Does the Spraino low-friction shoe patch prevent lateral ankle sprain injury in indoor sports? A pilot randomised controlled trial with 510 participants with previous ankle injuries.

BACKGROUND: Lateral ankle sprains are common in indoor sports. High shoe-surface friction is considered a risk factor for non-contact lateral ankle sprains. Spraino is a novel low-friction patch that can be attached to the outside of sports shoes to minimise friction at the lateral edge, which could mitigate the risk of such injury. We aimed to determine preliminary effectiveness (incidence rate and severity) and safety (harms) of Spraino to prevent lateral ankle sprains among indoor sport athletes. METHODS: In this exploratory, parallel-group, two-arm pilot randomised controlled trial, 510 subelite indoor sport athletes with a previous lateral ankle sprain were randomly allocated (1:1) to Spraino or 'do-as-usual'. Allocation was concealed and the trial was outcome assessor blinded. Match and training exposure, number of injuries and associated time loss were captured weekly via text messages. Information on harms, fear-of-injury and ankle pain was also documented. RESULTS: 480 participants completed the trial. They reported a total of 151 lateral ankle sprains, of which 96 were categorised as non-contact, and 50 as severe. All outcomes favoured Spraino with incidence rate ratios of 0.87 (95% CI 0.62 to 1.23) for all lateral ankle sprains; 0.64 (95% CI 0.42 to 0.98) for non-contact lateral ankle sprains; and 0.47 (95% CI 0.25 to 0.88) for severe lateral ankle sprains. Time loss per injury was also lower in the Spraino group (1.8 vs 2.8 weeks, p=0.014). Six participants reported minor harms because of Spraino. CONCLUSION: Compared with usual care, athletes allocated to Spraino had a lower risk of lateral ankle sprains and less time loss, with only few reported minor harms. TRIAL REGISTRATION NUMBER: NCT03311490.

Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial.

OBJECTIVE: The primary aim was to compare time from acute hamstring strain injury (HSI) to return-to-play (RTP) clearance following a standardized rehabilitation protocol performed within either pain-free or pain-threshold limits. Secondary aims were to compare isometric knee flexor strength, biceps femoris long head (BFLH) fascicle length, fear of movement, and reinjury occurrence at the 6-month follow-up between pain-free and pain-threshold groups. DESIGN: Randomized controlled trial. METHODS: Forty-three men with acute HSIs were randomly allocated to a pain-free (n = 22) or pain-threshold (n = 21) rehabilitation group. Days from HSI to RTP clearance, isometric knee flexor strength, BFLH fascicle length, fear of movement, and reinjury occurrence at the 6-month follow-up were reported. RESULTS: Median time from HSI to RTP clearance was 15 days (95% confidence interval [CI]: 13, 17) in the pain-free group and 17 days (95% CI: 11, 24) in the pain-threshold group, which was not significantly different (P = .37). Isometric knee flexor strength recovery at 90° of hip and 90° of knee flexion was greater in the pain-threshold group at RTP clearance by 15% (95% CI: 1%, 28%) and by 15% (95% CI: 1%, 29%) at 2-month follow-up, respectively. Improvement in BFLH fascicle length from baseline was 0.91 cm (95% CI: 0.34, 1.48) greater at 2-month follow-up in the pain-threshold group. Two reinjuries occurred in both the pain-free and pain-threshold groups between RTP clearance and the 6-month follow-up. CONCLUSION: Pain-threshold rehabilitation did not accelerate RTP clearance, but resulted in greater recovery of isometric knee flexor strength and better maintenance of BFLH fascicle length, compared to pain-free rehabilitation. J Orthop Sports Phys Ther 2020;50(2):91-103. Epub 28 Jun 2019. doi:10.2519/jospt.2020.8895.

Fear Avoidance Beliefs in College Athletes with a History of Ankle Sprain.

Ankle sprains are the most prevalent injuries, and elevated fear avoidance beliefs after ankle sprain episodes could inhibit athletic performance and contribute to residual symptoms, such as functional and/or mechanical instability. However, it remains unclear how fear avoidance beliefs differ according to conditions of posttraumatic sequelae. The purpose of this study was to determine whether fear of movement/reinjury differed between individuals with and without functional ankle instability (FI, NFI) and healthy controls (CON) and to examine the relationship between fear and ankle joint laxity by sex. Participants (115 male athletes, 105 female athletes) completed the Identification of Functional Ankle Instability, Athlete Fear Avoidance Questionnaire (AFAQ), Tampa Scale for Kinesiophobia (TSK), and ankle joint laxity test. Total 168 athletes (79 males, 89 females) data were eligible for analysis. The results demonstrated that fear of movement/reinjury was lower in individuals in the absence of functional ankle instability although they experienced ankle sprain (FI; TSK=38.6±4.5, AFAQ=27.4±6.2, NFI; TSK=35.7±5.6, AFAQ=24.5±6.6). The fear of movement/reinjury had correlation with ankle joint laxity only in female athletes (TSK; r=0.285, p=0.013, AFAQ; r 0=0.322, p=0.045).

Functional Outcomes and Psychological Benefits of Active Video Games in the Rehabilitation of Lateral Ankle Sprains: A Case Report.

CONTEXT: The use of active video games (AVG) as a treatment modality in the rehabilitation context is increasing. However, little is known about the functional outcomes and psychological benefits of such rehabilitation in college athletes with lateral ankle sprains (LASs). OBJECTIVE: To examine functional outcomes and psychological benefits of AVG-aided rehabilitation program for LAS. DESIGN: A mixed-methods, single-subject case series design. SETTING: College athletic training clinic. PATIENTS: Two female college soccer players who sustained LAS (grades I and II) during sport participation. INTERVENTION: A 4-week balance training program. One patient completed balance exercises using AVG, whereas the other patient completed traditional balance exercises. MAIN OUTCOME MEASURES: Several validated instruments were used to evaluate different functional outcomes and psychological factors: balance (Balance Error Scoring System, Star Excursion Balance Test), rehabilitation adherence (Rehabilitation Adherence Measure for Athletic Training), foot and ankle function (Foot and Ankle Ability Measure), perceptions of pain (Visual Analog Scale for pain), perceived readiness to return to sport (Injury-Psychological Readiness to Return to Sport Scale), and mood (Brunel Mood Scale). RESULTS: It appears that the balance training protocols (AVG and traditional balance exercises) were equally effective in restoring patient's balance to functional levels. Despite very individualistic processes of rehabilitation, the participants' perceived pain, perceived readiness to return to sport, and mood states were closely linked with objective and subjective functional measures of progress. CONCLUSIONS: Based on the results, AVG has the potential to provide more versatility into the static and dynamic postural control exercises typically used following acute LAS. Moreover, the current results support the existing psychological and biopsychosocial theoretical conceptualizations of athletes' responses to injuries and rehabilitation process.

Proposal for a Global Adherence Scale for Acute Conditions (GASAC): A prospective cohort study in two emergency departments.

BACKGROUND: Adherence in the context of patients with acute conditions is a major public health issue. It is neglected by the research community and no clinically validated generic scale exists to measure it. OBJECTIVE: To construct and validate a Global Adherence Scale usable in the context of Acute Conditions (GASAC) that takes into account adherence both to advice and to all types of prescriptions that the doctor may give. To measure adherence and to study its determinants. MATERIALS AND METHOD: We based the construction of the GASAC questionnaire on a theoretical model and a literature search. Then, between 2013 and 2014, we validated it in a prospective observational study in two hospital emergency departments. Patients were contacted by phone about one week after their consultation to answer several questionnaires, including GASAC and the Girerd self-administered questionnaire about medication adherence as a control. RESULTS: GASAC consists of four adherence subscales: drug prescriptions; blood tests/ radiography prescriptions; lifestyle advice and follow-up instructions. An analysis of the 154 sets of answers from patients showed that the GASAC drug subscale had satisfactory internal coherence (Cronbach's alpha = 0.78) and was correlated with the Girerd score, as was GASAC as a whole (p<0.01). The median score was 0.93 IQR [0.78-1] for a maximum value of 1 (n = 154). In multivariaable analysis, infection was more conducive of good adherence (cut off at ≥ 0.8; n = 115/154; 74.7% [67.0-81.3]) than trauma (OR 3.69; CI [1.60-8.52]). The Doctor-Patient Communication score (OR 1.06 by score point, CI [1.02-1.10]) also influenced adherence. CONCLUSIONS: GASAC is a generic score to measure all dimensions of patient adherence following emergency departments visits, for use in clinical research and the evaluation of clinical practice. The level of adherence was high for acute conditions and Doctor-Patient Communication was a major determinant of adherence.

Validation of the WHOQOL-BREF and Shorter Versions Using Rasch Analysis in Traumatic Brain Injury and Orthopedic Populations.

OBJECTIVE: To use Rasch analysis to validate the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and existing short versions in individuals with traumatic brain injury and orthopedic injuries, with comparisons to a general population group. DESIGN: The Partial Credit Rasch model was applied to evaluate the WHOQOL-BREF as well as shortened versions using a cross-sectional study design. SETTING: Regional hospital, and national electoral sample in New Zealand. PARTICIPANTS: Individuals with traumatic brain injury (n=74), individuals with orthopedic injuries (n=114), general population (n=140). INTERVENTIONS: None. MAIN OUTCOME MEASURE: WHOQOL-BREF. RESULTS: The WHOQOL-BREF met expectations of the unidimensional Rasch model and demonstrated good reliability (person separation index [PSI] =0.82) when domain items were combined into physical-psychological, social, and environmental superitems. Analysis of shorter versions, the EUROHIS-QOL-8 and World Health Organization Quality of Life-5 (WHOQOL-5), indicated overall acceptable fit to the Rasch model and evidence of unidimensionality. The EUROHIS-QOL-8 showed good reliability (PSI=0.81); however, reliability of the WHOQOL-5 (PSI=0.68) was below acceptable standards for group comparisons, in addition to demonstrating poor person-item targeting. CONCLUSIONS: The WHOQOL-BREF and the 8-item EUROHIS-QOL-8 version are both reliable and valid in the assessment of quality of life in both injury and general populations. Ordinal-interval conversion tables published for these validated scales as well as for the WHOQOL-5 can be used to improve precision of assessment. The transformation of ordinal scale scores into an interval measure of health-related quality of life also permits the calculation of a single summary score for the WHOQOL-BREF, which will be useful in a wide range of clinical and research contexts. Further validation work of the WHOQOL-5 is needed to ascertain its psychometric properties.

Risk Factors for Initial and Subsequent Core or Lower Extremity Sprain or Strain Among Collegiate Football Players.

CONTEXT: Exposure to game conditions and previous injury are known to increase the risk of injury, but little available evidence pertains to modifiable factors that may mediate dynamic control of body segments, such as core muscle endurance and neurocognitive capabilities. OBJECTIVE: To identify potentially modifiable factors associated with the occurrence of a core or lower extremity sprain or strain during participation in football. DESIGN: Prospective cohort study. SETTING: National Collegiate Athletic Association Division I Football Bowl Subdivision football program. PATIENTS OR OTHER PARTICIPANTS: All team members who participated for the duration of 1 season or both of 2 consecutive seasons (n = 142). MAIN OUTCOME MEASURE(S): Predictors of injury occurrence were derived from analysis of preparticipation data that included the results of front plank hold (FPH) and neurocognitive tests. Receiver operating characteristic analysis was used to establish binary classifications of injury risk. Logistic regression analyses were conducted to build multivariable injury-prediction models for optimal discriminatory power. RESULTS: Exceptionally good discrimination between injured and noninjured participants was provided by models that included the results of the FPH and ImPACT neurocognitive tests. A high level of exposure to game conditions and injury during the preceding year magnified the effects of other risk factors. A model for identifying players with an elevated risk for injury occurrence during both of 2 consecutive seasons included FPH ≤120 seconds, verbal memory score ≤87, composite reaction time ≥560 milliseconds, and starter status. Having ≥2 of the 4 risk factors demonstrated 44% sensitivity and 91% specificity, with an odds ratio = 8.40. CONCLUSIONS: Core muscle endurance and neurocognitive processes may both play important roles in generating anticipatory muscle stiffness during participation in collegiate football. These factors may be particularly important for players who sustained an injury during the previous year and those who have a high level of game exposure.

College Athletes With Ankle Sprain History Exhibit Greater Fear-Avoidance Beliefs.

CONTEXT: Postinjury, college athletes have reported elevated levels of fear. However, it is unclear how a history of ankle sprain impacts injury-related fear. OBJECTIVE: The aim of this study was to determine if Fear-Avoidance Beliefs Questionnaire (FABQ) scores differ between college athletes with a history of a single ankle sprain, those with recurrent ankle sprains, and healthy controls. DESIGN: Cross-sectional design. SETTING: National Collegiate Athletic Association institutions. PATIENTS: From a large database of college athletes, 75 participants with a history of a single ankle sprain, 44 with a history of recurrent ankle sprains (≥2), and 28 controls with no injury history were included. MAIN OUTCOME MEASURES: Participants completed an injury history questionnaire and the FABQ. On the injury history form, the participants were asked to indicate if they had ever sustained an ankle sprain and, if yes, to describe how many. FABQ scores ranged from 0 to 66 with higher scores representing greater fear. RESULTS: Athletes with a history of recurrent ankle sprains (median, 28.00; interquartile range, 18.25-38.00) reported higher levels of fear than those with a history of a single ankle sprain (21.00; 8.00-31.00; P = .03; effect size = 0.199) and healthy controls (5.50; 0.00-25.00; P < .001; effect size = 0.431). Athletes with a history of a single sprain reported greater fear than healthy controls (P = .01, effect size = 0.267). Athletes with a history of a single sprain reported greater fear than healthy controls (P = .02, effect size = 0.23). CONCLUSIONS: College athletes with a history of ankle sprain exhibited greater levels of fear on the FABQ than healthy controls. These findings suggest that ankle sprains in general may increase injury-related fear and that those with a history of recurrent sprains are more vulnerable.

Factors associated with pain intensity and physical limitations after lateral ankle sprains.

BACKGROUND: Swelling, tenderness, and ecchymosis don't correlate with time to functional recovery in patients with a lateral ankle sprain. It is established that psychosocial factors such as symptoms of depression and low pain self-efficacy correlate with pain intensity and magnitude of limitations in patients with musculoskeletal disorders. OBJECTIVE: We studied the correlation between pain self-efficacy or symptoms of depression and (1) ankle specific limitations and (2) pain intensity in patients with a lateral ankle sprain. Further we explored the correlation between estimation of sprain severity (grade) and (3) pain intensity or magnitude of ankle specific limitations. DESIGN: Eighty-four patients with a lateral ankle sprain prospectively completed the Pain Self Efficacy Questionnaire, the Olerud Molander Ankle Score, Ordinal scale of Pain and the Patient Health Questionnaire-2 at enrollment and the Olerud Molander Ankle Score and the Ordinal scale of Pain three weeks after the injury. Factors associated with higher ankle specific limitations and symptoms were investigated in bivariable and multivariable analysis. RESULTS: When accounting for confounding factors, greater self-efficacy (p=0.01) and older age (p<0.01) were significantly associated with greater ankle specific symptoms and limitations three weeks after the injury and explained 22% of the variability in ankle specific limitations and symptoms. There was no correlation between the grade of the sprain and pain intensity or ankle specific limitations or symptoms. CONCLUSIONS: Psychosocial factors (adaptiveness in response to pain in particular) explain more of the variation in symptoms and limitations after ankle sprain than the degree of pathophysiology. The influence of adaptive illness descriptions and recovery strategies based on methods for improving self-efficacy (i.e. cognitive behavioral therapy) might enhance and speed recovery from ankle injuries and merit additional investigation. LEVEL OF EVIDENCE: Level 2 prospective cohort study.

Building healthy construction workers: Their views on health, wellbeing and better workplace design.

Construction is a heavy manual industry where working into later life can be a challenge. An interview study was conducted to explore workers' understanding of their health at work and ways of making their jobs easier, safer or more comfortable. Using purposive sampling, 80 trades' workers were selected from construction sites in the UK. The Nordic Musculoskeletal Questionnaire and Work Ability Index were used to explore aches and pains and reducing strain on the body. A high prevalence of symptoms was reported and ratings of work ability were high. Workers were aware of the physical demands of their work and had over 250 ideas around health and wellbeing e.g. rucksacks for tools, bespoke benches, adapting PPE, and higher cost solutions e.g. mechanical lifting aids. Engagement of the workforce should be encouraged and feed into change processes in the industry to enable all workers stay fit for work for longer.

Physical exercise and burnout facets predict injuries in a population-based sample of French career firefighters.

Although firefighting is known to engender a high rate of injury, few studies have examined the contribution of physical exercise, burnout and coping strategies to firefighting-related injuries. Data were collected from a population-based sample of 220 male firefighters. In a descriptive study, the nature and site of the injuries and the relationships among firefighter injuries, physical exercise, burnout and coping strategies were examined. Sprains were the most prevalent type of injury (98%), followed by tendinitis (40%) and muscle tears (30%). More than two thirds of these injuries were located at the ankle. Weekly hours of physical exercise, cognitive weariness at work, social support seeking, problem-focused coping and emotional exhaustion were significantly related to these injuries. The findings suggest that physical exercise and cognitive weariness can be considered as risk factors for French firefighter injuries, whereas problem-focused coping can be seen as a protective factor. More research is needed to explain the relationship between social support seeking and injury.

The Consequence of a Medial Ankle Sprain on Physical and Self-reported Functional Limitations: A Case Study Over a 5-Month Period.

STUDY DESIGN: Case report. BACKGROUND: Little evidence exists about impairments and perceived disability following eversion injury to the deltoid ligament. This case study prospectively examined the neuromuscular, biomechanical, and psychological consequences of a case of a medial ankle sprain. CASE DESCRIPTION: A recreationally active man with a history of a lateral ankle sprain (grade I) was participating in a university Institutional Review Board-approved research study examining the neuromuscular and mechanical characteristics associated with chronic ankle instability. Twenty-two days after the testing session, the participant sustained an eversion injury to his left ankle while playing basketball. Outcomes The outcomes of this case are presented using the International Classification of Functioning, Disability and Health model. Outcome variables were assessed at preinjury (medial ankle sprain), 3 months postinjury, and 5 months postinjury. Measurements included neural excitability of the soleus, balance assessment, joint stability, and psychological assessments. Data from this case study revealed that a medial ankle sprain reduces joint mobility and alters neural excitability of the soleus, with concurrent deficits in balance and self-reported function. These impairments forced the participant to downgrade his physical activity lifestyle up to 5 months postinjury. DISCUSSION: These data suggest the need for the development of intervention strategies to address impairments in neural excitability and joint mobility at the ankle to help patients meet the goal of maintaining long-term joint health. LEVEL OF EVIDENCE: Prognosis, level 4.

Effect of a pain diary use on recovery from acute low back (lumbar) sprain.

UNLABELLED: The aim of the study was to examine the effect of a daily pain diary on recovery from acute low back sprain. SUMMARY OF BACKGROUND DATA: Pain diaries are often recommended to or used by patients suffering with acute lumbar (low back) sprain. Diaries have been shown to be associated, however, with a slower rate of recovery after whiplash (neck) injury. The effect of diary use on recovery from low back injury is unknown. Subjects with acute lumbar (low back) sprain were randomly assigned to one of the two groups: a diary group and control group. A total of 58 out of 62 initially recruited subjects were seen in follow-up 3-month post-injury, 29 in the diary group, and 29 in the control group. Data were gathered within 1 week of injury on sex, age, and Oswestry Disability Questionnaire (ODQ) scores. The diary group was asked then to keep a record of their overall pain experience, rating their pain on a scale of 1-10 on a daily basis for 4 weeks. At the outset, both groups had similar mean age, sex distribution, and mean ODQ scores. After 4 weeks of pain diary use, fewer diary group subjects reported recovery at 3 months compared with the control group (52 vs. 79 %, respectively, p < 0.05). The use of a pain diary for 4 weeks in acute lumbar sprain subjects is associated with a reduced rate of recovery.

Alteration in global motor strategy following lateral ankle sprain.

BACKGROUND: Lateral ankle sprain (LAS) has often been considered an injury leading to localized joint impairments affecting the musculoskeletal system. Persistent chronic ankle instability and bilateral alterations in motor control after a first ankle sprain episode suggest that the origin of relapses might be a maladaptive reorganization of central motor commands. The objectives of this study were (1) to compare the quality of motor control through motor strategy variables of two groups (with and without LAS) from a military population (n = 10/group), (2) to evaluate the contribution of the lower limbs and the trunk to global body strategy and (3) to identify which global variable best estimates performance on the Star Excursion Balance Test (SEBT) for each group, reaching direction, and lower limb. METHODS: Personal and clinical characteristics of the participants of both groups were collected. Their functional ability was measured using questionnaires and they performed a series of functional tests including the SEBT. During this test, the maximal reach distance (MRD) and biomechanical data were collected to characterize whole body and segmental strategies using a 3D motion capture system. RESULTS: At maximal lower limb reach, participants with LAS had a smaller variation in their vertical velocity in lowering-straightening and lowered the body centre of mass less for all injured limb conditions and some conditions with the uninjured lower limb. The global body centre of mass variables were significantly correlated to SEBT performance (MRD). CONCLUSION: Modifications in global motor strategies were found in participants with LAS as well as a decreased performance on the SEBT for the injured and uninjured lower limbs. These results support the hypothesis that following LAS, there may be a maladaptive reorganization of the central motor commands. LEVEL OF EVIDENCE: 3b.

Lesiones de los sargentos alumnos del Ejército de Tierra y factores de riesgo lesional / Injuries of the Ground Forces Student Sergeants and injury risk factors

ANTECEDENTES: los cursos de entrenamiento militar requieren un alto nivel de exigencia física y provocan un número importante de lesiones osteomusculares. Es de interés conocer el tipo de lesiones que se observan en estos cursos y los factores de riesgo lesional aso-ciados, para poder implantar posteriormente medidas preventivas adecuadas y correctas gestiones de los recursos que se disponen. OBJETIVO: presentar el tipo de lesiones observadas durante la fase común del primer curso de formación de los sargentos alumnos del Ejército de Tierra (ET) y analizar la frecuencia lesional y factores de riesgo relacionados. Material y MÉTODOS: estudio descriptivo observacional de corte transversal de 15 semanas de duración, en el que se incluyeron 579 sargentos alumnos (49 mujeres), edad media de 25,9 años (Rango 18-31). Al inicio del curso, se obtuvieron los parámetros antropométricos de los alumnos y se midió su condición física mediante las marcas obtenidas en carrera de 6000, 1000 y 50 m, y pruebas de salto vertical y flexo extensiones en suelo. Durante el curso, se registraron las lesiones observadas, sus causas, localización y tiempo de recuperación. Al final del curso, se comparó la frecuencia lesional observada y sus causas entre hombres y mujeres, y en el grupo de hombres, se compararon las marcas obtenidas y los parámetros antropométricos entre los lesionados y no lesionados. RESULTADOS: la edad media del grupo de mujeres vs hombres fue de 27,1 (3,18) vs 25,7 (3,03) años p < 0,01; la talla 1,63 (0,05) vs 1,77 (0,07) m, p < 0,0001; y el peso 57,2 (5,04) vs 75,2 (9,14) kg, p < 0,0001, respectivamente. Las marcas obtenidas por el grupo de mujeres fueron significativamente menores en todas las pruebas (p < 0,0001). Se lesionaron 111 alumnos (19,1%), observándose un total de 113 lesiones Se lesionaron 18 mujeres (36,7%) frente a 95 hombres (17,9%), p < 0,05. En el grupo de hombres, las marcas iniciales de los lesionados frente a no lesionados en extremidades inferiores, fueron las siguientes: en 6 km, 28,1 (2,40) vs 27,0 (2,82) min, p < 0,001; en 1 km, 3,49 (0,28) vs 3,39 (0,24) min, p < 0,001; en 50 m, 7,29 (0,41) vs 7,18 (0,40) seg, p < 0,05, respectivamente. No hubo diferencias significativas entre las marcas obtenidas en salto vertical y flexo-extensiones, entre los hombres lesionados y no lesionados, ni tampoco en edad, peso, talla e IMC. CONCLUSIONES: se observa que en torno al 20% de los alumnos se lesionan durante el curso académico, siendo los esguinces y tendinitis las lesiones más frecuentes. Las lesiones se localizan preferentemente en extremidades inferiores. La mitad de las lesiones se producen por sobrecarga y la otra mitad por accidente. Las mujeres se lesionan más que los hombres. Diferencias antropométricas y una menor condición física pueden determinar su mayor incidencia lesional. En el grupo de hombres, una peor condición física se relaciona con un mayor riesgo lesional, no encontrándose relación de la frecuencia lesional con la edad, peso, talla ni IMC en este grupo

BACKGROUND: military training courses are very physically demanding and they cause a significant number of musculos-keletal injuries. It is of interest to know the type of injuries observed in these courses and the associated injury risk factors in order to subsequently implant appropriate preventive measures and manage available resources. OBJECTIVE: to present the type of injuries observed during the common phase of the first training course of the Ground Forces Student Sergeants and to analyze the frequency of injuries and related risk factors. MATERIAL AND METHODS: descriptive, observational, cross-sectional, 15 week duration study, which included 579 student sergeants (49 women), average age of 25.9 years (range 18-31). At the beginning of the course, the anthropometric parameters of students were obtained and their physical condition was measured through the marks obtained in 6000, 1000 and 50 m career, and through vertical jump and flexion/extension tests on the ground. During the course, observed injuries, their causes, location and recovery time were recorded. At the end of the course, the observed frequency of injuries and their causes were compared between men and women, and in the male group, the obtained marks and the anthropometric parameters were compared between the injured and not injured. RESULTS: the average age of the women vs men's group was 27.1 (3.18) vs. 25.7 (3.03) years p <0, 01; height 1.63 (0.05) vs 1.77 (0.07) m, p <0 .0001; and weight 57.2 (5.04) vs 75.2 (9.14) kg, p < 0.0001, respectively. The marks obtained in the women's group were significantly lower in all tests (p < 0.0001). One hundred and eleven students got injured (19.1%), with a total of 113 injuries. The most frequent injuries were sprains and tendinitis which accounted for 61% of the lesions, and the most frequent location was in lower limbs (87.6%). Overload injuries occurred in 54.4% of cases compared to 49.6% caused by accident (p = NS). Eighteen women got injured (36.7%) against 95 men (17.9%), p < 0.05. In the male group, the initial marks in the subgroup with lower limbs injuries compared to the not injured, were the following: 6 km, 28.1 (2.40) vs 27.0 (2.82) min, p < 0.001; in 1 km, 3.49 (0.28) vs 3.39 (0.24) min, p < 0.001; in 50 m, 7.29 (0.41) vs 7.18 (0.40) sec, p < 0.05, respectively. There were no significant differences neither in the marks obtained in vertical jump and flexion/extensions among the injured and not injured, nor in age, weight, height and BMI. CONCLUSIONS: it is observed that around 20% of the students get injured during the academic year, being the sprains and tendinitis the most frequent injuries. The injuries are predominantly located in lower extremities. Half of the injuries are caused by overload and the other half by accident. Women get injured more than men. Anthropometric differences and a lower physical condition might determine the major incidence of their injuries. In the male group, worse physical condition is related to an increased risk of injury, but the relationship between the frequency of injuries and age, weight, height or BMI is not found in this group

Prognosis of ankle syndesmosis injury.

PURPOSE: Ankle syndesmosis injury has been associated with persistent pain and prolonged recovery; however, no predictors of prolonged recovery have been identified. The aims of this study were to establish prognosis for ankle syndesmosis injury compared with a lateral ankle sprain and to explore factors associated with prolonged recovery. METHODS: Participants (n = 63) age 21 ± 3.2 yr, with acute ankle ligament injuries (diagnosed through magnetic resonance imaging), were recruited from 10 sport clubs and sports medicine and physiotherapy clinics in two Australian cities. Follow-up was until full recovery and with preinjury activity level. Time to return to play was compared between injury types using Kaplan-Meier survival curves. Secondary analysis investigated putative factors that increased risk of prolonged recovery. For this analysis, participants unrecovered at 2 wk completed the following: Fear Avoidance Beliefs Questionnaire (FABQ); Star Excursion Balance Test, weight-bearing lunge, and vertical jump (VJ). These variables were correlated with time to recovery using bivariate Pearson's r correlation coefficient. RESULTS: The median recovery time for conservatively treated ankle syndesmosis injury was 62 and 15 d for lateral sprain. The sport-specific subscale scores of the FABQ were significantly higher (P = 0.017) for the ankle syndesmosis group, whereas vertical jump height was lower for this group, (P = 0.052). No baseline variables were strong predictors (r ≥ 0.6) of recovery. Moderate correlations were found for VJ (r = -0.471, P = 0.004) and the sport-specific subscale of the FABQ (r = 0.463, P = 0.004). CONCLUSIONS: Conservatively treated ankle syndesmosis injuries took four times longer to recover than lateral ankle sprain. Tests such as VJ and FABQ may identify individuals at risk of prolonged recovery and allow health professionals to determine realistic and appropriate time to recovery.

Patients' misunderstanding of common orthopaedic terminology: the need for clarity.

INTRODUCTION: Patients' understanding of their medical problems is essential to allow them to make competent decisions, comply with treatment and enable recovery. We investigated patients' understanding of orthopaedic terms to identify those words surgeons should make the most effort to explain. METHODS: This questionnaire-based study recruited patients attending the orthopaedic clinics. Qualitative and quantitative data were collected using free text boxes for the patients' written definitions and multiple choice questions (MCQs). RESULTS: A total of 133 patients took part. Of these, 74% identified English as their first language. 'Broken bone' was correctly defined by 71% of respondents whereas 'fractured bone' was only correctly defined by 33%. 'Sprain' was correctly defined by 17% of respondents, with 29% being almost correct, 25% wrong and 29% unsure. In the MCQs, 51% of respondents answered correctly for 'fracture', 55% for 'arthroscopy', 46% for 'meniscus', 35% for 'tendon' and 23% for 'ligament'. 'Sprained' caused confusion, with only 11% of patients answering correctly. Speaking English as a second language was a significant predictive factor for patients who had difficulty with definitions. There was no significant variation among different age groups. CONCLUSIONS: Care should be taken by surgeons when using basic and common orthopaedic terminology in order to avoid misunderstanding. Educating patients in clinic is a routine part of practice.

Adherence and effectiveness of rehabilitation in acute ankle sprain.

OBJECTIVE: To estimate adherence to and effectiveness of rehabilitation after acute ankle sprain. METHOD: Patients with acute ankle sprain attending four emergency departments were recruited between February and July 2009. After the initial examination (classification of the severity of the sprain), each patient received an Aircast(®) ankle brace and the same, standardized rehabilitation program. Between two and three months later; the patient was contacted by phone (always by the same investigator) in order to find out whether he/she had performed the prescribed rehabilitation, establish whether the physiotherapist had complied with the prescribed rehabilitation programme and assess subjective recovery. If a patient failed to respond to three phone calls, he/she was excluded from the study. RESULTS: Of the 245 patients initially included, 111 (67 men and 44 women; 17 mild sprains, 67 moderate sprains and 27 severe sprains) answered the "phone questionnaire". In terms of treatment adherence by the patient, 92 patients (82.9%) performed their rehabilitation (beginning an average of 13.8 days after the injury). In terms of prescription compliance by the physiotherapist, 88 patients (95.6%) received massage, 71 (77.2%) underwent physiotherapy, 83 (90.2%) performed weight training and 87 (94.5%) received proprioceptive training. Eighty-two patients said that they had received manipulative therapy that was not part of the prescribed programme. Impact on recovery: 61 patients (55%) considered that their injury had healed (10 mild, 42 medium and nine severe sprains), whereas 50 had not healed (seven mild, 25 medium and 18 severe sprains). There was no statistically significant association between recovery and compliance with rehabilitation. However, the application of massage (p=0.004) and proprioceptive training (p=0.017) were significantly associated with recovery, while physiotherapy, weight training and manipulative therapy were not. CONCLUSION: In acute ankle sprain, adherence with rehabilitation is good and the treating physiotherapists comply with the prescription. However, there was no statistically significant link between rehabilitation compliance and subjective recovery at 3 months. Revaluation of these patients at one year may be necessary for estimating the impact of rehabilitation on ankle function and the rate of injury recurrence.

Ankle sprains: patient perceptions of function and performance of physical tasks. A mixed methods approach.

PURPOSE: To investigate patient's perceptions of function and performance of physical tasks after discharge from treatment for an ankle sprain. METHODS: Using a mixed methods approach, 40 participants who presented with an acute sprained ankle and their treating clinicians completed two questionnaires related to function at the start and end of a rehabilitation programme. Additionally, participants completed the questionnaires at 6 weeks following discharge at which time they also performed physical tasks that were still perceived as difficult. Ten participants also completed a semi-structured interview. RESULTS: There were no significant differences (p > 0.05) in the participant's and clinician's initial assessment of function. However, at discharge participants scored their function significantly (p < 0.05) lower than clinicians. This difference was not apparent 6 weeks later (p > 0.05). However, there was a significant difference (p  < 0.05) following actual performance of tasks with an effect size of 1.58. Participant interviews confirmed that patients had a fear of re-injury until they actually performed tasks that were perceived as difficult. CONCLUSIONS: Clinicians and participants do not have a similar perception of the recovery of an ankle sprain at discharge. Performing tasks which were perceived as difficult were valuable in assisting participants gain an improved appreciation of their function.

A test of an adherence-enhancing adjunct to physiotherapy steeped in the protection motivation theory.

The primary aim of this study was to test the effect of a Protection Motivation Theory (PMT)-based patient education intervention on physiotherapy patients' beliefs about their injury and physiotherapy, intentions to adhere, rehabilitation adherence, and ankle function. A secondary aim was to explore the relationships between the patients' injury and physiotherapy beliefs, intentions, adherence behaviours, and ankle function. A randomized controlled trial was undertaken in New Zealand; 71 people with ankle sprains were allocated to either PMT present video information or two control groups (non-PMT information about ankle sprains and no formal information) before commencing their course of physiotherapy. The two information groups watched a video about ankle sprains and physiotherapy before answering the Beliefs about Ankle Sprains and Physiotherapy Scale and behavioural intentions questionnaires that measured the PMT constructs. Adherence was assessed at each treatment and ankle function was measured before and after the physiotherapy program. After viewing the video, the PMT present information group's beliefs about severity, vulnerability, and response efficacy were significantly higher than the other two groups. The groups did not differ significantly on their self-efficacy, intentions, rehabilitation adherence, and post-physiotherapy program ankle function. Significant correlations existed between the patients' PMT-based beliefs and intentions, intentions and adherence, and adherence and post-physiotherapy ankle function. With the exception of self-efficacy, the findings indicate that persuasive information grounded in PMT does enhance physiotherapy patients' beliefs about their injury and treatment.