Journal of Athletic Training最新文献

Context: Existing patellofemoral pain (PFP) literature has primarily been focused on quadriceps muscle volume, with limited attention given to the deep and superficial muscle volume of the lower limbs in individuals with unilateral and bilateral PFP. In this paper, we aim to fill this gap.

Objective: To explore superficial and deep lower extremity muscle volume in women with unilateral or bilateral PFP compared with a normative database of pain-free women.

Design: Cross-sectional study.

Setting: University imaging research center.

Patients or other participants: Twenty women with PFP (10 unilateral and 10 bilateral) and 8 pain-free women from a normative database.

Main outcome measure(s): We quantified lower extremity muscle volume via 3.0-T magnetic resonance imaging. Two separate 1-way analyses of variance were performed: (1) unilateral PFP (painful versus nonpainful limb) versus pain-free control groups and (2) bilateral PFP (more painful versus less painful limb) versus pain-free control groups.

Results: We observed no differences in age and body mass index across groups (P > .05). Compared with the pain-free group, the unilateral and bilateral PFP groups had bilaterally smaller volumes of the anterior (iliacus: P ≤ .0004; d range, 2.12-2.65), medial (adductor brevis, adductor longus, gracilis, and pectineus: P ≤ .02; d range, 1.25-2.48), posterior (obturator externus, obturator internus, and quadratus femoris: P < .05; d range, 1.17-4.82), and lateral (gluteus minimus: P ≤ .03; d range, 1.16-2.09) hip muscles and knee extensors (rectus femoris: P ≤ .003; d range, 1.67-2.16) and flexors (long and short head of the biceps femoris: P ≤ .01, d range, 1.56-1.93).

Conclusions: Women with unilateral and those with bilateral PFP displayed less volume of multiple superficial and deep muscles of the bilateral hips and knees than pain-free women. Interventions should bilaterally target lower limb muscles when treating PFP, and hypertrophy exercises for specific muscles should be explored to increase choices for intervention.

Context: It is unclear whether the response in femoral cartilage to running at different intensities is different.

Objective: To examine the acute patterns of deformation and recovery in femoral cartilage thickness during and after running at different speeds.

Design: Crossover study.

Setting: Laboratory.

Patients or other participants: A total of 17 healthy men (age = 23.9 ± 2.3 years, height = 173.1 ± 5.5 cm, mass = 73.9 ± 8.0 kg).

Intervention(s): Participants performed a 40-minute treadmill run at speeds of 7.5 and 8.5 km/h.

Main outcome measure(s): Ultrasonographic images of femoral cartilage thickness (intercondylar, lateral condyle, and medial condyle) were obtained every 5 minutes during the experiment (40 minutes of running followed by a 60-minute recovery period) at each session. Data were analyzed using analysis of variance and Bonferroni- and Dunnett-adjusted post hoc t tests. To identify patterns of cartilage response, we extracted principal components (PCs) from the cartilage-thickness data using PC analysis, and PC scores were analyzed using t tests.

Results: Regardless of time, femoral cartilage thicknesses were greater for the 8.5-km/h run than the 7.5-km/h run (intercondylar: F1,656 = 24.73, P < .001, effect size, 0.15; lateral condyle: F1,649 = 16.60, P < .001, effect size, 0.16; medial condyle: F1,649 = 16.55, P < .001, effect size, 0.12). We observed a time effect in intercondylar thickness (F20,656 = 2.15, P = .003), but the Dunnett-adjusted post hoc t test revealed that none of the time point values differed from the baseline value (P > .38 for all comparisons). Although the PC1 and PC2 captured the magnitudes of cartilage thickness and time shift (eg, earlier versus later response), respectively, t tests showed that the PC scores were not different between 7.5 and 8.5 km/h (intercondylar: P ≥ .32; lateral condyle: P ≥ .78; medial condyle: P ≥ .16).

Conclusions: Although the 40-minute treadmill run with different speeds produced different levels of fatigue, morphologic differences (<3%) in the femoral cartilage at both speeds seemed to be negligible.

Context: Early identification of knee osteoarthritis (OA) symptoms after anterior cruciate ligament reconstruction (ACLR) could enable timely interventions to improve long-term outcomes. However, little is known about the change in early OA symptoms from 6 to 12 months post-ACLR.

Objective: To evaluate the change over time in meeting classification criteria for early knee OA symptoms from 6 to 12 months after ACLR.

Design: Prospective cohort study.

Setting: Research laboratory.

Patients or other participants: Eighty-two participants aged 13 to 35 years who underwent unilateral primary ACLR. On average, participants' first and second visits were 6.2 and 12.1 months post-ACLR.

Main outcome measure(s): Early OA symptoms were classified using generic (Luyten Original) and patient population-specific (Luyten Patient Acceptable Symptom State [PASS]) thresholds on Knee injury and Osteoarthritis Outcome Score (KOOS) subscales. Changes in meeting early OA criteria were compared between an initial and follow-up visit at an average of 6 and 12 months post-ACLR, respectively.

Results: Twenty-two percent of participants exhibited persistent early OA symptoms across both visits using both the Luyten Original and PASS criteria. From initial to follow-up visit, 18% to 27% had resolution of early OA symptoms, while 4% to 9% developed incident symptoms. In total, 48% to 51% had no early OA symptoms at either visit. No differences were found for change in early OA status between adults and adolescents.

Conclusions: Nearly one-quarter of participants exhibited persistent early knee OA symptoms based on KOOS thresholds from 6 to 12 months post-ACLR. Determining if this symptom persistence predicts worse long-term outcomes could inform the need for timely interventions after ACLR. Future researchers should examine if resolving persistent symptoms in this critical window improves later outcomes. Tracking early OA symptoms over time may identify high-risk patients who could benefit from early treatment.

Context: The supplementary motor area (SMA) is involved in the functional deficits of chronic ankle instability (CAI), but the structural basis of its abnormalities remains unclear.

Objectives: To determine the differences in volume- and surface-based morphologic features of the SMA between patients with CAI and healthy controls and the relationship between these features and the clinical features of CAI.

Design: Cross-sectional study.

Setting: Sports medicine laboratory.

Patients or other participants: A total of 32 patients with CAI (10 women, 22 men; age = 32.46 ± 7.51 years) and 31 healthy controls (12 women, 19 men; age = 29.70 ± 8.07 years) participated.

Main outcome measure(s): We performed T1-weighted structural magnetic resonance imaging of participants and calculated volume- and surface-based morphologic features of SMA subregions. These subregions included anterior and posterior subdivisions of the medial portion of Brodmann area 6 (6 ma and 6 mp, respectively) and supplementary and cingulate eye fields. Between-group comparisons and correlation analysis with clinical features of CAI were performed.

Results: Moderately thinner 6 mp (motor-output site; Cohen d = -0.61; 95% CI = -1.11, -0.10; P = .02) and moderately plainer 6 ma (motor-planning site; Cohen d = -0.70; 95% CI = -1.20, -0.19; P = .01) were observed in the CAI than the control group. A thinner 6 mp was correlated with lower Foot and Ankle Ability Measure Activities of Daily Living subscale scores before (r = 0.400, P = .02) and after (r = 0.449, P = .01) controlling for covariates.

Conclusions: Patients with CAI had a thinner 6 mp and a plainer 6 ma in the SMA compared with controls. The thin motor-output site of the SMA was associated with ankle dysfunction in patients. This morphologic evidence of maladaptive neuroplasticity in the SMA might promote more targeted rehabilitation of CAI.

Context: Low scores on psychological patient-reported outcomes measures, including the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) and Injury-Psychological Readiness to Return to Sport (I-PRRS), after anterior cruciate ligament reconstruction (ACLR) have been associated with a maladaptive psychological response to injury and poor prognosis.

Objective: To assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores and generate normative reference curves.

Design: Case series.

Setting: Outpatient sports medicine and orthopaedic clinic.

Patients or other participants: A total of 507 patients (age at ACLR, 17.9 ± 3.0 years) who had undergone primary ACLR and completed ACL-RSI or I-PRRS assessments ≥1 times (n = 796) between 0 and 1 year post-ACLR.

Main outcome measure(s): An honest broker provided anonymous data from our institution's knee-injury clinical database. Generalized additive models for location, scale, and shape and generalized least-squares analyses were used to assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores.

Results: The ACL-RSI and I-PRRS scores increased over time post-ACLR. Males had higher scores than females until approximately 5 months post-ACLR, with scores converging thereafter.

Conclusions: Males reported higher ACL-RSI and I-PRRS scores than females in the initial stages of rehabilitation, but scores converged between sexes at times associated with return to play post-ACLR. Normative reference curves can be used to objectively appraise ACL-RSI and I-PRRS scores at any time post-ACLR. This may lead to timely recognition of patients with a maladaptive psychological response to injury and a higher likelihood of a poor prognosis, optimizing ACLR outcomes.

Context: The Concussion Clinical Profiles Screening Tool (CP Screen) self-report concussion symptom inventory is often administered at weekly intervals. However, 1-week reliable change indices (RCIs) for clinical cutoffs and the test-retest reliability of the CP Screen are unknown.

Objective: To document RCI cutoff scores and 1-week test-retest reliability for each profile and modifier of the CP Screen for men and women.

Design: Case series.

Setting: A large US university.

Patients or other participants: One hundred seventy-three healthy college students.

Main outcome measure(s): Participants completed 2 administrations of the CP Screen 7 days apart. The CP Screen items yielded 5 clinical profiles and 2 modifiers. Spearman ρ coefficients (rs), intraclass correlation coefficients (ICCs), single measures, and unbiased estimates of reliability (UERs) were used to assess test-retest reliability. Wilcoxon signed-rank tests assessed differences across time. Reliable change index values and cutoff scores are provided at 90%/95% CIs. All analyses were performed for the total sample and separately for men and women.

Results: Reliable change index cutoffs for clinically significant change (increase/decrease) at a 90% CI for men were as follows: ocular, vestibular >2/>4; anxiety/mood, cognitive/fatigue, and migraine >3/>3; sleep >4/>6; and neck >2/>2. Reliable change index cutoffs for clinically significant change (increase/decrease) at a 90% CI for women were as follows: anxiety/mood ≥2/≥4; cognitive/fatigue, migraine, ocular, vestibular, and sleep ≥3/≥3; and neck ≥1/≥1. Correlations for the CP Screen ranged from 0.51 (migraine) to 0.79 (anxiety/mood) for the total sample, from 0.48 (migraine) to 0.84 (vestibular) for men, and from 0.51 (migraine) to 0.77 (ocular) for women. Test-retest indices for each profile and modifier were moderate to good for the total sample (ICC, 0.64-0.82; UER, 0.79-0.90), men (ICC, 0.60-0.87; UER, 0.76-0.94), and women (ICC, 0.64-0.80; UER, 0.78-0.89).

Conclusion: The CP Screen is reliable and stable across a 1-week interval, and established RCIs for men and women can help identify meaningful change throughout recovery.

Context: Athletic trainers (ATs) have reported the need for more educational resources about clinical documentation.

Objective: To investigate the effectiveness of passive and active educational interventions to improve practicing ATs' clinical documentation knowledge.

Design: Randomized controlled trial, sequential explanatory mixed methods study.

Setting: Online module(s), knowledge assessment, and interviews.

Patients or other participants: We emailed 18 981 practicing ATs across employment settings, of which 524 ATs were enrolled into a group (personalized learning pathway [PLP = 178], passive reading list [PAS = 176], control [CON = 170]) then took the knowledge assessment. A total of 364 ATs did not complete the intervention or postknowledge assessment; therefore, complete responses from 160 ATs (PLP = 39, PAS = 44, CON = 77; age = 36.6 ± 11.2 years, years certified = 13.9 ± 10.7) were analyzed.

Main outcome measure(s): Knowledge assessment (34 items) and interview guides (12-13 items) were developed, validated, and piloted with ATs before study commencement. We summed correct responses (1 point each, 34 points maximum) and calculated percentages and preknowledge and postknowledge mean change scores. Differences among groups (PLP, PAS, CON) and time (preintervention, postintervention) were calculated using a 3 × 2 repeated-measures analysis of variance (P ≤ .05) with post hoc Tukey HSD. Semistructured interviews were conducted (PLP = 15, PAS = 14), recorded, transcribed, and analyzed following the consensual qualitative research tradition.

Results: No differences in the preknowledge assessment were observed between groups. We observed a group × time interaction (F2,157 = 15.30, P < .001; partial η2 = 0.16). The PLP group exhibited greater mean change (M = 3.0 ± 2.7) than the PAS (M = 1.7 ± 3.0, P = .049) and CON (M = 0.4 ± 2.2, P < .001) groups. Descriptively, ATs scored lowest on the legal (61.3% ± 2.1%), value of the AT (63.7% ± 4.3%), and health information technology (65.3% ± 3.7%) items. Whereas ATs described being confident in their documentation knowledge, they also identified key content (eg, legal considerations, strategies) which they deemed valuable.

Conclusions: The educational interventions improved ATs' knowledge of clinical documentation and provided valuable resources for their clinical practice; however, targeted continuing education is needed to address knowledge gaps.

Context: There are different ways to deliver external focus (EF) and internal focus (IF) instruction. Understanding each modality better will help to develop more effective interventions to reduce injury risk.

Objectives: To investigate the difference in landing biomechanics between participants who received EF and IF instruction and control participants. A secondary aim was to evaluate participant perceptions of focus of attention.

Design: Randomized controlled trial.

Setting: Laboratory.

Patients or other participants: Forty-one healthy women (EF: n = 14, 23.0 ± 2.9 years, 1.69 ± 0.07 m, 64.0 ± 6.8 kg; IF: n = 15, 22.9 ± 3.2 years, 1.66 ± 0.08 m, 66.2 ± 12.4 kg; control: n = 12, 21.1 ± 2.9 years, 1.67 ± 0.11 m, 74.3 ± 15.1 kg).

Main outcome measure(s): Participants scoring greater than or equal to 5 on the Landing Error Scoring System were allocated into the EF, IF, or control group. Knee and hip flexion and abduction were collected pre- and postintervention during 5 drop vertical jumps. For the intervention, each group was provided separate instructions. In between the intervention jumps, participants answered, "What strategy were you focusing on when completing the previous jump-landing trials?" Postintervention minus preintervention change scores were calculated, and separate 1-way analysis of variance assessments were performed to determine differences in the dependent variables.

Results: Individuals in the EF group had a greater change in hip and knee flexion angles than individuals in the control group. There was no significant difference between the EF and IF groups for any variables. There were no significant differences in frontal plane variables. In the EF group, 71.4% aligned with the instructions given; in the IF group, 80% aligned; and in the control group, 50% aligned.

Conclusions: External focus instruction may not produce immediate changes in movement compared with IF instruction. Hip and knee flexion were greater in the EF group than in the control group but was not better than that in the IF group. Clinicians should provide instructions to patients, but the mode of instruction may not be as critical to see positive biomechanical changes. Patients may not always focus on the instruction being given; therefore, the relationship between instruction and patient experience should be further explored.

Athletes with autism spectrum disorder (ASD) experience lesser care for injuries and athletic trainers (ATs) report feeling unprepared to provide care competently for this population. Provision of sports-related care can be impacted by sensory differences associated with ASD such as hyper-reactivity to sensation or poor integration of sensory information. An in-depth review of the literature using the Strength of Recommendation Taxonomy (SORT) guidelines was used to identify articles that address the sensory features of autism for athletic trainers with the purpose of informing athletic trainers about the sensory features of ASD and to present the most current evidence-based recommendations for providing care to athletes with ASD and other neurodivergent individuals who present with sensory differences. Relevant articles were reviewed by four independent researchers and organized by theme. Key themes included use of sensory friendly or adapted environments, sensory kits, and informed communication strategies that acknowledge sensory differences. Providing individualized care for athletes with ASD and sensory features can improve the quality of and participation in sports for autistic persons.

Objective: This review aimed to determine if gait training interventions influence lower extremity biomechanics during walking in individuals with chronic ankle instability (CAI).

Methods: A literature search was conducted in PubMed, CINAHL, SPORTDiscus, and MEDLINE to identify English-language studies from inception through September 2022. Eligible studies included randomized control trials, repeated measures design, and descriptive laboratory studies measuring the effects during or following a gait training intervention on biomechanical outcomes (kinematics, kinetics, electromyography) during walking in individuals with CAI. Gait training interventions were broadly categorized into devices (destabilization devices, novel gait training device) and biofeedback (visual, auditory, and haptic delivery modes). Meta-analyses were conducted when appropriate using random-effects to compare pre-and post- gait training intervention mean differences and standard deviations.

Results: Thirteen studies were included. Meta-analyses were conducted for single session gait training studies only. Eleven studies reported kinetic outcomes. Our meta-analyses showed location of center of pressure (COP) was shifted medially from 0-90% (Effect Size [ES] range=0.35-0.82) of stance, contact time was decreased in medial forefoot (ES=0.43), peak pressure was decreased for lateral midfoot (ES=1.18) and increased for hallux (ES=0.59), pressure time integral was decreased for lateral heel (ES=0.33) and lateral midfoot (ES=1.22) and increased for hallux (ES=0.63). Three studies reported kinematic outcomes. Seven studies reported electromyography outcomes. Our meta-analyses revealed increased activity following initial contact (IC) for fibularis longus (ES=0.83).

Conclusions: Gait training protocols improved some lower extremity biomechanical outcomes in individuals with CAI. Plantar pressure outcome measures seem to be most impacted by gait training programs with improvements in decreasing lateral pressure associated with increased risk for lateral ankle sprains. Gait training increased EMG activity post-IC for the fibularis longus. Few studies have assessed the impact of multi-session gait training on biomechanical outcome measures. Targeted gait trainning should be considered when treating patients with CAI.