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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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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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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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Courtney J. DeFeo, Nathan Morelli, and Matthew C. Hoch

Clinical Scenario: Postural control deficits are one of the most common impairments associated with sport-related concussion. The Modified Balance Error Scoring System (mBESS) is one of the current standard clinical measures for assessing these deficits; however, it is dependent upon observer-rated measurements. Advancements in inertial measurement units (IMUs) lend themselves to be a viable option in objectifying postural control assessments, such as the mBESS. Clinical Question: Are IMU-based measures of the mBESS more effective than observer-rated measures of the mBESS in identifying patients with sport-related concussion? Summary of Key Findings: Following a systematic search, three studies were included. One study compared observer-rated measures of the Balance Error Scoring System and mBESS to instrumented measures of both tests and determined that the instrumented mBESS had the highest diagnostic accuracy. The results of the second study determined that IMU-based measures were successful in both classifying group and identifying task errors. The final study found that using IMUs increased sensitivity of the mBESS, specifically the double-limb stance, to group classification. Clinical Bottom Line: Instrumentation of the mBESS using IMUs provides more objective and sensitive measures of postural control in patients with SRC. Strength of Recommendation: Due to the consistent, good-quality evidence used to answer this critically appraised topic, the grade of A is recommended by the Strength of Recommendation Taxonomy.

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Emily H. Gabriel, Cameron J. Powden, and Matthew C. Hoch

Context: The Y-Balance Test (YBT) and Star Excursion Balance Test (SEBT) are commonly used to detect deficits in dynamic postural control. There is a lack of literature on the differences in reach distances and efficiency of the tests. Objective: To compare the reach distances of the YBT and SEBT. An additional aim was to compare the time necessary to administer the 2 tests and utilize a discrete event simulation to determine the number of participants who could be screened within different scenarios. Design: Cross-sectional. Laboratory Patients: Twenty-four physically active individuals between the ages of 18–35 years volunteered to participate in this study (M/F: 11/13; age 22.78 [2.63] y, height 68.22 [4.32] cm, mass 173.27 [10.96] kg). Intervention: The participants reported to the laboratory on one occasion and performed the YBT and SEBT. The anterior, posteromedial, and posterolateral reach distances were recorded for each test. In addition, the time to administer each test was recorded in seconds. Main Outcome Measures: The average reach distances and time for each test were used for analysis. Paired t tests were utilized to compare the reach distances and time to administer the 2 tests. A discrete event simulation was used to determine how many participants could be screened using each test. Results: The anterior reach for the SEBT (64.52% [6.07%]) was significantly greater than the YBT (61.66% [6.37%]; P < .01). The administration time for the YBT (512.42 [123.97] s) was significantly longer than the administration time for the SEBT (364.96 [69.46] s; P < .01). The discrete event simulation revealed more participants could be screened using the SEBT when compared with the YBT for every situation. Conclusion: Scores on the anterior reach of the SEBT are larger when compared with the YBT. The discrete event simulation can successfully be used to determine how many participants could be screened with a certain amount of resources given the use of a specific test.

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Megan N. Houston and Matthew C. Hoch

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Johanna M. Hoch, Jamie L. Legner, Christina Lorete, and Matthew C. Hoch

Context: Documented barriers to implementation of patient-reported outcome instruments (PROs) in practice include administration and scoring time. The Quick Foot and Ankle Ability Measure (Quick-FAAM) was developed to decrease these barriers; however, the clinometric properties in an acute population are unknown. Purpose: To determine the internal consistency, validity, and the floor and ceiling effects of the Quick-FAAM in patients seeking treatment for an acute or subacute ankle or foot health condition. Study Design: Cross-Sectional. Setting: Healthcare facilities. Patients: 50 patients (20.3 ± 2.2 y, 177.9 ± 10.7 cm, 80 ± 19.4 kg) seeking treatment for an acute or subacute ankle or foot condition. Main Outcome Measures: Each patient completed a demographic and health-history questionnaire followed by 5 PROs: the Quick-FAAM, the FAAM-Activities of Daily Living (ADL), FAAM-Sport, the modified Disablement in the Physically Active Scale (mDPA), the Short-Form 12 (SF-12) and the PROMISv1.2 Physical Function (PROMIS-PF). Cronbach alpha was used to determine internal consistency and Spearman’s rank correlations were performed to examine the relationship between the Quick-FAAM and all other outcomes. Results: The Quick-FAAM was very strongly correlated with the FAAM-Total (r = .91, r 2 = .83, P < .001), FAAM-ADL (r = .83, r 2 = .69, P < .001), FAAM-Sport (r = .89, r 2 = .79, P < .001), SF12-Physical Component Score (PCS, r = .74, r 2 = .55, P < .001), mDPA-PCS (r = -.83, r 2 = .69, P < .001) and PROMIS PF (r = .85, r 2 = .72, P < .001). There was a weak or no relationship with the SF12-Mental Component Score (MCS, r = .04, r 2 = .00, P < .001) and the mDPA-MCS (r = -.35, r 2 = .12, P < .001). A total of 8% (n = 4) of the patients scored a 0, and 2% (n = 1) patients scored a 48. Conclusion: The Quick-FAAM demonstrated good convergent and divergent validity along with good internal consistency. There was no evidence of a floor or ceiling effect. Therefore, the Quick-FAAM should be considered for use in practice when determining treatment effectiveness for patients with acute or subacute ankle or foot health conditions. Future research should determine the test-retest reliability and the minimal detectable change of this instrument.

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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.