An Investigation Into the Measurement of Injury Severity in Running-Related Injury Research: A Scoping Review.

Understanding injury severity is essential to inform injury prevention practice. The aims of this scoping review were to investigate how running-related injury (RRI) severity is measured, compare how it differs across studies, and examine whether it influences study outcomes (i.e., injury rates and risk factor identification). This scoping review was prospectively registered with Open Science Framework. A systematic electronic search was conducted using PubMed, Scopus, SPORTDiscuss, MEDLINE, and Web of Science databases. Included studies were published in English between January 1980 and December 2023, investigated RRIs in adult running populations, and included a measure of injury severity. Results were extracted and collated. Sixty-six studies were included. Two predominant primary criteria are used to define injury severity: the extent of the effect on running and/or the extent of the physical description. When secondary definition criteria are considered, 13 variations of injury severity measurement are used. Two approaches are used to grade injury severity: a categorization approach or a continuous numerical scale. Overall, the measurement of RRI severity is relatively inconsistent across studies. Less than half of studies report incidence rates per level of injury severity, while none report specific risk factors across levels, making it difficult to determine if the approach to measuring injury severity influences these study outcomes. This lack of information is possibly contributing to inconsistent rates of RRIs reported, and the lack of clarity on risk factors.

One and Done? The Effectiveness of a Single Session of Physiotherapy Compared With Multiple Sessions to Reduce Pain and Improve Function and Quality of Life in Patients With a Musculoskeletal Disorder: A Systematic Review With Meta-analyses.

OBJECTIVE: To compare single and multiple physiotherapy sessions to improve pain, function, and quality of life (QoL) in patients with musculoskeletal disorders (MSKDs). DATA SOURCES: AMED, Cinahl, SportsDiscus, Medline, Cochrane Register of Clinical Trials, Physiotherapy Evidence Database, and reference lists. STUDY SELECTION: Randomized controlled trials (RCTs) comparing single and multiple physiotherapy sessions for MSKDs. DATA EXTRACTION: Two reviewers extracted data and assessed risk of bias and certainty of evidence using Cochrane Risk of Bias tool 2.0 and Grading of Recommendation Assessment, Development, and Evaluation. DATA SYNTHESIS: Six RCTs (n=2090) were included (conditions studied: osteoporotic vertebral fracture, neck, knee, and shoulder pain). Meta-analyses with low-certainty evidence showed a significant pain improvement at 6 months in favor of multiple sessions compared with single session interventions (3 RCTs; n=1035; standardized mean difference [SMD]: 0.29; 95% CI: 0.05 to 0.53; P=.02) but this significant difference in pain improvement was not observed at 3 months (4 RCTs; n=1312; SMD: 0.39; 95% CI: -0.11 to 0.89; P=.13) and at 12 months (4 RCTs; n=1266; SMD: -0.05; 95% CI: -0.49 to 0.39; P=.82). Meta-analyses with low-certainty evidence showed no significant differences in function at 3 (4 RCTs; n=1583; SMD: 0.05; 95% CI: -0.11 to 0.21; P=.56), 6 (4 RCTs; n=1538; SMD: 0.06; 95% CI: -0.12 to 0.23; P=.53) and 12 months (4 RCTs; n=1528; SMD: 0.08; 95% CI: -0.08 to 0.25; P=.30) and QoL at 3 (4 RCTs; n=1779; SMD: 0.08; 95% CI: -0.02 to 0.17; P=.12), 6 (3 RCTs; n=1206; SMD: 0.03; 95% CI: -0.08 to 0.14; P=.59), and 12 months (4 RCTs; n=1729; SMD: -0.03; 95% CI: -0.12 to 0.07; P=.58). CONCLUSIONS: Low certainty meta-analyses found no clinically significant differences in pain, function, and QoL between single and multiple physiotherapy sessions for MSKD management for the conditions studied. Future research should compare the cost-effectiveness of those different models of care.

Definitions and surveillance methods of running-related injuries: A scoping review.

Inconsistent and restricted definitions of injury have contributed to limitations in determining injury rates and identifying risk factors for running-related injuries (RRIs). The aim of this scoping review was to investigate the definitions and surveillance methods of RRIs. A systematic electronic search was performed using PubMed, Scopus, SPORTDiscuss, MEDLINE, and Web of Science databases. Included studies were published in English between January 1980 and June 2023 which investigated RRIs in adult running populations, providing a definition for a general RRI. Results were extracted and collated. 204 articles were included. Three primary criteria were used to define RRIs: physical description, effect on training and medical intervention, while three secondary criteria are also associated with definitions: cause/onset of injury, location, and social consequences. Further descriptors and sub-descriptors form these criteria. The use of Boolean operators resulted in nine variations in definitions. Inconsistency is evident among definitions of RRIs. Injury definitions seem to be important for two main reasons: firstly, determining accurate injury rates, and secondly, in research examining risk factors. For the latter, definitions seem to be very limited, only capturing severe injuries and failing to recognise the full development process of RRIs, precluding the identification of conclusive risk factors. A potential two-approach solution is the initial use of a broad definition acting as a gatekeeper for identifying any potential injury, and follow-up with an extensive surveillance tool to capture the specific consequences of the varying severity of RRIs.

"Storylistening" in the science policy ecosystem.

Expert analysis of narrative can complement and strengthen scientific evidence.

Running towards injury? A prospective investigation of factors associated with running injuries.

BACKGROUND: Given the high incidence and heavy burden of running related injuries, large-scale, prospective multifactorial investigations examining potential risk factors are warranted. This study aimed to identify factors associated with running related injuries and to evaluate their potential in injury screening. STUDY DESIGN: Prospective cohort study. MATERIALS AND METHODS: Two hundred and seventy-four recreational runners were recruited. Clinical measures (strength, range of motion, foot position), injury and training history (via questionnaire), impact loading (via accelerometery) and running technique measures were collected at baseline. Runners were tracked for injury for one year via fortnightly check-ins. A binary logistic regression, (injury versus no injury), was performed for each variable univariably, and then adjusting for age, sex and mileage. A multivariable regression was also performed to evaluate the model's discriminative ability. RESULTS: Of the 225 runners included in the final analysis 52% experienced a running related injury. Injury history in the past year, less navicular drop, and measures of running technique (knee, hip, and pelvis kinematics) were associated with increased odds of injury (p < .05). The multivariable logistic regression model was statistically significant, χ2(11) = 56.45, p < .001, correctly classifying 74% of cases with a sensitivity and specificity of 72% and 76%, respectively. The area under the receiver operating characteristic curve was 0.79 (CI95% = 0.73-0.85), demonstrating acceptable discriminative ability. CONCLUSIONS: This study found a number of clinical and running technique factors to be associated with prospective running related injuries among recreational runners. With the exception of injury history, the factors identified as being significantly associated with injury may be modifiable and therefore, could form the basis of interventions. Range of motion, spatiotemporal parameters and strength measures were not associated with injury and thus their utilisation in injury prevention practices should be reconsidered.

Aetiological Factors of Running-Related Injuries: A 12 Month Prospective "Running Injury Surveillance Centre" (RISC) Study.

BACKGROUND: Running-related injuries (RRIs) are a prevalent issue for runners, with several factors proposed to be causative. The majority of studies to date are limited by retrospective study design, small sample sizes and seem to focus on individual risk factors in isolation. This study aims to investigate the multifactorial contribution of risk factors to prospective RRIs. METHODS: Recreational runners (n = 258) participated in the study, where injury history and training practices, impact acceleration, and running kinematics were assessed at a baseline testing session. Prospective injuries were tracked for one year. Univariate and multivariate Cox regression was performed in the analysis. RESULTS: A total of 51% of runners sustained a prospective injury, with the calf most commonly affected. Univariate analysis found previous history of injury < 1 year ago, training for a marathon, frequent changing of shoes (every 0-3 months), and running technique (non-rearfoot strike pattern, less knee valgus, greater knee rotation) to be significantly associated with injury. The multivariate analysis revealed previous injury, training for a marathon, less knee valgus, and greater thorax drop to the contralateral side to be risk factors for injury. CONCLUSION: This study found several factors to be potentially causative of injury. With the omission of previous injury history, the risk factors (footwear, marathon training and running kinematics) identified in this study may be easily modifiable, and therefore could inform injury prevention strategies. This is the first study to find foot strike pattern and trunk kinematics to relate to prospective injury.

Influence of Electric Frequency-to-Place Mismatches on the Early Speech Recognition Outcomes for Electric-Acoustic Stimulation Users.

PURPOSE: Cochlear implant (CI) recipients with hearing preservation experience significant improvements in speech recognition with electric-acoustic stimulation (EAS) as compared to with a CI alone, although outcomes across EAS users vary. The individual differences in performance may be due in part to default mapping procedures, which result in electric frequency-to-place mismatches for the majority of EAS users. This study assessed the influence of electric mismatches on the early speech recognition for EAS users. METHOD: Twenty-one participants were randomized at EAS activation to listen exclusively with a default or place-based map. For both groups, the unaided thresholds determined the acoustic cutoff frequency (i.e., > 65 dB HL). For default maps, the electric filter frequencies were assigned to avoid spectral gaps in frequency information but created varying magnitudes of mismatches. For place-based maps, the electric filter frequencies were assigned to avoid frequency-to-place mismatches. Recognition of consonant-nucleus-consonant words and vowels was assessed at activation and 1, 3, and 6 months postactivation. RESULTS: For participants with default maps, electric mismatch at 1500 Hz ranged from 2 to -12.0 semitones (Mdn = -5 semitones). Poorer performance was observed for those with larger magnitudes of electric mismatch. This effect was observed through 6 months of EAS listening experience. CONCLUSIONS: The present sample of EAS users experienced better initial performance when electric mismatches were small or eliminated. These data suggest the utility of methods that reduce electric mismatches, such as place-based mapping procedures. Investigation is ongoing to determine whether these differences persist with long-term EAS use. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22096523.

Comparison of impact accelerations between injury-resistant and recently injured recreational runners.

INTRODUCTION/PURPOSE: Previous injury has consistently been shown to be one of the greatest risk factors for running-related injuries (RRIs). Runners returning to participation following injury may still demonstrate injury-related mechanics (e.g. repetitive high impact loading), potentially exposing them to further injuries. The aim of this study was to determine if the magnitude (Peakaccel) and rate of loading (Rateaccel) at the tibia and sacrum differ between runners who have never been injured, those who have acquired injury resistance (runners who have not been injured in the past 2 years) and those who have been recently injured (RRI sustained 3-12 months ago). METHODS: Runners completed an online survey capturing details of their RRI history over the previous 2 years. Never injured runners were matched by sex, quarterly annual mileage and typical training speed to runners who had acquired injury resistance and to runners who had been recently injured. Differences in Peakaccel and Rateaccel of the tibia and sacrum were assessed between the three groups during a treadmill run at a set speed, with consideration for sex. RESULTS: A total of 147 runners made up the three injury status groups (n: 49 per group). There was a significant main effect of injury status for Peakaccel and Rateaccel at the sacrum, with recently injured runners demonstrating significantly greater Rateaccel than never injured and acquired injury resistant runners. There was also a significant main effect for sex, with females demonstrating greater tibial Peakaccel, sacrum Peakaccel and Rateaccel than males. CONCLUSION: Rateaccel at the sacrum distinguishes recently injured runners from never injured runners and runners who may have acquired injury resistance, potentially highlighting poor impact acceleration attenuation in recently injured runners.

Are impact accelerations during treadmill running representative of those produced overground?

BACKGROUND: Although many runners train overground, measuring impact accelerations on a treadmill may be advantageous for researchers and clinicians. Previous investigations of peak and rate of acceleration (peakaccel, rateaccel) during treadmill running compared to overground running have not examined both the relative consistency and absolute agreement of these measures, or the effect of treadmill stiffness. RESEARCH QUESTION: (1) Are peakaccel and rateaccel produced during running on a stiff and less stiff treadmill 'representative' of those produced during overground running? (2) Are peakaccel and rateaccel measured on treadmills of different stiffness 'representative' of each other? METHODS: Eighteen participants ran at a self-selected pace on three surfaces: Treadmill 1 (reduced stiffness), Treadmill 2 (increased stiffness) and overground on asphalt, whilst peakaccel and rateaccel were recorded at the shank and lower back. Relative consistency (ICC (3,1)), absolute agreement (Bland-Altman analysis) and systematic differences (ANOVA/Friedman's Tests) were assessed. RESULTS: ICCs revealed moderate to excellent relative consistency in peakaccel and rateaccel between surfaces, with higher consistency for measures at the lower back. Absolute agreement was low, with the Bland Altman limits of agreement exceeding the clinical acceptable range for all comparisons. For systematic differences in means, peakaccel and rateaccel at the shank were significantly higher overground than on either treadmill; with no difference evident at the lower back. No differences were found for surface with respect to shank or lower back peakaccel and rateaccel between treadmills. SIGNIFICANCE: Moderate to excellent relative consistency of peakaccel and rateaccel between the surfaces suggests that using different surfaces in research involving rank ordering of participants by acceleration magnitude may be acceptable (e.g. prospective studies examining if impact accelerations are related to injury). However, low absolute agreement indicates that data collected on treadmills of different stiffness and overground should not be used interchangeably (e.g. running-retraining studies).

Relative and absolute reliability of shank and sacral running impact accelerations over a short- and long-term time frame.

Whilst running is hugely popular, running-related injuries (RRIs) are prevalent. High impact loading has been proposed to contribute to RRIs, with accelerometers becoming increasingly popular in estimating segmental loading for injury detection and biofeedback training. However, there is a lack of research examining the reliability of measures of impact acceleration across short- and long-term time periods, both prior to and following exerted running. The aim of this study was to assess the absolute and relative reliability of shank and sacral impact accelerations over a short- and long-term time period. Peak (Peakaccel) and rate (Rateaccel) of impact acceleration at the shank and sacrum were assessed in 18 recreational runners over short- and long-term time frames, across fixed and self-selected speeds. The relative and absolute reliabilities were investigated for pre- and post-exerted states of running. There was high-to-excellent relative reliability, and predominantly moderate absolute reliability for shank and sacrum Peakaccel and Rateaccel in the short- and long-term time frames between pre- and post-exerted states. High to excellent relative reliability of Peakaccel and Rateaccel at the shank and sacrum are appropriate and acceptable measures across short- and long-term time frames. These findings were consistent with different levels of speed and exertion. The minimal detectable change % was large for both sensors and associated measurements, indicating that their use may be limited to intervention studies that elicit large change (>30%) in these measures.

Do Injury-Resistant Runners Have Distinct Differences in Clinical Measures Compared with Recently Injured Runners?

INTRODUCTION: Although lower extremity muscle strength, joint motion, and functional foot alignment are commonly used, time-efficient clinical measures that have been proposed as risk factors for running-related injuries, it is unclear if these factors can distinguish injury resistance in runners. PURPOSE: This study compares clinical measures, with consideration of sex, between recently injured runners (3 months to 1 yr prior), those with a high level of injury resistance who have been uninjured for at least 2 yr, and never-injured runners. METHODS: Averaged bilateral values and between-limb symmetry angles of lower limb isometric muscle strength, joint motion, navicular drop, and foot posture index (FPI) were assessed in a cohort of recreational runners, and their injury history was recorded. Differences in clinical measures between injury groupings were examined, with consideration of sex. RESULTS: Of the 223 runners tested, 116 had been recently injured, 61 had been injured >2 yr ago and were deemed to have acquired reinjury resistance, and 46 were never injured. Plantarflexion was greater in both recently injured (P = 0.001) and acquired reinjury resistance runners (P = 0.001) compared with never-injured runners. Recently injured runners displayed higher hip abduction strength compared with never-injured runners (P = 0.019, η2 = 0.038, small effect size). There were no statistically significant differences in the remaining measures between the injury groupings. With the exception of FPI, there was no interaction between sex and injury grouping for any of the measures. CONCLUSION: Commonly used clinical measures of strength, joint motion, and functional foot alignment were not superior in injury-resistant runners compared with recently injured runners, questioning their relevance in identifying future injury resistance of runners.

Risk Factors for Injuries in Runners: A Systematic Review of Foot Strike Technique and Its Classification at Impact.

BACKGROUND: It has been suggested that foot strike technique (FST) at initial contact is related to running-related injuries (RRIs). PURPOSE: To explore the relationship between FST and RRIs. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: A systematic electronic search was performed using MEDLINE, PubMed, SPORTDiscus, Scopus, and Web of Science databases. Included were studies published in the English language that explored the relationship between FST and RRIs between January 1960 and November 2020. Results were extracted and collated. The Grading of Recommendations, Assessment, Development and Evaluation approach was applied to synthesize the quality of evidence. RESULTS: We reviewed 13 studies exploring the relationship between FST and RRIs. Of these, 6 studies reported FST categorically (foot strike pattern [FSP]), and 7 reported continuous measures (foot contact angle, ankle flexion angle, and strike index). Three of the 6 studies looking at categorical FSP found rearfoot strikers have a significantly greater retrospective injury rate than do non- rearfoot strikers, with 1 other study noting a greater risk associated with midfoot and forefoot strike. Regarding the continuous measures of FST, only 1 of the 7 studies reported a significant relationship with RRIs. CONCLUSION: There was low evidence to suggest a relationship between FST (or its subcategories of categorical FSP and continuous measures) and RRIs. While two-thirds of the categorical studies found a relationship between FSP and RRIs, these studies were very low quality, with limitations such as retrospective study design, low participant numbers, and poor FSP assessment methods. More large-scale prospective studies are required.

Speech Recognition as a Function of Age and Listening Experience in Adult Cochlear Implant Users.

OBJECTIVES/HYPOTHESIS: Speech recognition with a cochlear implant (CI) tends to be better for younger adults than older adults. However, older adults may take longer to reach asymptotic performance than younger adults. The present study aimed to characterize speech recognition as a function of age at implantation and listening experience for adult CI users. STUDY DESIGN: Retrospective review. METHODS: A retrospective review identified 352 adult CI recipients (387 ears) with at least 5 years of device listening experience. Speech recognition, as measured with consonant-nucleus-consonant (CNC) words in quiet and AzBio sentences in a 10-talker noise masker (10 dB signal-to-noise ratio), was reviewed at 1, 5, and 10 years postactivation. RESULTS: Speech recognition was better in younger listeners, and performance was stable or continued to improve through 10 years of CI listening experience. There was no indication of differences in acclimatization as a function of age at implantation. For the better performing CI recipients, an effect of age at implantation was more apparent for sentence recognition in noise than for word recognition in quiet. CONCLUSIONS: Adult CI recipients across the age range examined here experience speech recognition benefit with a CI. However, older adults perform more poorly than young adults for speech recognition in quiet and noise, with similar age effects through 5 to 10 years of listening experience. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2106-2111, 2021.

Influence of Protective Face Coverings on the Speech Recognition of Cochlear Implant Patients.

OBJECTIVES: The objectives were to characterize the effects of wearing face coverings on: 1) acoustic speech cues, and 2) speech recognition of patients with hearing loss who listen with a cochlear implant. METHODS: A prospective cohort study was performed in a tertiary referral center between July and September 2020. A female talker recorded sentences in three conditions: no face covering, N95 mask, and N95 mask plus a face shield. Spectral differences were analyzed between speech produced in each condition. The speech recognition in each condition for twenty-three adult patients with at least 6 months of cochlear implant use was assessed. RESULTS: Spectral analysis demonstrated preferential attenuation of high-frequency speech information with the N95 mask plus face shield condition compared to the other conditions. Speech recognition did not differ significantly between the uncovered (median 90% [IQR 89%-94%]) and N95 mask conditions (91% [IQR 86%-94%]; P = .253); however, speech recognition was significantly worse in the N95 mask plus face shield condition (64% [IQR 48%-75%]) compared to the uncovered (P < .001) or N95 mask (P < .001) conditions. CONCLUSIONS: The type and combination of protective face coverings used have differential effects on attenuation of speech information, influencing speech recognition of patients with hearing loss. In the face of the COVID-19 pandemic, there is a need to protect patients and clinicians from spread of disease while maximizing patient speech recognition. The disruptive effect of wearing a face shield in conjunction with a mask may prompt clinicians to consider alternative eye protection, such as goggles, in appropriate clinical situations. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2038-E2043, 2021.

Initial Hearing Preservation Is Correlated With Cochlear Duct Length in Fully-inserted Long Flexible Lateral Wall Arrays.

OBJECTIVES: To characterize the relationship between cochlear duct length (CDL) and initial hearing preservation among cochlear implant recipients of a fully inserted 31.5 mm flexible lateral wall electrode array. STUDY DESIGN: Retrospective review. SETTING: Tertiary academic referral center. PATIENTS: Adult cochlear implant recipients who presented preoperatively with unaided hearing detection thresholds of ≤ 65 dB HL at 125 Hz and underwent cochlear implantation with a 31.5 mm flexible lateral wall array. INTERVENTION: Cochlear implantation with a hearing preservation surgical approach. MAIN OUTCOME MEASURES: Computed tomography was reviewed to determine CDL. Hearing preservation was characterized by the shift in low-frequency pure-tone average (LFPTA; 125, 250, and 500 Hz), and shift in individual unaided hearing detection thresholds at 125, 250, and 500 Hz. RESULTS: Nineteen patients met the criteria for inclusion. The mean CDL was 34.2 mm (range: 30.8-36.5 mm). Recipients experienced a mean LFPTA shift of 27.6 dB HL (range: 10-50 dB HL). Significant, negative correlations were observed between CDL and smaller threshold shifts at individual frequencies and LFPTA (p ≤ 0.048). CONCLUSION: A longer CDL is associated with greater likelihood of preserving low-frequency hearing with long arrays. Low-frequency hearing preservation is feasible with fully inserted long flexible arrays within the initial months after cochlear implantation. Preoperative measurement of CDL may facilitate a more individualized approach in array selection to permit optimal cochlear coverage while enhancing hearing preservation outcomes.

Ondansetron to treat pruritus due to cholestatic jaundice.

Intractable itching is a symptom of cholestatic liver disease of various causes that is bothersome and difficult to manage. Although treatment of the primary cause of cholestasis is paramount in resolving the issue, given the debilitating consequences of pruritus, symptomatic treatment is frequently necessary. Although many medications including cholestyramine, rifampin, opioid antagonists (i.e., naloxone, naltrexone), phenobarbital, and antihistamines have been used to treat cholestatic-induced pruritus, none has resulted in uniform success. We report anecdotal success with the use of ondansetron to treat pruritus associated with cholestasis following prolonged intensive care unit course of a 16-year-old. The theories accounting for pruritus with cholestasis are presented, treatment options are reviewed, and the role of ondansetron in the treatment of pruritus is discussed.