Clinical Scenario : The anterior cruciate ligament (ACL) injury is a common knee injury within varying athletic levels. Clinical diagnostic tests and magnetic resonance imaging (MRI) are two methods of evaluating ACL injuries. Clinical Question : Are clinical diagnostic tests as accurate as MRI when diagnosing ACL tears? Summary of Key Findings: Three cross-sectional design studies were included. One study found that clinical diagnostic tests were superior to MRI when diagnosing an ACL tear. Another study found that clinical diagnostic tests were equal to MRI when measuring sensitivity, but scored higher in specificity, positive predictive value, negative predictive value, and diagnostic accuracy. The last study found that clinical diagnostic tests scored higher than MRI on specificity and positive predictive value, were equal when measuring accuracy, and scored lower when measuring sensitivity and negative predictive value. Clinical Bottom Line: The evidence supports the use of clinical diagnostic tests when diagnosing an ACL tear. Strength of Recommendation: Level 2–3.
Megan P. Brady and Windee Weiss
Megan P. Brady and Windee Weiss
Common injuries in high-level and recreational athletes, nonathletes, and the elderly are medial and lateral meniscus tears. Diagnosis of meniscus tears is done with clinical exam, magnetic resonance imaging (MRI), and arthroscopy. The gold standard is arthroscopy, but accuracy of a clinical exam versus MRI diagnosis of meniscus tears is in question. A clinician’s ability to detect a meniscus tear is beneficial to the patient from a timing standpoint. The process of obtaining an MRI and results could be lengthy, but if the meniscus tear is accurately diagnosed clinically, the patient could be suspended from athletics or specific job duties to prevent further injury. In addition, rehabilitation could be initiated immediately, resulting in better outcomes for the patient. The ability to diagnose a meniscus tear clinically could initiate the rehabilitation process much sooner than waiting for MRI testing and results. Beginning the rehabilitation phase earlier may lead to faster postoperative rehabilitation and better patient outcomes. Clinical detection of a meniscus tear will facilitate possible suspension, early treatment, and rehabilitation recommendations, but the MRI will provide more specific information about the injury, including type and location of tear. Thus, surgical decisions such as operative versus nonoperative or meniscectomy versus repair would be based on MRI results.
Focused Clinical Question:
Is a clinical exam as accurate as an MRI scan for diagnosing meniscus tears?
Windee M. Weiss and Maureen R. Weiss
The purpose of this study was to examine correlates of attraction- and entrapment-based commitment among young competitive female gymnasts. Participants were 124 gymnasts (Levels 9, 10, and Elite) ranging in age from 10 to 18 years. Based on theory and research (Raedeke, 1997; Schmidt & Stein, 1991), commitment profiles were determined based on benefits, costs, enjoyment, personal investments, and attractive alternatives. Three profiles emerged when using cluster analysis. Attracted gymnasts were higher in enjoyment and benefits but lower in costs and attractive alternatives. Entrapped gymnasts were lower in enjoyment and benefits but higher in costs and attractive alternatives. Vulnerable gymnasts were moderately lower in enjoyment and benefits, average in costs, and moderately higher in attractive alternatives. These groups were significantly different on social support, social constraints, motivational orientation, and training behaviors. The three profiles were similar but not identical to Schmidt and Stein’s predicted types of commitment, with each type being further differentiated by social, motivational, and behavioral variables.
Rachel E. Brinkman-Majewski and Windee M. Weiss
Context: The motivational climate created by the athletic trainer in rehabilitation may be critical in influencing athletes’ intrinsic motivation and other psychosocial outcomes in the rehabilitation and the recovery processes. Objective: To examine intercollege athletes’ perceptions of the motivational climate in the rehabilitation setting. Specifically, examining if perceptions of the motivational climate can predict athletes’ levels of intrinsic motivation with rehabilitation as well as the relationship between perceptions of the motivational climate and athlete demographics (gender, starter status, athletic trainer gender, etc). Design: Cross-sectional, descriptive research. Setting: College sport team and athletic training center. Participants: National Collegiate Athletic Association Division II intercollege athletes from one institution (n = 187; 125 males and 62 females). Main Outcome Measures: Paper-based survey measuring mastery and performance perceptions of the motivational climate in rehabilitation, athletes’ goal orientation in sport, and athletes’ levels of motivation in rehabilitation. Results: Perceptions of a performance climate were positively related to intrinsic motivation effort–improvement (effect size = 25.34%). Perceptions of a mastery climate were positively related to interest–enjoyment and perceived competence and negatively related to tension–pressure (effect size = 39.03%). In general, female athletes, as well as athletes with a female athletic trainer, had significantly higher perceptions of mastery motivational climate effort–improvement than male athletes and athletes with male athletic trainers. While male athletes and athletes with male athletic trainers had higher perceptions of intrateam member rivalry in rehabilitation. Conclusions: The athlete’s gender and goal orientation, as well as the gender of the athletic trainer creating the motivational climate, can influence whether the environment is perceived as more mastery or performance. The recovering athletes’ perceptions of the climate in rehabilitation can, in turn, affect their intrinsic motivation toward the therapeutic interventions.