Outcomes of Patients with Lower Limb Loss after Using a Training Prosthesis: A Retrospective Case Series Study.

The aim of this retrospective case series study was to investigate outcomes in patients with lower limb loss based on whether or not they used a training prosthesis (TP) during rehabilitation. The medical records of 171 consecutive patients admitted to rehabilitation hospitalization between January 2014 and December 2018 following a major amputation of the lower limb were reviewed. Patients were categorized into two groups: patients who underwent rehabilitation with a TP and patients who did not use a TP. Outcomes (i.e., discharge destination, length of stay, number of sockets required, and number of the size adaptation of each socket, as well as functional level) were compared between groups. Of the 171 patients, 126 underwent rehabilitation with a TP, and 45 patients underwent rehabilitation without any TP. In conclusion, we found that patients who used a TP had a significantly shorter hospital length of stay when compared to those who did not. This length of stay for patients with TP was not influenced by age but was lowered by a higher body mass index (BMI), tibial instead of femoral amputation, and the male gender. No association was found between the use of TP and discharge destination, functional level, number of socket modifications, and number of sockets required.

Which factors may influence medium-term quality of life of patients with lower-limb loss? A systematic review of the literature.

OBJECTIVES: The aim of this study was to systematically review the literature to identify factors that may influence quality of life in people with lower-limb amputation (all etiologies). Our primary focus was on identifying factors that can be modified, enabling a more concentrated integration of these aspects into the care and treatment of amputated patients. DATA SOURCE: Medline (via Ovid) and Scopus were searched in January 2023 for studies assessing quality of life for people with lower-limb loss. Studies were included if they reported on factors that could influence quality of life. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. STUDY SELECTION: Studies were identified and assessed independently by 2 reviewers. DATA EXTRACTION: Data were extracted by 2 independent reviewers. DATA SYNTHESIS: After removing duplicates, the search yielded 2616 studies, of which 24 met our inclusion criteria (cross-sectional n = 13; prospective n = 9; retrospective n = 2). The most commonly used quality-of-life instruments were the Short Form 36, followed by the World Health Organization Quality of Life-BREF and the EuroQoL 5 dimension. Younger age, traumatic etiology, unilateral or below-knee amputation, presence of comorbidities, and social integration were found to influence quality of life in people with lower-limb amputation, whereas sex and socioeconomic context do not seem to have a clear influence. CONCLUSIONS: This systematic review of the literature identified several factors that influence quality of life in patients with lower-limb amputation. However, the results are not always consistent across studies and there is still no consensus on some factors. Conclusive findings regarding sex and socioeconomic status remain elusive, primarily because of substantial disparities observed across the literature. Future prospective longitudinal studies with clear a priori inclusion of a wide range of potential factors are needed to clarify the impact of the identified factors. Factors such as age, type of amputation, comorbidities and social integration should be considered in the management of patients with amputation.

Return to play decision after shoulder dislocation in upper limb athletes: Critical analysis between the habits of medical professionals and the literature.

BACKGROUND: The return to field is a critical moment for an athlete who has dislocated his shoulder as there is a significant risk of recurrence. The decision to return to field made by the doctor will therefore be crucial for the smooth continuation of the athlete's career. HYPOTHESIS: This objective is to compare the criteria most used by specialists in clearing an overhead athlete to return to competition after a first episode of antero-internal dislocation of the glenohumeral joint with or without surgery and those mentioned in the literature. PATIENTS AND METHODS: The target population consisted of French-speaking physicians in orthopedic surgery, physical medicine and rehabilitation or sports medicine. This study was conducted by the means of a questionnaire. The questionnaire was validated by three experts in sports medicine and published on an online survey website. RESULTS: Sixty-three medical specialists responded to the questionnaire. On average, they use more than nine criteria to decide if an athlete is fit to return to competition. Over the 12 criteria proposed, four are used by more than 90% of respondents: laxity/instability, pain, range of motion and patient's subjective feeling. The methods used to evaluate certain criteria such as pain, joint range or muscular strength are often subjective and very often not validated by the literature. CONCLUSION: Doctors use a set of criteria to allow an overhead athlete to return to competition. This study highlights that the techniques employed to evaluate these criteria are not always thoroughly validated by literature reviews. LEVEL OF EVIDENCE: III; observational study.

Prevention of shoulder injuries in volleyball players: The usefulness and efficiency of a warm-up routine.

OBJECTIVES: The objective of this study was to assess the efficiency of a warm-up routine focused on shoulder injury prevention in volleyball players. DESIGN: Prospective study. SETTING: University. PARTICIPANTS: Eight recreational volleyball teams (44 males, 49 females) were included in the study and assigned to two different groups (prevention or control) in a blinded way. In the prevention group, the players had to perform specific exercises at the beginning of each training session twice a week. MAIN OUTCOME MEASURES: Injuries were recorded monthly in both groups with an online questionnaire. RESULTS: A significant decrease in the total number of injuries as well as in the severity of the injuries was observed in the prevention group in comparison to the control group (p = 0.0001-0.013). For the shoulder, a decrease in injury incidence was also observed in the prevention group. This decrease reached significance in male players (p = 0.045). CONCLUSIONS: The program appears to be efficient to reduce the risk of shoulder injuries in recreational volleyball players. Adjustments in the duration and in the contents of the program will have to be made to further improve compliance and better meet the requirements of both players and trainers.

Foot and Ankle Muscle Isometric Strength in Nonrearfoot Compared With Rearfoot Endurance Runners.

Background: Transitioning to a forefoot strike pattern can be used to manage running-related knee injuries. However, adopting a nonrearfoot strike induces a higher load on foot and ankle structures than rearfoot strike. Sufficient foot muscle strength is also necessary to prevent excessive longitudinal arch (LA) deformation when running with nonrearfoot strike. The aim of this study was to investigate the potential differences in foot-ankle muscle strength between RF and NRF runners. Methods: A cross-sectional study including 40 RF and 40 NRF runners was conducted. The foot posture and the maximal voluntary isometric strength (MVIS) of 6 foot-ankle muscles were measured. The footstrike pattern was determined using a 2-D camera during a self-paced run on a treadmill. Results: NRF had higher MVIS for ankle plantar flexor (+12.5%, P = .015), ankle dorsiflexor (+17.7%, P = .01), hallux flexor (+11%, P = .04), and lesser toe flexor (+20.8%, P = .0031). We found a small positive correlation between MVIS of ankle plantar flexor with MVIS of hallux flexor (r = 0.26; P = .01) and lesser toe flexor (r = 0.28; P = .01). Conclusion: In this cross-sectional study, we found that NRF runners on average have a higher MVIS of hallux and lesser toe flexor compared with RF runners. NRF runners also have a higher MVIS of ankle plantar flexor and dorsiflexor than RF runners. We found only a small correlation between ankle plantar flexor and foot muscle strength. Level of Evidence: Level III, case-control study.

Differences in strength and fatigue resistance of scapular protractors and retractors between symptomatic and asymptomatic dyskinesis.

CONTEXT: Scapular dyskinesis is a shoulder dysfunction that can be asymptomatic or associated with pain or weakness. Reduced strength and fatigue resistance of the scapular protractor and retractors muscles that stabilize the scapula might contribute to dyskinesis. OBJECTIVE: To determine the strength and fatigue resistance profiles of subjects with symptomatic and asymptomatic scapular dyskinesis, and to compare them to healthy controls using isokinetic assessment. DESIGN: Cross-sectional study. SETTING: University Hospital. PARTICIPANTS: Twenty healthy controls and 21 overhead athletes with symptomatic (n=10) and asymptomatic (n=11) scapular dyskinesis. MAIN OUTCOME MEASURES: Strength (peak torque, maximum work), fatigue resistance (total work) and protraction/retraction ratios measured during a closed-chain isokinetic protocol (40 repetitions in concentric mode at 24.4 cm/s). RESULTS: The scapular protractors' strength and fatigue resistance were significantly higher (p<0.01) in healthy controls (peak torque: 5.0±0.9 N/Kg; maximum work: 2.4±0.5 J/Kg; total work: 72.4±0.6 J/Kg) than in asymptomatic (peak torque: 3.4±0.7 N/Kg; maximum work: 1.7±0.4 J/Kg; total work: 50.0±13.7 J/Kg) and symptomatic (peak torque: 3.8±0.6 N/Kg; maximum work: 1.8±0.3 J/Kg; total work: 58.1±12.9 J/Kg) dyskinetic participants. The dyskinetic symptomatic group presented the highest retractors' strength and fatigue resistance (p<0.01) values (peak torque: 5.2±0.6 N/Kg; maximum work: 2.9±0.8 J/Kg; total work: 87.7±22.7 J/Kg) followed by the healthy controls (peak torque: 4.7±1.0 N/Kg; maximum work: 2.1±0.5 J/Kg; total work: 65.3±17.9 J/Kg) and the asymptomatic dyskinetic participants (peak torque: 3.9±1.0 N/Kg; maximum work: 1.9±0.6 J/Kg; total work: 58.6±18.5 J/Kg). The protraction / retraction ratios showed a gradual decrease (p<0.001) from healthy controls (1.1) to asymptomatic (0.9) and symptomatic (0.7) dyskinetic subjects. CONCLUSIONS: Scapular dyskinesis is characterized by weaker scapular protractors and reduced agonist/antagonist ratios, especially when symptomatic. Targeting the scapular protractors for a better balance of scapular musculature in rehabilitation and strengthening programs may improve shoulder symptoms and function, but more interventional studies are required.

Quadriceps handheld dynamometry during the post-ICU trajectory: using strictly the same body position is mandatory for repeated measures.

BACKGROUND: The level of quadriceps strength (QS) generated in the supine or seated position is not similar. For QS follow-up from intensive care unit (ICU) stay to recovery, getting comparable measures is essential. This study aimed to develop and validate new equations for estimating QS in a given position based on the measurement taken in another one. METHODS AND RESULTS: Isometric QS was measured using a handheld dynamometer and a standardized protocol in a supine and in a seated position. In a first cohort of 77 healthy adults, two QS conversion equations were developed using a multivariate model integrating independent parameters such as age, sex, body mass index (BMI) and baseline QS. These equations were tested in two cohorts for external validation, using the interclass correlation coefficient (ICC) and Bland-Altman graphical method. Only one was validated in the second cohort (62 different healthy adults): the ICC was 0.87 (95% CI 0.59-0.94) and the bias was - 0.49 N/Kg (limits of agreement: - 1.76-0.78 N/kg). However, this equation did not perform well in the third cohort (50 ICU survivors): the ICC was 0.60 (95% CI 0.24-0.78), and the bias was - 0.53 N/Kg (limits of agreement: - 1.01-2.07 N/kg). CONCLUSIONS: As no conversion equation has been validated in the present study, repeated QS measurements should be performed strictly in the same standardized and documented position.

Preseason shoulder screening in volleyball players: is there any change during season?

Background: Volleyball players sollicit their shoulder with high velocity and high ranges of motion. Musculoskeletal adaptations have been described after some years of practice but have not been explored after some months of practice. The objective of this study was to analyze the short-term evolution of shoulder clinical measures and functional performance in youth competitive volleyball players. Methods: Sixty-one volleyball players were assessed twice, at preseason and at midseason. Shoulder internal and external rotation range of motion as well as forward shoulder posture and scapular upward rotation were measured in all players. Two functional tests were also performed: the upper quarter Y-balance test and the Single-arm medicine ball throw. The results obtained at midseason were compared to those measured at preseason. Results: Compared to preseason, an increase in absolute value of shoulder external rotation, total rotation range of motion and forward shoulder posture were observed at midseason (P < .001). An increase in side-to-side difference for shoulder internal rotation range of motion was also observed during the season. As for scapular kinematics, scapular upward rotation was significantly decreased at 45° and increased at 120° of abduction at midseason. Concerning functional tests, an increase in throwing distance in the single-arm medicine ball throw was observed at midseason while no change was noted for the upper quarter Y-balance test. Conclusion: Significant changes in clinical measures and functional performance were observed after some months of practice. Since some variables have been suggested to be correlated to a higher risk of shoulder injuries, the current study emphasizes the importance of regular screening in order to highlight injury risk profiles throughout the season.

French Translation and Validation of the OSTRC-H2 Questionnaire on Overuse Injuries and Health Problems in Elite Athletes.

Background: To evaluate the burden of overuse injuries, the Oslo Sports Trauma Research Centre (OSTRC) questionnaire on health problems (OSTRC-H2) was developed in English in 2013. Purpose: To translate and culturally adapt the OSTRC-H2 into French and investigate the reliability and validity of this new version. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The OSTRC-H2 was translated from English to French according to international guidelines. A total of 80 elite athletes were then invited to complete the OSTRC-H2 weekly for 3 months. Potential ceiling effects, construct validity, and reliability were investigated. Convergent validity was measured using Pearson correlations for continuous items and kappa coefficients for binary items; internal consistency was measured using the Cronbach alpha coefficient; and test-retest reliability was measured using the intraclass correlation coefficient (ICC). Separate analyses were performed on the entire cohort of athletes (population 1 [P1]) and on athletes who reported a health problem during the follow-up (P2). Results: A total of 80 elite athletes took part in this study. The response rate was very high, with 909 of 960 questionnaires returned (95%). The mean weekly prevalence of health problems was 19.6% during the follow-up period. Nineteen participants reported a health problem during the follow-up (P2). The OSTRC-H2 showed very good test-retest reliability for both populations (ICC, 0.85 [95% CI, 0.77-0.90] for P1; ICC, 0.90 [95% CI, 0.68-0.98] for P2). Internal consistency was very good for P2 (Cronbach α = .94). The OSTRC-H2 demonstrated high concordance with the visual analog scale of symptom intensity (r = 0.52; P < .05), and low concordance with the overtraining questions from the Questionnaire de la Société Française de Médecine du Sport (κ from -0.01 to 0.12; P > .05). Conclusion: The French version of the OSTRC-H2 was found to be valid and reliable when applied to French-speaking elite athletes.

Common Bias and Challenges in Physical and Rehabilitation Medicine Research: How to Tackle Them.

The importance of evidence-based medicine is crucial, especially in physical and rehabilitation medicine (PRM), where there is a need to conduct rigorous experimental protocols, as in any medical field. Currently, in clinical practice, therapeutic approaches are often based on empirical data rather than evidence-based medicine. However, the field of PRM faces several challenges that may complicate scientific research. In addition, there is often a lack of appropriate research training in educational programs. In this context, we aim to review the methodological challenges in PRM and provide clear examples for each of them as well as potential solutions when possible. This article will cover the following themes: (1) Choosing the right study design and conducting randomized and benchmarking controlled trials; (2). Selecting the appropriate controlled, placebo or sham condition and the issue of blinding in non-pharmacological trials; (3) The impact of populations' heterogeneity and multi-comorbidities; (4). The challenge of recruitment and adherence; (5). The importance of homogeneity and proper quantification of rehabilitative strategies; and (6). Ethical issues. We are convinced that teaching the basics of scientific research in PRM could help physicians and therapists to choose a treatment based on (novel) scientific evidence. It may also promote scientific research in PRM to develop novel and personalized rehabilitation strategies using rigorous methodologies and randomized or benchmarking controlled trials in order to improve patients' management.

The Modified-Athletic Shoulder Test: Reliability and validity of a new on-field assessment tool.

OBJECTIVES: To assess the reliability and the validity of a modified version of the Athletic Shoulder Test (M-AST), using a handheld dynamometer instead of a force plate. DESIGN: Test-retest reliability and concordance between tools. SETTING: University Motion Lab. PARTICIPANTS: Twenty healthy volunteers who practiced an upper limb sport for at least 5 h per week were recruited for the study. MAIN OUTCOME MEASURES: The concordance between the Athletic Shoulder Test (AST) and the Modified-Athletic Shoulder Test (M-AST) was assessed with intra-class correlation coefficients (ICC), paired T-Test and Bland-Altman plots. The inter-session reliability was assessed with intra-class correlation coefficients (ICC), SEM, MDC and paired T-Test. RESULTS: A strong concordance was found between AST and M-AST values (ICC = 0.86-0.97; p > 0.05) in all the positions considered and for both sessions. Bland-Altman plots confirmed these results. However, the inter-session reliability was more variable for both AST and M-AST (ICC = 0.643-0.923; p < 0.05). CONCLUSIONS: The M-AST seems to be a reliable, cheaper and easier to implement alternative to the AST to measure recovery status following matches or training sessions in upper limb athletes. As for the AST, familiarization trials will have to be performed before the assessment to have accurate measurements. CLINICAL TRIALS REGISTRATION NUMBER: NCT05112380.

Post-intensive care screening: French translation and validation of the Healthy Aging Brain Care-Monitor, hybrid version.

BACKGROUND: The Healthy Aging Brain Care-Monitor (HABC-M) questionnaires (self-reported version and caregiver version) have been validated for post-intensive care syndrome (PICS) detection in patients surviving a stay in the intensive care unit (ICU). Their authors have also developed a hybrid version (HABC-M-HV) suited to the daily needs of their post-ICU follow-up clinic. The objectives of the present cross-sectional observational study were to translate the HABC-M-HV questionnaire into French (HABC-M-HV-F) according to international guidelines and to test its measurement properties. METHODS: The HABC-M-HV was translated according to international guidelines. The measurement performances of the questionnaire were tested using internal consistency, test-retest reliability, Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) calculation, floor and ceiling effect measurement and construct validity. RESULTS: The validation study included 51 ICU survivors (27.5% women, 63 [55-71] years old). The questionnaire was administered by phone. The internal consistency was very good (Cronbach's alpha coefficient 0.79). The intra- and inter-examinator reliabilities were excellent (Intraclass Coefficient Correlation = 0.99 and 0.97, respectively). The SEM was 0.62 and the SDC was 1.72. No floor or ceiling effects were observed. The convergent validity was almost entirely confirmed with 71.4% of our hypothesis confirmed. CONCLUSION: The HABC-M-HV-F has been shown to be a valid and reliable tool for PICS screening and follow-up in French-speaking ICU survivors. A remote administration by phone was feasible. TRIAL REGISTRATION: Not applicable.

The influence of growth and development on shoulder rotators strength in young male and female elite tennis players.

BACKGROUND: Tennis practice requires a lot of technical, physical and mental qualities that have to be trained from the youngest age. The important number of hours spent on the court can lead, medium-to-long term to strength or flexibility adaptations, even in the youngest players. The current study aimed to explore the developmental consequences of repetitively playing tennis on shoulder range of motion and shoulder rotators' strength in elite male and female tennis players. METHODS: Eigthy four painfree elite tennis players were assessed during preseason between 2009 and 2019. Clinical assessment included internal and external rotation range of motion and forward shoulder posture while maximal internal and external rotators strength were assessed with an isokinetic dynamometer in concentric and in eccentric modes (at 60°/s and 240°/s). RESULTS: In male players, growth and maturation induced an increase in forward shoulder posture. Absolute peak torque and bodyweight peak torque of internal and external rotators in concentric and eccentric mode were also significantly increased during with age while ER/IR concentric ratios were significantly decreased. In the female players, only absolute peak torque of internal and external rotators in concentric mode and eccentric strength of external rotators were significantly influenced by the development. CONCLUSIONS: Specific adaptations were found in male and female players with age and practice. The important variability in the results within the different age categories and the gender strengthens the importance of regular screening (and isokinetic evaluations) in young tennis players in order to highlight potential atypical profiles, which could have a negative influence on performance or increase the risk of injuries during the development of the player.

Evaluating the effects of tDCS in stroke patients using functional outcomes: a systematic review.

BACKGROUND AND PURPOSE: Transcranial direct current stimulation (tDCS) has been extensively studied over the past 20 years to promote functional motor recovery after stroke. However, tDCS clinical relevance still needs to be determined. The present systematic review aims to determine whether tDCS applied to the primary motor cortex (M1) in stroke patients can have a positive effect on functional motor outcomes. MATERIALS AND METHODS: Two databases (Medline & Scopus) were searched for randomized, double-blinded, sham-controlled trials pertaining to the use of M1 tDCS on cerebral stroke patients, and its effects on validated functional motor outcomes. When data were provided, effect sizes were calculated. PROSPERO registration number: CRD42018108157. RESULTS: 46 studies (n = 1291 patients) met inclusion criteria. Overall study quality was good (7.69/10 on the PEDro scale). Over half (56.5%) the studies were on chronic stroke patients. There seemed to be a certain pattern of recurring parameters, but tDCS protocols still remain heterogeneous. Overall results were positive (71.7% of studies found that tDCS has positive results on functional motor outcomes). Effect-sizes ranged from 0 to 1.33. No severe adverse events were reported. CONCLUSION: Despite heterogeneous stimulation parameters, outcomes and patient demographics, tDCS seems to be complementary to classical and novel rehabilitation approaches. With minimal adverse effects (if screening parameters are respected), none of which were serious, and a high potential to improve recovery when using optimal parameters (i.e.: 20 min of stimulation, at 2 mA with 25 or 35cm2 electrodes that are regularly humidified), tDCS could potentially be ready for clinical applications.Implications for RehabilitationtDCS could potentially be ready for clinical application.Evidence of very low to very high quality is available on the effectiveness of tDCS to improve motor control following stroke.This should with caution be focused on the primary motor cortex.

Evaluation of the effect of analgesic treatment on signs of nociception-related behaviors during physiotherapy in patients with disorders of consciousness: a pilot crossover randomized controlled trial.

ABSTRACT: Neuro-orthopedic disorders are common in patients with disorders of consciousness (DOC) and can lead to potential pain. However, the patients' inability to communicate makes pain detection and management very challenging for clinicians. In this crossover randomized double-blind placebo-controlled study, we investigated the effects of an analgesic treatment on the presence of nociception-related behaviors. At baseline, the Nociception Coma Scale-Revised (NCS-R) was performed in 3 conditions: a non-noxious stimulation, a noxious stimulation, and during a physiotherapy session. Patients with a NCS-R total score during physiotherapy equal or above the score observed after the noxious stimulation could participate to the clinical trial, as well as patients with a score above 5. They received an analgesic treatment and a placebo on 2 consecutive days in a randomized order followed by an assessment with the NCS-R. Of the 18 patients, 15 displayed signs of potential pain during physiotherapy. Patients showed higher NCS-R scores during physiotherapy compared with the other conditions, suggesting that mobilizations were potentially painful. Of these 15 patients, 10 met the criteria to participate in the placebo-controlled trial. We did not find any effect of analgesic treatment on the NCS-R scores. This study highlights that physiotherapy may be potentially painful for patients with DOC, while analgesic treatments did not reduced NCS-R scores. Therefore, careful monitoring with appropriate assessment and treatment before and during mobilization should become a priority in clinical settings. Future studies should focus on the development of assessment tools sensitive to analgesic dosage to manage pain in DOC.

Validity and reliability of the French translation of the Identification of Functional Ankle Instability (IdFAI).

PURPOSE: To translate and validate the Identification of Functional Ankle Instability (IdFAI) into French. METHODS: The IdFAI was translated according to international recommendations. Discriminative power, floor and ceiling effects, construct validity (including confirmatory factorial analysis (CFA)), internal consistency and test-retest reliability were measured. Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were also calculated. RESULTS: 160 participants were included. The IdFAI-F showed a very good test-retest reliability (ICC = 0.95). The SEM was 1.37 and the MDC was 3.79. The internal consistency was moderate (Cronbach's alpha coefficient = 0.68). The correlation between the IdFAI and the Cumberland Ankle Instability Tool (CAIT) was high (r = -0.75, p < 0.001). No floor, nor ceiling effects were observed. The CFA analyses did not confirm the factor structure proposed by the authors of the original English version. CONCLUSIONS: The IdFAI-F is a valid and reliable tool to accurately identify and measure chronic ankle instability in research and clinical settings for French-speaking individuals.

What Are the Main Risk Factors for Lower Extremity Running-Related Injuries? A Retrospective Survey Based on 3669 Respondents.

BACKGROUND: Despite the many studies on running-related injuries (RRIs), risk factors for injury remain unclear in the literature. PURPOSE: To investigate the risk factors of RRIs. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: An online survey was conducted among 3669 injured and noninjured runners. Injury was defined as pain of various kinds, without attention to its consequences on running practice. The survey included 41 questions on 5 main categories-personal characteristics, daily lifestyle, training and running characteristics, practice of other sporting activities, and prevention habits-as well as information about the occurrence of RRI over the previous 12 months. Continuous and qualitative variables were analyzed by Student t test and chi-square test, respectively. Sixteen variables were selected for multivariate binary logistic analysis. RESULTS: Among the 3669 runners, 1852 (50.5%) reported at least 1 injury over the previous 12 months. Overuse injuries were largely represented (60.6%). The variables associated with RRIs that remained significant in the fully adjusted model were previous injury (odds ratio [OR], 1.62; 95% CI, 1.42-1.86), higher weight (OR, 1.006; 95% CI, 1.00-1.012), competitive running (OR, 1.53; 95% CI, 1.19-1.98), running >2 h/wk (OR, 1.28; 95% CI, 1.01-1.62), running >20 km/wk (OR, 1.25; 95% CI, 1.001-1.55), and stretching before running (OR, 1.46; 95% CI, 1.25-1.71). CONCLUSION: Previous injury remains the most relevant risk factor for RRIs according to the current study and previous data. Many training characteristics seem to be involved but still have to be confirmed in view of conflicting data in the literature. Further research would help clinicians better understand RRIs and how to prevent them.

The "Ankle Instability Instrument": Cross-cultural adaptation and validation in French.

BACKGROUND: Functional ankle instability affects 20-40% of individuals who have already suffered from a sprain. Such dysfunctions are difficult to diagnose. Therefore, the information provided by self-administered questionnaires is essential. Thus, the Ankle Instability Instrument (AII) was developed and initially validated in English. Our goal is to create a French version of the instrument, named AII-F, by scrupulously respecting the cultural adaptation phases and to make sure the new instrument has good psychometric properties. METHODS: International recommendations have been rigorously followed for the cultural adaptation and the French-translation phase. Six steps are recommended: I) two initial translations from English to French; II) synthesis of the two versions; III) back-translations from French to English; IV) comparisons between the back-translations and the original questionnaire by the expert committee; V) pretest; and VI) approval of the final French version of the AII. In order to validate this French-translation, 91 subjects suffering from ankle instability matched to 91 healthy subjects were asked to complete the AII-F. The Short Form Health Survey (SF-36) was used as a comparative questionnaire as well as the French Cumberland Ankle Instability Tool (CAIT-F). The psychometric properties of the questionnaire were evaluated by determining the test-retest reliability after a 10-14-day interval, the internal consistency, construct validity, and the floor/ceiling effects. RESULTS: The French-translation did not pose a problem and could be validated by the expert committee. The AII-F showed a very good test-retest reliability for the total score, with an Intra Class Coefficient of 0.983. The internal coherence is high with an alpha coefficient of Cronbach of 0.861. The association of the AII-F with the CAIT-F was high, for the summary of the physical component of the SF-36, meaning a great convergent validity. The other subscales of the SF-36 (mental health) were weakly correlated with the AII-F, reflecting good divergent validity. An optimal cut-off score was obtained to dissociate pathological patients from healthy subjects: when the subject responded to "yes" 5 times or more, he is considered, with a very high degree of confidence, to be pathological. CONCLUSION: The AII-F is reliable and valid for evaluating and measuring functional ankle instability.

French Translation and Validation of the Victorian Institute of Sports Assessment for Gluteal Tendinopathy Questionnaire.

BACKGROUND: Developed in 2015, the Victorian Institute for Sport Assessment for Gluteal Tendinopathy (VISA-G) is the first patient-reported outcome measure tool specifically designed to measure the severity of disability associated with greater trochanteric pain syndrome. There is currently no French version of the VISA-G questionnaire. OBJECTIVE: To translate the VISA-G questionnaire into French (VISA-GF) and to test its psychometric performances. DESIGN: Cross-sectional study, validation study. SETTING: Clinics in Liège, Belgium and in France. PATIENTS: Participants with greater trochanteric pain syndrome and control asymptomatic participants. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: French translation of the VISA-G and psychometric performances of the questionnaire tested using internal consistency, construct validity and test-retest reliability with a 7-day interval. RESULTS: The eight items of the VISA-G questionnaire were translated without any difficulties. The psychometric validation study included 106 participants (median age 53 [58-64] years old, 65 women [61.3%]). The questionnaire discriminates well between pathologic (n = 52) and asymptomatic participants (n = 54). Moreover, we found a good internal consistency and excellent test-retest reliability for the VISA-GF questionnaire. We also confirmed the construct validity and did not find any floor or ceiling effects. CONCLUSIONS: The VISA-GF has been shown to be a valid and reliable way to measure the severity of disability associated with greater trochanteric pain syndrome in French-speaking participants.