Sports Specialization, Physical Literacy, and Physical Activity Levels in Young Adults.

CONTEXT: Youth sport specialization may be associated with physical literacy and physical activity in young adulthood. The purposes of this study were to compare young adult (18-25 y) physical literacy and physical activity by high school sport specialization status and to examine the relationship between current physical activity and physical literacy. DESIGN: Retrospective, cross-sectional study design. METHODS: Participants were recruited from ResearchMatch, university classes, and social media posts. Participants (N = 172; aged 22.1 [2.1] y; 80.1% female) completed the following anonymous surveys on REDCap to assess: demographics and injury history, sport specialization, physical literacy (PLAYself), and physical activity (Godin Leisure-Time Exercise Questionnaire). RESULTS: When controlling for age, there were no statistically significant differences in physical literacy (F2,166 = 2.02, P = .14) or moderate to vigorous physical activity (F2,161 = 0.24, P = .79) between sport specialization groups. There was a moderate, positive relationship between physical literacy and physical activity (r = .33, P < .001). CONCLUSIONS: Young adult physical literacy and physical activity were similar regardless of youth sport specialization level. Young adult physical literacy was positively associated with physical activity. Future studies should consider physical literacy as a possible correlate of physical activity among young adults.

Exploratory Examination of Knee Self-Efficacy in Individuals With a History of ACL Reconstruction and Sport-Related Concussion.

CONTEXT: Knee self-efficacy and injury-related fear are associated with poor self-reported knee function and decreased physical activity (PA) after ACL reconstruction (ACLR). Limited research has explored contextual factors that may influence psychological responses in this population, such as history of sport-related concussion (SRC). After SRC, individuals may experience increased negative emotions, such as sadness and nervousness. However, it is unknown how SRC history may influence knee-self efficacy and injury-related fear in individuals with ACLR. The purpose of this study was to compare knee self-efficacy and injury-related fear in individuals after ACLR who present with and without history of SRC. DESIGN: Cross-sectional study. METHODS: Forty participants ≥1 year postunilateral ACLR were separated by history of SRC (no SRC = 29, SRC = 11). The Knee Self-Efficacy Scale (KSES) and subscales measured certainty regarding performance of daily activities (KSES-ADL), sports/leisure activities (KSES-Sport), physical activities (KSES-PA), and future knee function (KSES-Future). The Tampa Scale of Kinesiophobia-11 measured injury-related fear. Mann-Whitney U tests were used to examine between-group differences. Hedges g effect sizes and 95% confidence interval were used to examine clinically meaningful group differences. RESULTS: Individuals with a history of ACLR and SRC demonstrated worse KSES-PA (7.5 [5.3]) compared with those without a history of SRC (8.1 [6.1], P = .03). No other statistically significant differences were observed. A medium effect size was present for the KSES-PA (0.62), KSES-ADL (0.42), KSES-Present (ADL + PA + Sport) (0.48), KSES-Total (0.53), and Tampa Scale of Kinesiophobia-11 (0.61) but must be interpreted with caution as 95% confidence interval crossed 0. CONCLUSIONS: This exploratory study indicated that individuals with a history of ACLR and SRC had worse knee self-efficacy for PA compared with those without history of SRC. Rehabilitation specialists should monitor knee self-efficacy deficits in the post-ACLR population and recognize the potential influence of cumulative injury history on rehabilitative outcomes.

The Relationship Between Health-Related Quality of Life and Lower-Extremity Visuomotor Reaction Time in Young Adult Women Following Ankle Sprain.

CONTEXT: Many individuals who sustain a lateral ankle sprain (LAS) fail to return to prior activity due to residual symptoms; and report elevated levels of injury-related fear, decreased function, and decreased health-related quality of life (HRQOL). Additionally, individuals with history of LAS exhibit deficits in neurocognitive functional measures like visuomotor reaction time (VMRT), which contributes to worse patient-reported outcome scores. The aim of this study was to examine the relationship between HRQOL and lower-extremity (LE) VMRT in individuals with LAS history. DESIGN: Cross-sectional. METHODS: Young adult female volunteers with history of LAS (n = 22; age = 24 [3.5] y; height = 163.1 [9.8] cm; mass = 65.1 [11.5] kg; and time since last LAS = 67.8 [50.5] mo) completed HRQOL outcomes including the following: (1) Tampa Scale of Kinesiophobia-11, (2) Fear-Avoidance Beliefs Questionnaire, (3) Penn State Worry Questionnaire, (4) modified Disablement in the Physically Active Scale, and (5) Foot and Ankle Disability Index (FADI). Additionally, participants completed a LE-VMRT task by responding to a visual stimulus using their foot to deactivate light sensors. Participants completed trials bilaterally. Separate Spearman rho correlations were performed to assess the relationship between patient-reported outcomes assessing constructs of HRQOL and LE-VRMT bilaterally. Significance was set at P < .05. RESULTS: There was a strong, significant negative correlation between FADI-Activities of Daily Living (ρ = -.68; P = .002) and FADI-Sport (ρ = -.76; P = .001) scores and injured limb LE-VMRT; moderate, significant negative correlations between the uninjured limb LE-VMRT and FADI-Activities of Daily Living (ρ = -.60; P = .01) and FADI-Sport (ρ = -.60; P = .01) scores; and moderate, significant positive correlations between the injured limb LE-VMRT and modified Disablement in the Physically Active Scale-Physical Summary Component (ρ = .52; P = .01) and modified Disablement in the Physically Active Scale-Total (ρ = .54; P = .02) scores. All other correlations were not statistically significant. CONCLUSIONS: Young adult women with history of LAS demonstrated an association between self-reported constructs of HRQOL and LE-VMRT. As LE-VMRT is a modifiable injury risk factor, future studies should examine the effectiveness of interventions designed to improve LE-VMRT and the impact on self-reported HRQOL.

Slower visuomotor reaction time in division-I collegiate athletes with a history of ankle sprain.

The purpose of this study was to compare visuomotor reaction time (VMRT) in collegiate athletes based on ankle sprain history. Participants included athletes with ankle sprain history (n = 18) and athletes with no ankle sprain history (n = 33). Participants completed an upper-extremity VMRT task which was comprised of eight wireless light-emitting diode sensors. The difference between reaction time (sec) and the number of "Hits" and "Misses" were compared between groups. The ankle sprain history group had significantly slower VMRT compared to the no ankle sprain history group with moderate effect sizes. However, there was no difference in the number of "Hits" or "Misses" between groups, despite observing moderate effect sizes. This result suggests that VMRT may be a potential target for prevention and rehabilitation strategies in individuals with ankle sprains. However, further research is needed to better understand the role of VMRT on the risk of ankle sprains.

Isometric Hip Strength and Patient-Reported Outcomes of Individuals With and Without Chronic Ankle Instability.

CONTEXT: Strength deficits and decreased scores on generic, dimension-specific, and region-specific health-related quality of life (HRQL) PRO measures are commonly documented among individuals with chronic ankle instability (CAI). However, it is unknown if there is a relationship between hip strength and self-reported patient-reported outcome (PRO) scores. OBJECTIVE: To compare isometric peak torque for hip-extension (H-EXT) and hip-abduction (H-ABD), as well as PRO scores between CAI, lateral ankle sprain copers (LAS copers), and uninjured controls (UC). The secondary purpose was to examine the relationship between isometric hip peak torque and PROs in participants with CAI. DESIGN: Cross-sectional. SETTING: Laboratory. PARTICIPANTS: Sixty-three individuals, 45 women (23.02 [3.83] y, 165.91 [7.55] cm, 67.28 [11.95] kg) and 18 men (26.28 [5.43] y, 179.28 [9.01] cm, 83.87 [13.26] kg), grouped as uninjured control (n = 26), LAS coper (n = 15), or CAI (n = 22). MAIN OUTCOME MEASURES: The Foot and Ankle Ability Measure was used to assess region-specific HRQL. The Fear Avoidance Beliefs Questionnaire was used to assess injury-related fear. The Disablement in Physically Active was used to assess global HRQL. Isometric peak torque was measured with a handheld dynamometer for H-EXT and H-ABD. RESULTS: No group differences were observed for H-ABD (P = .34) or H-EXT (P = .35). The CAI group had significantly worse scores on all PROs compared with LAS coper (P < .001) and HC (P < .001). Moderate-weak correlations were found between H-ABD and Foot and Ankle Ability Measure-activities of daily living (P = .047; ρ = .392) and Foot and Ankle Ability Measure-Sport (P = .013; ρ = .482) and H- EXT and Fear Avoidance Beliefs Questionnaire-Work (P = .007; ρ = -.517). CONCLUSIONS: Individuals with CAI displayed lower HRQL based on worse scores on generic, dimension-specific, and region-specific PROs compared with LAS copers and uninjured controls. There were no significant between-group differences for H-EXT and H-ABD isometric peak torque production, but there was a moderate positive relationship between isometric H-ABD and self-reported ankle disability in individuals with CAI.

Anterior cruciate ligament reconstructed individuals demonstrate slower reactions during a dynamic postural task.

INTRODUCTION: To determine whether individuals with a history of anterior cruciate ligament reconstruction (ACLR) exhibit altered neuromotor function compared to healthy controls. It was hypothesized that the ACLR group would have slower postural responses compared to healthy individuals of similar age. MATERIALS AND METHODS: Sixteen adults with a unilateral ACLR and 16 matched healthy controls participated. General assessments of neuromotor function were gathered and included measures of reaction time (both seated and postural conditions), walking ability, balance, ankle ROM, proprioception, knee joint laxity, patellar tendon reflex latency, and quadriceps strength. Data were analyzed using mixed generalized linear models with between-subject (ie, controls, ACLR) and within-subject factors (ie, affected, unaffected limb). RESULTS: Individuals with an ACLR exhibited a significant slowing of their postural reaction times compared to the control individuals. The ACLR group was slower under both the simple (ACLR: 484 ± 6.17 ms, control: 399 ± 1.95 ms) and choice reaction time conditions (ACLR: 550 ± 43 ms, control: 445 ± 43 ms). No other group differences were found in any of the other measures. CONCLUSION: Overall, ACLR individuals had a reduced ability to respond quickly under more challenging postural conditions (ie, stepping response). This finding would indicate that the impact of an ACLR is not purely mechanical and restricted to the joint. Rather, injury and reconstruction of the ACL impact neural mechanisms, altering individuals' ability to respond under challenging balance tasks.

Psychological factors are associated with return to pre-injury levels of sport and physical activity after ACL reconstruction.

PURPOSE: The impetus of anterior cruciate ligament reconstruction (ACLR) is to allow patients to return to sport and to remain engaged in physical activity. Many patients exhibit deficits in psychological domains of health-related quality of life which may impede return to sport and physical activity participation. Therefore, the purpose of this study was to examine the association of patient-based, specifically psychological, and functional outcomes with return to sport and physical activity. METHODS: Forty participants, a minimum of 1-year post-ACLR, reported to the laboratory for one-testing session. Participants completed a series of patient-based and functional outcome assessments. Participants were also instructed to wear a pedometer for 1 week to monitor their daily steps. RESULTS: Twenty-five participants (62%) did not return to sport and 29 participants (72%) did not average 10,000 steps per day. Individuals with elevated levels of self-reported kinesiophobia were 17% less likely to return to sport. Self-reported knee self-efficacy and knee-related quality of life accounted for 27.1% of the variance of average daily step counts. CONCLUSIONS: Psychological factors, specifically injury-related fear and self-efficacy, were associated more significantly than functional outcomes with return to sport and physical activity levels. Clinicians should examine psychological factors throughout rehabilitation in patients after ACLR. Future research should explore the effectiveness of psychoeducation techniques to decrease injury-related fear and enhance self-efficacy in this population. LEVEL OF EVIDENCE: III.

Fear-Avoidance Beliefs and Health-Related Quality of Life in Post-ACL Reconstruction and Healthy Athletes: A Case-Control Study.

CONTEXT: Many athletes return to sport after anterior cruciate ligament reconstruction (ACLR) with lingering physical or mental health impairments. Examining health-related quality of life (HRQL) and fear-avoidance beliefs across the spectrum of noninjured athletes and athletes with a history of ACLR may provide further insight into targeted therapies warranted for this population. OBJECTIVE: The purpose of this study was to examine differences in fear-avoidance beliefs and HRQL in college athletes with a history of ACLR not participating in sport (ACLR-NPS), participating in sport (ACLR-PS), and healthy controls (Control) with no history of injury participating in sport. DESIGN: Cross-sectional. SETTING: Laboratory. Patients (or Other Participants): A total of 10 college athletes per group (ACLR-NPS, ACLR-PS, and Control) were included. Participants were included if on a roster of a Division I or III athletic team during data collection. INTERVENTIONS: Participants completed a demographic survey, the modified Disablement in the Physically Active Scale (mDPA) to assess HRQL, and Fear-Avoidance Beliefs Questionnaire (FABQ) to assess fear-avoidance beliefs. MAIN OUTCOME MEASURES: Scores on the mDPA (Physical and Mental) and FABQ subscales (Sport and Physical Activity) were calculated, a 1-way Kruskal-Wallis test and separate Mann-Whitney U post hoc tests were performed (P < .05). RESULTS: ACLR-NPS (30.00 [26.00]) had higher FABQ-Sport scores than ACLR-PS (18.00 [26.00]; P < .001) and Controls (0.00 [2.50]; P < .001). ACLR-NPS (21.50 [6.25]) had higher FABQ-Physical Activity scores than ACLR-PS (12.50 [13.00]; P = .001) and Controls (0.00 [1.00]; P < .001). Interestingly, ACLR-PS scores for FABQ-Sport (P = .01) and FABQ-Physical Activity (P = .04) were elevated compared with Controls. ACLR-NPS had higher scores on the mDPA-Physical compared with the ACLR-PS (P < .001) and Controls (P < .001), and mDPA-Mental compared with ACLR-PS (P = .01), indicating decreased HRQL. CONCLUSIONS: The ACLR-NPS had greater fear-avoidance beliefs and lower HRQL compared with ACLR-PS and Controls. However, the ACLR-PS had higher scores for both FABQ subscales compared with Controls. These findings support the need for additional psychosocial therapies to address fear-avoidance beliefs in the returned to sport population.

Use of Goal Setting to Enhance Self-Efficacy After Sports-Related Injury: A Critically Appraised Topic.

Clinical Scenario: Patients after sports-related injury experience deficits in self-efficacy. Goal setting may be an appropriate psychoeducation technique to enhance self-efficacy after sports-related injury. Clinical Question: Does goal setting-enhanced rehabilitation improve self-efficacy compared with traditional rehabilitation alone in individuals with sports-related injury? Summary of Key Findings: Two randomized controlled trials were included. The two studies selected assessed changes in self-efficacy before and after a goal-setting intervention following sports-related injury in an athletic population. Both studies used the Sports Injury Rehabilitation Beliefs Survey to evaluate self-efficacy. Clinical Bottom Line: There is currently consistent, good-quality, patient-oriented evidence that supports the use of goal setting to improve self-efficacy in patients undergoing rehabilitation for sports-related injury compared with the standard of care group. Future research should examine optimal timing for the implementation of goal setting in order to enhance self-efficacy following sports-related injury. Strength of Recommendation: The grade of A is recommended by the Strength of Recommendation Taxonomy for consistent, good-quality, patient-oriented evidence.

The Relationship Between Musculoskeletal Injury and Objectively Measured Physical Activity Levels: A Critically Appraised Topic.

Clinical Scenario: Physical activity is vital for human health. Musculoskeletal injury may inhibit adults from participating in physical activity, and this amount may be less than adults without a history of musculoskeletal injury. Clinical Question: Do individuals with a history of ankle or knee musculoskeletal injury participate in less objectively measured physical activity compared with healthy controls? Summary of Key Findings: Four studies were included. Two studies concluded patients who have undergone an anterior cruciate ligament reconstruction (ACLR) spent less time in moderate to vigorous physical activity levels when compared with healthy controls, but still achieved the daily recommended amount of physical activity. One study determined that participants with CAI took fewer steps per day compared with the control group. The fourth study determined patients with patellofemoral pain were less physically active than healthy controls as they took fewer steps per day and spent less time participating in mild and high activity. Clinical Bottom Line: There is consistent, high quality evidence that demonstrates individuals with a history of ankle or knee musculoskeletal injury participate in less objectively measured physical activity compared with healthy individuals. Strength of Recommendation: Due to nature of study designs of the included articles in this critically appraised topic, we recommend a grade of 3B.

The Relationship Between Injury-Related Fear and Visuomotor Reaction Time in Individuals With a History of Anterior Cruciate Ligament Reconstruction.

CONTEXT: Deficits in reaction time, decreased self-reported knee function, and elevated levels of injury-related fear have been observed in individuals who sustain anterior cruciate ligament injury. Understanding the relationship between these variables may provide the impetus to further investigate effective intervention strategies to address these deficits in individuals after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE: To examine the relationship between injury-related fear and lower-extremity visuomotor reaction time (VMRT) in individuals with a history of ACLR. A secondary purpose was to determine the relationship between self-reported knee function and lower-extremity VMRT in individuals with a history of ACLR. DESIGN: Cross-sectional study. SETTING: Laboratory. PARTICIPANTS: Twenty participants between the ages of 18-35 years, with history of unilateral ACLR within the last 10 years, who injured their knee playing or training for organized or recreational sports. MAIN OUTCOME MEASURES: Scores on the athlete fear avoidance questionnaire, the fear-avoidance beliefs questionnaire (FABQ), the knee injury and osteoarthritis outcome score, and reaction time (in seconds) on the lower-extremity VMRT task using the FitLight Trainer™, bilaterally. Spearman Rho correlations examined the relationship between the dependent variables. RESULTS: There was a moderate positive correlation between VMRT and FABQ-total (r = .62, P < .01), FABQ-sport (r = .56, P = .01), and FABQ-physical activity (r = .64, P < .01) for the injured limb. Correlations between FABQ scores and VMRT for the uninjured limb were weak positive correlations (r = .36-.41, P > .05). Weak correlations between the osteoarthritis outcome score subscales, athlete fear avoidance questionnaire, and VMRT were observed for the injured limb (P > .05). CONCLUSIONS: Individuals with a history of ACLR who exhibited elevated levels of injury-related fear demonstrated slower VMRT. There were no relationships between self-reported knee function and VMRT. Future research should explore interventions to address injury-related fear and VMRT in individuals after ACLR.

The Reliability of an Upper- and Lower-Extremity Visuomotor Reaction Time Task.

CONTEXT: Fast visuomotor reaction time (VMRT), the time required to recognize and respond to sequentially appearing visual stimuli, allows an athlete to successfully respond to stimuli during sports participation, while slower VMRT has been associated with increased injury risk. Light-based systems are capable of measuring both upper- and lower-extremity VMRT; however, the reliability of these assessments are not known. OBJECTIVE: To determine the reliability of an upper- and lower-extremity VMRT task using a light-based trainer system. DESIGN: Reliability study. SETTING: Laboratory. Patients (or Other Participants): Twenty participants with no history of injury in the last 12 months. METHODS: Participants reported to the laboratory on 2 separate testing sessions separated by 1 week. For both tasks, participants were instructed to extinguish a random sequence of illuminated light-emitting diode disks, which appeared one at a time as quickly as possible. Participants were provided a series of practice trials before completing the test trials. VMRT was calculated as the time in seconds between target hits, where higher VMRT represented slower reaction time. MAIN OUTCOME MEASURES: Separate intraclass correlation coefficients (ICCs) with corresponding 95% confidence intervals (CIs) were calculated to determine test-retest reliability for each task. The SEM and minimal detectable change values were determined to examine clinical applicability. RESULTS: The right limb lower-extremity reliability was excellent (ICC2,1 = .92; 95% CI, .81-.97). Both the left limb (ICC2,1 = .80; 95% CI, .56-.92) and upper-extremity task (ICC2,1 = .86; 95% CI, .65-.95) had good reliability. CONCLUSIONS: Both VMRT tasks had clinically acceptable reliability in a healthy, active population. Future research should explore further applications of these tests as an outcome measure following rehabilitation for health conditions with known VMRT deficits.

Differences in the Modified Disablement in the Physically Active Scale in Those With and Without Chronic Ankle Instability.

Context: The modified Disablement in the Physically Active scale (mDPA) has become a commonly utilized patient-reported outcome instrument for physically active patients. However, the factor structure of this instrument has not been verified in individuals with chronic ankle instability (CAI). Furthermore, additional evidence examining the mDPA in individuals with CAI is warranted. Objective: The purpose of this study was to verify the factor structure of the mDPA and compare the physical summary component (PSC) and mental summary component (MSC) in those with and without CAI. Design: Cross-sectional. Setting: Laboratory. Participants: A total of 118 CAI and 81 healthy controls from a convenience sample participated. Intervention: Not applicable. Main Outcome Measures: All subjects completed the 16-item mDPA that included the PSC and MSC; higher scores represent greater disablement. To examine the model fit of the mDPA, a single-factor and 2-factor (PSC and MSC) structures were tested. Group differences were examined with independent t tests (P ≤ .05) and Hedges' g effect sizes (ESs). Results: Model fit indices showed the 2-factor structure to possess adequate fit to the data, χ2(101) = 275.58, P < .001, comparative-fit index = .91, root mean square error of approximation = .09 (95% confidence interval [CI], .08-.11), and standardized root mean square residual = .06. All items loaded significantly and in expected directions on respective subscales (λ range = .59-.87, all Ps < .001). The CAI group reported greater disablement as indicated from PSC (CAI: 11.45 [8.30] and healthy: 0.62 [1.80], P < .001, ES = 1.67; 95% CI, 1.33-1.99) and MSC (CAI: 1.75 [2.58] and healthy: 0.58 [1.46], P < .001, ES = 0.53; 95% CI, 0.24-0.82) scores. Conclusions: The 2-factor structure of the mDPA was verified. Individuals with CAI reported greater disablement on the PSC compared with healthy controls. The moderate ES on the MSC between groups warrants further investigation. Overall, these results indicate the mDPA is a generic patient-reported outcome instrument that can be utilized with individuals who have CAI.

Evaluation of Cognitive Behavioral Interventions and Psychoeducation Implemented by Rehabilitation Specialists to Treat Fear-Avoidance Beliefs in Patients With Low Back Pain: A Systematic Review.

OBJECTIVES: To systematically locate, critically appraise, and synthesize the available evidence regarding the effectiveness of cognitive behavioral therapies (CBTs) and psychoeducation that can be implemented by rehabilitation specialists to treat fear-avoidance beliefs in patients with acute, subacute, and chronic low back pain (LBP). DATA SOURCES: Electronic databases (CINAHL, PubMed, Psychology and Behavior Sciences Collection, SPORTDiscus, PsycINFO) were searched from inception to September 2017. STUDY SELECTION: Assessment of methodological quality was completed using the Physiotherapy Evidence Database (PEDro) scale. The Strength of Recommendation Taxonomy was used to evaluate the quality of evidence. DATA EXTRACTION: Study sample, subject demographics, CBT and/or psychoeducation intervention details, data collection time points, outcome assessments, statistical analysis, results, and conclusions were extracted from each study. In addition, effect sizes were calculated. DATA SYNTHESIS: Five high-quality studies (PEDro ≥6) were included. All included studies evaluated fear-avoidance beliefs. CBTs and psychoeducation strategies designed to target patient-specific fears demonstrated clinically meaningful results, while psychoeducation methodologies were not as effective. CONCLUSIONS: There is inconsistent, patient-oriented evidence (grade B) to support the use of CBTs and/or psychoeducation strategies by rehabilitation specialists to treat fear-avoidance beliefs. Patient-centered and personalized CBTs were most effective to treat these psychosocial factors in patients with LBP when compared with a control treatment.

Sex and number of concussions influence the association between concussion and musculoskeletal injury history in collegiate athletes.

OBJECTIVES: Examine the association between concussion and lower extremity injury in collegiate athletes and the influence of sex and the number of concussions on this relationship. METHODS: A total of 468 collegiate student-athletes (200 Males, 268 Females) were recruited from collegiate athletic facilities of three universities to participate in this retrospective review. Participants provided injury history (concussions, ankle sprains, and knee injuries) information through a survey. Chi-square tests and odds ratios examined the relationship between concussion and ankle sprain or knee injury history within each sex and based on concussion history (0, 1, >1). RESULTS: Females athletes with a concussion history had greater odds of reporting an ankle sprain or knee injury compared to females with no concussion history (OR = 1.88-2.54; p ≤ 0.020). Male athletes with a concussion history did not have greater odds of reporting an ankle sprain or knee injury. Athletes reporting multiple concussions had the greatest odds of ankle sprain or knee injury history compared to athletes with no previous concussions (OR = 2.43-2.56; p ≤ 0.004). No differences were identified between athletes with a single or multiple concussion history. CONCLUSION: Female athletes with a concussion history or participants with a multiple concussion history had the greatest odds of reporting an ankle or knee injury history compared to athletes with no concussion history.

College Athletes With Ankle Sprain History Exhibit Greater Fear-Avoidance Beliefs.

CONTEXT: Postinjury, college athletes have reported elevated levels of fear. However, it is unclear how a history of ankle sprain impacts injury-related fear. OBJECTIVE: The aim of this study was to determine if Fear-Avoidance Beliefs Questionnaire (FABQ) scores differ between college athletes with a history of a single ankle sprain, those with recurrent ankle sprains, and healthy controls. DESIGN: Cross-sectional design. SETTING: National Collegiate Athletic Association institutions. PATIENTS: From a large database of college athletes, 75 participants with a history of a single ankle sprain, 44 with a history of recurrent ankle sprains (≥2), and 28 controls with no injury history were included. MAIN OUTCOME MEASURES: Participants completed an injury history questionnaire and the FABQ. On the injury history form, the participants were asked to indicate if they had ever sustained an ankle sprain and, if yes, to describe how many. FABQ scores ranged from 0 to 66 with higher scores representing greater fear. RESULTS: Athletes with a history of recurrent ankle sprains (median, 28.00; interquartile range, 18.25-38.00) reported higher levels of fear than those with a history of a single ankle sprain (21.00; 8.00-31.00; P = .03; effect size = 0.199) and healthy controls (5.50; 0.00-25.00; P < .001; effect size = 0.431). Athletes with a history of a single sprain reported greater fear than healthy controls (P = .01, effect size = 0.267). Athletes with a history of a single sprain reported greater fear than healthy controls (P = .02, effect size = 0.23). CONCLUSIONS: College athletes with a history of ankle sprain exhibited greater levels of fear on the FABQ than healthy controls. These findings suggest that ankle sprains in general may increase injury-related fear and that those with a history of recurrent sprains are more vulnerable.

Examination of Response Shift After Rehabilitation for Orthopedic Conditions: A Systematic Review.

CONTEXT: There is an increased emphasis on the need to capture and incorporate self-reported function to make clinical decisions when providing patient-centered care. Response shift (RS), or a change in an individual's self-evaluation of a construct, may affect the accurate assessment of change in self-reported function throughout the course of rehabilitation. A systematic review of this phenomenon may provide valuable information regarding the accuracy of self-reported function. OBJECTIVES: To systematically locate and synthesize the existing evidence regarding RS during care for various orthopedic conditions. EVIDENCE ACQUISITION: Electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, and Psychology & Behavioral Sciences Collection) were searched from inception to November 2016. Two investigators independently assessed methodological quality using the modified Downs and Black Quality Index. The quality of evidence was assessed using the Strength-of-Recommendation Taxonomy. The magnitude of RS was examined through effect sizes. EVIDENCE SYNTHESIS: Nine studies were included (7 high quality and 2 low quality) with a median Downs and Black Quality Index score of 81.25% (range = 56.25%-93.75%). Overall, the studies demonstrated weak to strong effect sizes (range = -1.58-0.33), indicating the potential for RS. Of the 36 point estimates calculated, 22 (61.11%), 2 (5.56%), and 12 (33.33%) were associated with weak, moderate negative, and strong negative effect sizes, respectively. CONCLUSIONS: There is grade B evidence that a weak RS, in which individuals initially underestimate their disability, may occur in people undergoing rehabilitation for an orthopedic condition. It is important for clinicians to be aware of the potential shift in their patients' internal standards, as it can affect the evaluation of health-related quality of life changes during the care of orthopedic conditions. A shift in the internal standards of the patient can lead to subsequent misclassification of health-related quality of life changes that can adversely affect clinical decision making.

The Examination of Patient-Reported Outcomes and Postural Control Measures in Patients With and Without a History of ACL Reconstruction: A Case Control Study.

CONTEXT: There is a lack of literature to support the diagnostic accuracy and cut-off scores of commonly used patient-reported outcome measures (PROMs) and clinician-oriented outcomes such as postural-control assessments (PCAs) when treating post-ACL reconstruction (ACLR) patients. These scores could help tailor treatments, enhance patient-centered care and may identify individuals in need of additional rehabilitation. OBJECTIVE: To determine if differences in 4-PROMs and 3-PCAs exist between post-ACLR and healthy participants, and to determine the diagnostic accuracy and cut-off scores of these outcomes. DESIGN: Case control. SETTING: Laboratory. PARTICIPANTS: A total of 20 post-ACLR and 40 healthy control participants. MAIN OUTCOME MEASURES: The participants completed 4-PROMs (the Disablement in the Physically Active Scale [DPA], The Fear-Avoidance Belief Questionnaire [FABQ], the Knee Osteoarthritis Outcomes Score [KOOS] subscales, and the Tampa Scale of Kinesiophobia [TSK-11]) and 3-PCAs (the Balance Error Scoring System [BESS], the modified Star Excursion Balance Test [SEBT], and static balance on an instrumented force plate). Mann-Whitney U tests examined differences between groups. Receiver operating characteristic (ROC) curves were employed to determine sensitivity and specificity. The Area Under the Curve (AUC) was calculated to determine the diagnostic accuracy of each instrument. The Youdin Index was used to determine cut-off scores. Alpha was set a priori at P < 0.05. RESULTS: There were significant differences between groups for all PROMs (P < 0.05). There were no differences in PCAs between groups. The cut-off scores should be interpreted with caution for some instruments, as the scores may not be clinically applicable. CONCLUSIONS: Post-ACLR participants have decreased self-reported function and health-related quality of life. The PROMs are capable of discriminating between groups. Clinicians should consider using the cut-off scores in clinical practice. Further use of the instruments to examine detriments after completion of standard rehabilitation may be warranted.

Health-Related Quality of Life in University Dance Students.

Injuries are common among dancers and may negatively affect health-related quality of life (HRQL). The modified Disablement in the Physically Active Scale (mDPA) is a generic patient-reported outcome instrument that could be used when providing care to patients participating in performing arts. The objective of this pilot study was to examine the internal consistency of the mDPA and assess overall HRQL using the mDPA in university dance students. Thirty-one female university dance students completed the mDPA during one data collection session. Higher scores on the Physical Summary Component (mDPA-PSC), the Mental Summary Component (mDPAMSC), and mDPA-Total indicated increased disablement. The internal consistency was determined using Cronbachs alpha. The mDPA-Total, mDPA-PSC, and mDPAMSC scores were examined descriptively using mean and standard deviations. Individual item responses were also examined. The proportion of university dance students with clinically relevant levels of disablement on the mDPA-Total was examined using a previously established minimally clinically important difference value. The internal consistency for the mDPA-MSC (a=0.91) and mDPATotal (a=0.90) was excellent and good for the mDPA-PSC (a=0.88). A large proportion (71%) of university dance students demonstrated clinically relevant levels of disablement despite fully participating in dance-related activities. Pain, impaired motion, and stress were the greatest contributors to increased disablement in these individuals. The mDPA scores observed in this pilot study indicate that many dance students experience levels of disablement and decreased HRQL which may warrant physical and mental intervention. Clinicians providing healthcare services to performing artists should consider using the mDPA to provide patient-centered care.

Somatosensory deficits in post-ACL reconstruction patients: A case-control study.

INTRODUCTION: Diminished cutaneous detection thresholds have been identified in patients with multiple orthopedic conditions, and these phenomena may occur in postanterior cruciate ligament reconstructed (ACLR) patients. The purpose of this study was to determine if differences in lower extremity cutaneous detection thresholds exist in post-ACLR patients when compared with healthy controls. METHODS: Fifteen individuals who were post-ACLR and 15 individuals who had no history of knee injury participated. Light touch cutaneous detection thresholds were assessed at 4 locations on the foot and ankle (first metatarsal, fifth metatarsal, medial malleolus, and lateral malleolus). Nonparametric statistics examined group differences between the sites. RESULTS: ACLR subjects had decreased cutaneous sensation at the first metatarsal and medial malleolus compared with healthy controls. CONCLUSIONS: Somatosensory deficits are present in post-ACLR patients. Future research should investigate these phenomena longitudinally in post-ACLR individuals along with somatosensory targeted interventions. Muscle Nerve 55: 5-8, 2017.