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Continuing Education Assessment

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Volume 29 (2024): Issue 3 (May 2024)

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Adherence and Compliance of Different Delivery Methods of Home Exercise in Individuals With Nonspecific Low Back Pain

Luk Devorski, Aravinthan Suppiah, David H. Fukuda, Jeffrey Stout, Christopher D. Ingersoll, and L. Colby Mangum

Autonomous exercise within nonspecific low back pain rehabilitation is a necessary tool to treat low back pain. The purpose of this study was to quantify adherence and compliance during two different 6-week home-exercise programs. Forty adults were randomly allocated to a gamified and packet group. Adherence, compliance, and system usability assessments occurred after 3 and 6 weeks. Packet group adherence was similar at 3 weeks and at 6 weeks. System usability was significantly greater at 6 weeks than at 3 weeks in the packet group. Adherence or compliance was not influenced. The usability of the intervention methodology was considered great by both groups.

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Effect of Mindful Sport Performance Enhancement in College Athletes for Reducing Sports-Caused Anxiety and Improving Self-Awareness: A Critically Appraised Topic

Shivam Garg, Nancy A. Uriegas, Zachary K. Winkelmann, Morgan Adams, and Amy L. Fraley

Mindful Sport Performance Enhancement (MSPE) training is a relatively new concept, which focuses on helping athletes manage a variety of stressors experienced throughout a season, including performing well academically, staying fit, having a productive season in their sport, and maintaining a healthy social life. A need for a critical appraisal is needed to assess the effectiveness of the intervention. Two cohort studies and one randomized control trial were included in the study and assessed using STROBE and PEDro Scale. Key results show, all 3 studies identified participants experiencing benefits after MSPE with aspects of awareness, acceptance, and emotion regulation. Furthermore, student-athletes who attended either all the sessions or more sessions after the 6-week course showed greater satisfaction with mental and physical health. Overall, there is level “B” evidence to support effectiveness of MSPE for college athletes in reducing sport anxiety and improving their overall well-being.

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Ten Years Gone

Patrick O. McKeon and Jennifer M. Medina McKeon

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NATA News & Notes

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Exercise With Unstable Objects: A Descriptive Survey Among Health Care and Fitness Professionals

Scott W. Cheatham, Russell T. Baker, Wendy Batts, Tony Ambler-Wright, and Brian Sutton

Exercise with unstable objects is a popular intervention used by health care and fitness professionals. Understanding different professional beliefs and usage patterns might provide insight for future research and development of evidence-based guidelines. The purpose of this survey study was to document the perceptions, beliefs, and the use of exercise with unstable objects among health care and fitness professionals in the United States. Six hundred and sixteen respondents completed the survey. Most respondents used unstable objects for musculoskeletal postinjury fitness/return to performance (72%). Most believed the main therapeutic effects were enhanced motor control (88%), balance (86%), and somatosensory (85%) function. Most reported using the foam pad (80%) and BOSU (84%). The most used subjective measure was the Activities-specific Balance Confidence scale. Most respondents used single limb stance (85%) to measure static motor control and the single leg squat assessment (51%) for dynamic motor control. Respondents used variables such as dynamic movement, repetition and sets, and time during training. Respondents considered recent injury or surgery and neurological or vestibular conditions as the top precautions. Respondents considered acute injury or surgery and neurological or vestibular conditions as the top contraindications. This survey provides insight into health care and fitness professionals perceptions, beliefs, and use of exercise with unstable objects.

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Increasing Hamstring Range of Motion via Plantar Myofascial Release: A Critically Appraised Topic

Alexandra Finley and Jane McDevitt

Context: The concept of anatomical fascial trains and myofascial release are heavily researched topics independently. However, few studies have determined if myofascial release of remote areas can cause lengthening throughout more distal aspects of these fascial trains. Clinical Question: In healthy individuals, what is the effect of myofascial release on the plantar aspect of the foot in improving flexibility and hamstring length as determined by a sit-and-reach test? Clinical Bottom Line: The usage of myofascial release on the plantar aspect of the foot via a firm object has been shown to improve sit-and-reach distance. Each article included for analysis utilized similar methods of instructing self-myofascial release with regard to time as well as type of object used for the intervention. Though this was consistent between studies, the authors should have implemented secondary outcome measures. Despite the limitations to each of the studies analyzed, there is a Strength of Recommendation Taxonomy (SORT) Level B evidence to support the implementation self-myofascial release to the plantar fascia. This intervention should be considered a concurrent option for individuals with range of motion deficits or fascial restrictions in the upper thigh.

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Clinicians’ Attitudes, Perspectives, and Clinical Practices on Gait Retraining After Anterior Cruciate Ligament Reconstruction

Kyle Southall, Laura Vogtle, Harshvardhan Singh, Matthew P. Ithurburn, C. Scott Bickel, and Christopher P. Hurt

Introduction: It has been shown that 45%–85% of patients with anterior cruciate ligament reconstruction (ACLR) will have early-onset arthritis within 10–12 years following surgery. Over the past two decades, the amount of literature regarding ACLR, gait maladaptations after ACLR and their potential link to early-onset arthritis, and rehabilitation techniques has grown exponentially; however, long-term patient outcomes remain modest. Methods: To evaluate current clinicians’ attitudes, perspectives, and clinical practice approach for rehabilitation of patients following ACLR, a survey questionnaire was designed using the Delphi technique. Results: Of the 263 respondents, 84.4% (n = 226) reported that they believed gait training to be “Very” or “Extremely Important.” However, only 35.7% (n = 94) reported objectively measuring gait during ACLR rehabilitation. Of the total respondents, only 6.8% (n = 18) assessed gait during rehabilitation using two-dimensional or three-dimensional motion capture technologies. Discussion: Our results suggest that while gait evaluation was perceived as important, most respondents did not objectively measure gait metrics as a clinical outcome during ACLR rehabilitation. These findings provide a prospective rehabilitation target to potentially mitigate a known risk factor of early-onset arthritis (gait maladaptations) in individuals following ACLR.

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The Effect of Insurance Type on Time to Anterior Cruciate Ligament Reconstruction in Pediatric Patients: A Critically Appraised Topic

Alexis P. Tucker, Marc F. Norcross, Kimberly S. Hannigan, and Samuel T. Johnson

Clinical Scenario: Delay in surgery for anterior cruciate ligament (ACL) injuries increases the risk of complications including secondary injuries. Previous research has shown individuals with public insurance have greater delays in care for a variety of health conditions. Clinical Question: In pediatric patients with ACL injuries, is the time from injury to surgery longer for patients with public insurance than patients with private insurance? Summary of Key Findings: Four studies met the inclusion criteria. All studies reported a greater wait time for surgery in pediatric patients with public insurance. Clinical Bottom Line: There is moderate evidence indicating that there is a delay in ACL surgery for pediatric patients with public insurance compared to those with private insurance. Strength of Recommendation: Grade B evidence exists that there is a delay in surgery for ACL injuries in pediatric patients with public insurance compared to those with private insurance.