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Ian Robertson, Marina Lazarides, and Cody R. Butler

Clinical Scenario: Blood flow restriction (BFR) therapy has emerged as a viable treatment option to enhance clinical recovery in patients with primarily muscular injuries. However, BFR therapy has been rarely investigated in patients with osseous injuries to include extremity fracture. Focused Clinical Question: Does BFR-enhanced therapy improve clinical outcomes in patients during the acute to subacute rehabilitation period after extremity fracture? Summary of Key Findings: (1) In cases of 2 high-performing athletes with talus and osteochondral fracture of the knee, BFR was well tolerated and an effective rehabilitation regimen. (2) In 2 randomized controlled trials evaluating BFR use in patients after operative and nonoperative management of distal radius fractures, pain with activity and self-perceived function were improved in BFR-enhanced therapy as compared with a standard rehabilitation regimen. (3) Objective clinical outcomes including radiographic healing, extremity range of motion, and grip strength evaluated by the randomized controlled trials did not differ significantly between the BFR-enhanced and standard rehabilitation groups. Clinical Bottom Line: BFR-enhanced therapy may improve pain and self-perceived function of the injured extremity during the acute to subacute rehabilitation period after fracture. However, there is not yet a demonstrated benefit of BFR on hastening objective measures of clinical recovery. Large-scale clinical trials comparing BFR-enhanced rehabilitation with standard rehabilitation regimens are needed to better characterize BFR use in patients with osseous injuries. Strength of Recommendation: Two case reports and 2 randomized controlled trials provide level IIB evidence suggesting that BFR may improve pain in the acute rehabilitative stage and improve the patient’s perceived function of the injured extremity, without greater improvement in objectively measured clinical parameters as compared with a standard rehabilitation regimen.

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Cindy H.P. Sit, Wendy Y.J. Huang, Stephen H.S. Wong, Martin C.S. Wong, Raymond K.W. Sum, and Venus M.H. Li

Background: Following the 2019 Hong Kong Para Report Card, the 2022 Hong Kong Para Report Card aimed to provide an updated and evidence-based assessment for nine indicators related to physical activity in children and adolescents with special educational needs and to assess the results using a SWOT (strengths, weaknesses, opportunities, and threats) analysis. Methods: Using a systematic process, the best available data on nine indicators were searched from the past 10 years and were assessed by a research work group. Letter grades were assigned and considered by stakeholders and auditors. Results: Four indicators were assigned a letter grade (overall physical activity: F [mixed device-measured and self-reported data]; sedentary behaviors: D [device-measured data]; active transportation: D−; government strategies & investment: C+). SWOT analysis highlighted opportunities for facilitating children and adolescents with special educational needs to achieve health recommendations. Conclusion: There were deteriorating trends in physical activity and sedentary behaviors. Effective, multilevel, and cross-sector interventions are recommended to promote active behavior in children and adolescents with special educational needs.

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Susann Arnell, Kajsa Jerlinder, and Lars-Olov Lundqvist

Background: Participation in physical activity among adolescents with autism is often conditional. However, there is a lack of methods for identifying these specific conditions. Therefore, the purpose of this study was to develop and investigate the feasibility of a Q-sort tool to map individual-specific conditions for participation in physical activity among adolescents with autism and to identify different viewpoints regarding conditions for such participation. Method: An exploratory mixed-methods design was employed to investigate the feasibility of using Q methodology and the Q-sort procedure to identify what individual-specific conditions are important for participation in physical activity for adolescents with autism. Results: The adolescents ranked the statements with varying levels of ease. Two viewpoints were identified: Autonomous participation without surprises and Enjoyment of activity in a safe social context. Conclusion: Q-sort is a feasible method for mapping conditions for participation, which can guide the development of tailored physical activity interventions.

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Jeffrey J. Martin

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Sho Mitomo, Junya Aizawa, Kenji Hirohata, Shunsuke Ohji, Takehiro Ohmi, Toshiyuki Ohara, Hideyuki Koga, and Kazuyoshi Yagishita

Context: Deficits in knee extension strength after anterior cruciate ligament reconstruction have been a major problem. The inadequate recovery of the knee extension strength of surgical limb reportedly delays return to sports and increases reinjury risk. Accordingly, the early detection of knee extension strength deficits after reconstruction may help plan early interventions to manage impairment. This study aimed to clarify the association between knee extension strength at 3 and 6 months after anterior cruciate ligament reconstruction. Design: Retrospective study. Methods: Fifty patients who underwent primary anterior cruciate ligament reconstruction using hamstring grafts were included. At 3 months postoperatively, the limb symmetry index (LSI) of isokinetic knee extension strength (IKE) at 60°/s, degree of swelling, passive range of motion of knee flexion and extension, and anterior leg reach distance were measured. At 6 months postoperatively, the LSI of IKE was measured at 60°/s, which was used as the main outcome. A correlation analysis was performed with the LSI of IKE at 6 months postoperatively as the dependent variable and the LSI of IKE at 3 months postoperatively as the independent variable. Subsequently, a multiple regression analysis was performed, with LSI of IKE at 6 months postoperatively as the dependent variable; LSI of IKE at 3 months postoperatively as the independent variable; and other variables, demographic information, and surgical data as covariates. Results: The correlation analysis revealed that the LSIs of IKE at 3 and 6 months postoperatively were correlated (r = .535, P < .001). In the multiple regression analysis, the LSI of IKE at 3 months postoperatively was significantly associated with that at 6 months postoperatively, even when other variables were included as covariates (R 2 = .349, P = .004). Conclusion: Asymmetry of knee extension strength at 3 months postoperatively could be more useful than other variables related to knee strength in predicting the asymmetry of knee extension strength at 6 months postoperatively.

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Courtney C. Walton, Kelsey J. Lewis, James Kirby, Rosemary Purcell, Simon M. Rice, and Margaret S. Osborne

This cross-sectional study explored athlete responses to the Compassion Motivation and Action Scales Self-Compassion Scale, examining its relationship with well-being. Athlete (N = 207; mean age 27.9 years) scores were consistent with previous population means. Scores on the Compassion Motivation and Action Scales Self-Compassion Scale did not differ between elite and nonelite athletes, nor did they correlate significantly with trait competitiveness. Significant differences emerged based on athlete well-being state, with athletes categorized as “flourishing” scoring higher on the total score and all subscales of the Compassion Motivation and Action Scales Self-Compassion Scale, as compared with those with “moderate mental health” (Cohen’s ds from 0.58 to 0.92). Furthermore, the distress tolerance subscale significantly mediated the relationship between self-compassion intentions and well-being (indirect path: B = 0.034, p < .001). The results suggest that self-compassionate intentions are not enough, and athletes may need support to tolerate the distress that comes with moving toward one’s own suffering.

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Debra Kriger, Amélie Keyser-Verreault, Janelle Joseph, and Danielle Peers

Intersectional approaches are needed in sport research and administration to create significant changes in access, participation, and leadership. The operationalizing intersectionality framework—graphically represented as a wheel with spokes and points of traction—offers a nonexhaustive, evolving structure that can facilitate contextual, deliberate actions to disrupt overlapping systems of oppression. The framework was assembled to guide E-Alliance, the gender equity in sport in Canada research hub, in embodying its commitment to intersectional approaches and designed for broader application to sport. Current gender equity efforts mostly continue to prioritize the knowledge and needs of White, middle–upper-class, nondisabled, not fat, heteronormative, binary, cisgender women and have yet to achieve parity. Acting meaningfully on commitments to intersectional approaches means focusing on how axes work together and influence each other. The framework can help advance cultural sport psychology and ultimately improve athletic well-being.

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Marcella F. Pazzinatto, Christian J. Barton, Richard W. Willy, Amanda S. Ferreira, Fábio M. Azevedo, and Danilo de Oliveira Silva

Context: To determine (1) whether physical function and fear of movement are prospectively associated with the risk of females developing patellofemoral pain (PFP) and (2) whether they change following development of PFP. Design: Prospective observational study. Methods: A total of 114 asymptomatic females (18–22 y old) completed assessment of physical function (forward step-down test and single-leg hop for distance) and fear of movement using the Tampa Scale for Kinesiophobia at baseline and 2-year follow-up. Presence of symptoms of PFP was monitored bimonthly. Results: Ninety participants (retention rate = 79%) completed the 2-year follow-up assessment, with 27 (24% of the cohort) developing PFP. Physical function, including forward step-down test (P = .659) and single-leg hop for distance (P = .825), and fear of movement (P = .479) were not associated with the risk of developing PFP. Females who developed PFP presented with reduced forward step-down repetitions (mean difference = 2.8; 95% confidence interval, 0.2 to 5.3) and single-leg hop for distance (10.2; 95% confidence interval, 2.7 to 17.7 cm) at 2-year follow-up. There was no statistically significant difference between those who did and did not develop PFP for fear of movement (−3.4; 95% confidence interval, −7.0 to 0.2). Conclusions: Physical function and fear of movement were not associated with the risk of developing PFP in young females. However, the change over time in the step-down and single-leg hop for distance tests may suggest that, even in the early stages of PFP, young females present impaired physical function compared with females who did not develop symptoms. Fear of movement may develop due to persistent PFP, and does not appear to be a risk factor or key feature in females with PFP of short symptoms duration.

Open access

J. Ty Hopkins and Christopher D. Ingersoll