may be insufficient to address the unique pressures and risks within these disciplines. In particular, substances like anabolic agents, diuretics, hormone modulators, and NSAIDs are commonly detected, especially among athletes in heavier weight categories and those engaging in rapid weight loss. Psychological and social factors, including social norms and perceived acceptance within athletic environments, appear to play a significant role in shaping doping behaviors, complicating prevention efforts. Beta-agonists emerged as the sixth most frequent cause of adverse analytical findings (AAF) in 2020, according to WADA data, while kickboxing had the highest AAF rate among combat sports in a 2015 report. These trends suggest a pressing need for more comprehensive, nuanced approaches to regulation.

Research limitations/implications: Limited to English-language articles The honesty of athletes about their experience in doping could have influenced the results.

Originality/value: As the first systematic review on doping in combat sports, this study offers valuable insights and underscores the urgency of developing anti-doping policies and it provides insightful data for future research directions for addressing doping in these disciplines.

Aims: This study aimed to perform a cross-cultural adaptation and validate a questionnaire to assess the nutrition knowledge of Brazilian ultra-endurance athletes.

Methods: This is an observational and cross-sectional study, which adapted and validated the Nutritional Knowledge Questionnaire for Ultra-endurance Athletes (ULTRA-Q). ULTRA-Q was translated into Portuguese, and then the translated version was assessed for semantic, idiomatic, cultural and conceptual equivalence by six specialist nutritionists. In addition to suggesting adaptations to the questionnaire, the experts evaluated the clarity and relevance of the items, calculating the Content Validity Coefficient (CVC). The adapted version was applied to 46 ultra-endurance athletes to evaluate reproducibility and validity. After the test-retest, the instrument was also answered by 54 nutritionists, to evaluate the construct validity of the questionnaire.

Results: The Brazilian version (ULTRA-QBR) of the questionnaire for ultra-endurance athletes had adequate CVC for clarity (0.97) and pertinence (0.95), and presented adequate discriminant validity. The data from the intraclass correlation coefficient indicates good reproducibility of the questionnaire, and the difference observed between athletes and nutritionists reinforces the evidence of the questionnaire's construct validity.

Conclusion: The results demonstrate content, construct and discriminant validity, test-retest reproducibility, and internal consistency of the ULTRA-QBR. We concluded that this questionnaire can be used as an interesting tool in research and clinical practice in ultra-endurance sports.

Objectives: Golf participation numbers have increased in recent years within the UK and globally. A recent systematic review and meta-analysis of injuries in amateur and professional golfers showed over half of golfers sustain an injury during their lifetime. This review recommended that future research should utilize the recent international consensus on reporting of injury in golf. The aim of this study was to determine the frequency and severity of injuries sustained by UK-based golfers in the previous year.

Methods: A retrospective cross-sectional online survey consisting of 35 questions was disseminated to UK-based golfers. Non-overlapping 95% confidence intervals (CI) were utilized to indicate significant differences.

Results: There were 303 participants included for analysis. The overall injury incidence was 41.26 injuries per 1000 hours (CI 35.96-47.33). Consistent with the wider literature, the lower back at 9.94 injuries per 1000 hours (CI 7.48-13.22) is the most frequent injury site. The lower back had a mean time loss of 54 ± 89 days before full recovery. Repetitive movement injuries were noted to have a higher incidence (22.00 per 1000 hours, CI 18.19-26.61) in comparison to acute injuries (10.79 per 1000 hours, CI 8.21 to 14.18).

Conclusion: Anatomically, the proportion of injuries observed was comparable to previous epidemiology studies, with the lower back and elbow having the highest incidences in this largely amateur group of golfers. Most injuries were identified to be a muscle strain, joint sprain, or tendinopathy; however, no single identifiable mechanism of injury was identified.

Objective: To prospectively describe the incidence, severity, and burden of injuries in the youth divisions of an Argentinian professional soccer club during a competitive season.

Methods: Two hundred and twelve male soccer academy players were grouped by age categories and maturity offset as pre-peak height velocity (PHV), circa-PHV and post-PHV. Injury characteristics were recorded as the International Olympic Committee suggests.

Results: A total of 235 time-loss injuries were sustained by 101 different players. The overall injury incidence rate was of 5.8 injuries per 1000 hours (h), with a training and match injury incidence rate of 4.9 and 9.7 injuries per 1000 h, respectively. The prevalence over the season was 47%. Most of the injuries (202) affected the lower limbs (86.6%) and most of them were classified as muscle/tendon injuries (n = 117, 49.8%). Hamstring structural injury was the diagnosis with the highest burden in both circa and post-PHV groups.

Conclusions: The incidence, prevalence, and injury burden reported in this study would add valuable information to Argentinians' youth soccer institutions. Post-PHV players had higher incidence, severity, and burden compared to circa-PHV. Structural/functional injuries to the muscle/tendon represented the highest burden for type of injuries (41.1 per 1000 h), suggesting a need for implementing preventive measures.

Background: Injuries to the ulnar collateral ligament (UCL) are commonly reported in traditional overhead sports. Conversely, there is a lack of evidence outlining management and return to play (RTP) outcomes for gymnasts. This study aimed to evaluate RTP and patient reported outcomes (PROs) in gymnasts after operative and non-operative treatment of UCL injuries.

Methods: Gymnasts who presented with UCL injury and underwent operative and non-operative treatment were evaluated. Patient reported outcomes were collected via telephone: Conway-Jobe Scale, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) Score, Mayo Elbow Performance (MEP) Score, and quick DASH (qDASH) and Timmerman-Andrews (TA) Elbow Score.

Results: Nine patients met inclusion criteria and were available for follow-up. Five were initially treated operatively and four were initially treated non-operatively. The operative group initially consisted of three ulnar collateral ligament reconstructions (UCLR) and two UCL repairs with internal bracing. One patient crossed over to the operative group after failing non-operative treatment and underwent UCLR four months post injury. Overall, 66.7% and 100% of operatively and non-operatively treated gymnasts were able to return to play, respectively. At final follow-up, the operative groups' mean KJOC, MEP, TA, and qDASH scores were: 68.4 ± 7.7, 97.5 ± 2.7, 90.8 ± 10.7, and 1.9 ± 3.0, respectively. For the non-operative group, the mean scores were 67.4 ± 9.0, 71.7 ± 5.8, 71.7 ± 14.4, and 11.4 ± 9.9, respectively. Treatment satisfaction for the operative group was 81.7 ± 27.5 compared to 80.6 ± 34.5 in the non-operative group. Odds ratios indicated no differences between groups.

Conclusion: Both operative and non-operative interventions for UCL injuries in gymnasts can provide favorable outcomes with respect to return to play and subjective patient-reported outcomes. Further research is warranted to determine optimal treatment, especially regarding indications for operative vs. nonoperative treatment, of UCL injury based on injury severity and location in gymnasts.

Level of evidence: Case series; Level III Evidence.

Objective: To compare healthcare use and the number of days of sickness benefits between people with anterior cruciate ligament (ACL) injury who received physiotherapy before and after ACL reconstruction (ACLR) and those who received physiotherapy after ACLR only. Secondary aim: to measure the association between the volume of preoperative healthcare and post-ACLR recovery.

Methods: Each individual's care pathway was extracted from a section of the French National Health Data System (SNDS) database (province: Pays de La Loire). The database was queried for the codes related to sickness benefits and healthcare utilization, including physiotherapy, medical and paramedical visits and procedures, medication, and medical equipment provided up to six months before and eighteen months after the ACLR. (Registry/number: ClinicalTrials.gov/NCT05737719).

Results: Based on the timing of physiotherapy, two subcohorts were created from the database: 'prehabilitation' (n = 513) for those receiving physiotherapy before and after ACLR; 'no prehabilitation' (n = 630) for those only receiving physiotherapy after ACLR. Before ACLR, healthcare use was higher for the 'prehabilitation' group, including the number of medical visits (3.9 ± 2.3 vs. 3.0 ± 1.9 univariate p < 0.001), analgesia (mild opioids 60.4% vs. 49.8% univariate p < 0.001), dispensing of medical equipment (85.0% vs. 68.9% univariate p < 0.001) and sickness benefit days (52.7 ± 45.6 days vs. 33.2 ± 35.8 days, univariate p < 0.001). After ACLR, the 'prehabilitation' group underwent a higher number of physiotherapy sessions (46.8 ± 21.9 sessions vs 35.8 ± 19.0 sessions, p < 0.001) but had a similar number of sickness benefit days (94.7 ± 77.8 days vs 87.1 ± 69.9 days, p = 0.092). From the multivariate analysis (n = 1143): age, comorbidities, the preoperative number of sickness benefit days, and the number of physiotherapy sessions before ACLR explained 24% of the variance in days of sickness benefits after ACLR.

Conclusion: Prehabilitation was associated with higher healthcare utilization before and after ACLR. Prehabilitation, and other preoperative variables, explained only a part of the number of days of sickness benefits after ACLR.