The VetEd Conference: Evolution of an Educational Community of Practice.

The VetEd conference was developed with the aim of growing an educational community by providing an opportunity to share ideas, innovations, research, and best practices in veterinary education in a friendly, affordable, and inclusive environment. The annual conference has been hosted by the veterinary schools in the UK, Ireland, and the Netherlands, becoming the official conference of the Veterinary Schools Council in 2017. The current study investigates the extent to which the development of the conference has contributed to the evolution of a community of practice. The conference proceedings' abstracts were analyzed to identify trends in number, type, and author information. This was complemented by oral histories exploring the impact of VetEd on developing the veterinary education community. The number of abstracts has increased from 40 (2010) to 137 (2018), and these are predominantly posters, with the major themes being technology-enhanced learning, clinical skills, and assessment. The authors have been increasingly international, representing 8 countries in 2010 and 22 in 2018. Nine interviews were undertaken with those involved in organizing VetEd. The inclusivity of the conference and the engagement of a wide variety of delegate groups are key themes that emerged. Concerns emerged around the organizational challenges and the potential for the conference to outgrow the founding principles in the future. VetEd has become a key event in the annual calendar and represents an initiative that has contributed to the ongoing development of the veterinary education community.

The Use of Lecture Recordings as Study Aids in a Professional Degree Program.

Lecture recording is now common in many educational institutions, leading to discussion about how best to support student learning. In this mixed methods study, we used a survey (n = 46 participants), think-aloud methodologies in observed study sessions (n = 8 participants) and recording analytics (n = 637 recordings) to characterize how veterinary students utilize recordings during their studies. Only 48% of survey respondents considered they were more likely to use recordings as exams approached, but 78% considered they used recordings more when the topic was difficult. In the observed study sessions, students characterized their use of recordings as helping them to control their learning environment, allowing them to pause and rewind challenging topics, and as a jumping off point for future study, allowing them to structure the seeking out of additional information. In a linear model describing the recording analytics, students who had entered higher education directly from high school were more likely to watch more of a lecture than graduate entry students. In addition, the most visited lectures were also the ones with more view time (F(5, 631) = 129.5, R2 = 0.50, p < .001). Overall, this study suggests that veterinary students were selective about their use of recordings in their study strategies, often using them to make up for deficits in their knowledge and understanding, or to supplement their experience at veterinary school. We discuss the consequences and implications for student study skills support.

Advance care planning in motor neuron disease: A qualitative study of caregiver perspectives.

BACKGROUND: Motor neuron disease is a fatal disease, characterised by progressive loss of motor function, often associated with cognitive deterioration and, in some, the development of frontotemporal dementia. Life-sustaining technologies are available (e.g. non-invasive ventilation and enteral nutrition) but may compromise quality of life for some patients. Timely commencement of 'Advance Care Planning' enables patients to participate in future care choices; however, this approach has rarely been explored in motor neuron disease. AIM: We aimed to investigate caregiver perspectives on the acceptability and impact of advance care planning, documented in a letter format, for patients with motor neuron disease and caregivers. DESIGN: This is a qualitative cross-sectional study. Data were analysed by a narrative synthesis approach. PARTICIPANTS AND SETTING: Structured interviews were held with 18 former caregivers of deceased patients with motor neuron disease. A total of 10 patients had created a disease-specific advanced directive, 'Letter of Future Care', and 8 had not. RESULTS: A total of four global themes emerged: Readiness for death, Empowerment, Connections and Clarifying decisions and choices. Many felt the letter of future care was or would be beneficial, engendering autonomy and respect for patients, easing difficult decision-making and enhancing communication within families. However, individuals' 'readiness' to accept encroaching death would influence uptake. Appropriate timing to commence advance care planning may depend on case-based clinical and personal characteristics. CONCLUSION: Advance care planning can assist patients to achieve a sense of control and 'peace of mind' and facilitates important family discussion. However, the timing and style of its introduction needs to be approached sensitively. Tools and strategies for increasing the efficacy of advance care planning for motor neuron disease should be evaluated and implemented.

Advance care planning in motor neuron disease: A systematic review.

OBJECTIVE: Motor neuron disease (MND) is an incurable progressive illness, characterized by incessant deterioration of neuromuscular function. Timely commencement of advance care planning (ACP) may enable patients to participate in future care choices. The present systematic review aimed to summarize what is known about the prevalence, content, patient/caregiver benefits, healthcare professional (HCP) awareness/support, and healthcare outcomes associated with ACP in the MND setting. METHOD: Quantitative and qualitative studies were identified through database searches and eligibility assessed by one author and verified by her coauthor. Data extraction and quality assessments against standardized criteria were completed by the two authors. RESULTS: Of the 422 studies identified, 16 were included. The research methods generally lacked rigor. Advance directive (AD) prevalence varied considerably across studies. Disease progression was the strongest predictor of AD completion. ACP processes may clarify patients' wishes and promote communication. HCP attitudes or lack of awareness may limit ACP processes. Varying patient preferences may make flexible approaches and timing necessary. SIGNIFICANCE OF RESULTS: Important benefits may be associated with ACP in the context of a motor neuron disease (e.g., feelings of control/relief and refusal of unwanted treatments). However, further evidence is required to verify findings and identify optimal streamlined approaches (e.g., use of decision aids) consistent with patients' (and caregivers') needs over time.

Effect of mouse antisera targeting the Phlebotomus papatasi midgut chitinase PpChit1 on sandfly physiology and fitness.

In sandflies, the absence of the peritrophic matrix (PM) affects the rate of blood digestion. Also, the kinetics of PM secretion varies according to species. We previously characterised PpChit1, a midgut-specific chitinase secreted in Phlebotomus papatasi (PPIS) that is involved in the maturation of the PM and showed that antibodies against PpChit1 reduce the chitinolytic activity in the midgut of several sandfly species. Here, sandflies were fed on red blood cells reconstituted with naïve or anti-PpChit1 sera and assessed for fitness parameters that included blood digestion, oviposition onset, number of eggs laid, egg bouts, average number of eggs per bout and survival. In PPIS, anti-PpChit1 led to a one-day delay in the onset of egg laying, with flies surviving three days longer compared to the control group. Anti-PpChit1 also had a negative effect on overall ability of flies to lay eggs, as several gravid females from all three species were unable to lay any eggs despite having lived longer than control flies. Whereas the longer survival might be associated with improved haeme scavenging ability by the PM, the inability of females to lay eggs is possibly linked to changes in PM permeability affecting nutrient absorption.

Financial Resource Management Knowledge, Skills, and Attitudes for Entry-level Physical Therapist Practice: A Survey of Physical Therapists in Ohio.

INTRODUCTION: The purpose of this study was to explore the perceptions of physical therapists (PTs) regarding the importance of financial resource management (FRM) knowledge, skills, and attitudes (KSAs) for entry-level practice and investigate the roles of PT education programs (PTEPs), clinical education experiences (CEEs), and employers in addressing these KSAs. REVIEW OF LITERATURE: FRM KSAs have been identified as components of professionalism and leadership and, as such, are a required element in student PTs (SPTs) educational preparation. SUBJECTS: A purposive sampling of convenience strategy was employed by requesting a free mailing list for Ohio-licensed PTs. METHODS: An online survey was developed based on PT Clinical Performance Instrument Criterion #17, "Patient Management: Financial Resources," as this tool is frequently used to endorse entry-level status of SPTs. Potential participants were solicited through email. Mixed methodology was used to analyze survey results. RESULTS: The survey was completed by 266 PTs. FRM KSAs in legal and regulatory compliance were perceived as most important, followed by coding and billing. Forty-eight percent of participants indicated that FRM KSAs were "less important" (n = 111) or "considerably less important" (n = 17) than clinical care skills, whereas 39.8% (n = 106) believed that these skills are of the same level of importance. Ten themes were derived from qualitative responses regarding the FRM content that should be provided by PTEPs. Participants indicated that the role of PTEPs was to provide an introduction and foundation to FRM, whereas CEEs should facilitate intentional exposure and opportunities to apply FRM KSAs with supervision. Employers were expected to provide education regarding clinic-specific operations and reimbursement considerations, as well as mentorship that included reviewing complex billing for accuracy, offering guidance for improving time management skills, and discussing fiscal responsibilities to both the employer and patient. DISCUSSION AND CONCLUSION: This information may guide PTEPs and clinical personnel in providing focused meaningful instruction regarding FRM aspects of PT practice to SPTs and entry-level clinicians.

Sheep laterality.

Turning preferences among 309 white-faced ewes were individually evaluated in an enclosed, artificially lit T-maze, followed by each ewe choosing either a right or left return alley to return to peers. Data recorded included time in the start box, time in the T-maze, exit arm chosen to leave the T-maze, and return alley. Right and left arms of the T-maze were chosen 65.7% and 34.3% of the time, respectively, while right and left return alleys were chosen 32.4% and 67.6%, respectively. Exit arm and return alley were not independently chosen (p <.0001), with observed counts being higher than expected under independence when ewes made the same choice for exit and alley (RR or LL turn patterns) and being lower than expected for alternating choices (RL or LR). Out of the 309 ewes, 28.2% and 30.1% chose RR and LL turn patterns, respectively, while 37.5% chose the RL turn pattern, but only 13 (4.2%) chose the LR turning pattern. Overall, ewes that initially turned right when presented a second turning opportunity had a slight preference to alternate their turning direction, while ewes that initially turned left tended to continue turning left when given another chance to turn. Exit arm and return alley laterality was not related (α =.05) to time of day the test was administered, ewe's age or genetics, most recent liveweight, or most recent shorn fleece weight. The mean time spent in the start box (21 s) was not related to exit arm (p =.947) or return alley (p =.779). Mean time (15 s) spent in the T-maze was not related to exit arm (p =.086) or return alley (p =.952). More research will be required to understand sheep turning laterality and how it can impact working facilities and research equipment.

Impact of Task-Fit Misalignment and the Director of Clinical Education: A Grounded Theory Study.

INTRODUCTION: The roles and responsibilities of the director of clinical education (DCE) are of interest in the academic physical therapist (PT) community. This study explored the impact of professional and positional task characteristics of the DCE position on task-fit misalignment within PT education programs. Task-fit explores how the tasks of a particular job align with the appropriately trained person who holds the position. REVIEW OF THE LITERATURE: A recently published DCE Matrix highlights 2 extremes of misalignment and nonoptimal task-fit between the position and the person. Misalignment was investigated rather than alignment because negative connotations often have greater impact on behavior, decision making, and relationships. The impact of misalignment is unknown. SUBJECTS: Program directors and DCEs among ACAPT member PT programs were surveyed. METHODS: A qualitative grounded theory design was used. Two rounds of surveys with focused questions about the impact of task-fit misalignment. Qualitative content data analysis through a constant comparative process was followed. Respondent descriptive statistics were collected. RESULTS: Three realms of impact were identified when misalignment of positional and professional characteristics exists. The realms include the 1) individual person holding the position; 2) academic program; or 3) physical therapy profession. There is a high level of agreement that task-fit misalignment affects each realm; variability exists about its prevalence. DISCUSSION: There seems to be an interconnectedness of impact among the person, the program, and the profession when misalignment exists between the fit of the DCE to the job or the work environment to the DCE. Findings indicate job crafting may be necessary to evolve the nature of the DCE work toward higher director-level tasks. This is the first study of its kind to explore the impact intersection of person-job fit and task-fit and the impact on a DCE's responsibilities. Nonrespondent or attrition bias may have limited sample size.

An Anterior Cruciate Ligament (ACL) Injury Risk Screening and Reduction Program for High School Female Athletes: A Pilot Study.

Background: Anterior cruciate ligament (ACL) injury causes physical, mental, and financial burdens. Therefore, it is imperative to screen, identify, and educate athletes who are at high-risk. The combination of screening and education could identify those at risk and potentially reduce future injuries. Purpose: The purpose was to conduct a feasible community pre-season screening program for high school female athletes for the presence of known modifiable risk factors that predispose them to sustaining a non-contact ACL injury. Study Design: Non-experimental prospective study. Methods: A convenience sample of 15 healthy female athletes were recruited from local high schools, consisting of 11 soccer players and four basketball players.  A pre-season screening program was designed encompassing four stations that addressed modifiable neuromuscular and biomechanical risk factors including range of motion (ROM), jump-landing technique, strength, and balance. Athletes were categorized into high-risk versus low-risk groups based on cutoff scores previously established in the literature. Results: Every athlete met the high-risk cutoff score for at least one extremity during the ROM screening, and some met high-risk cutoff scores for more than one ROM. Out of all four categories tested, lower extremity ROM demonstrated the greatest deficits. Conclusion: This study identified athletes as having multiple modifiable risk factors that can be addressed with training and exercises. This supports implementing a pre-season program aimed at screening for injury risk factors. Level of Evidence: Level 3.

The effects of high- and low-dose aspirin on thermoregulation during and after acute cold exposure.

OBJECTIVE: To explore the effect of aspirin on the thermoregulatory responses of men during exposure to 12°C air (acute cold exposure) for a period of 120 minutes and recovery in 25°C air (rewarming) for 120 minutes. METHODS: Seven male subjects (26.1 ± 2.4 yr) underwent pre-experimental testing to determine peak VO(2) and body composition. Participants underwent 3 trials in which they ingested the following for 1 week prior to each experimental trial: a capsule filled with cellulose (placebo), 81 mg · day(-1) of aspirin (low-dose aspirin), or 650 mg · day(-1) of aspirin (high-dose aspirin). Each trial consisted of a 30-minute baseline period, 120 minutes of exposure to 12°C air, and 120 minutes of recovery in 25°C air. Mean skin temperature and rectal temperature (T(re)) were measured, and heat production was calculated. RESULTS: During both acute cold exposure and rewarming, analysis of variance revealed a main effect for time (P < .05) with respect to T(re), mean skin temperature, and heat production. However, there were no significant differences between the treatments or treatment by time interactions. CONCLUSIONS: These data demonstrate that aspirin had no significant effect on the thermal and metabolic responses during acute cold exposure and rewarming.

Effect of Temperature on Plant Resistance to Arthropod Pests.

Temperature has a strong influence on the development, survival, and fecundity of herbivorous arthropods, and it plays a key role in regulating the growth and development of their host plants. In addition, temperature affects the production of plant secondary chemicals as well as structural characteristics used for defense against herbivores. Thus, temperature has potentially important implications for host plant resistance. Because temperature directly impacts arthropod pests, both positively and negatively, distinguishing direct effects from indirect effects mediated through host plants poses a challenge for researchers and practitioners. A more comprehensive understanding of how temperature affects plant resistance specifically, and arthropod pests in general, would lead to better predictions of pest populations, and more effective use of plant resistance as a management tactic. Therefore, the goals of this paper are to 1) review and update knowledge about temperature effects on plant resistance, 2) evaluate alternative experimental approaches for separating direct from plant-mediated indirect effects of temperature on pests, including benefits and limitations of each approach, and 3) offer recommendations for future research.

Troponin and S100 beta are associated with depression in healthy older adults.

OBJECTIVES: Depression has a significant impact on the functioning of older adults and often precedes cognitive decline or dementia. The current study examines the association between biomarkers related to neurocognitive outcome and depression in this population. METHOD: Thirty-five older adults without significant neurological or psychiatric history underwent fasting blood draw and psychological testing. Self-reported measures of current and history of depression and assays for brain-derived neurotrophic factor, S100-beta, amyloid beta, and troponin were analyzed. RESULTS: Troponin levels were found to be inversely related to current depression (r = -0.35, p = 0.03), while individuals who reported having a past history of depression had significantly higher levels of S100 beta than those who did not report this (t (33) = -2.08, p < 0.05). CONCLUSION: The current study shows some support for the association of neurocognitive biomarkers to depression, though the mechanisms for these relationships are unclear and warrant further investigation.

SHORT-TERM OUTCOMES OF CONSERVATIVE TREATMENT FOR FEMOROACETABULAR IMPINGEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: Femoroacetabular Impingement (FAI) is becoming increasingly more common with noted impairments in physical function, increased pain, and decreased quality of life. Typically, a conservative approach is used through physical therapy or intra-articular injections before an invasive surgical approach is utilized. Identifying the proper course of conservative care by the clinician will aid in improving outcomes. PURPOSE: The purpose of this systematic review and meta-analysis was to investigate short-term effects of conservative physical therapy and intra-articular injections on pain and physical function measures in patients with FAI. STUDY DESIGN: Systematic Review & Meta-Analysis. METHODS: A systematic review and meta-analysis were completed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with the International Prospective Registry of Systematic Reviews. A literature review was performed in May 2018 using Pubmed, CINAHL, Proquest, and Scopus. Inclusion criteria included humans classified as having femoroacetabular impingement, conservative rehabilitation, and utilization of outcome measures in the domains of pain or function. Exclusion criteria included absence of skilled interaction and study protocols that were not completed. RESULTS: Seven studies were included that summarized physical therapy or intra-articular injection outcomes for femoroacetabular impingement management. Results showed that conservative interventions for short-term periods are effective in reducing pain and improving function for femoroacetabular impingement. Overall, physical therapy revealed moderate to large effect sizes and statistically significant differences in both pain (SMD, 0.91, CI: 0.07, 1.76, p=0.030) and function (SMD, 0.80, CI: 0.34, 1.28, p=0.001) for femoroacetabular impingement. Intra-articular injection demonstrated small effect sizes for pain outcomes (SMD, 0.29, CI: -1.25, 1.83, p = 0.710) and small to moderate effect size for improvement in function (SMD, 0.49, CI: 0.03, 0.96, p = 0.040). CONCLUSIONS: Physical therapy demonstrated positive results to self-reported pain and function and may hold more promise than intra-articular injection alone. Common treatments that were associated with improved outcomes were patient education, activity modification, manual therapy, and strengthening. There are a limited number of high-quality articles on this topic, which should be addressed in future research. LEVEL OF EVIDENCE: 1a.

Physical Therapist Student Readiness for Entrance Into the First Full-Time Clinical Experience: A Delphi Study.

Background: To consistently prepare physical therapist students for their first full-time clinical experience, the entry-level curriculum must provide and assess competency in the essential knowledge, skills, attitudes, and professional behaviors. Objective: The purpose of this Delphi study was to develop consensus on a core set of elements that should be demonstrated by physical therapist students prior to entry into their first full-time clinical experience. A second aim was to obtain the recommended competency levels and assessment methods. Design: The study was conducted using the Delphi method. Methods: Purposive selection and snowball sampling techniques were used to recruit clinical instructors, recent graduates, directors or academic coordinators of clinical education, and academic faculty. Four web-based survey rounds were used to achieve consensus, defined as agreement among ≥80% of respondents. The first round gathered demographic information on respondents and identified elements that were deemed essential; the second collected information about clarity and redundancy in the elements provided; the third asked participants to rank their agreement with elements and themes; and the fourth gathered the level of competency that physical therapist students should demonstrate prior to beginning a first full-time clinical experience. Results: Consensus revealed 95 elements, categorized under 14 themes, which were deemed essential for readiness for the first clinical experience. Levels of competency for each element were identified. Limitations: Participants might not have represented all academic programs, practice settings, and geographic locations. Conclusion: This study identified the specific knowledge, skills, attitudes, and professional behaviors in which all physical therapist students in the United States need to demonstrate competency before their first clinical experience, regardless of school or setting, which would allow learning experiences to be tailored appropriately.

Increased S100beta is associated with reduced cognitive function in healthy older adults.

OBJECTIVES: Vascular pathology is associated with reduced performance on neuropsychological tests, particularly in older adults. A likely explanation involves a disruption in the blood brain barrier (BBB). Work from clinical samples show alterations in BBB function is associated with cognitive dysfunction on testing, though no study has examined this possibility in healthy older adults. MATERIALS AND METHODS: 35 older adults, without significant neurological or psychiatric history, underwent fasting blood draw and neuropsychological testing. Serum levels of S100beta were quantified to provide a measure of BBB function. RESULTS: Partial correlations showed S100beta levels were inversely related to performance in multiple cognitive domains, including memory (r = 0.43, p = 0.02), psychomotor speed and visual attention (r = 0.37, p = 0.05), and working memory (r = -0.48, p = 0.008). CONCLUSIONS: Findings indicate that increased S100beta levels are associated with poorer cognitive function in neurologically healthy older adults, implicating BBB function in age-related cognitive decline. Further work is needed to clarify possible mechanisms, particularly longitudinal studies that involve neuroimaging.

Serum brain-derived neurotrophic factor is associated with cognitive function in healthy older adults.

Cognitive decline is common in older adults, even in the absence of significant medical or neurological conditions. Recent work implicates serum levels of brain-derived neurotrophic factor in age-related cognitive decline, though no study has directly examined this possibility. A total of 35 older adults without neurological history underwent fasting blood draw and completed a brief neuropsychological test battery during a single session. After adjusting for demographic and medical confounds, higher serum brain-derived neurotrophic factor levels were associated with better performance on the Mini-Mental State Examination (r = .36) and short form of the Boston Naming Test (r = .39). These findings extend work from Alzheimer disease and vascular dementia samples and indicate that higher brain-derived neurotrophic factor levels are associated with better neuropsychological function in healthy older adults. The exact mechanisms for this relationship are unknown and require further examination.

beta-Amyloid is associated with reduced cognitive function in healthy older adults.

Though elevated beta-amyloid deposition is associated with Alzheimer's disease, recent evidence suggests beta-amyloid is elevated in healthy older adults prior to the onset of Alzheimer's disease. No study has yet investigated whether reduced cognitive function is related to beta-amyloid elevation in healthy older adults. Thirty-five healthy older adults underwent neuropsychological testing and fasting blood draw with subsequent serum beta-amyloid 1-40 level quantification. beta-amyloid was negatively correlated with several aspects of cognition. Findings indicate that beta-amyloid level is associated with cognitive function in healthy older adults in a pattern similar to early Alzheimer's disease. Further work investigating possible mechanisms is needed.

Nutsedge Counts Predict Meloidogyne incognita Juvenile Counts in an Integrated Management System.

The southern root-knot nematode (Meloidogyne incognita), yellow nutsedge (Cyperus esculentus) and purple nutsedge (Cyperus rotundus) are important pests in crops grown in the southern US. Management of the individual pests rather than the pest complex is often unsuccessful due to mutually beneficial pest interactions. In an integrated pest management scheme using alfalfa to suppress nutsedges and M. incognita, we evaluated quadratic polynomial regression models for prediction of the number of M. incognita J2 in soil samples as a function of yellow and purple nutsedge plant counts, squares of nutsedge counts and the cross-product between nutsedge counts . In May 2005, purple nutsedge plant count was a significant predictor of M. incognita count. In July and September 2005, counts of both nutsedges and the cross-product were significant predictors. In 2006, the second year of the alfalfa rotation, counts of all three species were reduced. As a likely consequence, the predictive relationship between nutsedges and M. incognita was not significant for May and July. In September 2006, purple nutsedge was a significant predictor of M. incognita. These results lead us to conclude that nutsedge plant counts in a field infested with the M. incognita-nutsedge pest complex can be used as a visual predictor of M. incognita J2 populations, unless the numbers of nutsedge plants and M. incognita are all very low.

IS MULTI-JOINT OR SINGLE JOINT STRENGTHENING MORE EFFECTIVE IN REDUCING PAIN AND IMPROVING FUNCTION IN WOMEN WITH PATELLOFEMORAL PAIN SYNDROME? A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: Patellofemoral pain syndrome is one of the most common causes of knee pain, especially in the female population. Conflicting evidence exists on whether a multi-joint strengthening program produces a greater outcome when compared to a single joint approach. PURPOSE: The aim of this systematic review and meta-analysis was to investigate the effectiveness of a multi-joint strengthening program compared to a traditional single joint strengthening program in reducing pain and improving function in females diagnosed with patellofemoral pain syndrome. STUDY DESIGN: Systematic Review and Meta-Analysis. METHODS: A computer-based search (population: women with patellofemoral pain syndrome, intervention: multi-joint strengthening exercises, comparator: single joint strengthening exercises, outcome: pain and function) was performed. Databases including PubMed, CINAHL, SPORTDiscus, Cochrane, PEDro, and Scopus were searched up to May 23, 2017 for randomized clinical trials published since 2004. A hand search of relevant articles and exploration of Grey Literature (including clinical trials.gov, Grey Literature Report, and Open Grey) was also completed. Data was extracted for the following information: exercises prescribed, outcome measures, and overall results from the study. RESULTS: Five studies, each of high quality based on the PEDro scale, met the inclusion criteria for this systematic review and meta-analysis. Statistically different outcomes were found that favored the multi-joint intervention group for short-term and long-term self-reported pain and functional pain, short-term functional performance, and long-term self-reported function. CONCLUSION: The results of this review show that statistically significant data are available that favor implementing a multi-joint exercise program in comparison to a single joint program for the reduction of pain in females with patellofemoral pain syndrome. Limited statistical evidence, however, is available to support a multi-joint program over a single joint program in the improvement of short-term functional performance and long-term self-reported function in females with patellofemoral pain syndrome. LEVEL OF EVIDENCE: 1a.

EXERCISES THAT FACILITATE OPTIMAL HAMSTRING AND QUADRICEPS CO-ACTIVATION TO HELP DECREASE ACL INJURY RISK IN HEALTHY FEMALES: A SYSTEMATIC REVIEW OF THE LITERATURE.

BACKGROUND: Anterior cruciate ligament (ACL) injury is common among females due to many anatomic, hormonal, and neuromuscular risk factors. One modifiable risk factor that places females at increased risk of ACL injury is a poor hamstrings: quadriceps (H:Q) co-activation ratio, which should be 0.6 or greater in order to decrease the stress placed on the ACL. Exercises that produce more quadriceps dominant muscle activation can add to the tension placed upon the ACL, potentially increasing the risk of ACL injury. HYPOTHESIS/PURPOSE: The purpose of this systematic review was to compare quadriceps and hamstring muscle activation during common closed kinetic chain therapeutic exercises in healthy female knees to determine what exercises are able to produce adequate H:Q co-activation ratios. STUDY DESIGN: Systematic Review. METHODS: Multiple online databases were systematically searched and screened for inclusion. Eight articles were identified for inclusion. Data on mean electromyography (EMG) activation of both quadriceps and hamstring muscles, % maximal voluntary isometric contraction (MVIC), and H:Q co-activation ratios were extracted from the studies. Quality assessment was performed on all included studies. RESULTS: Exercises analyzed in the studies included variations of the double leg squat, variations of the single leg squat, lateral step-up, Fitter, Stairmaster® (Core Health and Fitness, Vancouver, WA), and slide board. All exercises, except the squat machine with posterior support at the level of the scapula and feet placed 50 cm in front of the hips, produced higher quadriceps muscle activation compared to hamstring muscle activation. CONCLUSION: Overall, two leg squats demonstrate poor H:Q co-activation ratios. Single leg exercises, when performed between 30 and 90 degrees of knee flexion, produce adequate H:Q ratios, thereby potentially reducing the risk of tensile stress on the ACL and ACL injury. LEVEL OF EVIDENCE: 2a- Systematic Review of Cohort Studies.