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Clinical Scenario: Critical appraisal of whole-body metabolism as a measure of concussion recovery is lacking in the available evidence. There has been extensive exploration of options for a gold standard assessment for concussion, including blood biomarkers, electroencephalogram, and neuroimaging, but none have yet to demonstrate good empirical evidence of efficacy. Clinical Question: In patients with sport-related concussion (SRC), can resting metabolic rate (RMR), as measured through indirect calorimetry, be used as a physiologic assessment of recovery? Summary of Key Findings: Three studies demonstrated relevance to the clinical question. Of the selected studies, 2 studies were case–control, and 1 was a case series. All studies observed reduced total energy expenditure and increased energy balance when initially assessed between 24 and 72 hours after injury. Clinical Bottom Line: Evidence exists to suggest that RMR as measured with indirect calorimetry is a poor indicator of SRC recovery. All 3 articles found that RMR was not affected by SRC, even when compared with healthy controls. One article did observe a between sex difference in RMR, but a very small sample size was included in the case series. Strength of Recommendation: The findings of this critically appraised topic suggest a strength of recommendation of grade B, demonstrating that RMR is a poor indicator of recovery from SRC.

Context: Sensorimotor impairments are common sequela following concussion, but recovery following a concussion is often determined through examiner scored clinical testing. There are emerging technologies that provide objective methods to determine physiological impairment after concussion, but the psychometrics of these tools are lacking and must be established for use in clinical practice. Objective: The purpose of this study was to examine the test–retest reliability and provide reliable change estimates in healthy young adults for outcomes from 3 emerging technologies providing objective assessments of sensorimotor function in healthy young adults. Design: Test–retest reliability design in a laboratory setting. Methods: Healthy, young adults completed testing at 2 time points 4 weeks apart on the Bertec Vision Trainer, the Concussion Balance Test (COBALT), and the Neurolign Dx-100 eye-tracking system. We determined test–retest reliability using intraclass correlation coefficients with a 2-way mixed-effects model absolute agreement. Reliable change estimates were calculated for 70%, 80%, 90%, and 95% CIs. Results: Participants included 30 healthy young adults (age = 25 [5] y, interquartile range = 20–29; range = 18–38; 17% [57%] women). Test–retest reliability for the Bertec Vision Trainer outcomes ranged from 0.56 to 0.88, with 45% of the outcomes being classified as clinically acceptable (>.70 intraclass correlation coefficients ); for COBALT conditions, sway velocity ranged from 0.50 to 0.95, 95% ellipse area ranged from −0.22 to 0.88, and Sway Score ranged from 0.07 to 0.85, with 50% of COBALT metrics being clinically acceptable; and for the Dx-100, outcomes ranged from −0.20 to 0.89, with 52% being clinically acceptable. Conclusions: Overall, test–retest reliability was moderate-to-good for the Bertec Vision Trainer assessment outcomes but were highly variable for outcomes of postural control using the COBALT and eye-tracking metrics using the Dx-100. This study adds clinically relevant test–retest reliability and reliable change estimates in healthy adults for 3 commercially available sensorimotor assessments.

Context: Handheld dynamometers provide clinicians an objective measure of lower-extremity force production at the hip and knee. While push-based dynamometers are common in clinical practice, they can be associated with patient discomfort, and standardization of methods is challenging when patient forces can exceed the ability of the rater. Development of novel, pull-based dynamometers allow for better patient comfort, but validity between dynamometers must be established before integration into clinical practice. Therefore, the purpose of this study was to compare measurement of lower-extremity force between push- and pull-based handheld dynamometers. Design: Descriptive laboratory study. Methods: Twenty-one healthy triathletes performed isometric hip abduction, hip external rotation, and knee extension testing against 2 separate handheld dynamometers. Pearson product correlations were calculated for the relationship between devices, while Bland–Altman plots were used to measure agreement with limit of agreement to assess systematic bias. Results: Correlations between devices were strong for hip abduction and knee extension (r = .743–.767, P < .001) and moderate for hip external rotation (r = .429, P = .052). Additionally, there was good agreement between the 2 devices, with acceptable limits of agreement across the 3 force tasks. The pull-based dynamometer resulted in greater torque values for knee-extension and hip external rotation, with a mean difference of −0.37 and −0.19 N·m/kg, but there was no difference in hip abduction with a mean difference of 0.03 N·m/kg. Conclusion: The results demonstrate that pull-based dynamometers are an acceptable alternative to push-based dynamometers for hip abduction and knee extension, but some caution may exist for hip external rotation. Clinicians should be aware of differences in lower-extremity force across multiple handheld dynamometers when assessing muscle function in practice.

Context: Guidelines for various movement assessments often instruct clinicians to conduct testing without a warm-up. Warm-ups are commonly performed to increase heart rate, decrease stiffness, and prepare for sport-specific demands. Since athletes typically complete a warm-up prior to sport participation, evaluating biomechanics in this condition may provide a better indication of their bodies’ physical capabilities. The primary purpose of this study was to compare scores on the Titleist Performance Institute (TPI) screen before and after a dynamic warm-up in adult golfers. Design: Twenty-four adult golfers (19 male/5 female, age 44.0 [15.4] y, height 171.3 [8.6] cm, weight 82.5 [16.3] kg, average 18-hole score 90.7 [10.3] strokes) completed a single-session crossover laboratory study. Methods: Participants completed the TPI screen, which included 15 simple tests scored based on their ability to properly complete the movement. Following a rest and washout period, participants performed a brief dynamic warm-up including exercises for the extremities and trunk, followed by 30 seconds of practice golf swings. Participants immediately retested the TPI screen, following the same procedures. Composite and individual test scores were compared before and after the warm-up with Wilcoxon signed-rank tests and r effect sizes at a significance of P ≤ .05. Results: TPI composite scores were significantly higher following the warm-up (median: 36, interquartile range 31/40) than before the warm-up (median: 33, interquartile range 28/36) (P < .001), with a large effect size (r = .81). Conclusions: Our findings suggest a warm-up leads to higher scores on the TPI screen, and that an athlete’s warm-up condition should be considered when interpreting their performance.

Background: Diastasis rectus abdominis is a condition in which the rectus abdominis muscles separate and move laterally, causing stretching of the linea alba tissue with weakness of the abdominal wall. Although it can lead to hernia of the abdominal viscera, diastasis rectus abdominis is not a hernia in itself. This condition is common among women during pregnancy and the postpartum period and can significantly affect their quality of life and their return to sports activity. Unfortunately, information on the incidence, risk factors, prevention, and treatment of diastasis rectus abdominis are limited. Methods: We conducted a pilot prospective observational study on 37 patients who practiced sports at high levels (at least 3 times a week with amateur/competitive competitions) who underwent ultrasound measurements of the distance between the rectus abdominis muscles at the level of the xiphoid process, supraumbilical, umbilical, and subumbilical at time (T0), after 2 months from the rehabilitation protocol (T1), and then after 4 months of rehabilitation protocol (T2) from approximately 3 months after giving birth, and we saw an early return to sport. Results: Our data analysis reveals that there is an initial decrease in diastasis during the first 2 months with 3 weekly physiotherapy activity sessions in all 4 measurements. One session takes place on site with physiotherapists, while the other 2 are carried out at home using the rehabilitation protocol provided by the medical staff. At the 4-month follow-up, the improvement was similar to the previous follow-up. Conclusion: Of the 37 women analyzed, 6 were referred to the surgeon; 2 for hernias and 4 for diastases greater than 4 cm. The remaining women benefited from a conservative approach. Patients undergoing the rehabilitation protocol showed improvements in all 4 measures, as well as their early return to sport.

Context: After completing rehabilitation, patients face a high risk of subsequent injury following anterior cruciate ligament reconstruction. It is important to identify potential barriers to patient success including clinician knowledge. The purpose of this study was to assess clinician knowledge of research related to anterior cruciate ligament reconstruction rehabilitation. Design: This was a survey study using snowball sampling. Methods: Survey development began with the creation of a construct map and contained varying levels of advanced concepts, level I indicating the most basic and level V the most complex. The survey was distributed to advertise to target population. A total of 60 participants (24 athletic trainers, 33 physical therapists, and 3 dual credentialed) completed the study. Results: Overall, participants displayed moderate to high levels of knowledge (79.7%–93.5% correct), apart from the implementation of motor learning principles. Conclusions: Clinician knowledge may not be the primary barrier to patient success, but the implementation of this knowledge should be explored in relation to patient outcomes. Future research should examine a larger cohort to examine differences between clinician types.

Context: Limited information exists regarding the immediate and short-term effects of scapula retraction exercises (SREs) on acromiohumeral distance (AHD) in subacromial pain syndrome (SPS). This study’s 2 main objectives were to investigate (1) the immediate effect of the SRE on AHD at varying shoulder abduction angles in patients with SPS and healthy controls and (2) the effect of the 8-week SRE program on AHD in patients with SPS. Design: Cross-sectional and pre–post intervention designs were utilized on this study. Methods: Twenty-one patients with SPS and age-matched healthy controls were included. First, AHD at 0°, 30°, 45°, 60°, and 90° of active shoulder abductions were recorded during (1) resting upper quadrant posture and (2) while participants were performing SREs. Patients then underwent an 8-week progressive SRE program. AHD measures, pain intensity (visual analog scale), and disability (Shoulder Pain and Disability Index) were recorded at baseline and 8 weeks. AHD were analyzed using mixed-model analyses of variance. Pain and disability were analyzed using paired samples t test. Results: The immediate effect of the SREs revealed a significant angle-by-exercise-by-group interaction for the AHD values (F _3,155 = 3.956, P = .009, ${\eta }_{\mathrm{p}}^2=.175$ ). Pairwise comparisons yielded that the SRE increased AHD values in patients with SPS (P < .05), yet it did not affect healthy controls (P > .05). Besides, the SRE program revealed a significant angle-by-time interaction for the AHD values (F _3,054 = 9.476, P < .001, ${\eta }_{\mathrm{p}}^2=.195$ ). AHD increased at all elevation angles, and pain and disability improved over time (P < .05). Conclusion: SREs immediately affect AHD in patients with SPS but not in healthy populations. Moreover, SREs applied in progressive abduction angles improve pain, functionality, and AHD values in patients with SPS.

Context: To further improve rehabilitation programs while preventing overstretching the anterior cruciate ligament (ACL), a thorough understanding of the knee kinematics and ACL length change during closed kinetic chain and open kinetic chain (OKC) exercises is essential. The measurement of ACL graft length relates to the changes in strain experienced by the ACL graft during different types of exercises rather than simple physical length. Objective: This study aimed to determine the effects of closed kinetic chain and OKC exercises on tibiofemoral kinematics and ACL graft length changes following double-bundle ACL reconstruction. Design: Cohort study (diagnosis); level of evidence, 3. Setting: Laboratory. Patients: Fifteen patients who underwent double-bundle ACL reconstruction were asked to perform 10-kg loaded seated knee extension (OKC-10) and single-leg lunge. During the seated knee extension, patients were instructed to extend and flex the knee within a range of 0° to 90° of flexion, with a 10-kg load applied to the ankle. For the lunge, patients began in a natural standing position and were instructed to flex the ACL-reconstructed knee to approximately 90°. Interventions: The 3-dimensional tibiofemoral kinematics under different weight-bearing conditions were determined using a dual-fluoroscopic imaging system. Main Outcome Measures: The tibiofemoral kinematics in 6 degrees-of-freedom were measured. And 3-dimensional ligament simulation technique was used to quantify length changes of the anteromedial bundle and posterolateral bundle. Results: The tibia exhibited significantly more external rotation during the OKC-10 motion than during the single-leg lunge from 35° to 70° of knee flexion (P ≤ .028). Beyond 30° of knee flexion, the tibia exhibited significantly more varus during the OKC-10 motion than during the single-leg lunge (P ≤ .028). And a significantly more anterior tibial translation was observed during the OKC-10 motion than during the lunge from 0° to 15° of flexion (P ≤ .018). The anteromedial bundle length was significantly longer during the OKC-10 motion than during the lunge between 0° and 25° of knee flexion (P ≤ .028). Conclusions: The effects of OKC exercises with loads on knee rotational stability should be considered in making rehabilitation programs for patients after ACL reconstruction. Since some degree of anterior tibial translation is physiological, it is important to note that increased translation alone does not necessarily indicate danger or instability.