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Kylie Roberts, Kiersten Kuhlman, Megan Byrd, and Tamerah Hunt

Clinical Scenario: Athletic identity (AI) can be defined as, “the degree to which an individual identifies with an athlete role, and the values, and social networks associated with that identity,” and can pose a problem when athletes do not explore themselves outside of sport. This lack of identity development beyond athletics has the potential to lead to the development of a high AI. High AI in athletes can have positive effects in areas such as performance, however, high AI may also pose negative consequences. The development of such an identity can limit the adaptive responses to substantial life changes such as retirement from sport. This inability to adapt may thereby contribute to mental health problems during the transition. Therefore, the purpose of this study is to better understand the relationship between athletic identity and mental health symptoms so clinicians may provide support to enable positive outcomes after retirement from sport. Clinical Question: What is the influence of athletic identity on mental health symptoms in athletes retiring from sports? Summary of Key Findings: (1) High athletic identity contributes to increased mental health symptoms following retirement. (2) Athletic identity had no relationship to mental health symptoms during the preretirement phase of an athlete’s career Clinical Bottom Line: The findings suggest that there is high-quality evidence to support that AI has no relationship with mental health symptoms during the preretirement phase and that athletes with high AI are more likely to experience mental health symptoms during their transition out of or retirement from sport. Strength of Recommendation: The grade of B is recommended by the Strength of Recommendation taxonomy for consistent, limited-quality, patient-oriented evidence that high AI has a strong relationship to mental health symptoms following retirement in athletes.

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Ling Zhang, Shuai Fan, and Bin Cai

Objectives: Although nonsurgical and surgical management of knee arthrofibrosis has been reported in the literature, there is little information on the effect of procedural treatment modalities of refractory arthrofibrosis on clinical outcomes. The purpose of this case report is to describe the intervention of refractory knee arthrofibrosis after anterior cruciate ligament reconstruction and investigate long-term clinical outcomes after procedural intervention. Methods: A 27-year-old male presented with decreased range of motion (ROM), patellar mobility, strength, and knee joint function following anterior cruciate ligament reconstruction of his left knee. After failed conservative management, the patient underwent manipulation under anesthesia (MUA) to release scar tissue. Following MUA, the emphasis of comprehensive physiotherapy was on decreasing inflammation, relieving pain, and maintaining patellar mobility while increasing knee joint ROM and strength. Knee ROM, patellofemoral motion, gait, and quadriceps recruitment were measured 3, 6, 12, and 24 months after MUA. Results: At 2-year follow-up after MUA, the patient continued to present with decreased ROM and quadriceps strength compared to the contralateral knee, but had returned to a running program and reported knee joint dysfunction no longer interfered with his daily activities. Conclusions: This case report demonstrates signs and symptoms that could indicate knee arthrofibrosis and introduces procedural intervention for refractory arthrofibrosis after anterior cruciate ligament reconstruction.

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Yan Wu and Sunyue Ye

Background: This study aimed to explore the relationship between the changes in parent-related factors and preschoolers exceeding screen time (ST) recommendations. Methods: A longitudinal analysis using 2-year follow-up data from 4 kindergartens (n = 409) was conducted in Zhejiang, China, from 2019 to 2021. Multivariate logistic regression models were used to determine the potential parental modifiable predictors. Results: The significant associations of baseline ST, change in screen accessibility, and the interaction of preschooler ST with maternal ST change with preschooler follow-up ST were observed. For preschool-aged children with baseline ST ≤ 1 hour per day, the follow-up of preschoolers with ST > 1 hour per day increased significantly when parental clarity of their ST rules decreased or remained low. For preschool children with baseline ST > 1 hour per day, follow-up ST increased significantly when their father kept ST >2 hours per day, when the screen accessibility became or remained easy, or when parental awareness of the ST decreased. Conclusions: Changes in parental correlates played an important role in preschooler ST based on 2-year longitudinal data. Early interventions should focus on improving the clarity of parental rules and perceptions, as well as on reducing parental ST and accessibility of home screens.

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Shakiba Oftadeh-Moghadam, Neil Weston, and Paul Gorczynski

This feasibility study aimed to evaluate the effectiveness of an educational intervention on stigma toward mental health symptoms and disorders, mental health literacy, and help-seeking intentions among U.K. semielite women rugby players. Seven semielite women rugby players participated. An A-B-A single-case experimental research design was used to assess stigma toward mental health symptoms and disorders, mental health literacy, and help-seeking intentions at baseline, intervention, and follow-up phases. The intervention was successful in enhancing the players’ mental health literacy and reducing stigmatizing attitudes toward seeking professional psychological help. Acknowledging the study’s small sample size, the findings revealed that there is a need for scaffolding to support future developments, advancements, and maintenance of mental health support in women’s rugby. Practical implications of future findings from a larger-scale study may lead to policy reformation across the game to inform and improve systemic mental health support for women rugby players.

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Virgílio Viana Ramires, Priscila Cristina dos Santos, Valter Cordeiro Barbosa Filho, Alexsandra da Silva Bandeira, Maria Cecilia Marinho Tenório, Edina Maria de Camargo, Fabrício Cesar de Paula Ravagnani, Paula Sandreschi, Victor José Machado de Oliveira, Pedro Curi Hallal, and Kelly Samara Silva

Background: Physical education (PE) classes in schools are considered relevant to implement interventions, especially focused on physical activity. However, evidence overviews on how PE classes contribute to general health (physical, social, affective, and cognitive domains) are still needed. Thus, we summarized evidence synthesis (eg, systematic reviews) that addressed the contribution of PE classes to the health of school-aged children and adolescents. Methods: We performed a scoping review with searches in 8 databases and institutional websites to find systematic reviews or meta-analyses that answered this review’s research question. Data charting form included the identification of the study, health outcomes, and PE classes’ strategies (policies and environment, curriculum, appropriate instructions, and evaluation). An interactive process was performed to build the evidence summary. Results: An initial search yielded 2264 titles, and 49 systematic reviews (including 11 with meta-analysis) were included in this review. Most documents reported the main benefits of PE classes on physical domain outcomes (eg, physical activity, cardiorespiratory fitness, body mass index, and fundamental motor skills). However, evidence on the benefits of PE classes in affective (eg, enjoyment, motivation, and autonomy); social (eg, cooperation, problem-solving, and making friends); and cognitive (eg, memory, attention, concentration, and decision making) domains were found. Strategies on PE classes for health benefits were highlighted. Conclusions: These elements were detailed in the evidence summary, which may be considered to guide researchers, teachers, and practitioners to define research and practice priorities on PE class interventions for health in the school context.

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Martin Alfuth and Elena Vieten

Clinical Scenario: Knee osteoarthritis (KOA) is a complex progressive synovial joint disease that results in impaired muscle function, including a considerable loss of maximal strength and power. Exercise therapies, such as sensorimotor or balance training and resistance training, are frequently used to improve muscle function, mobility, and quality of life, but their impact on maximal muscle strength in patients with KOA is not well understood. Focused Clinical Question: Does sensorimotor or balance training improve knee-extensor and knee-flexor maximal muscle strength compared with strength training or no intervention in patients with KOA? Summary of Key Findings: Results from 4 fair- to good-quality randomized controlled/clinical trials (level 1b) revealed inconsistent grade B evidence regarding the effect of sensorimotor or balance training to improve knee-extensor and knee-flexor maximal muscle strength in patients with KOA. Two studies, one good-quality study and one fair-quality study, showed significant strength improvements, and 2 good-quality studies demonstrated no significant strength enhancements. Clinical Bottom Line: Sensorimotor or balance training may be useful to improve maximal strength of quadriceps and hamstring muscle groups in patients with KOA; however, it seems that this depends on a training duration of at least 8 weeks and the use of unstable devices to induce destabilization of patients’ balance, initiating neuromuscular adaptations. Strength of Recommendation: Due to inconsistent evidence (grade B), the true effect of sensorimotor or balance training to improve knee-extensor and knee-flexor maximal muscle strength in patients with KOA remains unclear and needs to be further investigated.

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Andreza Abreus de Moura, Leonardo José Mataruna-Dos-Santos, and Erick Francisco Quintas Conde

Manual Reaction Time measures have been widely used to study interactions between perceptual, cognitive, and motor functions. The Stimulus–Response Compatibility is a phenomenon characterized through faster Manual Reaction Times when stimuli and response locations coincide (correspondent condition) than when they are on different sides (noncorrespondent condition). The present study adapted a protocol to study if the Stimulus–Response Compatibility effect can be detected during a virtual combat simulation. Twenty-seven participants were instructed to defend themselves by clicking a key in order to block the presented punch. Videos of two fighters were used, granting two types of basic strokes: the back fist, a punch performed with the dorsal part of the fighter’s hand, starting at the opposite side to which it is directed; and the hook punch, performed with a clenched fist starting and finishing ipsilaterally. The Manual Reaction Times were different between the correspondent and noncorrespondent conditions, F(1, 26) = 9.925; p < .004; η2 = .276, with an Stimulus–Response Compatibility effect of 72 ms. Errors were also different, F(1, 26) = 23.199; p < .001; η2 = .472, between the correspondent (13%) and the noncorrespondent conditions (23%). The study concluded that spatial codes presented at the beginning of the punch movement perception substantially influenced the response execution.

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Mark Cummings, Aditi Doshi, and Sangeetha Madhavan

Background: Transcranial direct current stimulation (tDCS) has been demonstrated to facilitate motor performance in healthy individuals; however, results are variable. The neuromodulatory effects of tDCS during visuomotor tasks may be influenced by extrinsic visual feedback. However, this interaction between tDCS and visual feedback has not been explored for the lower limb. Hence, our objective was to explore if tDCS over the primary lower limb motor cortex differentially facilitates motor performance based on the availability of visual feedback. Methods: Twenty-two neurotypical adults performed ankle plantarflexion and dorsiflexion movements while tracking a sinusoidal target. Spatiotemporal, spatial, and temporal error were calculated between the ankle position and target. Participants attended two sessions, a week apart, with (Stim) and without (No-Stim) anodal tDCS. Sessions were divided into two blocks containing randomized visual feedback conditions: full, no, and blindfold. During Stim sessions, the first block included the application of tDCS to the lower limb M1. Results: Spatiotemporal and spatial error increased as feedback faded (p < .001). A two-way repeated-measures analysis of variance showed a significant interaction between tDCS and visual feedback (p < .05) on spatiotemporal error. Post hoc analyses revealed a significant improvement in spatiotemporal error when visual feedback was absent (p < .01). Spatial and temporal errors were not significantly affected by stimulation or visual feedback. Discussion: Our results suggest that tDCS enhances spatiotemporal ankle motor performance only when visual feedback is not available. These findings indicate that visual feedback may play an important role in demonstrating the effectiveness of tDCS.

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Manolya Acar, Demet Öztürk, Mert Demirsöz, and Mustafa Agah Tekindal

Context: The Disablement in the Physically Active Scale (DPAS) was recently developed to evaluate the disability process and health-related quality of life. The aim of this study was to investigate the validity and reliability of the Turkish version of the DPAS in physically active individuals with musculoskeletal injury. Methods: The study sample comprised 64 physically active individuals with musculoskeletal injury aged 16–40 years. The DPAS was translated into Turkish according to the guidelines for cross-cultural adaptation. Short Form-36 was used concurrently to test the construct validity. The test–retest reliability of the Turkish version of the scale assessed by intraclass correlation coefficient and Cronbach α was calculated for internal consistency. Results: Confirmatory factor analysis carried out on the Turkish version of the DPAS was confirmed. Cronbach α was calculated to be .946. The intraclass correlation coefficients ranged between .593 and .924 (P < .001). The Turkish version of the scale showed significant correlations with domains of the Short Form-36 (P < .05). When the sensitivity of the study was evaluated, the highest correlation was found between DPAS total score and impairments (r = .906, P = .001), and the lowest correlation was  between DPAS total score and quality of life (r = .637, P = .001). Conclusion: The Turkish version of the DPAS is a reliable, valid, and practical tool. The Turkish version of the DPAS can be used by health professionals to understand quality of life, the disability process, and activity limitations in Turkish-speaking physically active people after musculoskeletal injuries.

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Cigdem Demir and Gulcan Harput

Context: Slideboards are commonly used in exercise programs, but there is limited information about how they affect muscle activities during exercise. We aim to compare the activation levels of quadriceps and hamstring muscles and hip- and knee-flexion angles during lunge and single-leg squat exercises between normal ground and slideboard in physically active individuals. Design: Cross-sectional study. Methods: Thirty healthy individuals (age: 23.83 [2.84] y, body mass index: 21.75 [1.72] kg/m2) were included in the study. Surface electromyography was used to measure vastus medialis, vastus lateralis, biceps femoris, and semitendinosus activation levels during reaching and returning phases of the forward, lateral, and back lunges and squats that were performed on the normal ground and slideboard. Exercises were performed at a slow pace (60 beats/min). Hip- and knee-flexion angles during the exercises were evaluated by using 2-dimensional motion analysis. Repeated measures of analysis of variance were used for statistical analysis. Results: Vastus medialis and vastus lateralis activation levels were greater during reaching and returning phases of the exercises on slideboard compared with normal ground (P < .05). However, semitendinosus and biceps femoris activity were greater only during the returning phase of the forward lunge (P < .001) and the returning phase of the back squat (P = .002, P = .009, respectively). Hip-to-knee flexion ratios were closer to 1 when the forward lunge (P < .001), back lunge (P = .004), and forward squat (P = .001) exercises were performed on a slideboard. Conclusion: In exercise programs that target the quadriceps and hamstring muscles, slideboards can be effectively used in exercise progressions as they can increase muscle activity. Moreover, squat and lunge exercises on slideboard with a slow pace may also be helpful for improving the balance between hip- and knee-flexion angles.