Clinical Scenario: Approximately 30% of all first-time patients with LAS develop chronic ankle instability (CAI). CAI-associated impairments are thought to contribute to aberrant gait biomechanics, which increase the risk of subsequent ankle sprains and the development of posttraumatic osteoarthritis. Alternative modalities should be considered to improve gait biomechanics as impairment-based rehabilitation does not impact gait. Taping and bracing have been shown to reduce the risk of recurrent ankle sprains; however, their effects on CAI-associated gait biomechanics remain unknown. Clinical Question: Do ankle taping and bracing modify gait biomechanics in those with CAI? Summary of Key Findings: Three case-control studies assessed taping and bracing applications including kinesiotape, athletic tape, a flexible brace, and a semirigid brace. Kinesiotape decreased excessive inversion in early stance, whereas athletic taping decreased excessive inversion and plantar flexion in the swing phase and limited tibial external rotation in terminal stance. The flexible and semirigid brace increased dorsiflexion range of motion, and the semirigid brace limited plantar flexion range of motion at toe-off. Clinical Bottom Line: Taping and bracing acutely alter gait biomechanics in those with CAI. Strength of Recommendation: There is limited quality evidence (grade B) that taping and bracing can immediately alter gait biomechanics in patients with CAI.
Kimmery Migel and Erik Wikstrom
Emma L. Sweeney, Daniel J. Peart, Irene Kyza, Thomas Harkes, Jason G. Ellis and Ian H. Walshe
Experimental sleep restriction (SR) has demonstrated reduced insulin sensitivity in healthy individuals. Exercise is well-known to be beneficial for metabolic health. A single bout of exercise has the capacity to increase insulin sensitivity for up to 2 days. Therefore, the current study aimed to determine if sprint interval exercise could attenuate the impairment in insulin sensitivity after one night of SR in healthy males. Nineteen males were recruited for this randomized crossover study which consisted of four conditions—control, SR, control plus exercise, and sleep restriction plus exercise. Time in bed was 8 hr (2300–0700) in the control conditions and 4 hr (0300–0700) in the SR conditions. Conditions were separated by a 1-week entraining period. Participants slept at home, and compliance was assessed using wrist actigraphy. Following the night of experimental sleep, participants either conducted sprint interval exercise or rested for the equivalent duration. An oral glucose tolerance test was then conducted. Blood samples were obtained at regular intervals for measurement of glucose and insulin. Insulin concentrations were higher in SR than control (p = .022). Late-phase insulin area under the curve was significantly lower in sleep restriction plus exercise than SR (862 ± 589 and 1,267 ± 558; p = .004). Glucose area under the curve was not different between conditions (p = .207). These findings suggest that exercise improves the late postprandial response following a single night of SR.
Matthew Pearce, Tom R.P. Bishop, Stephen Sharp, Kate Westgate, Michelle Venables, Nicholas J. Wareham and Søren Brage
Harmonization of data for pooled analysis relies on the principle of inferential equivalence between variables from different sources. Ideally, this is achieved using models of the direct relationship with gold standard criterion measures, but the necessary validation study data are often unavailable. This study examines an alternative method of network harmonization using indirect models. Starting methods were self-report or accelerometry, from which we derived indirect models of relationships with doubly labelled water (DLW)-based physical activity energy expenditure (PAEE) using sets of two bridge equations via one of three intermediate measures. Coefficients and performance of indirect models were compared to corresponding direct models (linear regression of DLW-based PAEE on starting methods). Indirect model beta coefficients were attenuated compared to direct model betas (10%–63%), narrowing the range of PAEE values; attenuation was greater when bridge equations were weak. Directly and indirectly harmonized models had similar error variance but most indirectly derived values were biased at group-level. Correlations with DLW-based PAEE were identical after harmonization using continuous linear but not categorical models. Wrist acceleration harmonized to DLW-based PAEE via combined accelerometry and heart rate sensing had the lowest error variance (24.5%) and non-significant mean bias 0.9 (95%CI: −1.6; 3.4) kJ·day−1·kg−1. Associations between PAEE and BMI were similar for directly and indirectly harmonized values, but most fell outside the confidence interval of the criterion PAEE-to-BMI association. Indirect models can be used for harmonization. Performance depends on the measurement properties of original data, variance explained by available bridge equations, and similarity of population characteristics.
Melanna F. Cox, Greg J. Petrucci Jr., Robert T. Marcotte, Brittany R. Masteller, John Staudenmayer, Patty S. Freedson and John R. Sirard
Purpose: Develop a direct observation (DO) system to serve as a criterion measure for the calibration of models applied to free-living (FL) accelerometer data. Methods: Ten participants (19.4 ± 0.8 years) were video-recorded during four, one-hour FL sessions in different settings: 1) school, 2) home, 3) community, and 4) physical activity. For each setting, 10-minute clips from three randomly selected sessions were extracted and coded by one expert coder and up to 20 trained coders using the Observer XT software (Noldus, Wageningen, the Netherlands). The coder defines each whole-body movement which was further described with three modifiers: 1) locomotion, 2) activity type, and 3) MET value (used to categorize intensity level). Percent agreement was calculated for intra- and inter-rater reliability. For intra-rater reliability, the criterion coder coded all 12 clips twice, separated by at least one week between coding sessions. For inter-rater reliability, coded clips by trained coders were compared to the expert coder. Intraclass correlations (ICCs) were calculated to assess the agreement of intensity category for intra- and inter-rater comparisons described above. Results: For intra-rater reliability, mean percent agreement ranged from 91.9 ± 3.9% to 100.0 ± 0.0% across all variables in all settings. For inter-rater reliability, mean percent agreement ranged from 88.2 ± 3.5% to 100.0 ± 0.0% across all variables in all settings. ICCs for intensity category ranged from 0.74–1.00 and 0.81–1.00 for intra- and inter-rater comparisons, respectively. Conclusion: The DO system is reliable and feasible to serve as a criterion measure of FL physical activity in young adults to calibrate accelerometers, subsequently improving interpretation of surveillance and intervention research.
Mohammadreza Pourahmadi, Hamid Hesarikia, Ali Ghanjal and Alireza Shamsoddini
Context: Advent of smartphones has brought a wide range of clinical measurement applications (apps) within the reach of most clinicians. The vast majority of smartphones have numerous built-in sensors such as magnetometers, accelerometers, and gyroscopes that make the phone capable of measuring joint range of motion (ROM) and detecting joint positions. The iHandy Level app is a free app which has a visual display alike with the digital inclinometer in regard to numeric size. Objective: The purpose of this systematic review was to evaluate available evidence in the literature to assess the psychometric properties (ie, reliability and validity) of the iHandy Level app in measuring lumbar spine ROM and lordosis. Methods: PubMed/MEDLINE, Scopus, Ovid, Google Scholar, and ScienceDirect were searched from inception to September 2018 for single-group repeated-measures studies reporting outcomes of lumbar spine ROM or lordosis in adult individuals without symptoms of low back pain (LBP) or patients with LBP. The quality of each included study was assessed using the Quality Appraisal of Reliability Studies checklist. Results: A total of 4 studies with 273 participants were included. Two studies focused on measuring active lumbar spine ROM, and 2 studies evaluated lumbar spine lordosis. Three studies included asymptomatic subjects, and one study recruited patients with LBP. The results showed that the iHandy Level app has sufficient psychometric properties for measuring standing thoraco-lumbo-sacral flexion, extension, lateral flexion, isolated lumbar spine flexion ROM, and lumbar spine lordosis in asymptomatic subjects. One study reported poor concurrent validity with a bubble inclinometer (r = .19–.53), poor intrarater reliability (intraclass correlation coefficient = .19–.39), and poor to good interrater reliability (intraclass correlation coefficient = .24–.72) for the measurement of active lumbar spine ROM using the iHandy Level app in patients with LBP. Conclusions: This review provided a valuable summary of the research to date examining the psychometric properties of the iHandy Level app for measuring lumbar spine ROM and lordosis.
Scott W. Cheatham and Russell Baker
Context: Floss bands are a popular intervention used by sports medicine professionals to enhance myofascial function and mobility. The bands are often wrapped around a region of the body in an overlapping fashion (eg, 50%) and then tensioned by stretching the band to a desired length (eg, 50%). To date, no research has investigated the stretch force of the bands at different elongation lengths. Objective: The purpose of this clinical study was to quantify the Rockfloss® band stretch force at 6 different elongation lengths (ie, 25%–150%) for the 5.08- and 10.16-cm width bands. Design: Controlled laboratory study. Setting: University kinesiology laboratory. Participants: One trained researcher conducted all measurements. Procedures: The stretch force of a floss band was measured at 6 different elongation lengths with a force gauge. Main Outcome Measures: Band tension force at different band elongation lengths. Results: The stretch force values for the 5.08-cm width (2 in) were as follows: 25% = 13.53 (0.25) N, 50% = 24.57 (0.28) N, 75% = 36.18 (0.39) N, 100% = 45.89 (0.62) N, 125% = 54.68 (0.26) N, and 150% = 62.54 (0.40) N. The stretch force values for the 10.16-cm width (4 in) were as follows: 25% = 16.70 (0.35) N, 50% = 31.90 (0.52) N, 75% = 47.45 (0.44) N, 100% = 57.75 (0.24) N, 125% = 69.02 (0.28) N, and 150% = 81.10 (0.67) N. Both bandwidths demonstrated a linear increase in stretch force as the bands became longer. Conclusion: These values may help professionals to understand and document the tension force being applied at different lengths to produce a more beneficial application during treatment. Future research should determine how the different length/tensions effect the local myofascia, arterial, and vascular systems.
Donald F. Kessler
Gemma N. Parry, Lee C. Herrington and Ian G. Horsley
Context: Muscular power output of the upper limb is a key aspect of athletic and sporting performance. Maximal power describes the ability to immediately produce power with maximal velocity at the point of release, impact, or takeoff, with research highlighting that the greater an athlete’s ability to produce maximal power, the greater the improvement in athletic performance. Despite the importance of upper-limb power for athletic performance, there is presently no gold-standard test for upper-limb force development performance. Objective: The aim of this study was to investigate the test–retest reliability of force plate–derived measures of the countermovement push-up in active males. Design: Test–retest design. Setting: Controlled laboratory. Participants: Physically active college athletes (age 24  y, height 1.79 [0.08] m, body mass 81.7 [9.9] kg). Intervention: Subjects performed 3 repetitions of maximal effort countermovement push-up trials on Kistler force plates on 2 separate test occasions 7 days apart. Main Outcome Measures: Peak force, mean force, flight time, rate of force development, and impulse were analyzed from the force–time curve. Results: No significant differences between the 2 trial occasions were observed for any of the derived performance measures. Intraclass correlation coefficient and within-subject coefficient of variation calculations indicated performance measures to have moderate to very high reliability (intraclass correlation coefficient = .88–.98), coefficient of variation = 5.5%–14.1%). Smallest detectable difference for peak force (7.5%), mean force (8.6%), and rate of force development (11.2%) were small to moderate. Conclusion: Force platform–derived kinetic parameters of countermovement push-up are reliable measurements of power in college-level athletes.
Natalie Cook and Tamerah N. Hunt
Clinical Scenario: Concussions are severely underreported, with only 47.3% of high school athletes reporting their concussion. The belief was that athletes who were better educated on the signs and symptoms and potential dangers of concussion would be more likely to report. However, literature has shown inconsistent evidence on the efficacy of concussion education, improving reporting behaviors. Factors such as an athlete’s attitude, subjective norms, and perceived behavioral control have shown promise in predicting intention to report concussions in athletes. Focused Clinical Question: Do attitudes, subjective norms, and perceived behavioral control influence adolescent athletes’ intention to report? Summary of Key Findings: Three studies (1 randomized control and 2 cross-sectional surveys) were included. Across the 3 studies, attitudes, subjective norms, and perceived behavioral control positively influenced athletes’ reporting intention. The studies found that attitude toward concussion reporting and perceived behavioral control were the most influential predictors of reporting intention. Clinical Bottom Line: There is moderate evidence to suggest that positive attitudes, supportive subjective norms, and increased perceived behavioral control influence reporting intention in secondary school athletes. Strength of Recommendation: Grade B evidence exists that positive attitudes, supportive subjective norms, and increased perceived behavioral control positively influence concussion reporting intention in secondary school athletes.