Classifiers of anterior cruciate ligament status in female and male adolescents using return-to-activity criteria.

PURPOSE: A lack of standardization exists for functional tasks in return-to-activity (RTA) guidelines for adolescents with anterior cruciate ligament injury (ACLi). Identifying the variables that discern ACLi status among adolescents is a first step in the creation of such guidelines following surgical reconstruction. This study investigated the use of classification models to discern ACLi status of adolescents with and without injury using spatiotemporal variables from functional tasks typically used in RTA guidelines for adults. METHODS: Sixty-four adolescents with ACLi and 70 uninjured adolescents completed single-limb hops, lunges, squats, countermovement jumps and drop-vertical jumps. Jumping distances, heights, and depths were collected. Decision trees (DTs) were used to classify ACLi status and were evaluated using the F-measure (F1), kappa statistic (ĸ) and area under the precision-recall curve (PRC). Independent t tests and effect sizes were calculated for each important classifier of the DT models. RESULTS: A five-variable model classified ACLi status with an accuracy of 67.5% (F1 = 0.6842; ĸ = 0.350; PRC = 0.491) with sex as a classifier. Significant differences were found in three of the four spatiotemporal variables (p ≤ 0.002). Separate models then classified ACLi status in males and females with an accuracy of 53.3% (F1 = 0.5882; ĸ = 0.0541; PRC = 0.476) and 76.9% (F1 = 0.7692; ĸ = 0.541; PRC = 0.528), respectively, with significant differences for all variables (p ≤ 0.013). CONCLUSIONS: Among the DT models, females were better able to classify ACLi status compared to males, highlighting the importance of sex-specific rehabilitation guidelines for adolescents. LEVEL OF EVIDENCE: Level III.

Oral Anticoagulant Use and Post-Fall Mortality in Long-Term Care Home Residents.

OBJECTIVES: Long-term care (LTC) residents are susceptible to falling and the risk of subsequent morbidity and mortality may be compounded with concurrent anticoagulation use. Uncertainty exists around the benefit and harm of anticoagulation use for residents with a high risk for falls because of concerns of major bleeding complications. We aimed to examine if anticoagulant use increases mortality risk among LTC residents who fall. DESIGN: A retrospective cohort study. SETTING AND PARTICIPANTS: Older adults (≥65 years) admitted to a LTC facility in Ontario, Canada between January 1, 2010, and December 1, 2019, who were transferred to emergency departments for fall-related injuries. METHODS: The exposure was the use of an oral anticoagulant (OAC). The primary outcome was mortality within 30 days of transfer. Secondary outcomes were major hemorrhage and care utilization. We used hierarchical logistic regression models to examine the association between the use of OAC and 30-day mortality. RESULTS: There were 56,419 residents transferred to the hospital for a fall, of whom 9611 (17.0%) were on an OAC. At 30 days, 5794 (10.3%) of the cohort had died: 12.0% (1151) on an OAC and 9.90% (4643) not on an OAC [risk difference (RD), 2.1%; 95% CI, 1.40%-2.82%]. There were 485 major hemorrhage cases: 1.3% (125) on an OAC and 0.8% (360) not on an OAC (RD, 0.5%; 95% CI, 0.26%-0.74%). Multivariable analysis found no significant association between OAC use and 30-day mortality [odds ratio (OR), 0.98; 95% CI, 0.90-1.06], but an increased risk of major hemorrhage (OR, 1.31; 95% CI, 1.04-1.66). Both groups had similar health system and neurosurgical care utilization. CONCLUSIONS AND IMPLICATIONS: Among LTC residents transferred to the emergency department for fall-related injuries, OACs did not increase the risk of post-fall mortality. OAC prescribing for frail older adults who experience falls should consider their individual risk profile.

Decision Tree Learning Algorithm for Classifying Knee Injury Status Using Return-to-Activity Criteria.

Anterior cruciate ligament (ACL) injury rates in female adolescents are increasing. Irrespective of treatment options, approximately 1/3 will suffer secondary ACL injuries following their return to activity (RTA). Despite this, there are no evidence-informed RTA guidelines to aid clinicians in deciding when this should occur. The first step towards these guidelines is to identify relevant and feasible measures to assess the functional status of these patients. The purpose of this study was therefore to evaluate tests frequently used to assess functional capacity following surgery using a Reduced Error Pruning Tree (REPT). Thirty-six healthy and forty-two ACLinjured adolescent females performed a series of functional tasks. Motion analysis along with spatiotemporal measures were used to extract thirty clinically relevant variables. The REPT reduced these variables down to two limb symmetry measures (maximum anterior hop and maximum lateral hop), capable of classifying injury status between the healthy and ACL injured participants with a 69% sensitivity, 78% specificity and kappa statistic of 0.464. We, therefore, conclude that the REPT model was able to evaluate functional capacity as it relates to injury status in adolescent females. We also recommend considering these variables when developing RTA assessments and guidelines.Clinical Relevance- Our results indicate that spatiotemporal measures may differentiate ACL-injured and healthy female adolescents with moderate confidence using a REPT. The identified tests may reasonably be added to the clinical evaluation process when evaluating functional capacity and readiness to return to activity.

Translation and Validation of the Hospital for Special Surgery Pediatric Functional Activity Brief Scale for French Paediatric Populations.

Purpose: Physical activity level is a prognostic variable for patients with injuries. Self-report questionnaires exist to obtain these measures; however, they are not accessible to all populations because of language barriers. Therefore, the purpose of this study was to translate and validate the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) for francophones. Method: We translated the HSS Pedi-FABS using the forward-reverse translation approach and validated it among bilingual adults and an expert panel before administering it to a paediatric population. A repeated-measures crossover design was used: forty-three middle school students, aged 13.1 (SD 0.75) years, were randomly administered either the English or the French questionnaire. Two days later, all participants completed the other version. The translated questionnaire was assessed for its convergent validity (Spearman's r correlation coefficients [rs ]), internal consistency (Cronbach's α), and reliability (standard error of measurement [SEM]). Results: All assessments had a significance level of p < 0.001 with an excellent Spearman's r correlation coefficient between the participants' total scores on the translated questionnaires (rs  = 0.911). The overall scores for the questionnaire and the individual items of the questionnaire revealed excellent internal consistency (α = 0.868) and reliability (SEM = 0.334). Conclusions: The validated and reliable translated questionnaire can be used by researchers and clinicians to assess physical activity levels in French paediatric populations.

Objectif : le niveau d'activité physique est un pronostic variable pour les patients qui présentent des blessures. Il existe des questionnaires d'autoévaluation pour obtenir ces mesures, mais ils ne sont pas accessibles à toutes les populations à cause de la barrière de la langue. La présente étude visait à traduire et à valider le Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) pour les francophones. Méthodologie : les chercheurs ont traduit le HSS Pedi-FABS au moyen du processus de rétrotraduction et l'ont validé auprès d'adultes bilingues et d'un groupe d'experts avant de l'utiliser auprès d'une population pédiatrique. Ils ont utilisé une méthodologie transversale par mesures répétées : 43 élèves du début du secondaire de 13,1 ans (ÉT 0,75) ont répondu au hasard au questionnaire anglais ou français. Deux jours plus tard, tous les participants ont rempli l'autre version. Les questionnaires traduits ont été évalués pour leur validité convergente (coefficients de corrélation Rho de Spearman [rs ]), leur cohérence interne (coefficient alpha [α] de Cronbach) et leur fiabilité (erreur type de mesure). Résultats : toutes les évaluations présentaient un seuil de signification de p < 0,001 et un excellent coefficient de corrélation Rho de Spearman entre les scores totaux des participants dans les questionnaires traduits (rs  = 0,911). Les scores totaux du questionnaire et de chacun de ses éléments ont révélé une excellente cohérence interne (α = 0,868) et une excellente fiabilité (erreur type de mesure = 0,334). Conclusion : le questionnaire validé et traduit avec fiabilité peut être utilisé par les chercheurs et les cliniciens pour évaluer les niveaux d'activité physique de populations pédiatriques francophones.