Differences in lower extremity joint stiffness during drop jump between healthy males and females.

The primary purpose of this study was to examine sex differences in lower extremity joint stiffness during vertical drop jump performance. A secondary purpose was to examine the potential influence of sex on the relationship between joint stiffness and jump performance. Thirty healthy and active individuals performed 15-drop jumps from 30 and 60 cm boxes. Hip, knee, and ankle joint stiffnesses were calculated for subphases of landing using a 2nd order polynomial regression model. Males had greater hip stiffness during the loading phase in drop jumps from both box heights than females' drop jump from 60 cm box. Also, males had a greater ground reaction force at the end of eccentric phase, net jump impulse, and jump height regardless of box height. The 60 cm box height increased knee stiffness during the loading phase, but reduced hip stiffness during the loading phase and knee and ankle stiffness during the absorption phase regardless of sex. Joint stiffnesses significantly predicted drop jump height for females (p < .001, r2 = 0.579), but not for males (p = .609, r2 = -0.053). These results suggest that females may have different strategies to maximize drop jump height as compared to males.

Evaluating a Project Extension for Community Health Outcomes Pediatric Behavioral Health Series in a Rural and Frontier State: An Exploratory Investigation.

Background: Idaho, a predominately rural state, has a high prevalence of mental illness with minimal access to care. Barriers in diagnosis and treatment of pediatric behavioral health disorders could be mitigated with an accessible and effective specialty training program. Methods: A 10-session Project Extension for Community Health Outcomes (ECHO) series was designed to expand provider knowledge about pediatric behavioral health conditions and improve perceived clinical practice skills. Pre- and postseries evaluation surveys and individual session evaluations were used to assess the program. Results: A total of 148 individuals attended at least 1 of the 10 sessions. Participants reported high satisfaction with individual sessions and indicated that attendance positively impacted their knowledge and competency. Participants also reported that the knowledge and skills gained from the series would benefit more than half of their patients or clients. Conclusion: The short ECHO series appears to be a viable and valuable option to provide Idaho providers with effective specialty training that is well attended and well received.

Stakeholder perceptions of the use of a rapidly deployed modified ECHO to train and prepare healthcare providers for COVID-19.

Background: Innovative approaches to deliver timely information to rural healthcare providers are necessary with the COVID-19 pandemic. Project Extension for Community Healthcare Outcomes (ECHO) is a telementoring program designed to provide practitioners in rural communities with opportunities to engage in specialty training. We examined participant perceptions of a rapidly deployed, single continuing education session to improve healthcare provider preparedness for COVID-19 in Idaho. Methods: A modified Project ECHO session was developed to inform providers about emergency preparedness, treatment, testing, and resources for COVID-19. A post-session survey examined session impact and barriers on clinical practice. Results: Respondents believed the modified ECHO session increased COVID-19 knowledge and would improve their clinical practice and preparedness. Respondents were satisfied with the session and identified content, interdisciplinary collaboration, and format as beneficial; perceived barriers for utilizing session information included a lack of relevance of content and clinical applicability, and time constraints. Conclusions: A rapidly deployed modified Project ECHO session was perceived as an effective mechanism to foster collaboration and relay information to promote best practices at the start of the COVID-19 pandemic. An established Project ECHO network may be useful to rapidly exchange knowledge and information during a health emergency.

Evaluation of an opioid and addiction treatment tele-education program for healthcare providers in a rural and frontier state.

OBJECTIVE: To develop and evaluate a relevant and readily accessible post-professional opioid use disorder (OUD) education program for a rural and frontier state. DESIGN: Observational study. SETTING/PARTICIPANTS: Healthcare providers enrolled in Extension for Community Healthcare Outcomes (ECHO) Idaho Opioid, a tele-mentoring education program. MAIN OUTCOME MEASURE: Participant-level demographics of those that attended the ECHO Idaho Opioid program and post-session and program evaluation -surveys. RESULTS: A total of 273 individuals attended at least one ECHO Idaho Opioid session (per session average = 22.8); 183 post-session evaluations (per session average = 6.3) and 42 program evaluations were completed. The program was well received by providers in a rural and frontier state and may be a viable option to enhance patient care for OUD patients in these communities. CONCLUSION: The Project ECHO model is successful at reaching providers across diverse geographic regions, overcoming barriers associated with attending advanced trainings or developing peer networks to improve patient care. The model can be used to develop educational content and delivery that participants believe is satisfactory, valuable, and applicable to their profession and practice.

Effects of a 4-Week Short-Foot Exercise Program on Gait Characteristics in Patients With Stage II Posterior Tibial Tendon Dysfunction.

CONTEXT: Clinically, it has been suggested that increased activation of intrinsic foot muscles may alter the demand of extrinsic muscle activity surrounding the ankle joint in patients with stage II posterior tibial tendon dysfunction. However, there is limited empirical evidence supporting this notion. OBJECTIVE: The purpose of this study was to investigate the effects of a 4-week short-foot exercise (SFE) on biomechanical factors in patients with stage II posterior tibial tendon dysfunction. DESIGN: Single-group pretest-posttest. SETTING: University laboratory. PARTICIPANTS: Fifteen subjects (8 males and 7 females) with stage II posterior tibial tendon dysfunction who had pain in posterior tibial tendon, pronated foot deformity (foot posture index ≥+6), and flexible foot deformity (navicular drop ≥10 mm) were voluntarily recruited. INTERVENTION: All subjects completed a 4-week SFE program (15 repetitions × 5 sets/d and 3 d/wk) of 4 stages (standing with feedback, sitting, double-leg, and one-leg standing position). MAIN OUTCOME MEASURES: Ankle joint kinematics and kinetics and tibialis anterior and fibularis longus muscle activation (% maximum voluntary isometric contraction) during gait were measured before and after SFE program. Cohen d effect size (ES [95% confidence intervals]) was calculated. RESULTS: During the first rocker, tibialis anterior activation decreased at peak plantarflexion (ES = 0.75 [0.01 to 1.49]) and inversion (ES = 0.77 [0.03 to 1.51]) angle. During the second rocker, peak dorsiflexion angle (ES = 0.77 [0.03 to 1.51]) and tibialis anterior activation at peak eversion (ES = 1.57 [0.76 to 2.39]) reduced. During the third rocker, the peak abduction angle (ES = 0.80 [0.06 to 1.54]) and tibialis anterior and fibularis longus activation at peak plantarflexion (ES = 1.34 [0.54 to 2.13]; ES = 1.99 [1.11 to 2.86]) and abduction (ES = 1.29 [0.50 to 2.08]; ES = 1.67 [0.84 to 2.50]) decreased. CONCLUSIONS: Our 4-week SFE program may have positive effects on changing muscle activation patterns for tibialis anterior and fibularis longus muscles, although it could not influence their structural deformity and ankle joint moment. It could produce a potential benefit of decreased tibialis posterior activation.

NON-CONTACT ANTERIOR CRUCIATE LIGAMENT AND LOWER EXTREMITY INJURY RISK PREDICTION USING FUNCTIONAL MOVEMENT SCREEN AND KNEE ABDUCTION MOMENT: AN EPIDEMIOLOGICAL OBSERVATION OF FEMALE INTERCOLLEGIATE ATHLETES.

BACKGROUND: Modifiable risk factors associated with non-contact anterior cruciate ligament (ACL) injuries are highly debated, yet the incidence rate of ACL injury continues to increase. Measures of movement quality may be an effective method for identifying individuals who are at a high risk of injury. PURPOSE: The purpose of this study was to investigate whether a movement screen and/or a drop-jump landing (DJL) task identifies female individuals at a higher risk for sustaining non-contact lower extremity (LE) injuries, particularly ACL injuries. STUDY DESIGN: Cohort study. METHODS: 187 women (mean age 19.5 ± 1.21 years) who played collegiate soccer, volleyball, or basketball completed the Functional Movement Screen (FMS™) and a drop-jump landing task. Weekly injury reports of participants who sustained a non-contact LE injury were collected. FMS™ scores (both total score and individual screens) and Knee Abduction Moment (KAM) values from the DJL task, were compared between injured and uninjured sample populations. RESULTS: A statistically significant difference (t = 1.98, p = 0.049) was observed in the FMS™ scores between the injured (ACL and LE injury) and uninjured groups. Prior ACL injury was also a significant predictor of LE injury (OR = 4.4, p = 0.01). CONCLUSIONS: The FMS™ can be used to identify collegiate female athletes who are at an increased risk of sustaining a non-contact ACL or LE injury. Female collegiate athletes that score 14 or less on the FMS™ have a greater chance of sustaining a non-contact LE injury than those who score above 14. LEVEL OF EVIDENCE: 3b.

Physiologic profile of the fitness status of collegiate cheerleaders.

Cheerleading, traditionally considered a nonathletic activity, has evolved into a competitive sport requiring high levels of fitness. Despite the trend of cheerleaders performing increasingly difficult and athletic skills, very little is known about their fitness levels. The purpose of this study was to provide a physiological profile of the fitness status of a squad of collegiate cheerleaders. Eighteen cheerleaders (11 men and 7 women) participated in this study. Each subject completed a Bruce protocol maximal treadmill test, underwater weighing, 1 repetition maximum bench press, sit-and-reach test, push-ups, curl-ups, and isokinetic strength testing. The mean and SD were calculated to provide the physical fitness profile for each parameter. A comparison to normative data demonstrated that cheerleaders have a high level of fitness and scores similar to other collegiate athletes.