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Megan N. Houston and Matthew C. Hoch

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Megan N. Houston, Johanna M. Hoch and Matthew C. Hoch

Context: Postinjury, college athletes have reported elevated levels of fear. However, it is unclear how a history of ankle sprain impacts injury-related fear. Objective: The aim of this study was to determine if Fear-Avoidance Beliefs Questionnaire (FABQ) scores differ between college athletes with a history of a single ankle sprain, those with recurrent ankle sprains, and healthy controls. Design: Cross-sectional design. Setting: National Collegiate Athletic Association institutions. Patients: From a large database of college athletes, 75 participants with a history of a single ankle sprain, 44 with a history of recurrent ankle sprains (≥2), and 28 controls with no injury history were included. Main Outcome Measures: Participants completed an injury history questionnaire and the FABQ. On the injury history form, the participants were asked to indicate if they had ever sustained an ankle sprain and, if yes, to describe how many. FABQ scores ranged from 0 to 66 with higher scores representing greater fear. Results: Athletes with a history of recurrent ankle sprains (median, 28.00; interquartile range, 18.25–38.00) reported higher levels of fear than those with a history of a single ankle sprain (21.00; 8.00–31.00; P = .03; effect size = 0.199) and healthy controls (5.50; 0.00–25.00; P < .001; effect size = 0.431). Athletes with a history of a single sprain reported greater fear than healthy controls (P = .01, effect size = 0.267). Athletes with a history of a single sprain reported greater fear than healthy controls (P = .02, effect size = 0.23). Conclusions: College athletes with a history of ankle sprain exhibited greater levels of fear on the FABQ than healthy controls. These findings suggest that ankle sprains in general may increase injury-related fear and that those with a history of recurrent sprains are more vulnerable.

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Johanna M. Hoch, Megan N. Houston, Shelby E. Baez and Matthew C. Hoch

Context: Many athletes return to sport after anterior cruciate ligament reconstruction (ACLR) with lingering physical or mental health impairments. Examining health-related quality of life (HRQL) and fear-avoidance beliefs across the spectrum of noninjured athletes and athletes with a history of ACLR may provide further insight into targeted therapies warranted for this population. Objective: The purpose of this study was to examine differences in fear-avoidance beliefs and HRQL in college athletes with a history of ACLR not participating in sport (ACLR-NPS), participating in sport (ACLR-PS), and healthy controls (Control) with no history of injury participating in sport. Design: Cross-sectional. Setting: Laboratory. Patients (or Other Participants): A total of 10 college athletes per group (ACLR-NPS, ACLR-PS, and Control) were included. Participants were included if on a roster of a Division I or III athletic team during data collection. Interventions: Participants completed a demographic survey, the modified Disablement in the Physically Active Scale (mDPA) to assess HRQL, and Fear-Avoidance Beliefs Questionnaire (FABQ) to assess fear-avoidance beliefs. Main Outcome Measures: Scores on the mDPA (Physical and Mental) and FABQ subscales (Sport and Physical Activity) were calculated, a 1-way Kruskal–Wallis test and separate Mann–Whitney U post hoc tests were performed (P < .05). Results: ACLR-NPS (30.00 [26.00]) had higher FABQ-Sport scores than ACLR-PS (18.00 [26.00]; P < .001) and Controls (0.00 [2.50]; P < .001). ACLR-NPS (21.50 [6.25]) had higher FABQ-Physical Activity scores than ACLR-PS (12.50 [13.00]; P = .001) and Controls (0.00 [1.00]; P < .001). Interestingly, ACLR-PS scores for FABQ-Sport (P = .01) and FABQ-Physical Activity (P = .04) were elevated compared with Controls. ACLR-NPS had higher scores on the mDPA-Physical compared with the ACLR-PS (P < .001) and Controls (P < .001), and mDPA-Mental compared with ACLR-PS (P = .01), indicating decreased HRQL. Conclusions: The ACLR-NPS had greater fear-avoidance beliefs and lower HRQL compared with ACLR-PS and Controls. However, the ACLR-PS had higher scores for both FABQ subscales compared with Controls. These findings support the need for additional psychosocial therapies to address fear-avoidance beliefs in the returned to sport population.

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Matthew C. Hoch, Johanna M. Hoch and Megan N. Houston

The study objective was to develop a shortened version of the Foot and Ankle Ability Measure (FAAM) for individuals with chronic ankle instability (CAI). Forty individuals with CAI completed the FAAM Activities of Daily Living and Sport subscales and the Short Form-12. Analyses were completed for item reduction followed by dimensionality, coverage redundancy, and internal consistency of a reduced-item instrument. Validity was examined through correlations with the original FAAM and Short Form-12. A 12-item FAAM was created which demonstrated strong internal consistency and convergent/divergent validity. The Quick-FAAM may provide an alternative patient-reported outcome for CAI which requires less administration time.

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Megan N. Houston, Johanna M. Hoch, Bonnie L. Van Lunen and Matthew C. Hoch

Context:

Health-related quality of life (HRQOL) is a broad term for the impact of injury or illness on physical, psychological, and social health dimensions. Injury has been associated with decreased HRQOL in athletes. However, the influence of injury history, participation status, time since last injury, and injury severity on HRQOL remains unclear.

Objective:

To compare HRQOL in collegiate athletes based on injury history, participation status, time since last injury, and injury severity and to examine relationships between HRQOL outcomes.

Design:

Cross-sectional.

Setting:

3 National Collegiate Athletic Association (NCAA) institutions.

Participants:

467 collegiate athletes (199 males, 268 females; 19.5 ± 1.3 y, 173.9 ± 10.5 cm, 71.9 ± 13.6 kg) were recruited from NCAA Division I (n = 299) and Division III (n = 168) institutions. Athletes were included regardless of participation status, which created a diverse sample of current and past injury histories.

Main Outcome Measures:

During a single session, participants completed an injury history form, the Disablement in the Physically Active Scale (DPA), and the Fear-Avoidance Beliefs Questionnaire (FABQ). Dependent variables included DPA-Physical Summary Component (DPA-PSC), DPA-Mental Summary Component (DPA-MSC), and FABQ Scores.

Results:

HRQOL differences were detected between groups based on injury history, participation status, and time since last injury. No differences were detected for injury severity. A moderate correlation was identified between the DPA-PSC and FABQ (rs = 0.503, P < .001) and a weak relationship was identified between the DPA-MSC and FABQ (rs = 0.266, P < .001).

Conclusions:

Injury negatively influenced HRQOL in athletes with a current injury. While those individuals participating injured reported better HRQOL than the athletes sidelined due to injury, deficits were still present and should be monitored to ensure a complete recovery. Identifying the patient’s perception of impairment will help facilitate evidencebased treatment and rehabilitation strategies that target the physical and psychosocial aspects of health.

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Alyssa J. Wagner, Casey D. Erickson, Dayna K. Tierney, Megan N. Houston and Cailee E. Welch Bacon

Clinical Scenario:

Eating disorders in female athletes are a commonly underdiagnosed condition. Better screening tools for eating disorders in athletic females could help increase diagnosis and help athletes get the treatment they need.

Focused Clinical Question:

Should screening tools be used to detect eating disorders in female athletes?

Summary of Key Findings:

The literature was searched for studies that included information regarding the sensitivity and specificity of screening tools for eating disorders in female athletes. The search returned 5 possible articles related to the clinical question; 3 studies met the inclusion criteria (2 cross-sectional studies, 1 cohort study) and were included. All 3 studies reported sensitivity and specificity for the Athletic Milieu Direct Questionnaire version 2, the Brief Eating Disorder in Athletes Questionnaire version 2, and the Physiologic Screening Test to Detect Eating Disorders Among Female Athletes. All 3 studies found that the respective screening tool was able to accurately identify female athletes with eating disorders; however, the screening tools varied in sensitivity and specificity values.

Clinical Bottom Line:

There is strong evidence to support the use of screening tools to detect eating disorders in female athletes. Screening tools with higher sensitivity and specificity have demonstrated a successful outcome of determining athletes with eating disorders or at risk for developing an eating disorder.

Strength of Recommendation:

There is grade A evidence available to demonstrate that screening tools accurately detect female athletes at risk for eating disorders.

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Michael L. Gabriner, Brittany A. Braun, Megan N. Houston and Matthew C. Hoch

Clinical Scenario:

Chronic ankle instability (CAI) is a condition commonly experienced by physically active individuals. It has been suggested that foot orthotics may increase a CAI patient’s postural control.

Clinical Question:

For patients with CAI, is there evidence to suggest that an orthotic intervention will help improve postural control?

Summary of Key Findings:

The literature was searched for studies of level 2 evidence or higher that investigated the effects of foot orthotics on postural control in patients with CAI. The search of the literature produced 5 possible studies for inclusion; 2 studies met the inclusion criteria and were included. One randomized controlled trial and 1 outcomes study were included. Foot orthotics appear to be effective at improving postural control in patients with CAI.

Clinical Bottom Line:

There is moderate evidence to support the use of foot orthotics in the treatment of CAI to help improve postural control.

Strength of Recommendation:

There is grade B evidence that foot orthotics help improve postural control in people with CAI. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.

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Megan N. Houston, Victoria E. Hodson, Kelda K.E. Adams and Johanna M. Hoch

Clinical Scenario:

Hamstring tightness is common among physically active individuals. In addition to limiting range of motion and increasing the risk of muscle strain, hamstring tightness contributes to a variety of orthopedic conditions. Therefore, clinicians continue to identify effective methods to increase flexibility. Although hamstring tightness is typically treated with common stretching techniques such as static stretching and proprioceptive neuromuscular facilitation, it has been suggested that whole-body-vibration (WBV) training may improve hamstring flexibility.

Clinical Question:

Can WBV training, used in isolation or in combination with common stretching protocols or exercise, improve hamstring flexibility in physically active young adults?

Summary of Key Findings:

Of the included studies, 4 demonstrated statistically significant improvements in hamstring flexibility in the intervention group, and 1 study found minor improvements over time in the intervention group after treatment.

Clinical Bottom Line:

There is moderate evidence to support the use of WBV training to improve hamstring flexibility in physically active young adults.

Strength of Recommendation:

There is grade B evidence that WBV training improves hamstring flexibility in physically active adults. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.

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Amy M. Gibson, Gary W. Cohen, Kelly K. Boyce, Megan N. Houston and Cailee E. Welch Bacon

Clinical Question: What personal and environmental characteristics are associated with burnout in athletic trainers, as measured by the Maslach Burnout Inventory (MBI) and Athletic Training Burnout Inventory (ATBI)? Clinical Bottom Line: There is strong evidence suggesting that personal and environmental factors are associated with burnout in athletic trainers, as measured by the MBI and ATBI. While it is difficult to identify a single contributing factor that increases the athletic trainer’s perception of burnout, athletic trainers should be aware of the characteristics associated with the condition and take appropriate action to reduce the risk of burnout.

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Megan N. Houston, Patrick O. McKeon and Matthew C. Hoch

Edited by Tricia Truner

Context:

Following joint mobilizations, individuals with chronic ankle instability (CAI) have reported increased self-reported function as measured by the Foot and Ankle Ability Measure (FAAM).

Objective:

To examine the effect of a 2-week talocrural joint mobilization intervention on individual items of the FAAM in physically active adults with CAI.

Participants:

Twelve adults with CAI.

Intervention:

Self-reported function was documented with the FAAM-ADL and FAAM-Sport at preintervention and at 1-week postintervention. The joint mobilization intervention consisted of six treatments over 2 weeks. During each treatment, subjects received 4 minutes of talocrural traction and 8 minutes of Maitland Grade-III anterior-to-posterior talocrural joint mobilization.

Main Outcome Measures:

Participants completed the 21-item FAAM-ADL and 8-item FAAM-Sport.

Results:

Signifcant changes were detected between preintervention and 1-week follow-up measures for “Walking on even ground” (p = 0.06), “Going down stairs” (p = 0.07), “Walking on uneven ground” (p = 0.03), “Light to moderate work” (p = 0.06), “Heavy work” (p = 0.03), “Recreational activity” (p = 0.07), “Landing” (p = 0.03), “Low impact activities” (p = 0.07), and “Cutting” (p = 0.02). No signifcant changes were identifed in the other 20 items (p > 0.10).

Conclusion:

The fndings suggest talocrural joint mobilization may address specifc mechanical and functional impairments associated with the aforementioned tasks during physical activity.