Breaking down the Digital Fortress: The Unseen Challenges in Healthcare Technology-Lessons Learned from 10 Years of Research.

Healthcare is undergoing a fundamental shift in which digital health tools are becoming ubiquitous, with the promise of improved outcomes, reduced costs, and greater efficiency. Healthcare professionals, patients, and the wider public are faced with a paradox of choice regarding technologies across multiple domains. Research is continuing to look for methods and tools to further revolutionise all aspects of health from prediction, diagnosis, treatment, and monitoring. However, despite its promise, the reality of implementing digital health tools in practice, and the scalability of innovations, remains stunted. Digital health is approaching a crossroads where we need to shift our focus away from simply looking at developing new innovations to seriously considering how we overcome the barriers that currently limit its impact. This paper summarises over 10 years of digital health experiences from a group of researchers with backgrounds in physical therapy-in order to highlight and discuss some of these key lessons-in the areas of validity, patient and public involvement, privacy, reimbursement, and interoperability. Practical learnings from this collective experience across patient cohorts are leveraged to propose a list of recommendations to enable researchers to bridge the gap between the development and implementation of digital health tools.

Longitudinal Vestibular and Oculomotor Impairments Among Amateur Athletes 1 Year Following Sport-Related Concussion: A Prospective Follow-Up.

OBJECTIVES: To investigate (i) the presence of vestibular and oculomotor impairments and (ii) the self-perceived effects of concussion-associated dizziness on health-related quality of life among amateur athletes 6 months and 1 year following sport-related concussion compared with nonconcussed, control athletes. DESIGN: Prospective, matched-cohort study. SETTING: Clinical assessment laboratory. PARTICIPANTS: Amateur athletes who were diagnosed with sport-related concussion within 1 week of injury, and sex-, age-, and activity-matched nonconcussed, control athletes. MAIN MEASURES: Participants were evaluated 6 months and 1 year following sport-related concussion and enrollment in the longitudinal study using the Vestibular and Oculo-Motor Screening and the Dizziness Handicap Inventory. We performed multivariate analyses of variance and chi-square analyses to compare concussion and control group scores at each study assessment. RESULTS: Forty-seven participants with concussion and 47 control participants completed the study. The concussion group reported similar mean symptom provocation scores on the Vestibular and Oculo-Motor Screening and exhibited a similar near-point convergence distance compared with the control group at the 6-month and 1-year study assessments. The concussion and control groups had similar perceptions of the effects of dizziness on their health-related quality of life at both study assessments. CONCLUSION: Meaningful differences in vestibular and oculomotor symptom provocation and self-perceived effects of dizziness on everyday life were not observed between concussed and nonconcussed, control athletes 6 months and 1 year following sport-related concussion.

Clinical Detection and Recovery of Vestibular and Oculomotor Impairments Among Amateur Athletes Following Sport-Related Concussion: A Prospective, Matched-Cohort Study.

OBJECTIVE: To (1) quantify the diagnostic accuracy of the vestibular/oculomotor screening (VOMS), and (2) determine the recovery of vestibular and oculomotor impairments exhibited by concussed athletes compared with nonconcussed athletes using the VOMS. SETTING: Clinical assessment laboratory. PARTICIPANTS: Amateur athletes who were diagnosed with sport-related concussion by emergency department physicians, and non-concussed, control athletes. DESIGN: Prospective, longitudinal study. MAIN MEASURES: Participants were assessed 1 week following sport-related concussion, upon clearance to return-to-sporting activity, and 2 weeks following return-to-sporting activity by a study investigator who administered the VOMS. We calculated test sensitivity, specificity, and positive and negative predictive values to estimate the diagnostic accuracy of the VOMS. We performed a mixed-design analysis of variance to assess differences in VOMS symptom scores reported by concussed athletes compared with control athletes. RESULTS: Fifty concussion participants and 50 control participants completed the study. The VOMS demonstrated sensitivity and specificity of 96% and 46%, respectively, and produced positive and negative predictive values of 64% and 92%, respectively. The concussion group exhibited a significantly greater symptom provocation change score from baseline than the control group for all test domains of the VOMS only in the first week following concussion. CONCLUSION: The VOMS may be most useful as a clinical screening tool to rule out, rather than confirm, the presence of sport-related concussion. The VOMS may be appropriate to inform the recovery of vestibular and oculomotor impairments exhibited by concussed individuals over time.

Physiotherapists' Use of Web-Based Information Resources to Fulfill Their Information Needs During a Theoretical Examination: Randomized Crossover Trial.

BACKGROUND: The widespread availability of internet-connected smart devices in the health care setting has the potential to improve the delivery of research evidence to the care pathway and fulfill health care professionals' information needs. OBJECTIVE: This study aims to evaluate the frequency with which physiotherapists experience information needs, the capacity of digital information resources to fulfill these needs, and the specific types of resources they use to do so. METHODS: A total of 38 participants (all practicing physiotherapists; 19 females, 19 males) were randomly assigned to complete three 20-question multiple-choice questionnaire (MCQ) examinations under 3 conditions in a randomized crossover study design: assisted by a web browser, assisted by a federated search portal system, and unassisted. MCQ scores, times, and frequencies of information needs were recorded for overall examination-level and individual question-level analyses. Generalized estimating equations were used to assess differences between conditions for the primary outcomes. A log file analysis was conducted to evaluate participants' web search and retrieval behaviors. RESULTS: Participants experienced an information need in 55.59% (845/1520) MCQs (assisted conditions only) and exhibited a mean improvement of 10% and 16% in overall examination scores for the federated search and web browser conditions, respectively, compared with the unassisted condition (P<.001). In the web browser condition, Google was the most popular resource and the only search engine used, accounting for 1273 (64%) of hits, followed by PubMed (195 hits; 10% of total). In the federated search condition, Wikipedia and PubMed were the most popular resources with 1518 (46% of total) and 1273 (39% of total) hits, respectively. CONCLUSIONS: In agreement with the findings of previous research studies among medical physicians, the results of this study demonstrate that physiotherapists frequently experience information needs. This study provides new insights into the preferred digital information resources used by physiotherapists to fulfill these needs. Future research should clarify the implications of physiotherapists' apparent high reliance on Google, whether these results reflect the authentic clinical environment, and whether fulfilling clinical information needs alters practice behaviors or improves patient outcomes.

Concussed athletes walk slower than non-concussed athletes during cognitive-motor dual-task assessments but not during single-task assessments 2 months after sports concussion: a systematic review and meta-analysis using individual participant data.

OBJECTIVES: To determine whether individuals who sustained a sports concussion would exhibit persistent impairments in gait and quiet standing compared to non-injured controls during a dual-task assessment . DESIGN: Systematic review and meta-analysis using individual participant data (IPD). DATA SOURCES: The search strategy was applied across seven electronic bibliographic and grey literature databases: MEDLINE, EMBASE, CINAHL, SportDISCUS, PsycINFO, PsycARTICLES and Web of Science, from database inception until June 2017. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Studies were included if; individuals with a sports concussion and non-injured controls were included as participants; a steady-state walking or static postural balance task was used as the primary motor task; dual-task performance was assessed with the addition of a secondary cognitive task; spatiotemporal, kinematic or kinetic outcome variables were reported, and; included studies comprised an observational study design with case-control matching. DATA EXTRACTION AND SYNTHESIS: Our review is reported in line with the Preferred Reporting Items for Systematic review and Meta-Analyses-IPD Statement. We implemented the Risk of Bias Assessment tool for Non-randomised Studies to undertake an outcome-level risk of bias assessment using a domain-based tool. Study-level data were synthesised in one of three tiers depending on the availability and quality of data: (1) homogeneous IPD; (2) heterogeneous IPD and (3) aggregate data for inclusion in a descriptive synthesis. IPD were aggregated using a 'one-stage', random-effects model. RESULTS: 26 studies were included. IPD were available for 20 included studies. Consistently high and unclear risk of bias was identified for selection, detection, attrition, and reporting biases across studies. Individuals with a recent sports concussion walked with slower average walking speed (χ2=51.7; df=4; p<0.001; mean difference=0.06 m/s; 95% CI: 0.004 to 0.11) and greater frontal plane centre of mass displacement (χ2=10.3; df=4; p=0.036; mean difference -0.0039 m; 95% CI: -0.0075 to -0.0004) than controls when evaluated using a dual-task assessment up to 2 months following concussion. SUMMARY/CONCLUSIONS: Our IPD evidence synthesis identifies that, when evaluated using a dual-task assessment, individuals who had incurred a sports concussion exhibited impairments in gait that persisted beyond reported standard clinical recovery timelines of 7-10 days. Dual-task assessment (with motion capture) may be a useful clinical assessment to evaluate recovery after sports concussion. PROTOCOL PRE-REGISTRATION: This systematic review was prospectively registered in PROSPERO CRD42017064861.

Rehabilitation Exercises Reduce Reinjury Post Ankle Sprain, But the Content and Parameters of an Optimal Exercise Program Have Yet to Be Established: A Systematic Review and Meta-analysis.

OBJECTIVES: To determine if exercise-based rehabilitation reduces reinjury following acute ankle sprain. Our secondary objective was to assess if rehabilitation efficacy varies according to exercise content and training volume. DATA SOURCES: The following electronic databases were searched: EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION: Randomized controlled trials investigating the effect of exercise-based rehabilitation programs on reinjury and patient-reported outcomes (perceived instability, function, pain) in people with an acute ankle sprain. No restrictions were made on the exercise type, duration, or frequency. Exercise-based programs could have been administered in isolation or as an adjunct to usual care. Comparisons were made to usual care consisting of 1 or all components of PRICE (protection, rest, ice, compression, elevation). DATA EXTRACTION: Effect sizes with 95% CIs were calculated in the form of mean differences for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. Pooled effects were calculated for reinjury prevalence with meta-analysis undertaken using RevMan software. DATA SYNTHESIS: Seven trials (n=1417) were included (median PEDro score, 8/10). Pooled data found trends toward a reduction in reinjury in favor of the exercise-based rehabilitation compared with usual care at 3-6 months (OR, 0.87; 95% CI, 0.48-1.58) with significant reductions reported at 7-12 months (OR, 0.53; 95% CI, 0.38-0.73). Sensitivity analysis based on pooled reinjury data from 2 high quality studies (n=629) also found effects in favor of exercise-based rehabilitation at 12 months (OR, 0.60; 95% CI, 0.49-0.89). Training volume differed substantially across rehabilitation programs with total rehabilitation time ranging from 3.5-21 hours. The majority of rehabilitation programs focused primarily on postural balance or strength training. CONCLUSIONS: Exercise-based rehabilitation reduces the risk of reinjury following acute ankle sprain when compared with usual care alone. There is no consensus on optimal exercise content and training volume in this field. Future research must explicitly report all details of administered exercise-based rehabilitation programs.

Sex differences in sagittal plane control emerge during adolescent growth: a prospective investigation.

PURPOSE: Females athletes have a higher incidence of non-contact knee joint injuries compared to their male counterparts. This may be attributable to sex-specific differences in neuromuscular control, which arise during the pubertal growth spurt. The purpose of this longitudinal study was to assess the development of landing kinematics of adolescent male and female athletes during the adolescent growth-spurt. METHODS: One hundred and eighty-four adolescent athletes (55% male, 45% female; mean age = 13 ± 0.3 years) participated. Testing was undertaken at baseline and then repeated at 6, 12, 18 and 24 months. Participants performed three drop vertical jump (DVJ) trials from a 31 cm box. Frontal and sagittal plane knee joint angles were recorded. The average measurement of the three jumps was used for analysis at each time point. To assess maturation status, participants were categorised according to their age from peak height velocity at baseline. Pre-initial contact knee flexion (pre-IC), peak knee flexion and knee valgus displacement were the dependant variables. The categorical independent variables were sex (male versus female) and time. RESULTS: There was a significant sex*time interaction for pre-IC knee flexion, with males increasing knee flexion with time to a greater extent than females. There was no significant sex*time interaction for knee valgus displacement; although females displayed greater knee valgus displacement across all time points. CONCLUSIONS: Adolescent male and female athletes display differing kinematic profiles across growth and development. This has clinical relevance for emphasising increased knee flexion, as well as decreasing abnormal frontal plane displacement in injury prevention programmes for adolescent females. LEVEL OF EVIDENCE: II.

Clinical Tests Have Limited Predictive Value for Chronic Ankle Instability When Conducted in the Acute Phase of a First-Time Lateral Ankle Sprain Injury.

OBJECTIVE: To evaluate whether a battery of clinical assessments for acute lateral ankle sprain (LAS) can be used to predict long-term recovery. DESIGN: Cohort study. SETTING: University biomechanics laboratory. PARTICIPANTS: Individuals (N=82) were assessed using a clinical test battery within 2 weeks of incurring a first-time LAS. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The clinical test battery included scores on the talar glide test (degrees), the anterior drawer, talar tilt, figure of 8 for swelling (millimeters) and knee to wall (millimeters) tests, and handheld goniometric range of motion (inversion, eversion, and plantarflexion [in degrees]). Scores on the Cumberland Ankle Instability Tool taken 12 months after the clinical test battery were used to classify participants as having chronic ankle instability (CAI) or as being LAS copers. RESULTS: Forty percent of participants were designated as having CAI, with 60% being designated as LAS copers. A logistic regression analysis revealed that a combined model using scores from the talar glide, talar tilt, and anterior drawer tests in addition to plantarflexion range of motion was statistically significant (P<.01) and correctly classified cases with moderate accuracy (68.8%). The final model had moderate sensitivity (64%) and good specificity (72%). CONCLUSIONS: The clinical tests used in this investigation have limited predictive value for CAI when conducted in the acute phase of a first-time LAS injury.

Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium.

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries.

Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis.

BACKGROUND: Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports. OBJECTIVE: To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI. DESIGN: Overview of intervention systematic reviews. PARTICIPANTS: Individuals with acute ankle sprain/CAI. MAIN OUTCOME MEASUREMENTS: The primary outcomes were injury/reinjury incidence and function. RESULTS: 46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains. CONCLUSIONS: For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI.

Single-leg drop landing movement strategies in participants with chronic ankle instability compared with lateral ankle sprain 'copers'.

PURPOSE: To compare the movement patterns and underlying energetics of individuals with chronic ankle instability (CAI) to ankle sprain 'copers' during a landing task. METHODS: Twenty-eight (age 23.2 ± 4.9 years; body mass 75.5 ± 13.9 kg; height 1.7 ± 0.1 m) participants with CAI and 42 (age 22.7 ± 1.7 years; body mass 73.4 ± 11.3 kg; height 1.7 ± 0.1 m) ankle sprain 'copers' were evaluated 1 year after incurring a first-time lateral ankle sprain injury. Kinematics and kinetics of the hip, knee and ankle joints from 200 ms pre-initial contact (IC) to 200 ms post-IC, in addition to the vertical component of the landing ground reaction force, were acquired during performance of a drop land task. RESULTS: The CAI group adopted a position of increased hip flexion during the landing descent on their involved limb. This coincided with a reduced post-IC flexor pattern at the hip and increased overall hip joint stiffness compared to copers (-0.01 ± 0.05 vs. 0.02 ± 0.05°/Nm kg(-1), p = 0.03). CONCLUSIONS: Individuals with CAI display alterations in hip joint kinematics and energetics during a unipodal landing task compared to LAS 'copers'. These alterations may be responsible for the increased risk of injury experienced by individuals with CAI during landing manoeuvres. Thus, clinicians must recognise the potential for joints proximal to the affected ankle to contribute to impaired function following an acute lateral ankle sprain injury and to develop rehabilitation protocols accordingly. LEVEL OF EVIDENCE: Level III.

Dynamic balance deficits in individuals with chronic ankle instability compared to ankle sprain copers 1 year after a first-time lateral ankle sprain injury.

PURPOSE: To quantify the dynamic balance deficits that characterise a group with chronic ankle instability compared to lateral ankle sprain copers and non-injured controls using kinematic and kinetic outcomes. METHODS: Forty-two participants with chronic ankle instability and twenty-eight lateral ankle sprain copers were initially recruited within 2 weeks of sustaining a first-time, acute lateral ankle sprain and required to attend our laboratory 1 year later to complete the current study protocol. An additional group of non-injured individuals were also recruited to act as a control group. All participants completed the anterior, posterior-lateral and posterior-medial reach directions of the star excursion balance test. Sagittal plane kinematics of the lower extremity and associated fractal dimension of the centre of pressure path were also acquired. RESULTS: Participants with chronic ankle instability displayed poorer performance in the anterior, posterior-medial and posterior-lateral reach directions compared with controls bilaterally, and in the posterior-lateral direction compared with lateral ankle sprain copers on their 'involved' limb only. These performance deficits in the posterior-lateral and posterior-medial directions were associated with reduced flexion and dorsiflexion displacements at the hip, knee and ankle at the point of maximum reach, and coincided with reduced complexity of the centre of pressure path. CONCLUSION: In comparison with lateral ankle sprain copers and controls, participants with chronic ankle instability were characterised by dynamic balance deficits as measured using the SEBT. This was attested to reduced sagittal plane motions at the hip, knee and ankle joints, and reduced capacity of the stance limb to avail of its supporting base. LEVEL OF EVIDENCE: III.

Dynamic postural stability in young adolescent male and female athletes.

PURPOSE: To investigate dynamic postural stability performance of young adolescent athletes. METHODS: Eighty-nine male and 81 female athletes participated. Each participant performed 3 trials of the anterior, posterior-medial, and posterior-lateral reach directions of the Star Excursion Balance Test on each limb. Distance achieved for each direction was expressed as a percentage of leg length, with the composite reach distance of these directions being used for statistical analysis. RESULTS: No significant interaction effect for sex and limb dominance (P > .05) was found, nor was a significant main effect for sex or limb dominance (P > .05) observed. Notably, the composite reach distance achieved by both male and female athletes was less than 94% of leg length, a value that has previously been identified for increased injury risk in adolescent athletes. CONCLUSION: Further longitudinal research is needed to fully understand how dynamic postural stability changes over adolescence.

Designing multimedia patient education materials for adolescent idiopathic scoliosis: A protocol for a feasibility randomized controlled trial of patient education videos.

Triple-masked three-armed feasibility parallel randomized controlled trial. Multimedia patient education materials are increasingly used in healthcare. While much research focuses on optimising their scientific content, research is equally needed to optimise design and implementation. This study aims to determine the feasibility of a study examining how the implementation of scientific advice on design affects patient outcomes. Participants aged 10-18 with radiographically confirmed adolescent idiopathic scoliosis will be recruited from community settings in Ireland and randomized into usual care or receiving multimedia educational videos with or without evidence-informed design principles. Participants will be masked in the two video intervention arms, as will the therapist sending the educational videos. Outcomes will include the number of participants recruited and randomized, the number analysed post-intervention and at week eight, and the outcomes for baseline, post-intervention, and week 8. Adverse events will also be reported. This feasibility randomized controlled trial will offer insight into the feasibility of implementing advice from the literature in designing a trial of multimedia patient education materials for a population with adolescent idiopathic scoliosis. Trial registration: Clinical Trail: Trial is registered on ClinicalTrials.gov as NCT06090344.

Using web log analysis to evaluate healthcare students' engagement behaviours with multimedia lectures on YouTube.

The objective of this study was to utilise web log analysis to evaluate the relationship between University students' engagement (e.g., watch time) and the characteristics of a catalogue of multimedia lectures, including their duration, the speaking rate of the narrator and the extent to which they implemented certain principles from Mayer's Cognitive Theory of Multimedia Learning (CTML). Fifty-six multimedia lectures covering topics related to healthcare (e.g., anatomy, physiology and clinical assessment) were developed to differentially employ the image/embodiment, redundancy, segmentation and signalling principles from the CTML. These lectures were delivered to multiple cohorts of students throughout an academic semester. Student watch time was evaluated using the meta-usage data provided by YouTube studio. The multimedia lectures were viewed 4338 times (mean = 35 views per lecture; 27 unique viewers per lecture). Generalised estimating equations revealed that videos that were segmented into shorter chunks, that incorporated signals to highlight important information for students and during which captions were toggled 'off' by students were associated with longer watch times (P < 0.05). Additionally, watch time diminished for videos placed later in a sequence based on the audience retention metric. When designing multimedia lectures, instructors should be encouraged to use on screen labels to highlight important information, segment learning material into shorter 'chunks' and incorporate a dynamic instructor on screen at regular intervals displaying high embodiment. If several videos are to be delivered to students as part of a learning 'unit', educators should consider placing the most important learning material earlier in the sequence.

An investigation into the relationship between multimedia lecture design and learners' engagement behaviours using web log analysis.

The purpose of this transaction log analysis was to evaluate university students' engagement behaviours with a catalogue of multimedia lectures. These lectures incorporated selected instructional design principles from the cognitive theory of multimedia learning (CTML). Specifically, thirty-two multimedia lectures which differentially employed the signalling, segmenting and embodiment principles from the CTML were delivered to a cohort of 92 students throughout an academic trimester. Engagement with each multimedia lecture was measured in three domains: affective engagement was measured using a Likert-style survey that accompanied each multimedia lecture; behavioural engagement was measured using the web logs provided by YouTube Studio analytics (average watch time); cognitive engagement was measured using students' average score on a quiz that accompanied each multimedia lecture. Separate multiple linear regression analyses for measures of affective, behavioural and cognitive engagement revealed that multimedia lectures that 'stacked' the instructional design principles of embodiment (whereby the lecture was interspersed with clips of an enthusiastic onscreen instructor), segmenting (where lectures were divided into shorter, user-paced segments) and signalling (where onscreen labels highlighted important material) increased measures of engagement, including overall watch time, number of survey submission and number of quiz attempts (P < 0.05). There was no association between any of the tested principles and students' quiz scores or their responses on the Likert-style survey. This study adds to the available literature demonstrating the effectiveness of the signalling, segmenting and embodiment principles for increasing learner engagement with multimedia lectures.

Condition-specific health-related quality of life amongst amateur athletes six months and one-year following sport-related concussion: A prospective, follow-up.

OBJECTIVE: To prospectively investigate the condition-specific health-related quality of life (HRQoL) of athletes six months and one-year following sport-related concussion. DESIGN: Prospective, longitudinal study. SETTING: Clinical research centre at university school of public health. PARTICIPANTS: Amateur athletes who were diagnosed with sport-related concussion within one-week after presenting to a hospital emergency department were recruited along with sex-, age-, and activity-matched, non-concussed, control athletes. Concussion and control participants were assessed six months and one-year following sport-related concussion and study enrolment, respectively. MAIN OUTCOME MEASURES: Participants completed the Post-Concussion Symptom Scale and five condition-specific HRQoL patient-reported outcome measures - Headache Impact Test-6, Fatigue Severity Scale, Neck Disability Index, Generalised Anxiety Disorder-7, and Dizziness Handicap Inventory. We performed Frequentist and Bayesian mixed-design analyses of variance to compare the concussion group and control group at both assessments and quantify whether there was greater evidence in favour of the null hypothesis compared with the alternative hypothesis. RESULTS: At six-month and one-year assessments, the concussion group (n = 47; male = 72%; mean (SD) age = 22.68 (5.07)) and the control group (n = 47; male = 72%; mean (SD) age = 23.81 (4.60)) reported similar clinical symptom severity scores and condition-specific HRQoL. The proportion of athletes in the concussion group with clinically-impaired scores was similar to the proportion of non-concussed athletes with clinically-impaired scores. At six-month and one-year assessments, there was moderate-to-very strong evidence that there was no difference between concussion and control participants' perceptions of the effects of headache, fatigue, neck pain, anxiety, and dizziness on HRQoL. CONCLUSION: There was moderate-to-very strong evidence in favour of no difference between the concussion and control groups on symptom severity scores and condition-specific HRQoL patient-reported outcome measures at six-month and one-year assessments. These results suggest that condition-specific HRQoL returns to the levels of non-concussed individuals within six months following sport-related concussion.

Using functional movement tests to investigate the presence of sensorimotor impairment in amateur athletes following sport-related concussion: A prospective, longitudinal study.

OBJECTIVE: To longitudinally investigate the presence of sensorimotor impairments in amateur athletes following sport-related concussion using two functional movement tests. DESIGN: Prospective, longitudinal study. SETTING: Human movement analysis laboratory. PARTICIPANTS: Athletes who presented to a hospital emergency department and were diagnosed with sport-related concussion, and sex-, age-, and activity-matched non-concussed, control athletes. Concussed participants were assessed within one-week following sport-related concussion, upon clearance to return-to-sporting activity (RTA), and two weeks after RTA. Control participants were assessed at an initial time-point and approximately two and four weeks following their initial study assessment. MAIN OUTCOMES MEASURES: At each laboratory assessment, participants completed two functional movement tests: the Star Excursion Balance Test to evaluate anterior reach distance (normalised for leg length) and fractal dimension (centre of pressure path complexity), and the Multiple Hop Test to evaluate corrective postural strategies and time-to-stabilisation. RESULTS: Fifty concussed athletes and 50 control athletes completed the study. There were no significant differences at any study assessment between the concussion and control group on the Star Excursion Balance Test anterior reach distance or fractal dimension (centre of pressure path complexity). During the Multiple Hop Test, the concussion group used a significantly greater number of corrective postural strategies than the control group one-week following sport-related concussion and upon clearance to RTA, but not two weeks following RTA. CONCLUSION: Recently concussed athletes made a greater number of corrective postural strategies than control participants during the Multiple Hop Test upon clearance to RTA but not two weeks after RTA. The Multiple Hop Test may offer a clinically useful tool for practitioners to examine the recovery of subtle sensorimotor impairments and related RTA readiness.