Effects of Collagen and Exercise on Tendon Properties and Pain: A Critically Appraised Topic.

CLINICAL SCENARIO: Achilles tendon ruptures are prevalent and devastating injuries that require the need for extensive rehabilitation. The methods for preventing these injuries vary between different exercise methods and nutritional supplementation. Although proven effective for decreasing pain and increasing tendon properties, the influence of these 2 methods in combination has not yet been evaluated. CLINICAL QUESTION: Does exercise combined with collagen supplementation improve Achilles tendon structural and mechanical properties and diminish subsequent patient-reported pain compared with exercise alone in adults? SUMMARY OF KEY FINDINGS: Exercise training, including eccentric training protocols and concentric resistance training protocols, combined with collagen supplementation influence Achilles tendon properties and subsequent patient-reported pain compared with exercise alone. CLINICAL BOTTOM LINE: Evidence supports that collagen along with exercise training has a significant influence on pain mitigation, augmented cross-sectional area, and tendon thickness, but may have little to no influence on tendon stiffness and microvascularity compared with exercise alone. Further research is needed to determine the effects of combined methods on various populations. STRENGTH OF RECOMMENDATION: Collectively, the body of evidence included to answer the clinical question aligns with the strength of recommendation of A.

Test-Retest Reliability of the King-Devick Test in an Adolescent Population.

CONTEXT: The King-Devick (KD) test is a screening tool designed to assess cognitive visual impairments, namely saccadic rhythm, postconcussion. Test-retest reliability of the KD in a healthy adolescent population has not yet been established. OBJECTIVE: To investigate the overall test-retest reliability of the KD among a sample of healthy adolescents. Additionally, we sought to determine if sex and age influenced reliability. DESIGN: Cross-sectional study. SETTING: Secondary school. PATIENTS OR OTHER PARTICIPANTS: Sixty-eight healthy adolescents, 41 boys (age = 15.4 ± 1.9 years) and 27 girls (age = 15.4 ± 1.9 years). MAIN OUTCOME MEASURE(S): Participants completed the KD (version 1) at 3 testing sessions (days 1, 30, and 45) following standard instructions. We recorded total time to complete the reading of 3 cards for each participant during each testing session. Two-way random-effects intraclass correlation coefficients (ICCs) using single measurements repeated over time and repeatability coefficients were calculated. Linear mixed models were used to determine whether differences existed at each testing time and to examine whether changes that took place among visits were different by sex or age. RESULTS: Adolescents who completed the KD demonstrated acceptable reliability (ICC = 0.81; 95% confidence interval = 0.73, 0.87); however, the repeatability coefficient was large (±8.76 seconds). The sample demonstrated improvements between visits 1 and 2 (mean ± standard error = 4.3 ± 0.5 seconds, P < .001) and between visits 2 and 3 (2.4 ± 0.5 seconds, P < .001) for a total improvement of 6.9 seconds over 3 tests. No significant visit-by-sex or visit-by-age interactions were observed. CONCLUSIONS: Despite the ICC being clinically acceptable, providers using the KD test for serial assessment of concussion in adolescents should be cautious in interpreting the results due to a large learning effect. Incorporating multiple measures can ensure accurate detection of sport concussion.

Effects of Mindfulness-Based Interventions in High School and College Athletes for Reducing Stress and Injury, and Improving Quality of Life.

Clinical Scenario: Student athletes experience a variety of stressors from school and social activities, as well as the additional demands of sport participation. Mindfulness-based interventions can help increase mental awareness and acceptance, as well as mitigate negative thoughts and emotions. The use of mindfulness-based interventions may be beneficial for reducing thoughts of stress, injury reduction, and improving overall wellbeing. CLINICAL QUESTION: Does the use of mindfulness-based interventions for student-athletes aged 13-24 years reduce stress and injury as well as improve overall quality of life? SUMMARY OF FINDINGS: The literature was searched for studies that investigated the use of mindfulness-based strategies for student-athletes specifically for reducing stress and injury and/or improving quality of life. The literature search returned 8 possible studies related to the clinical question and 3 studies met the inclusion criteria (1 randomized control trial, 2 nonrandomized control cohort studies). All 3 included studies demonstrated overall improved levels of mindfulness among student-athletes after the use of a mindfulness-based intervention. Mindfulness-based interventions had positive effects for reducing negative thoughts and levels of perceived stress. The number of injury occurrences were found to decrease following the integration of a mindfulness-based intervention within an athletic population. Clinical Bottom Line: There is sufficient evidence supporting the use of mindfulness-based interventions with student-athletes for increasing mindfulness, managing negative emotions and perceived stress, as well as improving overall well-being. There is also current literature that advocates the use of mindfulness-based interventions for reducing injury, but further research is needed for support. Strength of Recommendation: Grade B evidence exists to support that the use of mindfulness-based interventions for student-athletes will reduce stress and improve overall well-being as well as support the possibility that if a student-athlete is more mindful, it may help decrease risk of injury incurred if the student-athlete is under mental stress.