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The Effect of Bone-Bruise Lesions on Pain in Patients With Traumatic Knee Injury

Johanna M. Hoch and Carl G. Mattacola

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Sports Specialization, Physical Literacy, and Physical Activity Levels in Young Adults

Chloe McKay, Johanna M. Hoch, Matthew C. Hoch, and Deirdre Dlugonski

Context: Youth sport specialization may be associated with physical literacy and physical activity in young adulthood. The purposes of this study were to compare young adult (18–25 y) physical literacy and physical activity by high school sport specialization status and to examine the relationship between current physical activity and physical literacy. Design: Retrospective, cross-sectional study design. Methods: Participants were recruited from ResearchMatch, university classes, and social media posts. Participants (N = 172; aged 22.1 [2.1] y; 80.1% female) completed the following anonymous surveys on REDCap to assess: demographics and injury history, sport specialization, physical literacy (PLAYself), and physical activity (Godin Leisure-Time Exercise Questionnaire). Results: When controlling for age, there were no statistically significant differences in physical literacy (F 2,166 = 2.02, P = .14) or moderate to vigorous physical activity (F 2,161 = 0.24, P = .79) between sport specialization groups. There was a moderate, positive relationship between physical literacy and physical activity (r = .33, P < .001). Conclusions: Young adult physical literacy and physical activity were similar regardless of youth sport specialization level. Young adult physical literacy was positively associated with physical activity. Future studies should consider physical literacy as a possible correlate of physical activity among young adults.

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College Athletes With Ankle Sprain History Exhibit Greater Fear-Avoidance Beliefs

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.

Open access

Examination of Response Shift After Rehabilitation for Orthopedic Conditions: A Systematic Review

Cameron J. Powden, Matthew C. Hoch, and Johanna M. Hoch

Context: There is an increased emphasis on the need to capture and incorporate self-reported function to make clinical decisions when providing patient-centered care. Response shift (RS), or a change in an individual’s self-evaluation of a construct, may affect the accurate assessment of change in self-reported function throughout the course of rehabilitation. A systematic review of this phenomenon may provide valuable information regarding the accuracy of self-reported function. Objectives: To systematically locate and synthesize the existing evidence regarding RS during care for various orthopedic conditions. Evidence Acquisition: Electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, and Psychology & Behavioral Sciences Collection) were searched from inception to November 2016. Two investigators independently assessed methodological quality using the modified Downs and Black Quality Index. The quality of evidence was assessed using the Strength-of-Recommendation Taxonomy. The magnitude of RS was examined through effect sizes. Evidence Synthesis: Nine studies were included (7 high quality and 2 low quality) with a median Downs and Black Quality Index score of 81.25% (range = 56.25%–93.75%). Overall, the studies demonstrated weak to strong effect sizes (range = −1.58–0.33), indicating the potential for RS. Of the 36 point estimates calculated, 22 (61.11%), 2 (5.56%), and 12 (33.33%) were associated with weak, moderate negative, and strong negative effect sizes, respectively. Conclusions: There is grade B evidence that a weak RS, in which individuals initially underestimate their disability, may occur in people undergoing rehabilitation for an orthopedic condition. It is important for clinicians to be aware of the potential shift in their patients’ internal standards, as it can affect the evaluation of health-related quality of life changes during the care of orthopedic conditions. A shift in the internal standards of the patient can lead to subsequent misclassification of health-related quality of life changes that can adversely affect clinical decision making.

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Y-Balance Test Performance After a Competitive Field Hockey Season: A Pretest-Posttest Study

Matthew C. Hoch, Lauren A. Welsch, Emily M. Hartley, Cameron J. Powden, and Johanna M. Hoch

Context: The Y-Balance Test (YBT) is a dynamic balance assessment used as a preseason musculoskeletal screen to determine injury risk. While the YBT has demonstrated excellent test-retest reliability, it is unknown if YBT performance changes following participation in a competitive athletic season. Objective: Determine if a competitive athletic season affects YBT performance in field hockey players. Design: Pretest-posttest. Setting: Laboratory. Participants: 20 NCAA Division I women's field hockey players (age = 19.55 ± 1.30 y; height = 165.10 ± 5.277 cm; mass = 62.62 ± 4.64 kg) from a single team volunteered. Participants had to be free from injury throughout the entire study and participate in all athletic activities. Interventions: Participants completed data collection sessions prior to (preseason) and following the athletic season (postseason). Between data collections, participants competed in the fall competitive field hockey season, which was ~3 months in duration. During data collection, participants completed the YBT bilaterally. Main Outcome Measures: The independent variable was time (preseason, postseason) and the dependent variables were normalized reach distances (anterior, posteromedial, posterolateral, composite) and between-limb symmetry for each reach direction. Differences between preseason and postseason were examined using paired t tests (P ≤ .05) as well as Bland-Altman limits of agreement. Results: 4 players sustained a lower extremity injury during the season and were excluded from analysis. There were no significant differences between preseason and postseason reach distances for any reach directions on either limb (P ≥ .31) or in the between-limb symmetries (P ≥ .52). The limits of agreement analyses determined there was a low mean bias across measurements (≤1.67%); however, the 95% confidence intervals indicated there was high variability within the posterior reach directions over time (±4.75 to ± 14.83%). Conclusion: No changes in YBT performance were identified following a competitive field hockey season in Division I female athletes. However, the variability within the posterior reach directions over time may contribute to the limited use of these directions for injury risk stratification.

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Are There Effective Intervention Strategies Available to Improve Physical Literacy in Adults? A Critically Appraised Topic

Chloe McKay, Johanna M Hoch, and Deirdre Dlugonski

Clinical Scenario: Physical inactivity among adults is prevalent. Physical literacy is a potential modifiable factor that, if targeted effectively, may increase physical activity and decrease the risk of health conditions that are associated with physical inactivity. Clinical Question: Are there effective intervention strategies available to improve physical literacy in adults? Summary of Key Findings: Two nonrandomized experimental studies were included. Both studies assessed changes in physical literacy before and after a physical literacy intervention using two different sets of physical literacy outcome measures. Clinical Bottom Line: There is currently Level 2, limited quality, patient-oriented evidence that indicates that physical literacy can be improved in an adult population. The creation of a valid and reliable physical literacy outcome measure for adults is a necessary next step to enhance knowledge about physical literacy among adults. Future research should use a randomized control trial design to test the efficacy of physical literacy interventions with valid and reliable outcome measures. Strength of Recommendation: There is Level 2, limited quality, patient-oriented evidence for physical literacy interventions among adults. Due to the limited number of, and lack of consistency between studies, the authors did not make a formal grade recommendation.

Open access

The Association of Fear-Avoidance Beliefs and Self-Reported Knee Function in Patients With a Knee Injury: A Critically Appraised Topic

Francesca Genoese, Shelby Baez, and Johanna M. Hoch

Clinical Question : Are fear-avoidance beliefs associated with self-reported knee function in patients with a knee injury? Clinical Bottom Line : There is currently consistent, good-quality, patient-oriented evidence that demonstrates an association between fear-avoidance beliefs and self-reported knee function in patients with a knee injury. Future research should longitudinally examine the association of fear-avoidance beliefs and self-reported knee function in patients with a knee injury.

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Using Patient Evidence to Guide Clinical Care: Consulting the Other Expert in the Room

Jennifer S. Howard, Aaron Sciascia, and Johanna M. Hoch

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Use of Goal Setting to Enhance Self-Efficacy After Sports-Related Injury: A Critically Appraised Topic

Caitlin Brinkman, Shelby E. Baez, Francesca Genoese, and Johanna M. Hoch

Clinical Scenario: Patients after sports-related injury experience deficits in self-efficacy. Goal setting may be an appropriate psychoeducation technique to enhance self-efficacy after sports-related injury. Clinical Question: Does goal setting–enhanced rehabilitation improve self-efficacy compared with traditional rehabilitation alone in individuals with sports-related injury? Summary of Key Findings: Two randomized controlled trials were included. The two studies selected assessed changes in self-efficacy before and after a goal-setting intervention following sports-related injury in an athletic population. Both studies used the Sports Injury Rehabilitation Beliefs Survey to evaluate self-efficacy. Clinical Bottom Line: There is currently consistent, good-quality, patient-oriented evidence that supports the use of goal setting to improve self-efficacy in patients undergoing rehabilitation for sports-related injury compared with the standard of care group. Future research should examine optimal timing for the implementation of goal setting in order to enhance self-efficacy following sports-related injury. Strength of Recommendation: The grade of A is recommended by the Strength of Recommendation Taxonomy for consistent, good-quality, patient-oriented evidence.

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Development of the Quick-FAAM: A Preliminary Shortened Version of the Foot and Ankle Ability Measure for Chronic Ankle Instability

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.