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Megan D. Granquist, Diane L. Gill and Renee N. Appaneal

Context:

Rehabilitation adherence is accepted as a critical component for attaining optimal outcomes. Poor adherence is recognized as a problem in the athletic training setting. Measurement has been inconsistent, and no measure has been developed for athletic training settings.

Objective:

To identify indicators of sportinjury rehabilitation adherence relevant to athletic training and develop a Rehabilitation Adherence Measure for Athletic Training (RAdMAT) based on these indicators.

Design:

Mixed methods, 3 steps.

Setting:

College athletic training facility.

Participants:

Practicing certified athletic trainers (ATCs; n = 7) generated items, experts (n = 12) reviewed them, and practicing ATCs (n = 164) completed the RAdMAT for their most, average, and least adherent athlete.

Main Outcome Measure:

RAdMAT.

Results:

The RAdMAT is 16 items with 3 subscales. Subscales and total have good internal consistency and clearly discriminate among adherence levels.

Conclusions:

The RAdMAT is based on scholarly literature and clinical practice, making it particularly appropriate for use in athletic training clinical practice or for research purposes.

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Paul A. Borsa, Scott M. Lephart, Mininder S. Kocher and Susan P. Lephart

Following injury to the articular ligaments, disruption of mechanoreceptors results in partial deafferentation of the joint. This has been shown to inhibit normal neuromuscular joint stabilization, and it contributes to repetitive injuries and the progressive decline of the joint. Assessment of proprioception is valuable in identification of proprioceptive deficits and subsequent planning of the rehabilitation program. A shoulder rehabilitation program must address both the mechanical and sensory functions of articular structures by incorporating a proprioceptive training element within the normal protocol. The objective of proprioception rehabilitation is to enhance cognitive appreciation of the respective joint relative to position and movement, and to enhance muscular stabilization of the joint in the absence of structural restraints. If these objectives are properly addressed, the restoration of the proprioceptive mechanism will prevent further disability of the shoulder joint.

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Julie K. Wilson, Thomas L. Sevier, Robert Helfst, Eric W. Honing and Aly Thomann

Objective:

To compare outcomes of 2 rehabilitation protocols on patellar tendinitis subjects.

Design:

Prospective, randomized, blinded, controlled clinical trial.

Setting:

Outpatient rehabilitation clinic.

Subjects:

Randomized into 2 rehabilitation groups—traditional (n = 10) and ASTM AdvantEDGE (n = 10).

Main Outcome Measures:

Clinical data and self-reported questionnaires collected at 0, 6, and 12 weeks.

Results:

On completion of the 6th week, 100% of the ASTM AdvantEDGE group and 60% of the traditional group had resolved. The unresolved subjects were crossed over to the ASTM AdvantEDGE for additional therapy. At the end of the additional therapy, 50% of the crossover subjects had resolved. The ASTM AdvantEDGE group's clinical outcomes and weekly journals indicated a statistically significant (P = .04) improvement in subjective pain and functional-impairment ratings.

Conclusions:

Findings suggest that ASTM AdvantEDGE resulted in improved clinical outcomes in treating patellar tendinitis.

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Carla Sordoni, Craig Hall and Lorie Forwell

Objectives:

To determine whether athletes use motivational and cognitive imagery during injury rehabilitation and to develop an instrument for measuring imagery use.

Design:

A survey concerning imagery use during rehabilitation was administered to injured athletes.

Setting:

The Fowler Kennedy Sport Medicine Clinic in London, Ontario, Canada.

Participants:

Injured athletes (N = 71) receiving physiotherapy.

Main Outcome Measure:

The Athletic Injury Imagery Questionnaire (AIIQ).

Results:

As hypothesized, 2 distinct factors emerged from the items on the AIIQ: motivational and cognitive imagery. Motivational imagery was used more often than cognitive imagery in this context, yet less frequently than in other sport situations (eg, training and competition).

Conclusions:

The study indicates that the AIIQ is a potentially useful tool through which physiotherapists and sport psychologists can examine athletes' use of imagery in injury rehabilitation.

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Alana Ninedek and Gregory S. Kelt

Context:

Recent literature has focused on the role of physiotherapists in addressing psychological sequelae of sport injury and rehabilitation.

Objective:

The study investigated sports physiotherapists' views of psychological characteristics that distinguished athletes who cope well with injury from those who cope poorly. Physiotherapists' opinions on the role of psychological skills in rehabilitation were also examined.

Design:

A questionnaire-based study.

Participants:

Participants were 150 physiotherapists who had completed, or were completing, a postgraduate sports physiotherapy program.

Main Outcome Measures:

The test instrument used was the Sports Physiotherapists' Views on Psychological Strategies questionnaire (adapted from Wiese et al1).

Results:

The physiotherapists reported communication skills, a positive attitude, intrinsic motivation, and realistic goal setting as important aspects of effective rehabilitation.

Conclusions:

The findings are discussed in relation to physiotherapists' roles in addressing basic psychological aspects of injury.

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Matthew P. Bejar, Leslee A. Fisher, Benjamin H. Nam, Leslie K. Larsen, Jamie M. Fynes and Rebecca A. Zakrajsek

Although the biopsychosocial model of sport injury rehabilitation (Brewer, Andersen, & Van Raalte, 2002) is one of the most comprehensive frameworks to address athletes’ postinjury responses, there has been little research centralizing the myriad of cultural factors (e.g., nationality, ethnicity, socioeconomic status) that can impact psychological, social/contextual, and biological factors that, in turn, impact athletes’ recovery. The purpose of the current study was to explore high-level South Korean athletes’ experiences of injury and rehabilitation. Retrospective semistructured interviews were conducted with 11 retired high-level South Korean athletes. Employing Consensual Qualitative Research (CQR) methodology (Hill, 2012), four domains were constructed from the data: (a) Experience of the South Korean Sport System, (b) Immediate Post-Injury Perceptions, (c) Experience of Recovery Process, and (d) Post-Injury Reflections. The findings indicated that participants’ experiences of the forced hierarchy and power dynamics within the South Korean athletic specialist system influenced perceived sport injury rehabilitation outcomes.

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Diane M. Wiese and Maureen R. Weiss

Psychological rehabilitation in response to physical injury is of primary concern to athletes, trainers, coaches, and sport psychologists. To date, there is little empirical research to shed light on this topic, as well as on the role of sport psychology practitioners in facilitating the prevention, rehabilitation, and recovery from athletic injuries. The purpose of this paper is to consolidate and report the information available on the nature of injuries and make suggestions concerning the application of sport psychology principles when working with injured athletes. Four major concerns are addressed with regard to current knowledge and practical implications: how injuries happen, how athletes respond to injuries, how psychological rehabilitation as well as physical recovery from injuries can be facilitated, and determining when injured athletes are psychologically ready to return to competition.

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Scott W. Cheatham, Keelan R. Enseki and Morey J. Kolber

Context:

Hip arthroscopy has become an increasingly popular option for active individuals with recalcitrant hip pain. Conditions that may be addressed through hip arthroscopy include labral pathology, femoral acetabular impingement, capsular hyperlaxity, ligamentum teres tears, and the presence of intra-articular bodies. Although the body of literature examining operative procedures has grown, there is a paucity of evidence specifically on the efficacy of postoperative rehabilitation programs. To date, there are no systematic reviews that have evaluated the available evidence on postoperative rehabilitation.

Objective:

To evaluate the available evidence on postoperative rehabilitation programs after arthroscopy of the hip joint.

Evidence Acquisition:

A search of the PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar databases was conducted in January 2014 according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews.

Evidence Synthesis:

Six studies met the inclusion criteria and were either case series or case reports (level 4 evidence) that described a 4- or 5-phase postoperative rehabilitation program. The available evidence supports a postoperative period of restricted weight bearing and mobility; however, the specific interventions in the postoperative phases are variable with no comparison trials.

Conclusion:

This review identified a paucity of evidence on postoperative rehabilitation after hip arthroscopy. Existing reports are descriptive in nature, so the superiority of a particular approach cannot be determined. One can surmise from existing studies that a 4- to 5-stage program with an initial period of weight-bearing and mobility precautions is efficacious in regard to function, patient satisfaction, and return to competitive-level athletics. Clinicians may consider such a program as a general guideline but should individualize treatment according to the surgical procedure and surgeon guidelines. Future research should focus on comparative trials to determine the effect of specific postoperative rehabilitation designs.

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James J. Irrgang, Susan L. Whitney and Emily D. Cox

Recently there has been emphasis on including balance and proprioceptive training in the rehabilitation of sports-related lower extremity injuries. It is believed that injury to joint and musculotendinous structures results in altered somatosensory information that adversely affects motor control. This may result in increased risk for recurrent injury, decreased performance, or both. Balance and proprioceptive training have been advocated to restore motor control to the lower extremity. This paper will review the current scientific rationale for use of balance and proprioceptive training in the rehabilitation of sports-related lower extremity injuries. Additionally, guidelines for training to improve balance and proprioception will be discussed.

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Joe Hart, Damien Clement, Jordan Hamson-Utley, Monna Arvinen-Barrow, Cindra Kamphoff, Rebecca A. Zakrajsek and Scott B. Martin

Context:

Injured athletes begin the rehabilitation process with expectations about the nature of the working relationship with an athletic trainer. These expectations can infuence the effectiveness of the assistance provided.

Objective:

To determine whether male and female athletes differed in terms of expectations about injury rehabilitation services with an athletic trainer.

Design:

A questionnaire was administered to student athletes that assessed expectations about injury rehabilitation. Setting: Five colleges and universities.

Patients or Other Participants:

Questionnaire responses were provided by 679 student athletes (443 males and 236 females).

Main Outcome Measure:

Responses to the Expectations about Athletic Training questionnaire were used to assess factors identifed as Personal Commitment, Facilitative Conditions, Athletic Trainer Expertise, and Realism.

Results:

A statistically signifcant interaction between gender and prior experience was identifed. Male athletes with no prior experience had lower expectations for a facilitative environment. Female athletes with prior experience were less likely to have realistic expectations.

Conclusions:

Gender and prior experience infuence athletes’ expectations of injury rehabilitation with an athletic trainer.