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Jaebin Shim, Deanna H. Smith and Bonnie L. Van Lunen

Clinical Scenario:

Over the past decade, sport-related concussions have received increased attention due to their frequency and severity over a wide range of athletics. Clinicians have developed return-to-play protocols to better manage concussions in young athletes; however, a standardized process projecting the length of recovery time after concussion has remained an elusive piece of the puzzle. The recovery times associated with such an injury once diagnosed can last anywhere from 1 wk to several months. Risk factors that could lead to protracted recovery times include a history of 1 or multiple concussions and a greater number, severity, and duration of symptoms after the injury. Examining the possible relationship between on-field or sideline signs and symptoms and recovery times would give clinicians the confident ability to properly treat and manage an athlete’s recovery process in a more systematic manner. Furthermore, identifying factors after a head injury that may be predictive of protracted recovery times would be useful for athletes, parents, and coaches alike.

Focused Clinical Question:

Which on-field and sideline signs and symptoms affect length of recovery after concussion in high school and college athletes?

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Stephanie J. Facchini, Matthew C. Hoch, Deanna H. Smith and Johanna M. Hoch

Context:

The intrinsic foot muscle test (IFMT) is purported to identify intrinsic foot muscle (IFM) weakness during clinical examination. However, before this test can be used in clinical practice the clinometric properties must be determined. In addition, it is unclear if the IFMT provides information regarding the integrity of the foot arch beyond static foot posture assessments such as the navicular drop test (NDT).

Objective:

To determine the reliability of the IFMT as well as its correlation with the NDT.

Setting:

Laboratory.

Patients or other Participants:

Two novice ATs served as the raters. The NDT was assessed by a third investigator during the first session. Twenty-five participants (16 females, 9 males; age: 22.4 ± 1.7 years; height: 170.8 ± 10.2 cm; mass: 73.5 ± 12.8 kg) completed two data collection sessions separated by one week.

Interventions:

During each session the IFMT was assessed bilaterally in a counterbalanced order by the raters. Each test was rated simultaneously by both raters during each trial and the raters were blinded to each other’s results during and between test sessions.

Main Outcome Measures:

The independent variable was time (session one and session two) and the dependent variables included rating on the IFMT and navicular drop height.

Results:

Intrarater agreement was poor to fair (κ = .03−.41) and interrater agreement was fair to moderate (κ = .25−.60). Post hoc Wilcoxon rank tests demonstrated a significant number of participants improved between sessions for both raters. A weak correlation was observed between the NDT and IFMT for both right (r = −.14 to .04, p < .49) and left (r = −.19 to .07, p < .37) feet.

conclusion:

The IFMT demonstrated poor to fair intrarater and fair to moderate interrater agreement, suggesting future research is needed to modify this method of measuring IFM function. The improvement between sessions indicates a potential familiarization period within the test. The weak correlation between the IFMT and NDT indicates these tests evaluate different aspects of foot function.