TENDINopathy Severity assessment-Achilles (TENDINS-A): evaluation of reliability and validity in accordance with COSMIN recommendations.

OBJECTIVE: To evaluate the construct validity (structural validity and hypothesis testing), reliability (test-retest reliability, measurement error and internal consistency) and minimal important change (MIC) of the 13-item TENDINopathy Severity assessment-Achilles (TENDINS-A). METHODS: Participants with Achilles pain completed an online survey including: demographics, TENDINS-A, Foot and Ankle Outcome Score (FAOS) and Victorian Institute of Sport Assessment-Achilles (VISA-A). Exploratory factor analysis (EFA) assessed dimensionality. Confirmatory factor analysis (CFA) assessed structural validity (root mean square error of approximation (RMSEA); Comparative Fit Index (CFI); Tucker-Lewis Index (TLI); standardised root measure square (SRMS)). Correlations between TENDINS-A and the FAOS or VISA-A assessed hypothesis testing. Intraclass correlation (ICC) assessed test-retest reliability. Cronbach's alpha assessed internal consistency. SE of the measurement (SEM) assessed measurement error. A distribution-based approach assessed MIC. RESULTS: 79 participants (51% female) with a mean (SD) age=42.6 (13.0) years, height=175.0 (11.7) cm and body mass=82.0 (19.1) kg were included. EFA identified three meaningful factors, proposed as pain, symptoms and function. The best model identified using CFA for TENDINS-A had structural validity (RMSEA=0.101, CFI=0.959, TLI=0.947, SRMS=0.068), which included three factors (pain, symptoms and function), but excluded three items from the original TENDINS-A. TENDINS-A exhibited moderate positive correlation with FAOS (r=0.598, p<0.001) and a moderate negative correlation with VISA-A (r=-0.639, p<0.001). Reliability of the TENDINS-A was excellent (ICC=0.930; Cronbach's α=0.808; SEM=6.54 units), with an MIC of 12 units. CONCLUSIONS: Our evaluation of the revised 10-item TENDINS-A determined it has construct validity and excellent reliability, compared with the VISA-A and FAOS which lack content and construct validity. The TENDINS-A is recommended as the preferred patient-reported outcome measure to assess disability in people with Achilles tendinopathy.

Efficacy of heavy eccentric calf training for treating mid-portion Achilles tendinopathy: a systematic review and meta-analysis.

OBJECTIVE: To assess the effectiveness of heavy eccentric calf training (HECT) in comparison with natural history, traditional physiotherapy, sham interventions or other exercise interventions for improvements in pain and function in mid-portion Achilles tendinopathy. DESIGN: A systematic review and meta-analysis were conducted as per the PRISMA guidelines. DATA SOURCES: PUBMED, CINAHL (Ovid) and CINAHL (EBSCO) were searched from inception until 24 September 2018. ELIGIBILITY CRITERIA: Randomised controlled trials comparing HECT to natural history, sham exercise, traditional physiotherapy and other exercise interventions were included. Primary outcome assessing pain and function was the Victorian Institute of Sports Assessment-Achilles. RESULTS: Seven studies met the inclusion criteria. This review suggests HECT may be superior to both natural history, mean difference (MD) (95% CI) of 20.6 (11.7 to 29.5, one study) and traditional physiotherapy, MD (95% CI) of 17.70 (3.75 to 31.66, two studies). Following removal of one study, at high risk of bias, due to pre-planned sensitivity analysis, this review suggests HECT may be inferior to other exercise interventions, MD (95% CI) of -5.65 (-10.51 to -0.79, three studies). However, this difference is unlikely to be clinically significant. CONCLUSION: Current evidence suggests that HECT may be superior to natural history and traditional physiotherapy while HECT may be inferior to other exercise interventions. However, due to methodological limitations, small sample size and a lack of data we are unable to be confident in the results of the estimate of the effect, as the true effect is likely to be substantially different. SYSTEMATIC REVIEW REGISTRY: PROSPERO registration number: CRD4201804493 PROTOCOL REFERENCE: This protocol has been published open access: Murphy M, Travers MJ, Gibson, W. Is heavy eccentric calf training superior to natural history, sham rehabilitation, traditional physiotherapy and other exercise interventions for pain and function in mid-portion Achilles tendinopathy? Systematic Reviews 2018; 7: 58.

Maximising neuromuscular performance in people with pain and injury: moving beyond reps and sets to understand the challenges and embrace the complexity.

Rehabilitative practice is often criticised for being non-individualised, monotonous and not well aligned with foundational principles that drive continued physiological adaptation(s). However, our understanding of neuromuscular physiology is rapidly increasing and the way we programme rehabilitation is improving. This viewpoint highlights some of the potential considerations around why the adaptations achieved during rehabilitation programmes may be suboptimal. We provide basic, clinician-focused discussion about potential confounding physiological factors, and put forward several exercise-based programming recommendations and novel approaches to consider in contemporary rehabilitative practice. Specifically, we outline several potential mechanisms contributing to poor muscle activation and function that might be present following musculoskeletal injury. However, clinicians require strategies capable of attenuating these impairments to restore proper function. Therefore, we also provide an overview of recommended strength and conditioning guidelines, and novel strategies (such as external pacing and electrical stimulation techniques) that clinicians can consider to potentially improve the efficacy of musculoskeletal rehabilitation.

What is the Prevalence of General Anxiety Disorder and Depression Symptoms in Semi-elite Australian Football Players: A Cross-Sectional Study.

BACKGROUND: The prevalence of anxiety and depression symptoms in semi-elite Australian footballers is unknown. The primary objective of this study was to determine the prevalence of generalised anxiety disorder (GAD) and depressive symptoms in semi-elite Australian Football players. Our secondary objective was to explore the association between demographic and football-specific factors with GAD and depressive symptoms. A cross-sectional epidemiological study including 369 semi-elite Western Australian Football League (WAFL) players from the Men and Women's 2022 season (n = 337 men, 91%) was conducted. Symptoms of depression were measured using the Patient Health Questionnaire-9 scale (PHQ-9) and symptoms of GAD with the GAD-7 scale. RESULTS: Our response rate was 82.9%. Thirteen players had missing data. The prevalence of GAD symptoms was 8.5% in men and 28.6% in women (10% overall). The prevalence of depressive symptoms was 20% in men and 57% in women (23% overall). Being a woman (gender) was associated with a sevenfold increased risk of GAD and/or depression symptoms [odds ratio (OR): 7.33, 95% confidence interval (CI): 3.18-16.92; p < 0.001]. Players of 'Aboriginal or Torres Strait Islander' ethnicity were two times more likely to report GAD and/or depression symptoms in comparison to players of 'Australian' ethnicity (OR: 2.13; 95% CI: 1.01-4.49; p = 0.048). Concussion history was not a significant risk factor for GAD or depression symptoms. CONCLUSION: This study demonstrated that approximately 1 in 10 WAFL players met the diagnostic cut-off criteria for probable GAD, and 1 in 5 for probable depression. The prevalence for depression symptoms in this study were far higher than the national average in the comparative age bracket. WAFL women's players also reported a substantially higher prevalence of GAD and depressive symptoms than men, and should be further investigated as a priority by the WAFL.

Musculoskeletal injury epidemiology in law enforcement and firefighter recruits during physical training: a systematic review.

Objectives: Report the injury epidemiology of law enforcement and firefighter recruits. Design: A systematic epidemiological review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was completed. Data sources: Five online databases were searched from database inception to 5 May 2021. Eligibility criteria for selecting studies: Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by law enforcement or firefighter recruits were included. We reported on all components of injury where data were available. All injury incidence rates were calculated as per 1000 training days (Poisson 95% CI) to allow comparisons between studies. Study quality was assessed using the Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies. Results: No studies reporting firefighter recruits were identified. Eight published studies that reported on injuries to law enforcement recruits were identified. The studies were all low quality, and the credibility of the evidence was assessed as very low. Seven studies reported medical attention injuries, and one study reported the number of medical withdrawals from a recruit training programme. The prevalence of law enforcement recruits with medical attention injuries ranged from 13.7% to 24.5%. The overall medical attention injury incidence rate for law enforcement recruits ranged from 1.67 injuries per 1000 training days (Poisson 95% CI 1.00 to 2.34 injuries per 1000 training days) to 4.24 injuries per 1000 training days (Poisson 95% CI 2.97 to 5.51 injuries per 1000 training days). Conclusion: This review reported the prevalence and incidence rates for musculoskeletal injuries in law enforcement officers. However, the credibility of the evidence is very low. PROSPERO registration number: CRD42021251084.

Assessment and monitoring of Achilles tendinopathy in clinical practice: a qualitative descriptive exploration of the barriers clinicians face.

Our primary objective was to explore the barriers preventing clinicians from implementing what they think is ideal practice as it relates to using tools to aid diagnosis and monitor progress in mid-portion Achilles tendinopathy. Our secondary objectives were to describe the assessments employed by clinicians in their own practice to aid with (a) diagnosis and (b) monitoring progress in Achilles tendinopathy and explore the outcome measure domains clinicians believe to be the most and least important when managing patients with Achilles tendinopathy. We employed a qualitative descriptive study design. Thirteen participants (eight female, five male) from across Australia, consisting of two junior physiotherapists, five senior physiotherapists working in private practice, four senior physiotherapists working within elite sports organisations and two sport and exercise medicine doctors, were included and one-on-one interviews were performed. Audio was transcribed then entered into NVivo for coding and analysis. Four main themes were perceived as barriers to implementing ideal practice of assessment and monitoring in people with Achilles tendinopathy: financial constraints, time constraints, access to equipment and patient symptom severity. Assessments related to function, pain on loading, pain over a specified time frame and palpation are commonly used to assist diagnosis. Assessments related to disability, pain on loading, pain over a specified time frame and physical function capacity are used to monitor progress over time. Furthermore, pain on loading and pain over a specified time frame were considered the most important outcome measure domains for assisting diagnosis whereas pain on loading, patient rating of the condition and physical function capacity were the most important outcome measure domains for monitoring progress. A number of barriers exist that prevent clinicians from implementing what they view as ideal assessment and monitoring for Achilles tendinopathy. These barriers should be considered when developing new assessments and in clinical practice recommendations.