Cameron Haun, Cathleen N. Brown, Kimberly Hannigan and Samuel T. Johnson
Clinical Scenario: Deformation of the arch, as measured by navicular drop (ND), is linked to lower-extremity musculoskeletal injuries. The short foot exercise (SFE) has been used to strengthen the intrinsic foot muscles that support the arch. Clinical Question: Does the SFE decrease ND in healthy adults? Summary of Key Findings: Three studies that examined the use of the SFE on ND were included. A randomized control trial that compared the SFE to a towel-curl exercise and a control group found no significant differences between the 3 groups. A randomized control trial compared the SFE to the use of arch support insoles in individuals with a flexible flatfoot and found a significant improvement in the SFE group. A prospective cohort study, without a control group, reported a significant decrease in ND following a 4-week SFE intervention without a regression at an 8-week follow-up. Overall, two of the three studies reported a significant reduction in ND following an SFE. Clinical Bottom Line: There is preliminary data supporting the use of the SFE to decrease ND—particularly in individuals with a flexible flatfoot. However, issues with the study designs make it difficult to interpret the data. Strength of Recommendation: Due to limited evidence, there is grade B evidence to support the use of the SFE to decrease ND.
Alison Griffin, Tim Roselli and Susan L. Clemens
Background: Health benefits of physical activity (PA) accrue with small increases in PA, with the greatest benefits for those transitioning from inactivity to any level of PA. This study examined whether self-reported PA time in Queensland adults changed between 2004 and 2018. Methods: The Queensland government conducts regular cross-sectional telephone surveys. Between 2004 and 2018, adults aged 18–75 years answered identical questions about their weekly minutes of walking, moderate PA, and vigorous PA. Hurdle regression estimated the average annual change in weekly minutes of PA overall and by activity type, focusing on sociodemographic differences in trends. Results: The sample size averaged 1764 (2004–2008) and 10,188 (2009–2018), totaling 107,171 participants aged 18–75 years. Unadjusted PA increased by 10 minutes per week per year (95% confidence interval [CI], 8.8–11.1) overall, with increases for most subgroups. Adjusted PA increased by 10.5 minutes per week per year (95% CI, 9.4–11.7). Trends differed by employment—employed adults and those not in the labor force increased by 14.3 (95% CI, 12.8–15.8) and 2.2 minutes per week per year (95% CI, 0.4–4.0), respectively, with no increase for unemployed adults. The increases were due to both an increased prevalence of doing any activity and an increased average duration among active adults. Conclusions: Since 2004, PA time has increased for Queensland adults, with substantial variability by employment status.
Paul M. Wright and David Walsh
Don Hellison (1938–2018) was a leader and trailblazer in sport and physical education pedagogy. Early in his career, he was an advocate for humanistic physical education. His engaged approach to scholarship culminated in the development of the Teaching Personal and Social Responsibility (TPSR) model, which is now recognized as a best practice for promoting social and emotional learning in physical education. The TPSR model has also been widely applied in the field of sport-based youth development. This is the introduction to the special issue devoted to Don’s life and legacy. It provides opening comments from the guest editors and a brief overview of the articles in the special issue.
Jordan Bettleyon and Thomas W. Kaminski
Clinical Scenario: Low-level laser therapy (LLLT) is a controversial topic for its use in athletic recovery, mainly due to inconsistency in research regarding the application of LLLT. Articles on LLLT have assessed its effectiveness in untrained humans through pain scales, functional scales, and blood draws, and it has been found capable in nonathletic rehabilitative use. The controversy lies with LLLT in the recovering athlete. Not only do athletes need to perform at high levels, but each sport is unique in the metabolic demands placed on the athletes’ bodies. This modality can alter chemical mediators of the inflammatory process, specifically blood lactate (BL) and creatine kinase (CK). During soccer contests, it is a common problem for athletes to have an average CK level of 800 U/L and BL of 8 mmol·L, increasing delayed-onset muscle soreness and fatigue. Micro-CK level elevation is associated with cellular membrane damage, localized hypoxia, and electrolyte imbalances, hindering the recovery process. Clinical Question: Does LLLT decrease muscle-damaging mediators effecting player fatigue and delayed-onset muscle soreness after performance in soccer athletes versus sham treatment? Summary of Key Findings: In 3 studies, preperformance, postperformance, or preperformance and postperformance LLLT was performed and evaluated BL (2 of 3) and CK (2 of 3). In each article, BL and CK showed a significant decrease (P < .05) when performed either preperformance or postperformance versus the control group. The greatest decrease in these mediators was noticed when postperformance laser therapy was performed. Clinical Bottom Line: LLLT at 10, 30, or 50 J performed at a minimum of 2 locations on the rectus femoris, vastus lateralis, and vastus medialis bilaterally for 10 seconds each is significant in decreasing blood serum levels of BL and CK when performed postexercise. Strength of Recommendations: All 3 articles obtained a Physiotherapy Evidence Database score of ≥8/10.
Xin He, Hio Teng Leong, On Yue Lau, Michael Tim-Yun Ong and Patrick Shu-Hang Yung
Context: Altered lower-limb biomechanics have been observed during landing task in patients with anterior cruciate ligament reconstruction (ACLR), which increases the risk of secondary anterior cruciate ligament injury. However, the alteration in neuromuscular activity of the lower-extremity during landing task is not clear. Objective: To compare the muscle activity pattern assessed by electromyography between the involved limb of patients with ACLR and the contralateral limb or control limb of matched healthy subjects during landing task. Evidence Acquisition: Database of PubMed, Ovid, Scopus, and Web of Science from the inception of the databases until July 2019, using a combination of keywords and their variations: (anterior cruciate ligament OR ACL) AND (electromyography OR EMG) AND (landing OR land). Studies that assessed lower-extremity muscle activity patterns during landing task in patients with ACLR and compared them either with the contralateral side or healthy controls were included. Evidence Synthesis: Of the 21 studies, 16 studies reported altered muscle activity pattern during landing tasks when compared with either the healthy controls or the contralateral side. For the specific muscle activity patterns, the majority of the studies showed no significant difference in reactive muscle activity, and comparisons across studies revealed a possible trend toward the early onset of quadriceps and hamstring activity and increased cocontraction of the involved limb. There are inconsistent findings regarding the alteration in muscle timing and preparatory muscle activity. Conclusions: Patients with ACLR displayed an altered muscle activity pattern during landing tasks, even though they were considered to be capable for sport return. Nevertheless, a firm conclusion could not be drawn due to great heterogeneity in the subject selection and study methods.
Christopher J. Burcal, Sunghoon Chung, Madison L. Johnston and Adam B. Rosen
Background: Region-specific patient-reported outcomes (PROs) are commonly used in rehabilitation medicine. Digital versions of PROs may be implemented into electronic medical records and are also commonly used in research, but the validity of this method of administration (MOA) must be established. Purpose: To determine the agreement between and compare the test–retest reliability of a paper version (FAAM-P) and digital version (FAAM-D) of the Foot and Ankle Ability Measure (FAAM). Study Design: Randomized, nonblinded, crossover observational study. Methods: A total of 90 adults were randomized to complete the FAAM-P or FAAM-D first, and then completed the second MOA (first day [D1]). The FAAM-D was a digital adaptation of both FAAM-P subscales on Qualtrics. Identical test procedures were completed 1 week later (D2). Data were removed if a participant scored 100% on both MOA, reported injury between D1 and D2, or did not complete both MOA. Agreement was assessed on 46 participants between the 2 MOA using intraclass correlation coefficients (ICC) at D1. There was good-to-excellent test–retest reliability for the FAAM activities of daily living. Results: The authors observed good agreement between the FAAM-P and FAAM-D for the activities of daily living (ICC = .88) and sport scales (ICC = .87). Test–retest reliability was good-to-excellent for the FAAM activities of daily living (FAAM-P: ICC = .87; FAAM-D: ICC = .89) and sport (FAAM-P: ICC = .71; FAAM-D: ICC = .91). Conclusions: The MOA does not appear to affect the responses on the FAAM; however, the authors observed slightly higher reliability on the FAAM-D. The FAAM-D is sufficient to be used for generating practice-based evidence in rehabilitation medicine.
Jillian J. Haszard, Kim Meredith-Jones, Victoria Farmer, Sheila Williams, Barbara Galland and Rachael Taylor
Although 24-hour time-use data are increasingly being examined in relation to indices of health, consensus has yet to be reached about the best way to present estimates from compositional analyses. This analysis explored the impact of different presentations of results when assessing the relationship between 24-hour time-use and body mass index (BMI) z-score using compositional analysis of 5-day actigraphy data in 742 children. First it was found that reallocating non-wear time to day-time components only (sedentary behavior, light physical activity, and moderate-to-vigorous physical activity [MVPA]) before normalization to 24 hours provided stronger estimates with BMI z-score than simply removing non-wear time before normalization. Estimates for sleep time were substantially affected, where associations with BMI z-score nearly doubled (mean difference [95% CI] in BMI z-score for 10% longer sleep were −0.20 [−0.32, −0.08] compared to −0.11 [−0.23, 0.002]). Presenting estimates in terms of a greater number of minutes in a component, relative to all others, showed MVPA to be the strongest predictor of BMI z-score, while estimates in terms of the proportion of minutes showed sleep to be the strongest predictor. Both presentations have value. However, presentations in terms of one-to-one “substitutions” of time may need careful interpretation due to the uneven distribution of time in each component. In conclusion, when analyzing relationships between 24-hour time-use and health outcomes, non-wear time and presentation of estimates can impact final conclusions. As a result, the current understanding of the importance of sleep for child health may be underestimated.
Stephanie Field, Jeff Crane, Patti-Jean Naylor and Viviene Temple
Children who underestimate their physical abilities have lower motivation, higher anxiety, and lack of understanding as to why they may be succeeding or struggling in sports settings, which can result in withdrawal from physical activities. Theoretically, middle childhood is a time when perceptions of physical competence (PPC) become more accurate as children develop the cognitive capacity to interpret new sources of feedback and develop a realistic sense of their physical abilities. The purpose of this study was to investigate the extent to which accuracy of PPC changed from grade 2 to grade 4. Participants were 238 boys and girls (M age = 7.8 yrs) from eight participating elementary schools in Victoria, British Columbia, Canada. The Test of Gross Motor Development–Second Edition was used to assess motor skills. PPC were assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (for grade 2) and the Self-Perception Profile for Children (for grades 3 and 4). Results revealed that participants who underestimated or overestimated their physical competence in grade 2 saw an improvement in accuracy, and, by grade 4, had similar accuracy scores to their peers who were considered ‘accurate’ estimators. These results reinforce theory that suggests PPC become more accurate in middle childhood.