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Samantha A. Campbell and Alison R. Valier

Clinical Scenario:

Patellofemoral pain syndrome (PFPS) occurs in 25% of adolescents and adults and is the leading cause of knee pain in runners. Pain is commonly felt when ascending or descending stairs, deep squatting, kneeling, or running. There is no consensus on the etiology of this condition, but insufficient hip strength, malalignment of the lower extremity, hyperpronation of the foot, and patellar incongruence have been suggested. Common treatments of PFPS include strengthening of quadriceps and hip muscles, McConnell taping, electrical stimulation, and foot orthotics, but effectiveness of these treatments is inconclusive. Kinesio Taping is an alternative taping technique for musculoskeletal injuries including PFPS. Although research suggests that Kinesio Taping decreases pain and improves range of motion for some musculoskeletal injuries, its effectiveness in decreasing pain in patients with PFPS in unknown. Furthermore, Kinesio Taping has not been compared with other taping techniques including McConnell taping.

Focused Clinical Question:

For patients with anterior knee pain consistent with PFPS, does treatment with Kinesio Taping decrease pain more than McConnell taping or no tape at all?

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Sara J. Golec and Alison R. Valier

Clinical Scenario: Health care clinicians are encouraged to practice according to the best available evidence for the purpose of improving patient outcomes. Clinical practice guidelines are one form of evidence that has been developed to enhance the care that patients receive for particular conditions. Low back pain is a common condition in rehabilitation medicine that places a significant financial burden on the healthcare system. Patients with low back pain often suffer great pain and disability that can last a long time, making effective and efficient care a priority. Several guidelines for the treatment of low back pain have been created; however, there is no consensus on whether following these guidelines will positively reduce the pain and disability experienced by patients. Clinical Question: Does adherence to clinical practice guidelines for patients with nonspecific low back pain reduce pain and disability? Summary of Key Findings: A total of 4 studies of level 3 or higher were found. Four studies noted an improvement in disability following guidelines adherent care. Two studies reported greater reduction in pain with guideline adherent care and 2 did not.  Clinical Bottom Line: Moderate evidence exists to support adherence to clinical practice guidelines to improve pain and disability ratings in patients with nonspecific low back pain.

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Janie L. Kelly and Alison R. Valier

Overuse injuries are common in physically active populations. Lower limb overuse injuries can occur anywhere in the lower-extremity and include injuries such as medial tibial stress syndrome, plantar fasciitis, and anterior knee pain. One reason that overuse injuries have received attention is because they have both short- and long-term consequences on health and burden the lives of physically active people. Over the years, a variety of approaches have been proposed for prevention of lower limb overuse injury that addresses various intrinsic or extrinsic risk factors. One extrinsic risk factor is footwear and the use of orthotic insoles to prevent injury. To date, there is no consensus as to whether these supports prevented lower limb overuse injuries. A critical appraisal of recent studies examining the injury prevention capabilities of orthotic insoles was completed. The long-term objective of this research is to help identify effective strategies for preventing injuries in physically active people.

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Alison R. Valier, Ryan S. Averett, Barton E. Anderson and Cailee E. Welch Bacon

Clinical Scenario:

Shoulder pain is a common musculoskeletal complaint and is often associated with shoulder impingement. The annual incidence of shoulder pain is estimated to be 7% of all injuries, and is the third-most-common type of musculoskeletal pain. Initial treatment of shoulder impingement follows a conservative plan and emphasizes rehabilitation programs as opposed to surgical interventions. Shoulder rehabilitation programs commonly focus on strengthening the muscles of the shoulder complex and, more specifically, the rotator cuff. The rotator cuff is a primary dynamic stabilizer of the glenohumeral joint, using both eccentric and concentric contractions. The posterior rotator cuff, including teres minor and infraspinatus, works eccentrically to decelerate the arm during overhead throwing. Exercises to strengthen the rotator cuff and the surrounding dynamic stabilizers of the shoulder girdle vary and include activities such as internal and external rotation, full-can lifts, and rhythmic stabilizations. Traditionally, shoulder rehabilitation programs have focused on isotonic concentric contractions. Common strengthening exercises typically involve movements that result in shortening the muscle length while simultaneously loading the muscles. However, recent attention has been given to eccentric exercises, which involve lengthening of the muscle during loading, for the treatment of a variety of different tendinopathies including those of the Achilles and patellar tendons. The eccentric, or lengthening, motion is thought to be beneficial for people who are involved in activities that place eccentric stress on their shoulder, such as overhead throwers. Based on studies related to the Achilles tendon, eccentric exercise may positively influence the tendon structure by increasing collagen production and decreasing neovascularization. The changes that occur as a result of eccentric exercises may improve function, strength, and performance and decrease pain more than concentric programs, producing better patient outcomes. Although eccentric strength training has been shown to provide strength gains, there are no clear guidelines as to the inclusion of this form of exercise training in shoulder rehabilitation programs for the purposes of improving function and decreasing pain.

Focused Clinical Question:

Does adding an eccentric-exercise component to the rehabilitation program of patients with shoulder impingement improve shoulder function and/or decrease pain?

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Ashley N. Marshall, Alison R. Snyder Valier, Aubrey Yanda and Kenneth C. Lam

Context: There has been an increased interest in understanding how ankle injuries impact patient outcomes; however, it is unknown how the severity of a previous ankle injury influences health-related quality of life (HRQOL). Objective: To determine the impact of a previous ankle injury on current HRQOL in college athletes. Design: Cross-sectional study. Setting: Athletic training clinics. Participants: A total of 270 participants were grouped by the severity of a previous ankle injury (severe = 62, mild = 65, and no injury = 143). Main Outcome Measures: Participants completed the Foot and Ankle Ability Measure (FAAM) and the Short Form 12 (SF-12). Methods: A 2-way analysis of variance with 2 factors (injury group and sex) was used to identify interaction and main effects for the FAAM and SF-12. Results: No interactions were identified between injury group and sex. Significant main effects were observed for injury group, where the severe injury group scored lower than athletes with mild and no injuries on the FAAM activities of daily living, FAAM Global, and SF-12 mental health subscale scores. In addition, a main effect was present for sex in the SF-12 general health, social functioning, and mental health subscales in which females reported significantly lower scores than males. Conclusions: Our findings suggest that a severe ankle injury impacts HRQOL, even after returning back to full participation. In addition, females tended to report lower scores than males for aspects of the SF-12, suggesting that sex should be considered when evaluating HRQOL postinjury. As a result, clinicians should consider asking athletes about their previous injury history, including how much time was lost due to the injury, and should mindful of returning athletes to play before they are physiologically and psychologically ready, as there could be long-term negative effects on the patients’ region-specific function as well as aspects of their HRQOL.

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Alison R. Snyder Valier, Elizabeth M. Swank, Kenneth C. Lam, Matthew L. Hansen and Tamara C. Valovich McLeod

Context:

Accurate assessment of health-related quality of life (HRQoL) is important for quality patient care. Evaluation of HRQoL typically occurs with patient self-report, but some instruments, such as the Pediatric Quality of Life Inventory (PedsQL), allow for proxy reporting. Limited information exists comparing patient and proxy reports of HRQoL after sport-related injury in adolescent athletes.

Objective:

To compare patient ratings and parent-proxy ratings of HRQoL in adolescent athletes who suffer musculoskeletal injuries requiring orthopedic consultation. The authors hypothesized poor agreement between patient and parent-proxy ratings of HRQoL.

Design:

Cross-sectional study.

Setting:

Orthopedic practice.

Patients:

Thirteen adolescent patients with a sport-related musculoskeletal injury requiring orthopedic consultation and 1 of their parents participated.

Interventions:

During the initial visit to the physician’s office, each patient was asked to complete the PedsQL, and the patient’s parent was asked to complete the parent-proxy version of the PedsQL.

Main Outcome Measurements:

The PedsQL is a pediatric generic outcome measure that consists of a total score and 4 subscale scores: physical, emotional, social, and school functioning. Means and standard deviations were calculated for all scores, and comparisons between patient-self report and parent-proxy ratings of HRQoL were made for the PedsQL total score and subscale scores using Pearson product–moment correlations (r).

Results:

Pearson product–moment correlations showed little to fair insignificant relationships between patient self-report and parent-proxy report of the PedsQL for the total score (r = −.1) and all subscales (range r = .1 to .4).

Conclusions:

Our results suggest a lack of agreement between patient and parent-proxy ratings of HRQoL, with patients rating their HRQoL lower than their parent. Patient perception of HRQoL may be more accurate than proxy report, which supports the use of patient-rated HRQoL in patient evaluation. Assessments of HRQoL made by proxies, even those close to the patient, may not represent patient health status.