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Melanie A. Mason, Anne C. Russ, Ryan T. Tierney, and Jamie L. Mansell

Context: Exercise can cause fluctuations in blood glucose control in type 1 diabetics. For athletes with type 1 diabetes, maintenance of blood glucose within an ideal range may be difficult. Objective: To determine, in individuals with type 1 diabetes, the effectiveness of the closed loop control system versus the open loop control system in keeping blood glucose levels in the ideal range with exercise. Data Sources: A search of PubMed was conducted in June of 2020 using the Boolean phrases: (closed loop control system OR artificial pancreas) AND type 1 diabetes AND exercise AND ideal range AND adolescents, artificial pancreas AND glucose prediction AND exercise. Study Selection : Titles were reviewed for relevance, the abstract was then assessed for applicability, and finally the full text was examined. Articles were included that examined the percent of time in the ideal blood glucose range when exercise occurred during that day. Articles were excluded that didn’t compare the closed loop and open loop control systems and articles that did not involve exercise. Data Extraction : The PEDro scale was used to determine the methodological quality of the included studies. The measure addressed was the percent of time in the ideal blood glucose range of 70-180 mg/dL. 95% Confidence Intervals and Cohen’s D were calculated for each article. Data Synthesis : The search yielded 268 articles and 3 were selected for inclusion. The two randomized controlled trials scored 9/10 on the PEDro scale and the randomized two-arm crossover clinical trial scored 9/10 on the PEDro scale. Percent time spent in the ideal blood glucose range when exercise was performed was significantly higher in the closed loop group versus the open loop group in each of the three studies. In one randomized control trial, mean time in the ideal range was 71.3% (SD = 17.6, 95% CI = 62.5, 80.10) in the closed loop group versus 64.7% (SD = 13.3, 95% CI = 58.1–71.4) in the open loop group. Cohen’s D was 0.4. In the second randomized control trial, mean time in the ideal range was 73.5% (SD = 8.4, 95% CI = 70.1, 76.9) for the closed loop group versus 50% (SD = 26.8, 95% CI = 39.1, 60.9). Cohen’s D was 1.2. The two-arm crossover clinical trial resulted in a mean time in target range of 84.1% (SD = 11.5, 95% CI = 79.0, 89.2) in the closed loop group versus 68.7% (SD = 13.9, 95% CI = 62.5, 74.9) in the open loop group. Cohen’s D was 1.2. Conclusions : For adolescents with type 1 diabetes who exercise, the closed loop control system maintains blood glucose levels in the ideal range for a longer percent of time versus an open loop system. Each patient should be evaluated on a case-by-case basis with his/her healthcare team. Future research should examine the closed loop control system on specific energy systems.

Open access

Sierra Hakanson, Samuel T. Johnson, Emily C. Norcross, and Cathleen N. Brown

Clinical Scenario: Ulnar collateral ligament injuries are common in baseball pitchers, with excessive elbow varus torque linked to medial elbow injuries. Trunk tilt, or motion in the frontal plane, could be an identifiable and modifiable factor in medial elbow loading. Clinical Question: In high school through professional baseball pitchers, how does increased contralateral trunk tilt compared with no/limited contralateral trunk tilt influence elbow varus torque? Summary of Key Findings: Four studies were included: all were labeled as “controlled” or “descriptive laboratory studies,” representing cross-sectional observational analytic design. One study compared biomechanics of professional pitchers with and without ulnar collateral ligament reconstruction. Two studies measured biomechanics in college pitchers, one of which also included simulations of joint angles. The fourth study measured biomechanics of high school pitchers. All studies measured trunk tilt and its relationship to elbow varus torque, with 3 of the studies linking increased contralateral trunk tilt with increased elbow varus torque. Clinical Bottom Line: Moderate evidence indicated as contralateral trunk tilt increased, so did elbow varus torque, indicating trunk tilt may be a modifiable factor to decrease medial elbow loading during pitching. Strength of Recommendation: Majority consistent findings from the level 3 cross-sectional observational analytic designs suggest grade B evidence in support of trunk tilt as a factor in increasing elbow varus torque.

Open access

Kyndell R. Crowell, Ryan D. Nokes, and Nicole L. Cosby

Clinical Scenario: Dynamic knee valgus (DKV) is a mechanical alteration in the knee that leads to increased risk of injury. Weakness of hip musculature in hip abduction (HABD), extension (HEXT), and external rotation (HER) may contribute to increased DKV in single-leg landing tasks. Focused Clinical Question: Is decreased hip strength associated with an increase in DKV during a single-leg landing task in collegiate female athletes? Summary of Key Findings: Three studies were included: One randomized control trial (RCT), one cohort study, and one case-control. All three studies found that decreases in HABD and HER strength contributed to increased DKV during single-leg landing tasks. One study also found that the hip extensors contribute to controlling hip adduction, a common factor in many mechanisms of injuries. These three studies recommended strengthening HABD, HEXT, and HER to decrease DKV and reduce the risk of injury at the knee. Clinical Bottom Line: Weak HABD, HEXT, and HER contribute to increased DKV in college female athletes, but strengthening HABD, HEXT, and HER can lead to decreases in DKV and, overall, reduce the risk of injury at the knee. Strength of Recommendation: These articles were graded with a level of evidence of III or higher, giving a grade of B strength of recommendation that weak HABD, HEXT, and HER are associated with increased DKV in collegiate female athletes.

Open access

Jessica Murphy, Karen A. Patte, Philip Sullivan, and Scott T. Leatherdale

The mental health benefits of physical activity may relate more to the context of the behavior, rather than the behavior of being active itself. The association between varsity sport (VS) participation, depression, and anxiety symptoms was explored using data from 70,449 high school students from the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior study. The model adjusted for potential covariates; interactions by sex and participation in outside of school sport (OSS) were explored. Overall, 70% and 24% of respondents met or exceeded cutoff values for depression and anxiety, respectively. Students participating in VS had lower symptoms of anxiety and depression compared with nonparticipants. Results were consistent regardless of OSS participation; associations were strongest among students who participated in both VS and OSS and males. Participation in VS may prove beneficial for the prevention and/or management of depression or anxiety symptoms, particularly among males. An additive beneficial effect of OSS on depression and anxiety scores may exist.

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Kyle Pushkarenko, Janice Causgrove Dunn, and Donna L. Goodwin

Countering the declining physical activity patterns of children labeled with autism spectrum disorder (ASD) has gained considerable research attention given its impact on health and quality of life. The purpose of this study was to explore how parents of children labeled with ASD understand the concept of physical literacy, based on their children’s participation in community-based physical activity programs. Using interpretive phenomenological analysis, six mothers of children labeled with ASD participated in one-on-one semistructured interviews. The conceptual framework of ecological systems theory supported the rationale for the study purpose, provided structure for the interview guide, and offered a reflexive context for interpretation. Four themes were generated from the thematic analysis: From embodied movement to normative skill expectations, Be flexible, not rigid, Systematic exclusion, and Valuable? . . . Absolutely! Despite experiences of marginalization, exclusion, and trauma within physical activity programs, mothers valued physical literacy development for their children given the positive outcomes of increasing family connections, engagement with peers, and enhanced wellness.

Open access

Michael W. Kirkwood, David R. Howell, Brian L. Brooks, Julie C. Wilson, and William P. Meehan III

While placebo effects are well recognized within clinical medicine, “nocebo effects” have received much less attention. Nocebo effects are problems caused by negative expectations derived from information or treatment provided during a clinical interaction. In this review, we examine how nocebo effects may arise following pediatric concussion and how they may worsen symptoms or prolong recovery. We offer several suggestions to prevent, lessen, or eliminate such effects. We provide recommendations for clinicians in the following areas: terminology selection, explicit and implicit messaging to patients, evidence-based recommendations, and awareness of potential biases during clinical interactions. Clinicians should consider the empirically grounded suggestions when approaching the care of pediatric patients with concussion.

Open access

Jamon Couch, Marc Sayers, and Tania Pizzari

Context: An imbalance between shoulder internal rotation (IR) and external rotation (ER) strength in athletes is proposed to increase the risk of sustaining a shoulder injury. Hand-held (HHD) and externally fixed dynamometry are reliable forms of assessing shoulder IR and ER strength. A new externally fixed device with an attachable fixed upper-limb mold (The ForceFrame) exists; however, its reliability in measuring shoulder strength is yet to be investigated. Objective: To determine the test–retest reliability of the ForceFrame, with and without the fixed upper-limb mold, in the assessment of shoulder IR and ER strength, as compared with HHD. Design: Test–retest reliability study. Setting: Laboratory, clinical. Participants: Twenty-two healthy and active individuals were recruited from the university community and a private physiotherapy practice. Main Outcome Measures: Maximal isometric shoulder IR and ER strength was measured using the ForceFrame and traditional HHD in neutral and at 90° shoulder abduction. Mean (SD) strength measures were calculated. Test–retest reliability was analyzed using intraclass correlation coefficients (3, 1). The SEM and minimal detectable change were calculated. Results: Good to excellent test–retest reliability was found for all shoulder strength tests across HDD and ForceFrame dynamometry (intraclass correlation coefficients [3, 1] = .854–.916). The minimal detectable changes ranged between 25.61 and 41.84 N across tests. Test–retest reliability was not affected by the dynamometer or testing position. Conclusions: The results from this study indicate that both the ForceFrame and HHD are suitable for measuring shoulder strength in clinical practice. The use of the fixed upper-limb mold with the ForceFrame does not improve reliability.

Open access

Aaron Byrne, Clare Lodge, and Jennifer Wallace

Context: Single-leg stability has been associated with injury risk and is a key component of many injury prevention interventions. Methods of measuring single-leg stability are varied yet often unreliable. Objective: To establish within- and between-day test–retest reliability for single-leg time to stabilization (SL-TTS) following a drop-landing maneuver of 20 cm in height among a healthy cohort. Design: Test–retest reliability study. Setting: Healthy cohort from a third-level educational institution. Participants: Nineteen (11 females and 8 males) healthy individuals. Main Outcome Measures: The SL-TTS in the vertical plane. Results: The SL-TTS showed good within-day (intraclass correlation coefficient = .715) and excellent between-day (intraclass correlation coefficient = .83) test–retest reliability. The minimal detectable change was calculated as 171.6 ms for within-day contexts and 123.8 ms for between-day contexts. Conclusions: This method of measuring SL-TTS is reliable and could be used to detect changes over time in a healthy cohort. This could be of value to clinicians in injury risk factor identification or assessing the effectiveness of single-leg stability training. However, further research is needed to investigate its reliability in pathological populations.

Open access

Jennifer L. Ostrowski, Alexa Beaumont, and Emily Dochterman

Clinical Scenario: Pathologies of the long head of the biceps brachii (LHB) tendon are a source of shoulder pain in many people. It is important to have a reliable assessment of the LHB tendon to make an accurate diagnosis and provide the correct treatment or referral if necessary. Shoulder ultrasound is very accurate in the diagnosis of rotator cuff tears. However, its ability to detect pathologies of the LHB tendon is still unclear. Clinical Question: In patients with shoulder pain, can musculoskeletal ultrasound accurately diagnose LHB tendon pathologies? Summary of Key Findings: Four high-quality cohort studies met inclusion criteria and were included in the critical appraisal. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used to score the articles on methodology and consistency. Three studies evaluated accuracy in diagnosis of full-thickness tears and found high sensitivity (SN) and specificity (SP). Three studies evaluated accuracy in diagnosis of partial-thickness tears and found low SN and negative predictive value, but high SP and positive predictive value. Two studies evaluated tendon subluxation/dislocation and found high SN and SP. Two studies evaluated tendinitis and found moderate SN and high SP. Clinical Bottom Line: There is moderate to strong evidence to support the use of musculoskeletal ultrasound in diagnosis of LHB tendon pathology. Strength of Recommendation: There is grade B evidence that musculoskeletal ultrasound can accurately diagnose full-thickness tears and tendon subluxation/dislocation; can rule in partial-thickness tears (based on SP and positive predictive value), but not rule out partial-thickness tears; and can rule in tendinitis (based on SP and positive predictive value), but not rule out tendinitis.