Low Self-Efficacy and High Kinesiophobia Are Associated With Worse Function in Patients With Femoroacetabular Impingement Syndrome.

CONTEXT: Femoroacetabular impingement syndrome (FAIS) is a painfully debilitating hip condition disproportionately affecting active individuals. Mental health disorders are an important determinant of treatment outcomes for individuals with FAIS. Self-efficacy, kinesiophobia, and pain catastrophizing are psychosocial factors that have been linked to inferior outcomes for a variety of orthopedic conditions. However, these psychosocial factors and their relationships with mental health disorders, pain, and function have not been examined in individuals with FAIS. OBJECTIVE: (1) To examine relationships between self-efficacy, kinesiophobia, pain catastrophizing, pain, and function in patients with FAIS and (2) to determine if these variables differ between patients with and without a self-reported depression and/or anxiety. DESIGN: Cross-sectional. SETTING: University health center. PARTICIPANTS: Fifty-one individuals with FAIS (42 females/9 males; age 35.7 [11.6] y; body mass index 27.1 [4.9] kg/m2). MAIN OUTCOME MEASURES: Participants completed the Pain Self-Efficacy Questionnaire, Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, visual analog scale for hip pain at rest and during activity, and the 12-item International Hip Outcome Tool. Self-reported depression and/or anxiety were recorded. The relationships between psychosocial factors, pain, and function were examined using Spearman rank-order correlations. Independent t tests and Mann-Whitney U tests were used to evaluate the effect of self-reported depression and/or anxiety on psychosocial factors, pain and function. RESULTS: The 12-item International Hip Outcome Tool was correlated with pain during activity (ρ = -.57, P ≤ .001), Tampa Scale for Kinesiophobia (ρ = -.52, P ≤ .001), and Pain Self-Efficacy Questionnaire (ρ = .71, P ≤ .001). The Pain Self-Efficacy Questionnaire was also correlated with pain at rest (ρ = -.43, P = .002) and pain during activity (ρ = -.46, P = .001). Individuals with self-reported depression and/or anxiety (18/51; 35.3%) had worse self-efficacy and pain catastrophizing (P ≤ .01). CONCLUSION: Self-reported depression and/or anxiety, low self-efficacy, and high kinesiophobia were associated with more hip pain and worse function for patients with FAIS. These findings warrant further examination including psychosocial treatment strategies to improve the likelihood of a successful clinical outcome for this at-risk population.

Elastic Resistance Effectiveness on Increasing Strength of Shoulders and Hips.

Picha, KJ, Almaddah, MR, Barker, J, Ciochetty, T, Black, WS, and Uhl, TL. Elastic resistance effectiveness on increasing strength of shoulders and hips. J Strength Cond Res 33(4): 931-943, 2019-Elastic resistance is a common training method used to gain strength. Currently, progression with elastic resistance is based on the perceived exertion of the exercise or completion of targeted repetitions; exact resistance is typically unknown. The objective of this study was to determine whether knowledge of load during elastic resistance exercise will increase strength gains during exercises. Participants were randomized into 2 strength training groups, elastic resistance only and elastic resistance using a load cell (LC) that displays force during exercise. The LC group used a Smart Handle (Patterson Medical Supply, Chicago, IL, USA) to complete all exercises. Each participant completed the same exercises 3 times weekly for 8 weeks. The LC group was provided with a set load for exercises, whereas the elastic resistance only group was not. The participant's strength was tested at baseline and program completion, measuring isometric strength for shoulder abduction (SAb), shoulder external rotation (SER), hip abduction (HAb), and hip extension (HEx). Independent t-tests were used to compare the normalized torques between groups. No significant differences were found between groups. Shoulder strength gains did not differ between groups (SAb p > 0.05; SER p > 0.05). Hip strength gains did not differ between groups (HAb p > 0.05; HEx p > 0.05). Both groups increased strength because of individual supervision, constantly evaluating degree of difficulty associated with exercise and providing feedback while using elastic resistance. Using an LC is as effective as supervised training and could provide value in a clinical setting when patients are working unsupervised.

Calculation of Resistive Loads for Elastic Resistive Exercises.

CONTEXT: What is the correct resistive load to start resistive training with elastic resistance to gain strength? This question is typically answered by the clinician's best estimate and patient's level of discomfort without objective evidence. OBJECTIVE: To determine the average level of resistance to initiate a strengthening routine with elastic resistance following isometric strength testing. DESIGN: Cohort. SETTING: Clinical. PARTICIPANTS: 34 subjects (31 ± 13 y, 73 ± 17 kg, 170 ± 12 cm). INTERVENTIONS: The force produced was measured in Newtons (N) with an isometric dynamometer. The force distance was the distance from center of joint to location of force applied was measured in meters to calculate torque that was called "Test Torque" for the purposes of this report. This torque data was converted to "Exercise Load" in pounds based on the location where the resistance was applied, specifically the distance away from the center of rotation of the exercising limb. The average amount of exercise load as percentage of initial Test Torque for each individual for each exercise was recorded to determine what the average level of resistance that could be used for elastic resistance strengthening program. MAIN OUTCOME MEASURES: The percentage of initial test torque calculated for the exercise was recorded for each exercise and torque produced was normalized to body weight. RESULTS: The average percentage of maximal isometric force that was used to initiate exercises was 30 ± 7% of test torque. CONCLUSIONS: This provides clinicians with an objective target load to start elastic resistance training. Individual variations will occur but utilization of a load cell during elastic resistance provides objective documentation of exercise progression.

Reliability of 5 Novel Reaction Time and Cognitive Load Protocols.

CONTEXT: Reaction time (RT) is crucial to athletic performance. Therefore, when returning athletes to play following injury, it is important to evaluate RT characteristics ensuring a safe return. The Dynavision D2® system may be utilized as an assessment and rehabilitation aid in the determination of RT under various levels of cognitive load. Previous research has demonstrated good reliability of simple protocols when assessed following a 24- to 48-hour test-retest window. Expanding reliable test-retest intervals may further refine novel RT protocols for use as a diagnostic and rehabilitation tool. OBJECTIVE: To investigate the test-retest reliability of a battery of 5 novel RT protocols at different time intervals. DESIGN: Repeated measures/reliability. SETTING: Interdisciplinary sports medicine research laboratory. PARTICIPANTS: Thirty healthy individuals. METHODS: Participants completed a battery of protocols increasing in difficulty in terms of reaction speed requirement and cognitive load. Prior to testing, participants were provided 3 familiarization trials. All protocols required participants to hit as many lights as quickly as possible in 60 seconds. After completing the initial testing session (session 1), participants waited 1 hour before completing the second session (session 2). Approximately 2 weeks later (average 14 [4] d), the participants completed the same battery of tasks for the third session (session 3). MAIN OUTCOME MEASURES: The intraclass correlation coefficient, standard error of measurement, minimal detectable change, and repeated-measures analysis of variance were calculated for RT. RESULTS: The intraclass correlation coefficient values for each of the 5 protocols illustrated good to excellent reliability between sessions 1, 2, and 3 (.75-.90). There were no significant differences across time points (F < 0.105, P > .05). CONCLUSIONS: The 1-hour and 14-day test-retest intervals are reliable for clinical assessment, expanding the time frames previously reported in the literature of when assessments can be completed reliably. This study provides novel protocols that challenge cognition in unique ways.

Applying the National Institute on Minority Health and Health Disparities Research Framework to Social Determinants of Health in the Context of Sport-Related Concussion: A Clinical Commentary.

Sport-related concussion (SRC) is a prevalent injury. Significant disparities in SRC outcomes exist across racial and ethnic groups. These disparities may be attributed to the unequal distribution of political power (or influence) and resource allocation in various communities, shaping individuals' social determinants of health (SDOH). However, the influence of SDOH on SRC outcomes remains understudied. In this clinical commentary, we use the National Institute on Minority Health and Health Disparities Research Framework and describe how its application can help address gaps in our understanding of SDOH and SRC. This framework provides a comprehensive approach to investigating and addressing health disparities by considering SDOH along multiple levels and domains of influence. Using this framework, athletic trainers can identify areas requiring intervention and better understand how SDOH influence SRC outcomes. This understanding can help athletic trainers develop tailored interventions to promote equitable care for patients with SRC.

Athletic Trainers' Familiarity, Comfort, Knowledge, and Recognition of Social Determinants of Health.

CONTEXT: Social determinants of health (SDH)-education, transportation, housing, employment, health systems and services, economic status, and physical and social environments-influence patient outcomes; therefore, athletic trainers (ATs) need to be able to understand and address these factors. However, little is known about how ATs perceive SDH or how knowledgeable they are about social factors that contribute to patient health and well-being. OBJECTIVE: To evaluate ATs' familiarity and comfort with SDH and their perceived knowledge and recognition of SDH. DESIGN: Cross-sectional. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Our survey was distributed to 17 000 ATs; 1829 accessed it (access rate=10.8%), and 1694 completed it (completion rate=92.6%, AT experience=15.2±10.6 years, age=36.6±10.8 years). MAIN OUTCOME MEASURES: The survey included multipart questions that evaluated ATs' perceptions of their familiarity, comfort, and knowledge about SDH. Data were summarized using descriptive statistics. RESULTS: Few respondents (4.1%, 70/1691) reported they were extremely familiar with SDH. Most reported being moderately familiar (45.0%, 761/1691), minimally familiar (34.7%, 587/1691), or not familiar at all (16.1%, 273/1691). For questions about comfort, few reported being extremely comfortable (3.5%, 59/1691) with SDH, and most reported being moderately comfortable (35.4%, 598/1691), minimally comfortable (41.1%, 695/1691), or not comfortable at all (18.6%, 314/1691). For questions about knowledge, few reported being extremely knowledgeable (2.7%, 46/1686) about SDH, and the majority reported being moderately (38.9%, 622/1686), minimally (41.8%, 704/1686) or not knowledgeable at all (18.6%, 314/1686). Over half of ATs accurately categorized 8 of the 9 SDH listed in the survey, and 22% endorsed more correct than incorrect items. CONCLUSIONS: A majority of ATs perceived their familiarity, comfort, and knowledge about SDH to be moderate-to-low, which may reflect the relatively recent emphasis on SDH in athletic healthcare. Because SDH can have a major impact on patient health and well-being, strategies should be developed for educating ATs about SDH. Developing strategies to increase comfort with the SDH in patient care is critical to ensure that those factors that can be addressed at the patient level are identified and managed.

Athletic Trainers' Observations of Social Determinants of Health in the Collegiate Setting: A Card Study.

CONTEXT: Addressing social determinants of health (SDH) in all populations improves patient outcomes, leading to better patient-centered care. Despite known influences of SDH, little is known about the ability of athletic trainers (ATs) to observe SDH in practice. OBJECTIVE: To explore ATs' observations of SDH and describe actions taken at the point-of-care in college/university settings. DESIGN: Descriptive via an observational card study. SETTING: Athletic training facilities. PARTICIPANTS: ATs (23 participants across 20 institutions) employed in the college/university setting. DATA COLLECTION AND ANALYSIS: ATs used a modified observation card to document observations of SDH during patient encounters in the college/university setting. Cards contained instructions for completion and a table with 4 columns: (1) a list of 19 predetermined SDH, (2) checkbox for observed SDH, (3) checkbox for perceived negative influence of observed SDH on patient health, and (4) open box to write in what actions, if any, were taken to address the observed SDH. RESULTS: Overall, 424 cards were collected. Of 725 observed SDH, access to social media (153/725, 21.1%), academic stressors (131/725, 18.1%), and behavioral health issues (71/725, 9.8%) were the most commonly observed. Nearly 39% (281/725) had a perceived negative 16.4%), and transportation issues (32/281, 11.4%) were most common. For the 23.0% (166/725) of SDH acted on, ATs used counseling and education (73/166), provided additional resources (60/166), referred to others (29/166), or communicated with others (4/166). CONCLUSIONS: Because ATs are positioned to accurately assess SDH, they can promote better patient-centered care and improve patient outcomes. Our results suggested many SDH observed by ATs in the college/university setting had a negative influence on patient health. Better support for patients with behavioral health issues and academic stressors is important because these SDH were commonly perceived to negatively influence health and well-being.

Athletic Trainers' Perceptions of and Experience with Social Determinants of Health.

The role that social determinants of health (SDHs) play in athletic healthcare is gaining attention, yet little is known about athletic trainers' (ATs) perceptions of and encounters with the impact of SDHs. The purpose of this study was to evaluate ATs' perceptions of various SDHs and their experience treating patients whose health and well-being were influenced by SDHs. This was a cross-sectional, web-based survey completed by 1694 ATs (completion rate = 92.6%; 61.1% female; age = 36.6 ± 10.8 years). The survey consisted of several multipart questions focusing on specific SDHs. Descriptive statistics were used to report frequencies and percentages. Results indicated widespread agreement that SDHs matter to patient health and are of concern in athletic healthcare. The SDHs that ATs most commonly reported encountering included lifestyle choices (n = 1306/1406; 93.0%), social support (n = 1185/1427; 83.0%), income (n = 1167/1502; 77.7%), and access to quality and timely healthcare (n = 1093/1420, 77.0%). The SDHs that ATs least commonly reported having experience with was governmental policy (n = 684/1411; 48%). The perceived importance of SDHs among ATs and their commonly reported experiences managing patient cases in which SDHs negatively influence patients' health and healthcare suggest that efforts to assess these factors are needed so that strategies to address their influence on athletic healthcare can be identified.

Social Determinants of Health: Considerations for Athletic Health Care.

Health disparities are prevalent concerns in the United States and a frequent topic of conversation in the public health realm. Causes of health disparities include social inequities and social determinants of health. Although social determinants of health have been suggested to contribute more to individual and population health than the health care provided, this concept in athletic health care has received little attention. Therefore, the purpose of our article was to describe social determinants of health, present examples of social determinants, and discuss actionable steps for the athletic training profession to become more culturally proficient. By increasing the awareness of and acknowledging social determinants of health, athletic trainers will be positioned to improve patient outcomes more readily and contribute to ongoing conversations at the policy level of health care.

Line Hops and Side Hold Rotation Tests Load Both Anterior and Posterior Shoulder: A Biomechanical Study.

BACKGROUND: Clinical tests should replicate the stressful positions encountered during sport participation. Evaluating the kinetic and electromyographical demands of clinical tests enables clinicians to choose appropriate tests for specific sports. PURPOSE: To describe the shoulder forces and muscle activation levels during closed chain functional tests of Line Hops (LH) and Side Hold Rotation (SHR). STUDY DESIGN: Descriptive biomechanical study. METHODS: Ten asymptomatic participants were examined in a university laboratory. Two functional tests were evaluated using three-dimensional video analysis and electromyography to measure shoulder forces, moments, and muscular activity levels. RESULTS: SHR produced a peak average posterior translation force of 4.84 N/kg (CI95 4.32-5.36N/kg) and a peak average anterior translational force of 1.57 N/kg (CI95 1.10-2.01N/kg). High levels of serratus anterior (98% maximum voluntary isometric contraction (MVIC) and infraspinatus (52 %MVIC) were recorded during SHR. LH produced a posterior translational force of 4.25 N/kg (CI95 3.44-5.06N/kg). High levels of serratus anterior (105 %MVIC) and infraspinatus (87 %MVIC) were recorded during the push off phase of this activity. CONCLUSIONS: LH and SHR placed large posterior translational forces that approached half of a person's bodyweight on shoulder structures. SHR produced an anterior translation force at extremes of horizontal abduction placing approximately 18% of bodyweight on shoulder structures. The LH test required the serratus anterior to provide power to push the upper torso of the ground while both the serratus and the infraspinatus provides scapular and humeral stability, respectively. LEVEL OF EVIDENCE: 4: Case series.

Physical Therapists' Assessment of Patient Self-Efficacy for Home Exercise Programs.

BACKGROUND: Patient adherence to home exercise programs (HEPs) is low, and poor patient self-efficacy is a barrier clinicians can influence. However, little evidence suggests that clinicians assess level of patient self-efficacy before prescribing HEPs. PURPOSE: To determine the importance of patient self-efficacy to physical therapists (PTs) when addressing patient barriers, determine how PTs assess and use patient self-efficacy for HEPs, and describe the barriers facing PTs when assessing patient self-efficacy for HEPs. STUDY DESIGN: Survey. METHODS: Practicing PTs were recruited from the American Physical Therapy Association's Orthopedic Section and emailed the electronic survey. RESULTS: Email invitations were sent to 17730 potential participants, and 462 PTs completed the survey over one month. PTs rated self-efficacy as "very" to "extremely" important for patient adherence (58%, 265/454). Most (71%, 328/462) reported assessing self-efficacy before prescribing HEPs and did so through verbal discussion and observation of the patient (50% and 38% respectively). Half of respondents individualized HEPs through self-efficacy related themes. PTs not assessing self-efficacy reported not knowing how (51%, 68/134), being unsure what to do with the information (24%, 32/134), or reporting other barriers (21%, 28/134). CONCLUSIONS: Most PTs indicated that self-efficacy was important for patient adherence, but assessment strategies reported, such as verbal discussion and observation, may not be the most accurate. PTs who did not assess self-efficacy reported not knowing how or what to do with the information once collected. These findings suggest that there is a gap in knowledge related to how to evaluate self-efficacy for HEPs. Better assessment of self-efficacy may lead to more appropriate and effective implementation strategies. LEVEL OF EVIDENCE: Level II.

INFLUENCE OF LIMB DOMINANCE AND SHOULDER INJURY ON STRENGTH AND EXPLOSIVE FORCE IN US MARINES.

BACKGROUND: The specialized roles of many military personnel require specific skills and high physical demands, placing unique stresses on the shoulders and increasing risk of injury. As normal dominant/nondominant shoulder asymmetries have been established in military personnel, bilateral strength comparisons must be understood in context of daily physical demands to monitor patients' progress or readiness to return to duty. PURPOSE: This study aims to assess bilateral differences in strength and explosive force in United States Marines with a history of dominant or nondominant shoulder pathology. STUDY DESIGN: Cross-Sectional. METHODS: A total of 52 full-duty, male US Marines with a shoulder injury within the prior year participated. Bilateral isokinetic shoulder internal (IR) and external (ER) rotation strength, and peak force (Peak Force) and average rate of force production (Avg Rate) during an explosive push-up were collected. Dominant versus nondominant side data were independently examined within each group (DOM: dominant injury, NOND: nondominant injury). Comparison between DOM and NOND, as well as previously published CON (no history of shoulder injury) was also completed. RESULTS: NOND (n = 26) demonstrated significantly less IR (p < 0.001) and ER (p = 0.003) strength and Peak Force (p = 0.001) and Avg Rate (p = 0.047) on the injured side, while DOM (n = 26) demonstrated no bilateral differences in strength or push-up performance. Comparison between the three groups showed that NOND demonstrated significantly less ER strength than CON (p = 0.022). CONCLUSIONS: Military personnel demonstrate asymmetric strength patterns likely due to increased demand of the dominant shoulder. US Marines with a history of injury to the nondominant shoulder performed differently than those with a dominant side injury, presenting with both strength and push-up asymmetries. They also demonstrated significant ER strength deficits compared to CON. Common clinical practice and previous literature often compare injured and uninjured limbs or injured individuals to healthy controls, but further distinction of dominant or nondominant side may provide more accurate information needed to develop targeted treatment strategies. CLINICAL RELEVANCE: Recognizing unique occupational demands and how patients may present differently with dominant versus nondominant side shoulder injuries are important considerations for ensuring accurate assessment and effective individualized rehabilitation. LEVEL OF EVIDENCE: 3.

Considerations of Conservative Treatment After a Partial Ulnar Collateral Ligament Injury in Overhead Athletes: A Systematic Review.

CONTEXT: Ulnar collateral ligament (UCL) reconstructions continue to increase without consensus on an evidence-based treatment protocol for nonoperative management. Currently, there is no consensus on an effective nonoperative protocol for partial UCL injuries that uses return-to-play (RTP) rates in determining the outcome of conservative treatment. OBJECTIVE: To systematically review RTP rates after conservative treatment of partial UCL injuries in overhead athletes along with descriptive components of each conservative intervention to identify an effective evidence-based nonoperative rehabilitation protocol. DATA SOURCES: Articles in PubMed, CINAHL, MEDLINE, Academic Search Complete, and SPORTDiscus were identified in October 2018 based on the following terms: overhead athlete, ulnar collateral ligament, nonoperative treatment, and return to play. STUDY SELECTION: Seven retrospective, level 4 studies (n = 196) qualified for analysis. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Study design, level of evidence, demographics, sample size, sports involved, level of competition, grade or type of UCL diagnosis, conservative treatment components, and percentage RTP were extracted. RESULTS: Overall, RTP rates after conservative treatment ranged between 42% and 100% (mean, 78% ± 20%). The most frequently reported components of rehabilitation protocols were (1) a period of rest, (2) stretching, (3) strengthening, and (4) a throwing program. Platelet-rich plasma injections were included in 5 (71%) of the 7 protocols with a rehabilitation period. CONCLUSION: Conservative treatment is a viable option for partial UCL tears in overhead athletes. A successful rehabilitation protocol includes the use of patient-reported outcomes, a sport-specific tailored treatment plan, kinetic chain strengthening, and an interval throwing program. Factors such as age, grading of tear, level of play, sport, and athlete's perceived well-being should all be considered during treatment decisions.

The Self-Efficacy for Home Exercise Programs Scale: Development and Psychometric Properties.

BACKGROUND: The Self-Efficacy for Home Exercise Programs Scale (SEHEPS) was developed to help clinicians evaluate patients' self-efficacy for performing prescribed home exercise programs. Prior to clinical adoption, the scale's psychometric properties need to be examined. OBJECTIVE: To determine the psychometric properties of the SEHEPS. METHODS: Eighty-one patients (32 men, 49 women; mean ± SD age, 42 ± 17 years) with varying musculoskeletal conditions participated in this cohort study. Patients were given a home exercise program at the initial physical therapy visit and completed the SEHEPS and a modified Self-Efficacy for Exercise (SEE) scale. The SEHEPS is a 12-item patient-reported questionnaire designed to assess self-efficacy for prescribed home exercise. Patients rated their confidence on a 7-point scale that ranged from 0 (not confident) to 6 (very confident). Total scores ranged from 0 (low self-efficacy) to 72 (high self-efficacy). We assessed the internal consistency of the SEHEPS using Cronbach's alpha and its test-retest reliability using an intraclass correlation coefficient. Convergent validity between the SEHEPS and SEE scale was evaluated with a Spearman correlation. RESULTS: High internal consistency (α = .96) and good test-retest reliability (intraclass correlation coefficient = 0.88; SEM, 4; minimal detectable change at the 95% confidence level, 12) were demonstrated. The SEHEPS was strongly correlated with the SEE scale (ρ = 0.83, P<.01), indicating strong convergent validity. CONCLUSION: The SEHEPS demonstrates excellent internal consistency and convergent validity with the SEE scale. Overall, the SEHEPS is a clinically useful tool to evaluate a patient's self-efficacy in home-based musculoskeletal exercise programs. This scale can be used prior to prescribing a home exercise program for patients with musculoskeletal conditions. LEVEL OF EVIDENCE: Therapy, level 4. J Orthop Sports Phys Ther 2019;49(9):647-655. Epub 10 Jul 2019. doi:10.2519/jospt.2019.8779.

A model to increase rehabilitation adherence to home exercise programmes in patients with varying levels of self-efficacy.

Patient adherence to rehabilitation programmes is frequently low - particularly adherence to home exercise programmes. Home exercise programmes have been identified as complementary to clinic-based physical therapy in an orthopaedic setting. Barriers to patient adherence have previously been identified within the literature. Low self-efficacy is a barrier to adherence that clinicians have the ability to have an impact on and improve. The theory of self-efficacy is defined as a person's confidence in their ability to perform a task. This theory examines the ability of a person to change through exerting control over inner processes of goal setting, self-monitoring, feedback, problem solving and self-evaluation. If clinicians are able to identify patients with low self-efficacy prior to the prescription of a home exercise programme, adjustments to individualized care can be implemented. Individualized care based on improving self-efficacy for home exercise programmes may improve patient adherence to these programmes. The purpose of this article was to use the theory of self-efficacy to direct clinicians in providing individualized programmes to patients with varying levels of self-efficacy.

Versão brasileira da Self-efficacy for home exercise programs scale para a população idosa / Brazilian version of Self-efficacy for home exercise programs scale for the elderly population / Versión brasileña de "self-efficacy for home exercise programs scale" para la población de ancianos

Objetivo: buscar evidências de validade da versão brasileira Self-efficacy for home exercise programs scale" para a população idosa. Método: foram analisadas as evidências de conteúdo, processo de resposta e estrutura interna. Foram utilizados dois painéis de especialistas (equivalências e conteúdo) por ser um assembly. Três formatos da escala foram analisados: original, 5 pontos e 7 pontos. Para o processo de resposta e estrutura interna participaram 174 idosos. A Estrutura interna foi testada pela análise fatorial exploratória. Resultados: Sete dos 12 itens passaram por ajuste de redação, e um item foi adicionado por orientação dos especialistas. O processo de resposta indicou que a versão com 5 pontos foi a apontada pelos idosos como a melhor para ser respondida. Na estrutura interna, o modelo unidimensional com a escala de 5 pontos obteve com os melhores indicadores. Conclusão: recomenda-se a adoção do instrumento de forma unidimensional e o uso da escala de 5 pontos(AU)

Objective: to seek evidence of validity of the Brazilian version Self-efficacy for home exercise programs scale" for the elderly population. Method: evidence of content, response process and internal structure were analyzed. Two expert panels were used (equivalences and content) as it is an assembly. Three scale formats were analyzed: original, 5 points and 7 points. For the response process and internal structure, 174 older people participated. The Internal Structure was tested by exploratory factor analysis. Results: Seven of the 12 items underwent wording adjustments, and one item was added following expert guidance. The response process indicated that the version with 5 points was pointed out by the elderly as the best to be answered. In the internal structure, the one-dimensional model with the 5-point scale obtained the best indicators. Conclusion: it is recommended to adopt the instrument in a unidimensional way and use the 5-point scale(AU)

Objetivo: buscar evidencias de validez de la versión brasileña de "Self-efficacy for home exercise programs scale" (escala de autoeficacia de programas de ejercicios en el hogar) para la población anciana. Método: se analizaron evidencias de contenido, proceso de respuesta y estructura interna. Se utilizaron dos paneles de expertos (equivalencias y contenido) por tratarse de una asamblea. Se analizaron tres formatos de escala: original, 5 puntos y 7 puntos. 174 ancianos participaron en el proceso de respuesta y la estructura interna. Se probó la Estructura Interna mediante análisis factorial exploratorio. Resultados: Siete de los 12 ítems se sometieron a ajustes de redacción y se agregó un ítem siguiendo la opinión de expertos. El proceso de respuesta indicó que los ancianos indicaron la versión con 5 puntos como siendo la mejor para ser respondida. En la estructura interna, el modelo unidimensional con escala de 5 puntos obtuvo los mejores indicadores. Conclusión: se recomienda adoptar el instrumento de forma unidimensional y utilizar la escala de 5 puntos(AU)

Pitch Volume and Glenohumeral and Hip Motion and Strength in Youth Baseball Pitchers.

CONTEXT: Increased pitch volume and altered glenohumeral (GH) and hip range of motion (ROM) and strength contribute to injury risk in baseball pitchers. Although these factors affect one another, whether they are related is unknown. OBJECTIVE: To examine relationships among cumulative and seasonal pitch volume, ROM, and strength of the GH and hip joints in youth baseball pitchers. DESIGN: Cross-sectional study. SETTING: Baseball practice facilities. PATIENTS OR OTHER PARTICIPANTS: A total of 28 healthy baseball pitchers (age = 13.9 ± 2.9 years). MAIN OUTCOME MEASURE(S): A demographic and pitching questionnaire was used to quantify pitch volume. Glenohumeral internal-rotation (IR) and external-rotation (ER) ROM and strength of the throwing arm; total arc of motion (IR + ER ROM); and bilateral hip IR, ER, and total arc of motion ROM and strength in IR, ER, and abduction were measured. A goniometer was used to assess ROM; a handheld dynamometer, to assess strength. Frequency analyses and bivariate correlations (age covariate) described data and identified relationships. RESULTS: Correlations between years of competitive play and increased strength in lead-leg hip IR ( r = 0.52, P = .02) and abduction ( r = 0.48, P = .04) and stance-leg hip IR ( r = 0.45, P = .05) were fair to good. The number of months played in the last year had a fair correlation with decreased GH IR strength ( r = -0.39, P = .04) and increased stance-leg hip IR strength ( r = 0.44, P = .05). Limited pitch time had a fair correlation with increased GH ER ROM ( r = 0.40, P = .04) and an excellent correlation with increased lead-leg hip IR ROM ( r = 0.79, P < .001). Increased innings pitched per game had a fair to good correlation with decreased GH IR strength ( r = -0.41, P = .04) and stance-leg hip ER ROM ( r = -0.53, P = .03). More pitches per game had a fair to good correlation with increased GH ER ROM ( r = 0.44, P = .05) and decreased stance-leg hip ER ROM ( r = -0.62, P = .008). CONCLUSIONS: The significant relationships identified in this study suggest the need to further examine youth and adolescent cumulative and seasonal pitch guidelines.

Patterns and Associations of Shoulder Motion, Strength, and Function in MARSOC Personnel Without History of Shoulder Injury.

Introduction: Military personnel are at an increased risk of shoulder injuries due to training and deployment demands, however, there is a lack of information on the tactical athlete's upper extremity profile. Therefore, the purpose of this study was to examine shoulder musculoskeletal characteristics, including range of motion (ROM), strength, and function, and the relationships between these measures in Marine Corps Forces Special Operations Command (MARSOC) personnel without history of shoulder injury. Materials and Methods: Participants included 195 full-duty male MARSOC personnel (age: 25.38 ± 2.85 yr; height: 1.79 ± 0.06 m, mass: 82.79 ± 7.88 kg) without history of shoulder injury. Measurements of ROM, strength, and function were obtained bilaterally. Shoulder internal rotation (IR) and external rotation (ER) ROM were summed to calculate total arc of motion (ARC). Shoulder IR and ER strength were assessed using an isokinetic dynamometer. Function was evaluated with an explosive push-up. Results: MARSOC personnel present with significantly increased ER ROM, and decreased IR ROM and ARC in their dominant shoulder. They demonstrated greater IR strength and peak force during the explosive push-up on the dominant side but no bilateral differences in average or peak rate were found. Correlation analyses suggest a weak inverse relationship between strength and ARC (r = -0.15 to -0.24). Positive relationships between strength and function were identified except for dominant IR strength and push-up variables. Those with the greatest ARC demonstrated significantly weaker IR and ER strength compared to those with less motion. Conclusions: MARSOC personnel demonstrate shoulder ROM and strength symmetry patterns similar to overhead athletes. Increased dominant shoulder strength does appear to translate to a bilateral functional performance, but overall performance may be limited by the weaker nondominant upper extremity. As ARC increases, IR and ER rotation strength decrease. Repetitive, increased loading of the dominant shoulder during functional movements and training may increase risk of chronic, overuse-type injuries, common to the military. Unilateral exercises and movement analysis should be incorporated to encourage proper development of bilateral shoulder strength, which may be particularly important in those with high ranges of ARC.