Journal of Athletic Training最新文献

Context: The anterior cruciate ligament (ACL) is well researched since injuries typically result in lengthy recoveries and rehabilitation periods until athletes can return to full activity. Although a large body of literature on the early and late stages of rehabilitation following ACL reconstructive (ACLR) surgery exists, less is known regarding the mid-phase of ACL rehabilitation and healthy versus injured limb differences in functional testing during this stage.

Objectives: The purpose of this study is to determine if Y-Balance Test (YBT) scores obtained during the mid-phase of ACLR rehabilitation change over months 4, 5, and 6.

Design: Case Series.

Setting: Research laboratory. Patients or Other Participants: A total of 27 participants (17 females; 18.96±3.02 years (range 15-24); 173.63±10.29cm; 72.55±17.83kg) who sustained a unilateral ACL injury, experienced no episodes of instability or knee giving away, had not suffered a previous ACL injury, and expressed a desire to return to sport at the end of rehabilitation came in once a month following ACLR to participate in a battery of tests.

Main outcome measures: YBT scores in the anterior, posterolateral (PL), and posteromedial (PM) directions in the healthy and reconstructed limbs.

Results: A main effect for limb was observed for the anterior (Healthy: m4: 78.8cm±5.8, m5: 79.5cm±5.2, m6: 79.4±5.8; Reconstructed: m4: 77.2±5.9, m5: 78.5±5.1, m6: 78.1±6.4, p=0.023) and PM (Healthy: m4: 80.0cm±8.7, m5: 81.0cm±9.1, m6: 82.9cm±8.9; Reconstructed: m4: 79.3cm±6.8, m5: 79.4cm±8.2, m6: 81.1cm±8.5, p=0.013). directions indicating that the reconstructed limb performed worse than the healthy limb. A main effect for time was observed for the PL direction (Healthy: m4: 78.8cm±5.8, m5: 79.5cm±5.2, m6: 79.4cm±5.8; Reconstructed: m4: 77.2cm±5.9, m5:78.5cm±5.1, m6: 78.1cm±6.4, p=0.023).

Conclusions: The YBT measured improvement in the PL direction across time in the reconstructed limb. In the PM and anterior directions, the YBT did not measure these same improvements across this period.

Context: Quadriceps strength is a key outcome for guiding rehabilitation and return to sport-specific activities after ACL reconstruction (ACLR) surgery.

Objectives: 1) Describe the quadriceps strength testing practices and barriers college athletic trainers (ATs) are using and experiencing when returning patients to sport-specific activities after ACLR. 2)Compare testing methods between college ATs working in the National Collegiate Athletic Association (NCAA) Division I setting and other college settings.

Design: Cross-sectional.

Setting: Online survey.

Patients or other participants: 243 full-time collegiate ATs who had primarily overseen/directed an ACLR rehabilitation in the past five years (age: 34.8±10.7, years of AT practice: 11.7±9.3, NCAA division I setting: 56%).

Main outcomes: Our survey included four sections: Demographics, General ACLR rehabilitation practices, Quadriceps strength testing methods & criteria, and Quadriceps strength testing barriers.

Results: Knee muscle strength was the most common (98%) outcome collegiate ATs use when determining whether an ACLR patient is ready to progress to sport-specific activities. Manual muscle testing (MMT) was the most used testing method (57%), followed by isokinetic dynamometry (IKD) (48%), repetition max (RM) testing (35%) and handheld dynamometry (HHD) (22%). Most ATs (63-64%) used >90% side-to-side symmetry as their return to sport-specific activities criteria. Lack of equipment needed (83%), lack of financial means (28%), and lack of training/education (20%) were the barriers that most limited ATs use of IKD testing, the gold-standard testing method. Compared to ATs in other settings, a greater proportion of ATs working in the NCAA Division I setting used IKD testing (65% vs 28%) and a smaller proportion used MMT (47% vs 70%).

Conclusions: While almost all college ATs considered knee muscle strength an important outcome to assess when returning patients to sport-specific activities after ACLR, quadriceps strength testing practices were highly variable among ATs and may be impacted by access to necessary resources.

Context: Individuals with anterior cruciate ligament (ACL) injury commonly experience injury related stressors which can adversely impact subjective knee function after ACL reconstruction (ACLR). Due to the positive effect of active coping skills on perceived stressors, use of such strategies may influence clinical outcomes in individuals with ACLR, such as self-reported knee function. However, it is unknown whether active coping skills are associated with self-reported knee function in this population.

Objectives: Examine the relationship between active coping skills and self-reported knee function in individuals with ACLR.

Design: Cross-Sectional Study.

Setting: Laboratory.

Patients or other participants: Forty-five participants (34 females; age=20.0[3.3] years) 4-months to 5-years post-unilateral ACLR (time since ACLR=12.0[16.0] months).

Main outcome measure(s): The Athlete Coping Skills Inventory (ACSI) Confidence and Achievement Motivation (ACSI Confid), Goal Setting/Mental Preparation (ACSI Goal/Prep), and Coping with Adversity (ACSI Coping) subscales were used to measure active coping skill facets. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to measure self reported knee function across 5 subscales: pain (KOOS-Pain), symptoms (KOOS-Symptoms), activities of daily living (KOOS-ADL), quality of life (KOOS-QOL), and sports/recreation (KOOS-Sport). Partial Spearman's correlations were used to examine relationships between active coping skills and self-reported knee function after controlling for time since ACLR and age.

Results: Moderate positive correlations were observed between the ACSI Confid and KOOS Pain (r=0.493, P=0.001), ACSI Confid and KOOS-QOL (r=0.505, P<0.001), ACSI Confid and KOOS-Sport (r=0.422, P=0.007), and ACSI Goal/Prep and KOOS-Pain (r=0.441, P=0.004). Weak positive correlations were observed between the ACSI Goal/Prep and KOOS-ADL (r=0.373, P=0.018) and ACSI Goal/Prep and KOOS-QOL (r=0.374, P=0.017).

Conclusions: Individuals with ACLR who exhibited greater active coping skill facets reported better knee-related function. Assessing active coping skills among individuals with ACLR and poor self-reported knee function may provide clinicians with insight into the role of coping in perceived function and potential treatment approaches.

Context: Assessment of sport-related concussion (SRC) has begun to include patient-reported outcome measures. However, understanding of which health limitations are most meaningful to adolescents after SRC is limited.

Objective: To explore patient-perceived activity limitations after SRC and throughout recovery to return to play and mapped according to the International Classification of Functioning, Disability, and Health (ICF) model.

Design: Longitudinal study.

Setting: Secondary school athletic training facilities.

Patients or other participants: Fifty patients (41 males, 5 females, 4 sex not reported, age = 14.9 ± 3.5 years, grade = 10.2 ± 0.93 level) with a medically diagnosed SRC.

Intervention(s): The Patient Specific-Functional Scale (PSFS) was used to assess changes in the patient's condition and the effect the injury posed on their ability to perform activities. The PSFS is a self-reported assessment of health used to identify activity limitations and rate the difficulty of performing those tasks. The PSFS was administered to patients on days 3 (D3) and 10 (D10) after SRC and at return to play.

Main outcome measure(s): Activities affected by injury were coded into common categories and themes by a 3-person research team for subsequent analysis. The coded themes were also mapped to the ICF domains, chapters, and categories. The dependent variables were the PSFS themes, number of activities endorsed, PSFS scores, ICF domains, chapters, and categories. Descriptive analyses and frequencies were reported for the dependent variables.

Results: A total of 157 different activities were identified at D3 and coded into 28 categories that fit into 6 themes: activities of daily living, cognitive and school (COG), sports and physical activity (SPA), screen time, sleep, and social. On D3, all patients (50/50) identified at least 1 activity limitation. Most related to SPA (37.6%) and COG (31.2%). Sixty percent of patients endorsed activity limitations at D10, primarily in COG (38.6%) and SPA (36.6%). All (100%) response categories were mapped to the ICF, with most (75%) fitting the activities and participation domain.

Conclusions: Our primary findings suggest that SRC influences many facets of the lives of adolescent athletes. Specifically, adolescent athletes identified activity restrictions primarily related to physical activity and sports participation.

Context: Concussion assessment in adapted and parasport athletes has continued to evolve with growing considerations in parasports, but little is known about vestibular/ocular performance assessment in this sample.

Objective: To examine baseline performance on the Vestibular/Ocular Motor Screening (VOMS) in collegiate adapted athletes. A secondary objective was to investigate the role of sex, history of concussion, and functional classification on baseline measures.

Design: Cross-sectional study.

Setting: University adapted athletics facility.

Patients or other participants: Fifty-four collegiate adapted athletes (age = 21.19 ± 2.6 years) from multiple institutions' adapted athletics programs across the United States.

Main outcome measure(s): Adapted athletes completed a baseline VOMS assessment while at the host university for in-season competition and tournaments. Independent variables were sex, history of concussion and functional classification (1.0-4.5 at 0.5 intervals). Vestibular/Ocular Motor Screening performance consisted of pretest symptoms (headache, dizziness, nausea, and fogginess) and postitem (eg, smooth pursuits, saccades) symptom provocation or change from pretest scores.

Results: A proportion of 50.9% reported zero symptom provocation on the VOMS, with 72% having no pretest symptoms. No sex differences were noted on the VOMS (P > .05); however, adapted athletes with a history of concussion reported greater VOMS provocation on horizontal saccades (P = .008) than those with no history. Higher functional classifications (2.0-4.5) reported greater provocation on horizontal saccades (P = .010), horizontal and vertical (P = .043 and .048) vestibular/ocular reflex, and vestibular/ocular reflex cancellation (P = .036) than 1.0-1.5 athletes.

Conclusions: Our findings provide context for baseline VOMS performance in collegiate adapted athletes and identifying modifiers at baseline. Special consideration is warranted on vestibular and oculomotor assessment in adapted and parasport athletes with a history of concussion and higher functional classifications.

Context: Athletic trainers (ATs) face organizational-professional conflict (OPC), often surrounding return-to-sport decisions. To prioritize patient safety and establish a healthy work environment, OPC must be mitigated, yet few researchers have determined how ATs manage conflicts with stakeholders.

Objective: To explore ATs' experiences with OPC in the secondary school setting.

Design: Qualitative study.

Setting: Telephone interviews.

Patients or other participants: Sixteen ATs (9 females, 7 males; age = 43 ± 11 years; years certified = 17 ± 9; years in their current positions = 9 ± 6).

Data collection and analysis: We digitally recorded telephone interviews and had them professionally transcribed. Data saturation guided recruitment efforts and was met. To ensure rigor and trustworthiness of the data, we completed basic member checks along with multiple-analyst triangulation. We analyzed the qualitative data using an interpretive phenomenological approach.

Results: Four themes emerged effective communication, professional relationships, stakeholder education, and professional experience. Participants used effective communication described as frequent, open, and direct, during interactions with stakeholders to manage OPC. Organizational-professional conflict was reduced when ATs built professional relationships with stakeholders centered on trust and respect. Participants used stakeholder education as a primary strategy for managing OPC by educating stakeholders about prognosis and return-to-sport timelines postinjury and providing rationale for decisions made. Additionally, years of experience served as a mitigating factor of conflict, in that as ATs gained experience and confidence, they perceived less OPC.

Conclusions: Participants suggested various interpersonal relationship development strategies that can be implemented to manage OPC, especially when starting a new position or building rapport with stakeholders. Specifically, educating various stakeholders on reasons for clinical decisions via effective communication and developing strong professional relationships built on mutual respect assisted in avoiding OPC. Since professional experience appears to alleviate conflict, OPC management strategies should be taught during professional preparation and used early during transition to autonomous practice.

Context: Before examining the impact of training load on injury risk in runners, it is important to gain insight into the differences between methods that are used to measure change in training load.

Objective: To investigate differences between 4 methods when calculating change in training load: (1) weekly training load; (2) acute : chronic workload ratio (ACWR), coupled rolling average (RA); (3) ACWR, uncoupled RA; (4) ACWR, exponentially weighted moving average (EWMA).

Design: Descriptive epidemiology study.

Setting: This study is part of a randomized controlled trial on running injury prevention among recreational runners. Runners received a baseline questionnaire and a request to share global positioning system training data.

Patients or other participants: Runners who registered for running events (distances 10-42.195 km) in the Netherlands.

Main outcome measure(s): The primary outcome measure was the predefined significant increase in training load (weekly training loads ≥ 30% progression and ACWRs ≥ 1.5), based on training distance. Proportional Venn diagrams visualized the differences between the methods.

Results: A total of 430 participants (73.3% men; mean age = 44.3 ± 12.2 years) shared their global positioning system training data for a total of 22 839 training sessions. For the weekly training load, coupled RA, uncoupled RA, and EWMA method, respectively, 33.4% (95% CI = 32.8, 34.0), 16.2% (95% CI = 15.7, 16.6), 25.8% (95% CI = 25.3, 26.4), and 18.9% (95% CI = 18.4, 19.4) of the training sessions were classified as significant increases in training load. Of the training sessions with significant increases in training load, 43.0% from the weekly training load method were different than the coupled RA and EWMA methods. Training sessions with significant increases in training load based on the coupled RA method showed 100% overlap with the uncoupled RA and EWMA methods.

Conclusions: The difference in the change in training load measured by weekly training load and ACWR methods was high. To validate an appropriate measure of change in training load in runners, future research on the association between training loads and running-related injury risk is needed.

Context: Limited longitudinal data exist on patient-reported outcomes (PROs) after acute lateral ankle sprain (LAS). The impact of prospective hop testing on PROs at return to play (RTP) and 6 months post-RTP is unclear.

Objective: To determine if high school athletes with an LAS who return to baseline physical function as measured by a single-leg hop for distance (SLHOP) have better PROs relative to individuals who return to symmetry.

Design: Cohort study.

Setting: Ten high schools over 2 years.

Patients or other participants: Two hundred six high school athletes who sustained an LAS were included. Baseline SLHOP testing was completed preinjury. Patient-reported outcomes were recorded at time of injury, RTP, and 6 months post-RTP. Participants were classified as symmetry (n = 134) or restorative (n = 72). Symmetry was defined as achieving an SLHOP performance within 10% of the uninjured limb at RTP. Restorative was defined as achieving an SLHOP performance within 10% of preinjury levels.

Main outcome measure(s): The Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living, FAAM-Sport, Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, and PROMIS Depression were analyzed using a 2-way nonparametric analysis of variance. The interaction term of group by time was the main comparison of interest and was interpreted if significant. Post hoc multiple comparisons were performed using the Tukey-Kramer test.

Results: The restorative group reported better FAAM scores at RTP and 6 months post-RTP (P < .05) relative to the symmetry group. There were no differences in PROMIS Anxiety scores at time of injury, RTP, or 6 months post-RTP between groups (P > .05). There were no differences in PROMIS Depression scores at time of injury between groups (P = .34), but the restorative group had worse PROMIS Depression scores at RTP (P = .03).

Conclusions: The restorative group reported better FAAM-ADL and FAAM-Sport scores at RTP and 6 months post-RTP relative to the symmetry group. Restoring individuals to baseline physical function rather than limb symmetry may ensure better PROs after an LAS.

Context: Although the relationship between high-impact sports like football and basketball and the development of knee osteoarthritis is well established, the effect of martial arts on the knee joint remains unclear.

Objective: To compare the imaging abnormalities of knee joints and T2 relaxation times of cartilage in professional martial arts athletes and healthy controls.

Design: Cross-sectional study.

Setting: Hospital imaging center.

Patients or other participants: Nine asymptomatic professional martial arts athletes and 18 healthy volunteers.

Main outcome measure(s): We performed 3T magnetic resonance imaging of the knee on both legs of athletes and the dominant leg of controls. The magnetic resonance imaging protocol included conventional sequences used for morphological assessment (cartilage, meniscus, ligaments, joint effusion, and bone marrow edema) and T2 mapping used for quantitatively evaluating the cartilage. Knee cartilage was manually divided into 8 regions, and T2 relaxation times of the corresponding subregions were measured. Fisher exact test and t test were used to compare the frequency of lesions and cartilage T2 values both between groups and between the athletes' limbs. P < .05 was considered significant.

Results: Professional martial arts athletes exhibited significantly higher frequencies of cartilage (55.6% vs 11.1%, P = .023) and ligament lesions (66.7% vs 16.7%, P = .026) compared with the control group. Athletes showed higher T2 values in 3 distinct cartilage segments: the central weight-bearing segment of the medial femoral condyle (P = .006), the medial tibial plateau (P = .012), and the trochlea (P = .032), when compared with the controls. Additionally, the dominant leg of athletes showed significantly higher T2 values compared with the nondominant leg.

Conclusions: The findings demonstrated the impact of martial arts on the knee joint, characterized by higher prevalence of lesions and elevated cartilage T2 values, particularly in the medial compartment. The dominant legs of martial arts athletes seem to have higher risk of cartilage degeneration due to the observed interlimb differences in T2 values.