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Lewis J. Macgregor, Massimiliano Ditroilo, Iain J. Smith, Malcolm M. Fairweather and Angus M. Hunter

Context:

Assessments of skeletal-muscle functional capacity often necessitate maximal contractile effort, which exacerbates muscle fatigue or injury. Tensiomyography (TMG) has been investigated as a means to assess muscle contractile function after fatigue; however, observations have not been contextualized by concurrent physiological measures.

Objective:

To measure peripheral-fatigue-induced alterations in mechanical and contractile properties of the plantar-flexor muscles through noninvasive TMG concurrently with maximal voluntary contraction (MVC) and passive muscle tension (PMT) to validate TMG as a gauge of peripheral fatigue.

Design:

Pre- and posttest intervention with control.

Setting:

University laboratory.

Participants:

21 healthy male volunteers.

Interventions:

Subjects’ plantar flexors were tested for TMG parameters, along with MVC and PMT, before and after either a 5-min rest period (control) or a 5-min electrical-stimulation intervention (fatigue).

Main Outcome Measures:

Temporal (contraction velocity) and spatial (radial displacement) contractile parameters of the gastrocnemius medialis were recorded through TMG. MVC was measured as an indicator of muscle fatigue, and PMT was measured to assess muscle stiffness.

Results:

Radial displacement demonstrated a fatigue-associated reduction (3.3 ± 1.2 vs 4.0 ± 1.4 mm, P = .031), while contraction velocity remained unaltered. In addition, MVC significantly declined by 122.6 ± 104 N (P < .001) after stimulation (fatigue). PMT was significantly increased after fatigue (139.8 ± 54.3 vs 111.3 ± 44.6 N, P = .007).

Conclusions:

TMG successfully detected fatigue, evident from reduced MVC, by displaying impaired muscle displacement accompanied by elevated PMT. TMG could be useful in establishing skeletalmuscle fatigue status without exacerbating the functional decrement of the muscle.

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Barbara C. Belyea, Ethan Lewis, Zachary Gabor, Jill Jackson and Deborah L. King

Context: Lower-extremity landing mechanics have been implicated as a contributing factor in knee pain and injury, yet cost-effective and clinically accessible methods for evaluating movement mechanics are limited. The identification of valid, reliable, and readily accessible technology to assess lower-extremity alignment could be an important tool for clinicians, coaches, and strength and conditioning specialists. Objective: To examine the validity and reliability of using a handheld tablet and movement-analysis application (app) for assessing lower-extremity alignment during a drop vertical-jump task. Design: Concurrent validation. Setting: Laboratory. Participants: 22 healthy college-age subjects (11 women and 11 men, mean age 21 ± 1.4 y, mean height 1.73 ± 0.12 m, mean mass 71 ± 13 kg) with no lower-extremity pathology that prevented safe landing from a drop jump. Intervention: Subjects performed 6 drop vertical jumps that were recorded simultaneously using a 3-dimensional (3D) motion-capture system and a handheld tablet. Main Outcomes Measures: Angles on the tablet were calculated using a motion-analysis app and from the 3D motion-capture system using Visual 3D. Hip and knee angles were measured and compared between both systems. Results: Significant correlations between the tablet and 3D measures for select frontal- and sagittal-plane ranges of motion and angles at maximum knee flexion (MKF) ranged from r = .48 (P = .036) for frontal-plane knee angle at MKF to r = .77 (P < .001) for knee flexion at MKF. Conclusion: Results of this study suggest that a handheld tablet and app may be a reliable method for assessing select lower-extremity joint alignments during drop vertical jumps, but this technology should not be used to measure absolute joint angles. However, sports medicine specialists could use a handheld tablet to reliably record and evaluate lower-extremity movement patterns on the field or in the clinic.

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Scott W. Cheatham

Background: In sports medicine, the interprofessional care of athletes has become a frequent practice. This type of care often involves different interventions used among professionals. One common intervention prescribed is roller massage (RM) or self-myofascial release. The trends in the use of RM among allied health professionals are nonexistent. The surveillance of such responses has not been documented. Purpose: To survey and document responses in the knowledge, clinical application, and use of RM devices among allied health professionals in the United States. Design: Cross-sectional descriptive survey study. Methods: A 20-question survey was sent to allied health professionals including physical therapists, athletic trainers, and fitness professionals. The survey covered topics such as demographics, beliefs about RM, preferred devices, exercise prescription, and client education. Results: One thousand and forty-two professionals (N = 1042) completed the survey. Most respondents believed that RM decreases pain (82%) and increases mobility (76%). A high percentage use a foam roller in their practice (81%), recommend a full-size foam roller (49%), and believe the medium density (48%) is the most effective. A high proportion of respondents prescribe RM for injury treatment (69%) and for preexercise and postexercise (61%). They also recommend rolling daily for 30 seconds to 2 minutes per muscle group (33%) at a self-paced cadence (46%). A high percentage of respondents use patient-reported outcomes (74%), joint range of motion (49%), and movement-based testing (48%) to measure effects of RM. Eighty-seven percent use live instruction to educate clients, and 88% believe there is a gap in the research. Conclusion: The results of this survey document responses in the use of RM among allied health professionals. The reported responses provide insight into how professionals are using RM as an intervention and the potential gaps between the research and professional practice. Future studies are needed to further validate these findings.

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Scott Cheatham, Morey J. Kolber and Michael P. Ernst

Context:

Pulse oximetry has become mobile with the use of smartphone and Bluetooth wireless technology. This technology offers many benefits but has not been extensively studied. There is a need to further validate its clinimetric properties for health professionals to provide proper guidance to patients.

Objective:

This investigation assessed the concurrent validity of the iSpO2 pulse oximeter against a traditional pulse oximeter in measuring short-term resting blood oxygen saturation (SpO2) and pulse rate.

Design:

Observational study of reliability.

Setting:

University kinesiology laboratory.

Participants:

Thirty healthy, recre-ationally active adults (18 men, 12 women; mean age = 25.7 ± 5.46 years, mean height = 170.3cm ± 9.51, mean body mass = 76.4 kg ± 19.33).

Intervention:

Resting measurement of SpO2 and pulse rate using the iSpO2 pulse oximeter with the iPad Mini and a traditional pulse oximeter with Bluetooth.

Main Outcome Measure:

Resting SpO2 and pulse rate were concurrently measured over 5 min.

Results:

The concurrent validity between the iSpO2 and traditional pulse oximeter was moderate for measuring SpO2, intraclass correlation coeffcient (ICC)(3, 1) = .73, SEM = 0.70%, and good for pulse rate, ICC(3, 1) = .97, SEM = 1.74 beats per minute (bpm). The minimal detectable change at the 95% confidence interval for both instruments suggests that there may be 1.94% disagreement for SpO2 and 4.82 bpm disagreement between pulse oximetry methods. The 95% limits of agreement (LoA) for measuring SpO2 suggests that the iSpO2 and traditional pulse oximeters may vary -0.28 ± 1.98%, or approximately 2%. The 95% LoA for measuring pulse rate suggests that the iSpO2 and traditional pulse oximeter may vary 1.74 ± 4.98 bpm, potentially upward of 6 bpm. On the basis of the results of the LoA, it appears that there may be a slight systematic bias between the two devices, with the traditional pulse oximeter producing higher pulse rates than the iSpO2.

Conclusion:

The findings suggest that both instruments may be beneficial for indirect short-term measurements of resting SpO2 and pulse rate.

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Robert J. de Vos, Marinus P. Heijboer, Harrie Weinans, Jan A.N. Verhaar and Hans T.M. van Schie

Context:

Chronic midportion Achilles tendinopathy is a common and hard-to-treat disorder characterized by degenerative changes of the tendon matrix. Ultrasonographic tissue characterization (UTC) was successfully used to quantify structural human Achilles tendon changes. This novel and reliable technique could be used in follow-up studies to relate tendon structure to symptoms.

Objective:

To quantify structural tendon changes and assess clinical change in patients with tendinopathy.

Design:

Prospective observational study.

Setting:

Orthopedic department in a university medical center.

Patients:

23 patients with chronic midportion Achilles tendinopathy.

Intervention:

The patients performed a 16-wk home-based eccentric exercise program. An experienced researcher performed the ultrasonographic data collection with the UTC procedure. These data were assessed by a blinded observer. The severity of symptoms was established with the validated Victorian Institute of Sport Assessment–Achilles (VISA-A) questionnaire.

Main Outcome Measures:

UTC was performed to quantify tendon structure through measuring the proportion of 4 echo types. Echo types I and II represent more or less organized tendon bundles, and echo types III and IV represent disintegrated tendon structure. On the VISA-A, the total possible score is divided by 100 for a percentage score, with a perfect score of 100. Follow-up was at 2, 8, 16, and 24 wk.

Results:

The mean percentage of echo types I and II changed by 0.3% after 24 wk (P = .92, 95% CI −5.8 to 5.3). The mean VISA-A score increased slightly but significantly by 11.3 points after 24 wk (P = .01, 95% CI 2.6–20.0). An increased VISA-A score was not correlated with an increased percentage of echo types I and II (P = .94, r = −.02), and the baseline percentage of echo types I and II did not correlate with an increased VISA-A score (P = .74, r = .07).

Conclusions:

There is no short-term increase in organized tendon structure after eccentric exercises. Tendon structure is not related to symptom severity and cannot be used as a predictor of clinical outcome.

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Mark A. Sutherlin

Collegiate Swimmers Shoulder Functional Performance Status on National Collegiate Athletic Association Swimmers: Baseline Kerlan-Jobe Orthopedic Clinic Scores Development and Validation of a Swimmer’s Functional Pain Scale Study Participants 18 NCAA Division II female swimmers 99 NCAA swimmers 58 USA

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Reed D. Gurchiek, Hasthika S. Rupasinghe Arachchige Don, Lasanthi C. R. Pelawa Watagoda, Ryan S. McGinnis, Herman van Werkhoven, Alan R. Needle, Jeffrey M. McBride and Alan T. Arnholt

to train and validate the regression models. Since regression models are improved with more observations and the photocells failed to register the 40-m time for some of the sprints, only the 10-, 20-, and 30-m split times were used in this study. Of the 84 sprint trials, the photocell system false

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Elshan Najafov, Şeyda Özal, Ahmet Yiğit Kaptan, Coşkun Ulucaköy, Ulunay Kanatlı, Baybars Ataoğlu and Selda Başar

examination findings (range of motion and muscle strength assessment) constitute the remaining 65 points. Originally, Constant and Murley did not give a standard test protocol in their first article and the CMS did not undergo validation. 11 Multiple modifications were made after its development. 12 The

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Christopher J. Burcal, Sunghoon Chung, Madison L. Johnston and Adam B. Rosen

properties of PROs. The Foot and Ankle Ability Measure (FAAM) assesses function during activities of daily living (FAAM-ADL) and sports (FAAM-Sport). 5 It is a common PRO that can be used during the initial evaluation of a patient as well as a metric to assess treatment success. The FAAM has been validated

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Sarah P. Shultz, Jinsup Song, Andrew P. Kraszewski, Jocelyn F. Hafer, Smita Rao, Sherry Backus, Rajshree M. Hillstrom and Howard J. Hillstrom

extract the parameters associated most strongly with foot type. A third canonical regression analysis was performed on the pooled extracted structure, function, and flexibility variables to find a combined model. Cross-validation is a standard statistical method that is used to validate a model with data