Belief Factors Associated With Employees' Intention to Evacuate During a Fire Alarm.

BACKGROUND: Nonresidential fires and resultant injuries and deaths have been on the rise the last decade in the United States. Although evacuation is a primary prevention method, people in the workplace still fail to evacuate when they hear a fire alarm. The current formative study applied the Reasoned Action Approach (RAA) to identify belief factors associated with university employees' intention evacuate. METHODS: Data were collected from employees at a large public university (N = 490) through an online survey. Multiple linear regression quantified the relative contribution of six RAA constructs that represent belief factors underlying employees' intention to leave the office building immediately the next time they hear a fire alarm. FINDINGS: Nearly 60% of the variation in employees' intention to leave was predicted from the belief factors, adjusted R2 = 0.598, F(17, 472) = 43.80, p < .001. Controlling for demographic characteristics, five of the six RAA global constructs showed statistically significant independent associations with intention: instrumental attitude (B = .272, SE = .026, p < .001), experiential attitude (B = -.073, SE = .026, p = .024), injunctive norm (B = .210, SE = .075, p < .001), descriptive norm (B = .347, SE = .070, p < .001), and capacity (B = .178, SE = .077, p < .001). CONCLUSIONS/APPLICATIONS TO PRACTICE: These findings show the RAA can be successfully applied to provide employees' perspective on safety decisions like evacuation. The belief factors' relative contributions can help safety professionals prioritize interventions to facilitate leaving immediately. Here the high weights for the two normative factors suggest addressing employees' descriptive beliefs that others like them leave and their injunctive beliefs that significant others, like supervisors and safety personnel, approve of their leaving.

Secondary School Socioeconomic Status and Athletic Training Practice Characteristics.

CONTEXT: Socioeconomic status (SES) is a significant predictor of morbidity and mortality across health outcomes. Limited information exists on how school SES affects athletic training practice when a certified athletic trainer (AT) is present at secondary schools. OBJECTIVE: To describe contact frequencies and service rates provided by ATs for injuries among secondary school student-athletes and how these differ by school SES. DESIGN: Cross-sectional study. SETTING: The number of athletic training facility (ATF) visit days and AT services were collected from 77 secondary schools. Schools were separated into 3 school SES groups: affluent (n = 31), average (n = 29), and disadvantaged (n = 17). PATIENTS OR OTHER PARTICIPANTS: Secondary school student-athletes who participated in ≥1 of 12 boys' or 11 girls' sports, visited the ATF during the 2014-2015 through 2018-2019 academic years, and received athletic or nonathletic injury care. MAIN OUTCOME MEASURE(S): Contact frequencies were expressed as ATF visit days per injury, AT services per injury, and AT services per ATF visit day. Rates for service type used were expressed as the total count over reported athlete-exposures. RESULTS: The ATs documented 1191 services. Affluent and average SES school communities provided more contact frequencies for injury-related care than did disadvantaged school communities, particularly in AT services per injury (7.10 ± 13.08 versus average: 9.30 ± 11.60 and affluent: 9.40 ± 12.20; P = .020). Affluent school communities supplied greater rates of services in 5 of the 11 service groups reported. No differences were observed among school SES groups in therapeutic exercise. CONCLUSIONS: Our findings reflect that AT practice characteristics may have differed by school SES, but these differences did not appear to result in less medical care. Given the complexity and widespread effects of SES, future investigators should use a complex method to determine SES and aim to identify how SES may affect secondary school student-athletes in ways other than AT practice characteristics.

Perceptions and Utilization of Strength Training and Conditioning in Collegiate Contemporary and Ballet Dancers: A Qualitative Approach.

AIMS: Research demonstrates that dancers benefit from reduced injury risk and improved health by engaging in strength training and conditioning (STC). Historic bias within the discipline of dance, however, establishes a long-standing stigma that gains in muscle mass and strength lessen a dancer's aesthetic appearance, and thus many dancers rebuff STC as a supplement to dance training. However, there is growing evidence that dancers and dance educators are beginning to under¬stand the importance of additional resistance training and cardiovascular conditioning. This study explored dancers' perceptions and utilization of STC using a general qualitative approach. METHODS: Twenty-three female collegiate dancers (13 contemporary dancers, 10 ballet dancers, mean age 19.95 ± 0.97 yrs) volunteered to participate in this study. The principal investigator conducted individual, semi-structured interviews. RESULTS: Inductive analysis revealed three major themes: 1) evolving body image, 2) motivation, and 3) education. Trustworthiness was established using member checks, peer debriefing, and journaling. This study concluded collegiate dancers utilized STC as a means to enhance the individual's body image. This was driven by a continuum of motivating factors. Although collegiate dancers are utilizing STC, education on STC techniques and practices was minimal. CONCLUSIONS: While further research is needed, results from this study suggest STC could be initiated and promoted in the discipline of dance to further enhance physical fitness and general well-being. Dancers and dance instructors should receive education about the importance of STC within dance training as well as how to safely implement STC exercise into training regimens.

Validity and reliability of the Arabic version of the Identification of Functional Ankle Instability questionnaire (IdFAI-Ar) in college-aged population.

OBJECTIVES: The aims of this work are to culturally adapt the Identification of Functional Ankle Instability questionnaire (IdFAI) into Arabic language and to examine its psychometrics. DESIGN: Cross-sectional study. SETTING: This research took place at Cairo University in Egypt. PARTICIPANTS: Twenty eight college-aged students participated in the translation and cultural adaptation, while another 86 college-aged students participated in the measurements (validity and reliability). MAIN OUTCOME MEASURES: The original IdFAI was translated into Arabic language using standard guidelines. The Arabic version of the IdFAI (IdFAI-Ar) and the Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) were applied to 86 college-aged students with and without functional ankle instability. The IdFAI-Ar was tested on two occasions with an interval of one week to investigate its psychometrics. RESULTS: The IdFAI-Ar had a moderate correlation with LEFS-Ar and a strong correlation with ankle status classification. The reliability and internal consistency were excellent. The accuracy, sensitivity, and specificity were 0.91, 0.80, and 0.99 respectively. CONCLUSION: The IdFAI-Ar has high validity and reliability. It can be used in clinical and research practices as a region-specific tool to discriminate between participants with and without functional ankle instability in the Arabic-speaking countries.

Identifying Range-of-Motion Deficits and Talocrural Joint Laxity After an Acute Lateral Ankle Sprain.

CONTEXT: Approximately 72% of patients with an ankle sprain report residual symptoms 6 to 18 months later. Although 44% of patients return to activity in less than 24 hours after experiencing a sprain, residual symptoms should be evaluated in the long term to determine if deficits exist. These residual symptoms may be due to the quality of ligament tissue and motion after injury. OBJECTIVE: To compare mechanical laxity of the talocrural joint and dorsiflexion range of motion (DFROM) over time (24 to 72 hours, 2 to 4 weeks, and 6 months) after an acute lateral ankle sprain (LAS). DESIGN: Cross-sectional study. SETTING: Athletic training research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 108 volunteers were recruited. Fifty-five participants had an acute LAS and 53 participants were control individuals without a history of LAS. MAIN OUTCOME MEASURE(S): Mechanical laxity (talofibular interval and anterior talofibular ligament length) was measured in inversion (INV) and via the anterior drawer test. The weight-bearing lunge test was conducted and DFROM was measured. The data were analyzed using repeated-measures analysis of variance, independent-samples t tests, and 1-way analysis of variance. RESULTS: Of the 55 LASs, 21 (38%) were grade I, 27 (49%) were grade II, and 7 (13%) were grade III. Increases were noted in DFROM over time, between 24 and 72 hours, at 2 to 4 weeks, and at 6 months (P < .05). The DFROM was less in participants with grade III than grade I LASs (P = .004) at 24 to 72 hours; INV length was greater at 24 to 72 hours than at 2 to 4 weeks (P = .023) and at 6 months (P = .035) than at 24 to 72 hours. The anterior drawer length (P = .001) and INV talofibular interval (P = .004) were greater in the LAS group than in the control group at 6 months. CONCLUSIONS: Differences in range of motion and laxity were evident among grades at various time points and may indicate different clinical responses after an LAS.

Health-Related Quality of Life in Former National Collegiate Athletic Association Division I Collegiate Athletes Compared With Noncollegiate Athletes: A 5-Year Follow-Up.

CONTEXT: The effect of athletic participation on lifelong health among elite athletes has received increasing attention, as sport-related injuries can have a substantial influence on long-term health. OBJECTIVE: To determine the current health-related quality of life (HRQoL) of former National Collegiate Athletic Association Division I athletes compared with noncollegiate athletes 5 years after an initial assessment. DESIGN: Cohort study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: From the former Division I athletes, 193 responses were received (response rate = 83.2%; 128 men, 65 women; age = 58.47 ± 6.17 years), and from the noncollegiate athletes, 169 surveys were returned (response rate = 75.1%; 80 men, 89 women; age = 58.44 ± 7.28 years). MAIN OUTCOME MEASURE(S): The independent variables were time (baseline, 5 years later) and group (former Division I athlete, noncollegiate athlete). Participants completed 7 Patient-Reported Outcomes Measurement Information System scales: sleep disturbance, anxiety, depression, fatigue, pain interference, physical function, and satisfaction with participation in social roles. RESULTS: Sleep disturbance, depression, fatigue, pain, and physical function were significant for a time × group interaction (P < .05), with the largest differences seen in pain and physical function between groups at time point 2 (22.19 and 13.99 points, respectively). Former Division I athletes had worse scores for depression, fatigue, pain, and physical function at follow-up (P < .05), with the largest differences seen on the depression, fatigue, and physical function scales (8.33, 6.23, and 6.61 points, respectively). CONCLUSIONS: Because of the competitive nature of sport, the long-term risks of diminished HRQoL need to become a priority for health care providers and athletes during their athletic careers. Additionally, physical activity transition programs need to be explored to help senior student-athletes transition from highly structured and competitive collegiate athletics to lifestyle physical activity, as it appears that individuals in the noncollegiate athlete cohort engaged in more physical activity, weighed less, and had increased HRQoL.

Health-Related Quality of Life in Former National Collegiate Athletic Association Division I Collegiate Athletes Compared With Noncollegiate Athletes: A 5-Year Follow-Up.

CONTEXT: The effect of athletic participation on lifelong health among elite athletes has received increasing attention, as sport-related injuries can have a substantial influence on long-term health. OBJECTIVE: To determine the current health-related quality of life (HRQoL) of former National Collegiate Athletic Association Division I athletes compared with noncollegiate athletes 5 years after an initial assessment. DESIGN: Cohort study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: From the former Division I athletes, 193 responses were received (response rate = 83.2%; 128 men, 65 women; age = 58.47 ± 6.17 years), and from the noncollegiate athletes, 169 surveys were returned (response rate = 75.1%; 80 men, 89 women; age = 58.44 ± 7.28 years). MAIN OUTCOME MEASURE(S): The independent variables were time (baseline, 5 years later) and group (former Division I athlete, noncollegiate athlete). Participants completed 7 Patient-Reported Outcomes Measurement Information System scales: sleep disturbance, anxiety, depression, fatigue, pain interference, physical function, and satisfaction with participation in social roles. RESULTS: Sleep disturbance, depression, fatigue, pain, and physical function were significant for time × group interactions (P values < .05), with the largest differences seen in pain and physical function between groups at time point 2 (22.19 and 13.99 points, respectively). Former Division I athletes had worse scores for depression, fatigue, pain, and physical function at follow-up (P values < .05), with the largest differences seen on the depression, fatigue, and physical function scales (8.33, 6.23, and 6.61 points, respectively). CONCLUSIONS: Because of the competitive nature of sport, the long-term risks of diminished HRQoL need to become a priority for health care providers and athletes during their athletic careers. Additionally, physical activity transition programs need to be explored to help senior student-athletes transition from highly structured and competitive collegiate athletics to lifestyle physical activity, as it appears that individuals in the noncollegiate athlete cohort engaged in more physical activity, weighed less, and had increased HRQoL.

Modulation of cutaneous reflexes during sidestepping in adult humans.

A common neural control mechanism coordinates various types of rhythmic locomotion performed in the sagittal plane, but it is unclear whether frontal plane movements show similar neural patterning in adult humans. The purpose of this study was to compare cutaneous reflex modulation patterns evoked during sagittal and frontal plane rhythmic movements. Eight healthy, neurologically intact adults (three males, five females) walked and sidestepped on a treadmill at approximately 1 Hz. The sural nerve of the dominant (and lead) limb was stimulated randomly every 3-7 steps at eight phases of each gait cycle. Ipsilateral electromyographic recordings from four lower leg muscles and kinematic data from the ankle were collected continuously throughout both tasks. Data from unstimulated gait cycles were used as control trials to calculate middle-latency reflex responses (80-120 ms) and kinematic changes (140-220 ms) following electrical stimulation. Results show that the cutaneous reflex modulation patterns were similar across both tasks despite significant differences in background EMG activity. However, increased reflex amplitudes were observed during the late swing and early stance phases of sidestepping, which directly altered ankle kinematics. These results suggest that the neural control mechanisms responsible for coordinating sagittal locomotion are flexibly modified to coordinate frontal plane activities even with very different foot landing mechanics.

Using Normative Data and Unilateral Hopping Tests to Reduce Ambiguity in Return-to-Play Decisions.

CONTEXT: After a lower extremity injury, patients often return to sport (RTS) when the injured limb's performance on unilateral hopping tests is similar to that of the uninjured limb. However, the exact target symmetry value patients must reach before the RTS is unclear. OBJECTIVE: To identify variables that predict limb symmetry index (LSI) values on 6 unilateral hopping tests in healthy, physically active adults. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: In total, 275 healthy, physically active adults, consisting of recreational athletes (n = 198), National Collegiate Athletic Association Division I student-athletes (n = 56), and Army Reserve Officer Training Corps cadets (n = 21), volunteered to participate (143 men, 132 women, age = 20.16 ± 2.19 years, height = 172.66 ± 10.22 cm, weight = 72.64 ± 14.29 kg). INTERVENTION(S): Each participant completed 3 speed (6-m crossover-hop, side-hop, figure-8 hop) and 3 distance (triple-crossover-hop, lateral-hop, medial-hop) functional performance tests on both limbs. MAIN OUTCOME MEASURE(S): Mean performance of the dominant and nondominant limbs and LSI values. Two multiple regression models were used to find variables that might help to predict a participant's LSI for each functional performance test. RESULTS: The models helped to predict limb symmetry for 10 of the 12 multiple regressions. Unilateral limb performance was the best predictor of LSI values, as it was statistically significant in 11 of the 12 regression models. Sex and body mass index were significant predictor variables for the side hop and figure-8 hop, respectively. CONCLUSIONS: We found significant predictor variables that clinicians can use in the absence of baseline testing to determine patient-specific LSI values. Individualizing RTS decisions in this way may help to minimize subjectivity in the decision-making process and ensure a safe and timely return to competition.

Effects of chronic ankle instability on cutaneous reflex modulation during walking.

Chronic ankle instability (CAI) is characterized by persistent giving way at the ankle following an acute lateral ankle sprain and is associated with an early onset of osteoarthritis. Researchers have reported that the cutaneous afferent pathway from certain leg muscles is modified in people with CAI while in a seated position. However, we do not know if these reflex modulations persist during functional activities. The purpose of this study was to further explore sensorimotor function in patients with CAI by analyzing cutaneous reflex modulation during gait. CAI (n = 11) and uninjured control (n = 11) subjects walked on a treadmill at 4 km/h and received non-noxious sural nerve stimulations at eight different time points during the gait cycle. Net electromyographic responses from four lower leg muscles were quantified 80-120 ms after stimulation for each phase of the gait cycle and compared between groups. We found that cutaneous reflex responses between groups were largely similar from the late stance to late swing phases, but uninjured control subjects, and not CAI subjects, experienced significant suppression in the medial gastrocnemius and lateral gastrocnemius muscles during the early stance phase of the gait cycle. Our results indicate that people with CAI lack a protective unloading response in the triceps surae following high-intensity sural nerve stimulation during the early stance phase of the gait cycle. Evaluating cutaneous reflex modulations may help to identify neural alterations in the reflex pathways that contribute to functional deficits in those with CAI.

Ground Reaction Forces in Ballet Differences Resulting from Footwear and Jump Conditions.

In the research devoted to ballet, ground reaction force (GRF) and shoe condition have been identified as possible risk factors for injury. Shoe conditions vary immensely between dancers and could indeed have significant impact on biomechanics and injury rates. Therefore, the objectives of this study were: 1. to investigate the maximal ground reaction force (GRFmax) when ballet dancers land from two jump conditions in pointe shoes, in flat technique shoes, and barefoot; and 2. to explore the effects that specific pointe shoe characteristics (shoe age, shank style) have on GRFmax. Twenty-one healthy female ballet majors in an elite college program volunteered for the study. All participants had similar years of classical ballet training (12.85 ± 2.37). For the study, they performed two ballet jumps, assemblé and grand jeté. Each jump was performed in the three shoe conditions mentioned previously. A total of 18 trials per subject were completed, with the order of jump type and shoe condition randomized. Each jump was landed on a force plate, and maximal GRFs were recorded. A repeated measures analysis of variance was calculated with two within subject factors, shoe type at three levels and jump type at two levels. Tukey's post hoc test was applied to significant findings. Alpha level was set a priori at p = 0.05. Results demonstrated no significant differences in GRFmax between the three shoe conditions; however, significant differences in GRFmax between the jump types were identified. Post-hoc testing revealed that when dancers performed the grand jeté jump, higher GRFmax was obtained compared to the assemblé jump. In conclusion, results of this study indicate that GRFmax varies between ballet jumps; however, it does not appear that shoe condition significantly affects GRFmax.

The Long-Term Impact of Osteoarthritis Following Knee Surgery in Former College Athletes.

CONTEXT: Individuals who sustain a knee surgery have been shown to have an increased likelihood to develop osteoarthritis (OA). OBJECTIVE: Identify the consequences of knee surgery in a cohort of former college athletes. DESIGN: Cross-sectional. SETTING: Research laboratory. PARTICIPANTS: A group of 100 former Division I college athletes aged 40-65 years (60 males and 40 females) participated in the study. INTERVENTIONS: All individuals self-reported whether they sustained a knee injury during college requiring surgery and if they have been diagnosed with knee OA by a medical physician post knee injury. Individuals were categorized into 3 groups: no history of knee injury requiring surgery (33 males and 24 females; 54.53 [5.95] y), history of knee surgery in college with no diagnosis of OA later in life (4 males and 6 females; 51.26 [7.29] y), and history of knee surgery in college with physician diagnosed OA later in life (23 males and 10 females; 54.21 [7.64] y). All individuals completed the knee injury and osteoarthritis outcome score (KOOS) and short form-36 version 2. MAIN OUTCOME MEASURES: Scores on the KOOS and short form-36 version 2. RESULTS: A majority (76.7%) of individuals who had a knee surgery in college did develop OA. The largest mean differences were between the healthy knee and surgical knee/OA groups on the KOOS-quality of life scale (mean difference: 49.76; χ2(3) = 44.65; P < .001) and KOOS-sports scale (mean difference: 43.69; χ2(3) = 28.69; P < .001), with the surgical knee/OA group scoring worse. CONCLUSIONS: Later in life functional limitations were observed in individuals who sustained a knee injury requiring surgery and developed OA. These findings support increased efforts toward prevention of knee injuries and consideration of the long-term implication when making treatment and return to activity decisions.

Athletic Training Service Characteristics for Patients With Ankle Sprains Sustained During High School Athletics.

CONTEXT: Limited information exists on the amount and type of care provided by athletic trainers (ATs) treating athletes who sustained ankle sprains in the high school setting. OBJECTIVE: To describe AT services provided for patients with ankle sprains injured in high school athletics. DESIGN: Descriptive epidemiology study. SETTING: Athletic training facility (ATF) visits and AT services collected from 147 high schools in 26 states. PATIENTS OR OTHER PARTICIPANTS: High school student-athletes participating in 13 boys' and 14 girls' sports who sustained a diagnosed ankle sprain during the 2011-2012 through 2013-2014 academic years. The ATs documented 3213 ankle sprains. MAIN OUTCOME MEASURE(S): Number of ATF visits and individual AT services and mean ATF visits (per injury) and AT services (per injury) were calculated by sport and for time-loss injuries (participation-restriction time of at least 24 hours) and non-time-loss injuries (participation-restriction time <24 hours). RESULTS: During the 3-year period, 19 925 ATF visits were reported, with an average of 6 (interquartile range = 1-7) ATF visits per ankle sprain. Most ATF visits were for non-time-loss injuries (65.1%). Football accounted for the largest proportions of ankle sprains (27.3%) and ATF visits (35.0%). In total, 71 404 AT services were provided for ankle sprains. Therapeutic activities or exercise were the most common AT services (47.4%), followed by neuromuscular reeducation (16.6%), strapping (14.2%), and modalities (11.5%). An average of 22 (interquartile range = 4-28) AT services were reported per ankle sprain. The average number of AT services per injury was higher among patients with time-loss than non-time-loss injuries (35 versus 19; P < .001). CONCLUSIONS: The ATs provided a variety of services to treat high school athletes who had sustained ankle sprains, including therapeutic exercises and neuromuscular reeducation, which were supported by research. However, ATs should consider using manual therapy (use supported by grade B evidence) and therapeutic exercise more (use supported by grade A evidence).

The Influence of Ankle Braces on Functional Performance Tests and Ankle Joint Range of Motion.

CONTEXT: The lateral ankle sprain is one of the most common lower-extremity injuries in sports. Previous research has found that some prophylactic ankle supports reduce the risk of recurrent ankle sprains and provide extra support to the joint. However, there is a continued concern that these supports may negatively influence performance. OBJECTIVE: To determine if wearing an ankle brace influences athlete performance and ankle kinematics during functional performance tests. DESIGN: Repeated measures. SETTING: University gymnasium. OTHER PARTICIPANTS: Male and female recreational or competitive athletes (n = 20). INTERVENTION: Participants performed 3 trials of a standing long jump, vertical jump, 40-yard sprint, and T-drill under each of the following 3 conditions: wearing traditional lace-up brace (brace 1), modified lace-up brace (brace 2), and no-brace. MAIN OUTCOME MEASURES: A 2-dimensional motion capture camera was used to measure ankle range of motion (ROM) in the sagittal plane during the vertical and standing long jumps and in the frontal plane during the cutting phase of the T-drill. Performance of each test and ankle ROM were compared between each of the braced conditions. RESULTS: Ankle braces did not influence performance in speed or agility functional performance tests (P > .05). Ankle braces negatively affected performance of the standing long jump (P = .01) and vertical jump (P = .01). There was no significant difference between brace or no-brace conditions in ankle inversion ROM during the T-drill (P > .05). Both brace conditions restricted ROM in the sagittal plane during the vertical and standing long jumps (P < .05). CONCLUSIONS: Braced conditions restricted sagittal plane ROM during the vertical jump and long jump. This decrease in ROM explains the decline in functional performance also seen during these tests.

Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part II: Assessing Patient-Reported Outcome Measures.

CONTEXT: Assessing global, regional, and fear-of-reinjury outcomes in individuals with chronic ankle instability (CAI) is critical to understanding the effectiveness of clinical interventions. OBJECTIVE: To determine the improvement of patient-reported outcomes after balance- and strength-training and control protocols among participants with CAI. DESIGN: Randomized controlled clinical trial. SETTING: Athletic training research laboratory. PATIENTS OR OTHER PARTICIPANTS: Thirty-nine volunteers with CAI who scored 11 or greater on the Identification of Functional Ankle Instability questionnaire were randomly assigned to 1 of 3 groups: balance-training protocol (7 males, 6 females; age = 23.5 ± 6.5 years, height = 175.0 ± 8.5 cm, mass = 72.8 ± 10.9 kg), strength-training protocol (8 males, 5 females; age = 24.6 ± 7.7 years, height = 173.2 ± 9.0 cm, mass = 76.0 ± 16.2 kg), or control (6 males, 7 females; age = 24.8 ± 9.0 years, height = 175.5 ± 8.4 cm, mass = 79.1 ± 16.8 kg). INTERVENTION(S): Each group met for 20 minutes, 3 times each week, for 6 weeks. The control group completed a mild to moderately strenuous bicycle workout. MAIN OUTCOME MEASURE(S): Global patient-reported outcomes, regional ankle function, and perceived instability were measured using the Disablement in the Physically Active Scale, the Fear-Avoidance Beliefs Questionnaire, the Foot and Ankle Ability Measure, and a visual analog scale for perceived instability. Participants completed the questionnaires at pretest and 6 weeks posttest. A multivariate repeated-measures analysis of variance with follow-up univariate analysis was conducted. The α level was set a priori at .05. RESULTS: No time-by-group interaction was found ( P = .78, η2 = 0.09). However, we observed a main effect for time ( P = .001, η2 = 0.49). Follow-up univariate analyses revealed differences between the pretest and posttest for the Disablement in the Physically Active Scale ( P = .02, η2 = 0.15), Fear-Avoidance Beliefs Questionnaire ( P = .001, η2 = 0.27), Foot and Ankle Ability Measure-Activities of Daily Living subscale ( P = .003, η2 = 0.22), Foot and Ankle Ability Measure-Sport subscale ( P = .001, η2 = 0.36), and visual analog scale ( P = .008, η2 = 0.18). CONCLUSIONS: Statistically, after the 6-week intervention, all groups improved in global and regional health-related quality of life. Clinicians should compare patient-reported outcomes with clinical measures to have a better understanding of progression during rehabilitation.

Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part I: Assessing Clinical Outcome Measures.

CONTEXT: Functional rehabilitation may improve the deficits associated with chronic ankle instability (CAI). OBJECTIVE: To determine if balance- and strength-training protocols improve the balance, strength, and functional performance deficits associated with CAI. DESIGN: Randomized controlled clinical trial. SETTING: Athletic training research laboratory. PATIENTS OR OTHER PARTICIPANTS: Participants were 39 volunteers with CAI, which was determined using the Identification of Functional Ankle Instability Questionnaire. They were randomly assigned to 1 of 3 groups: balance-training protocol (7 males, 6 females; age = 23.5 ± 6.5 years, height = 175.0 ± 8.5 cm, mass = 72.8 ± 10.9 kg), strength-training protocol (8 males, 5 females; age = 24.6 ± 7.7 years, height = 173.2 ± 9.0 cm, mass = 76.0 ± 16.2 kg), or control (6 males, 7 females; age = 24.8 ± 9.0 years, height = 175.5 ± 8.4 cm, mass = 79.1 ± 16.8 kg). INTERVENTION(S): Each group participated in a 20-minute session, 3 times per week, for 6 weeks. The control group completed a mild to moderately strenuous bicycle workout. MAIN OUTCOME MEASURE(S): Participants completed baseline testing of eccentric and concentric isokinetic strength in each ankle direction (inversion, eversion, plantar flexion, and dorsiflexion) and the Balance Error Scoring System (BESS), Star Excursion Balance Test (SEBT), and side-hop functional performance test. The same variables were tested again at 6 weeks after the intervention. Two multivariate repeated-measures analyses of variance with follow-up univariate analyses were conducted. The α level was set a priori at .05. RESULTS: We observed time-by-group interactions in concentric ( P = .02) and eccentric ( P = .01) inversion, eccentric eversion ( P = .01), concentric ( P = .001) and eccentric ( P = .03) plantar flexion, BESS ( P = .01), SEBT ( P = .02), and side hop ( P = .004). With pairwise comparisons, we found improvements in the balance- and strength-training protocol groups in concentric and eccentric inversion and concentric and eccentric plantar flexion and the BESS, SEBT, and side hop (all P values = .001). Only the strength-training protocol group improved in eccentric eversion. The control group did not improve in any dependent variable. CONCLUSIONS: Both training protocols improved strength, balance, and functional performance. More clinicians should incorporate hop-to-stabilization exercises into their rehabilitation protocols to improve the deficits associated with CAI.

Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium.

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries.

Health-related quality of life is decreased in middle-aged adults with chronic ankle instability.

OBJECTIVES: The purpose of this study was to determine whether health-related quality of life and region-specific outcomes differ between middle-aged adults with and without chronic ankle instability. DESIGN: Cross-sectional. METHODS: Two hundred middle-aged individuals (40 years or older) volunteered to participate in the study. There were 75 individuals classified as having chronic ankle instability (51.5±7.3years, 175.8±3.7cm, 86.5±18.9kg) and 125 classified as not having chronic ankle instability (53.2±7.3years, 176.2±5.4cm, 81.3±17.6kg). Participants completed the Identification of Functional Ankle Instability as the inclusionary survey and the Internal Ankle Consortium guidelines were followed to classify individuals. Following the inclusionary survey participants completed the American Academy of Orthopaedic Surgeons Lower Limb Questionnaire and the Short Form-36 v2. RESULTS: The Academy of Orthopaedic Surgeons Lower Limb Questionnaire, and the Physical Component Summary score of the Short Form-36 v2 were statistically different between groups (p<0.05). Specifically, the mean difference was 16.7 points and 12.3 points for the Academy of Orthopaedic Surgeons Lower Limb Questionnaire and the Physical Component Summary score, respectively, with the CAI participants scoring worse. CONCLUSIONS: Individuals with CAI displayed decreased generic health-related quality of life and reduced region-specific ankle function.

Assessing Outcomes in People With Chronic Ankle Instability: The Ability of Functional Performance Tests to Measure Deficits in Physical Function and Perceived Instability.

Study Design Laboratory-based, cross-sectional study. Background Functional performance tests (FPTs) assess short bouts of unilateral hops for either distance or speed. More research is needed to identify specific FPTs that may be useful for measuring asymmetry outcomes related to functional performance and perceived instability deficits in individuals with chronic ankle instability (CAI). Objectives To identify FPTs that are sensitive to subjective and objective deficits associated with CAI. Methods Twenty-four subjects with unilateral CAI (10 male, 14 female; mean ± SD age, 20.7 ± 3.0 years) and 24 healthy, matched controls (10 male, 14 female; age, 20.1 ± 2.6 years) completed 5 unilateral FPTs in random order. Mean FPT scores and functional symmetry percentages were calculated and compared between groups using 2 separate 1-way multivariate analyses of variance (MANOVAs). Perceived instability symmetry percentages were compared between groups using a Mann-Whitney U analysis. Results There were no differences in the mean FPT scores (P>.05) or functional symmetry percentages (P>.05) between groups for any of the 5 FPTs. However, participants with CAI perceived greater instability when using their involved limb during the side hop (P = .02), 6-meter crossover hop (P = .003), lateral hop (P = .007), and figure-of-eight hop (P = .008). Conclusion There were no differences in mean functional scores between groups for all 5 FPTs, and each group performed symmetrically. Regardless, administering a visual analog scale following the completion of the side hop, 6-meter crossover hop, lateral hop, and figure-of-eight hop tests captures subjective reports of perceived instability in the involved limb that can be compared bilaterally throughout treatment. J Orthop Sports Phys Ther 2018;48(5):372-380. Epub 30 Mar 2018. doi:10.2519/jospt.2018.7514.