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Kate N. Jochimsen, Carl G. Mattacola, Brian Noehren, Kelsey J. Picha, Stephen T. Duncan, and Cale A. Jacobs

Context: Femoroacetabular impingement syndrome (FAIS) is a painfully debilitating hip condition disproportionately affecting active individuals. Mental health disorders are an important determinant of treatment outcomes for individuals with FAIS. Self-efficacy, kinesiophobia, and pain catastrophizing are psychosocial factors that have been linked to inferior outcomes for a variety of orthopedic conditions. However, these psychosocial factors and their relationships with mental health disorders, pain, and function have not been examined in individuals with FAIS. Objective: (1) To examine relationships between self-efficacy, kinesiophobia, pain catastrophizing, pain, and function in patients with FAIS and (2) to determine if these variables differ between patients with and without a self-reported depression and/or anxiety. Design: Cross-sectional. Setting: University health center. Participants: Fifty-one individuals with FAIS (42 females/9 males; age 35.7 [11.6] y; body mass index 27.1 [4.9] kg/m2). Main Outcome Measures: Participants completed the Pain Self-Efficacy Questionnaire, Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, visual analog scale for hip pain at rest and during activity, and the 12-item International Hip Outcome Tool. Self-reported depression and/or anxiety were recorded. The relationships between psychosocial factors, pain, and function were examined using Spearman rank-order correlations. Independent t tests and Mann–Whitney U tests were used to evaluate the effect of self-reported depression and/or anxiety on psychosocial factors, pain and function. Results: The 12-item International Hip Outcome Tool was correlated with pain during activity (ρ = −.57, P ≤ .001), Tampa Scale for Kinesiophobia (ρ = −.52, P ≤ .001), and Pain Self-Efficacy Questionnaire (ρ = .71, P ≤ .001). The Pain Self-Efficacy Questionnaire was also correlated with pain at rest (ρ = −.43, P = .002) and pain during activity (ρ = −.46, P = .001). Individuals with self-reported depression and/or anxiety (18/51; 35.3%) had worse self-efficacy and pain catastrophizing (P ≤ .01). Conclusion: Self-reported depression and/or anxiety, low self-efficacy, and high kinesiophobia were associated with more hip pain and worse function for patients with FAIS. These findings warrant further examination including psychosocial treatment strategies to improve the likelihood of a successful clinical outcome for this at-risk population.

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Caitlin Brinkman, Shelby E. Baez, Carolina Quintana, Morgan L. Andrews, Nick R. Heebner, Matthew C. Hoch, and Johanna M. Hoch

Context: Fast visuomotor reaction time (VMRT), the time required to recognize and respond to sequentially appearing visual stimuli, allows an athlete to successfully respond to stimuli during sports participation, while slower VMRT has been associated with increased injury risk. Light-based systems are capable of measuring both upper- and lower-extremity VMRT; however, the reliability of these assessments are not known. Objective: To determine the reliability of an upper- and lower-extremity VMRT task using a light-based trainer system. Design: Reliability study. Setting: Laboratory. Patients (or Other Participants): Twenty participants with no history of injury in the last 12 months. Methods: Participants reported to the laboratory on 2 separate testing sessions separated by 1 week. For both tasks, participants were instructed to extinguish a random sequence of illuminated light-emitting diode disks, which appeared one at a time as quickly as possible. Participants were provided a series of practice trials before completing the test trials. VMRT was calculated as the time in seconds between target hits, where higher VMRT represented slower reaction time. Main Outcome Measures: Separate intraclass correlation coefficients (ICCs) with corresponding 95% confidence intervals (CIs) were calculated to determine test–retest reliability for each task. The SEM and minimal detectable change values were determined to examine clinical applicability. Results: The right limb lower-extremity reliability was excellent (ICC2,1 = .92; 95% CI, .81–.97). Both the left limb (ICC2,1 = .80; 95% CI, .56–.92) and upper-extremity task (ICC2,1 = .86; 95% CI, .65–.95) had good reliability. Conclusions: Both VMRT tasks had clinically acceptable reliability in a healthy, active population. Future research should explore further applications of these tests as an outcome measure following rehabilitation for health conditions with known VMRT deficits.

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Nathan Waite, John Goetschius, and Jakob D. Lauver

Runners experience repeated impact forces during training, and the culmination of these forces can contribute to overuse injuries. The purpose of this study was to compare peak vertical tibial acceleration (TA) in trained distance runners on 3 surface types (grass, asphalt, and concrete) and 3 grades (incline, decline, and level). During visit 1, subjects completed a 1-mile time trial to determine their pace for all running trials: 80% (5%) of the average time trial velocity. During visit 2, subjects were outfitted with a skin-mounted accelerometer and performed 18 separate running trials during which peak TA was assessed during the stance phase. Each subject ran 2 trials for each condition with 2 minutes of rest between trials. Peak TA was different between decline (8.04 [0.12] g) and incline running (7.31 [0.35] g; P = .020). On the level grade, peak TA was greater during grass (8.22 [1.22] g) compared with concrete (7.47 [1.65] g; P = .017). On the incline grade, grass (7.68 [1.44] g) resulted in higher peak TA than asphalt (6.99 [1.69] g; P = .030). These results suggest that under certain grade conditions grass may result in higher TA compared with either concrete or asphalt.

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Chung-Ju Huang, Hsin-Yu Tu, Ming-Chun Hsueh, Yi-Hsiang Chiu, Mei-Yao Huang, and Chien-Chih Chou

This study examined the effects of acute aerobic exercise on sustained attention and discriminatory ability of children with and without learning disabilities (LD). Fifty-one children with LD and 49 typically developing children were randomly assigned to exercise or control groups. The participants in the exercise groups performed a 30-min session of moderate-intensity aerobic exercise, whereas the control groups watched a running/exercise-related video. Neuropsychological tasks, the Daueraufmerksamkeit sustained attention test, and the determination tests were assessed before and after each treatment. Exercise significantly benefited performance in sustained attention and discriminatory ability, particularly in higher accuracy rate and shorter reaction time. In addition, the LD exercise group demonstrated greater improvement than the typically developing exercise group. The findings suggest that the acute aerobic exercise influenced the sustained attention and the discriminatory function in children with LD by enhancing regulation of mental states and allocation of attentional resources.

Open access

Jaap van Dieen

Open access

Christanie Monreal, Lindsay Luinstra, Lindsay Larkins, and James May

Context: Technological advances have given smartphones the capabilities of sensitive clinical measurement equipment at lesser cost and higher availability. The Clinometer is a smartphone application that can be used to measure the joint range of motion in a clinical setting, but psychometric properties of the tool’s use measuring cervical range of motion (CROM) are not established. Objectives: The purpose of this study was to examine the validity and intrarater reliability of the Clinometer application for the measurement of CROM (ie, flexion, extension, rotation, lateral flexion) and to determine the minimal detectable change and SEM. Design: A blinded, repeated-measures correlational design was employed. Setting: The study was conducted collaboratively between 2 athletic training clinics. Participants: A convenience sample of healthy adults ages 18–30 years were recruited. Participants with any history in the last 3 months of cervical or thoracic pathology, pain, or any musculoskeletal injury were excluded. Main Outcome Measures: Three repetitions of each motion were measured by a primary researcher with a goniometer. The same researcher then conducted 3 blinded measurements with the Clinometer application following the same procedure. A second researcher, blinded to the goniometer measurements, recorded the results. Thirty minutes later, testing was repeated with the application. The Pearson correlation was calculated to determine validity of the application compared with goniometry. Results: The measurements between devices had moderate to excellent concurrent validity, with the coefficients ranging between 0.544 and 0.888, P < .01. Test–retest reliability of the CROM measurement using the application was moderate to excellent, with intraclass correlation coefficients ranging between .774 and .928. Across all movements, the SEM ranged from 1.17° to 2.01°, and the minimal detectable change ranged from 1.18° to 2.02°. Conclusion: The Clinometer application is a valid and reliable instrument for measuring active CROM. Level of evidence: clinical measurement, level 1b.

Open access

Kimberly Bigelow and Michael L. Madigan

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Ansley E. Swann, Rachel R. Kleis, and Johanna M. Hoch

Clinical Question: Is there a relationship between resilience and self-reported function in patients who underwent a total joint arthroplasty? Clinical Bottom Line: There is inconsistent, good-quality Level II evidence that investigates the relationship between resilience and self-reported function in patients after joint arthroplasty.

Open access

Daniel G. Miner, Brent A. Harper, and Stephen M. Glass

Context: Current tools for sideline assessment of balance following a concussion may not be sufficiently sensitive to identify impairments, which may place athletes at risk for future injury. Quantitative field-expedient balance assessments are becoming increasingly accessible in sports medicine and may improve sensitivity to enable clinicians to more readily detect these subtle deficits. Objective: To determine the validity of the postural sway assessment on the Biodex BioSway™ compared with the gold standard NeuroCom Smart Equitest System. Design: Cross-sectional cohort study. Setting: Clinical research laboratory. Participants: Forty-nine healthy adults (29 females: 24.34 [2.45] y, height 163.65 [7.57] cm, mass 63.64 [7.94] kg; 20 males: 26.00 [3.70] y, height 180.11 [7.16] cm, mass 82.97 [12.78] kg). Intervention(s): The participants completed the modified clinical test of sensory interaction in balance on the Biodex BioSway™ with 2 additional conditions (head shake and firm surface; head shake and foam surface) and the Sensory Organization Test and Head Shake Sensory Organization Test on the NeuroCom Smart Equitest. Main Outcome Measures: Interclass correlation coefficient and Bland–Altman limits of agreement for Sway Index, equilibrium ratio, and area of 95% confidence ellipse. Results: Fair–good reliability (interclass correlation coefficient = .48–.65) was demonstrated for the stance conditions with eyes open on a firm surface. The Head Shake Sensory Interaction and Balance Test condition on a firm surface resulted in fair reliability (interclass correlation coefficient = .50–.59). The authors observed large ranges for limits of agreement across outcome measures, indicating that the systems should not be used interchangeably. Conclusions: The authors observed fair reliability between BioSway™ and NeuroCom, with better agreement between systems with the assessment of postural sway on firm/static surfaces. However, the agreement of these systems may improve by incorporating methods that mitigate the floor effect in an athletic population (eg, including a head shake condition). BioSway™ may provide a surrogate field-expedient measurement tool.

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Ghada Jouira, Selim Srihi, Fatma Ben Waer, Haithem Rebai, and Sonia Sahli

Context: Athletes with intellectual disability (ID) have a high risk of injury while participating in various sports. Warm-up (WU) is the most preventive measure to reduce injuries in sports. Objective: To investigate the effects of dynamic stretching WU (DS-WU) and plyometric WU (PL-WU) on dynamic balance in athletes with ID. Design: Crossover study. Setting: Research laboratory. Participants: A total of 12 athletes with ID (age 24.5 [3.22] y, height 165.7 [8.4] cm, weight 61.5 [7.1] kg, intelligence quotient 61.1 [3.5]). Main Outcome Measures: Dynamic balance was assessed using the Star Excursion Balance Test (SEBT) at pre-WU, post-WU, and 15 minutes post-WU for both the DS-WU and the PL-WU. A 2-way analysis of variance (3 sessions × 2 WU methods) with repeated-measures was used in this study. Results: Following the DS-WU, participants demonstrated significant improvements in the SEBT composite score post-WU (89.12% [5.54%] vs 87.04% [5.35%]; P < .01) and at 15 minutes post-WU (89.55% [5.28%] vs 87.04%, P < .01) compared with pre-WU. However, no significant difference between these two post-WU scores (post-WU and 15 min post-WU) was found. For the PL-WU, participants demonstrated a significant decrease in the SEBT composite score at post-WU (85.95% [5.49%] vs 87.02% [5.73%]; P < .05); however, these scores increased significantly at 15 minutes post-WU (88.60% [5.42%] vs 87.02% [5.49%]; P < .05) compared with that at pre-WU. The SEBT composite scores are significantly higher in the DS-WU than in the PL-WU at both post-WU sessions (P < .05). Conclusion: Both DS-WU and PL-WU could improve dynamic balance and may be recommended as WUs in athletes with ID; however, particular caution should be exercised immediately after the PL-WU.