Impairments in peroneal muscle size and activation in individuals with patellofemoral pain in weight-bearing position.

BACKGROUND: Patellofemoral pain (PFP) is characterized by chronic pain in the anterior aspect of the knee during loading activities. Many studies investigating muscle morphology changes for individuals with PFP focus on the proximal joints, however, few studies have investigated muscles of the foot and ankle complex. This study aimed to explore the differences in peroneal muscle size and activation between individuals with PFP and healthy controls using ultrasound imaging in weight-bearing. METHODS: A case-control study in a university lab setting was conducted. Thirty individuals with PFP (age: 20.23 ± 3.30 years, mass: 74.70 ± 27.63 kgs, height: 161.32 ± 11.72 cm) and 30 healthy individuals (age: 20.33 ± 3.37 years, mass: 64.02 ± 11.00 kgs, height: 169.31 ± 9.30 cm) participated. Cross-sectional area (CSA) images of the peroneal muscles were taken in non-weight bearing and weight-bearing positions. The functional activation ratio from lying to single-leg standing (SLS) was calculated. RESULTS: There was a statistically significant (p = 0.041) group (PFP, healthy) by position (non-weight-bearing, weight-bearing) interaction for the peroneal muscle CSA with a Cohen's d effect size of 0.2 in non-weight-bearing position and 0.7 in weight-bearing position. The functional activation ratio for the healthy group was significantly more (p = 0.01) than the PFP group. CONCLUSION: Peroneal muscles were found to be smaller in size in those with PFP compared to the healthy subjects in the weight-bearing SLS position. This study found that those with PFP have lower activation of peroneal muscles in functional position.

Poor Mental Health Indicators in Individuals With Patellofemoral Pain.

CONTEXT: Patellofemoral pain (PFP) is a common source of knee pain in active individuals, accounting for a large number of knee injuries examined in sports medicine clinics. As a chronic condition, PFP can affect mental health. However, this effect has not yet been studied in individuals with PFP. OBJECTIVE: To determine how subjective physical and mental health measures in individuals with PFP differed from those measures in pain-free individuals. DESIGN: Case-control study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Volunteers for the study were 30 people with PFP (19 women, 11 men; age = 20.23 ± 3.32 years, height = 166.69 ± 6.41 cm, mass = 69.55 ± 13.15 kg) and 30 matched pain-free individuals (19 women, 11 men; age = 20.33 ± 3.37 years, height = 169.31 ± 9.30 cm, mass = 64.02 ± 11.00 kg). MAIN OUTCOME MEASURE(S): Current and worst pain levels in the past 24 hours were determined using a visual analog scale (VAS). The Anterior Knee Pain Scale, Fear Avoidance Belief Questionnaire, and Lower Extremity Functional Scale were administered. Physical and mental health measures were obtained using a modified 12-item Short Form Health Survey. Scores for 2 subscales on the modified Short Form-12 were weighted and calculated: physical component and mental component.Independent t tests were calculated to compare variables between groups. Coefficient correlations were used to measure the associations between the variables. RESULTS: Individuals with PFP reported lower levels of physical (pain free: 56.13 ± 1.63, PFP: 50.54 ± 7.10, P < .001) and mental (pain-free: 53.32 ± 4.71, PFP: 48.64 ± 10.53, P = .03) health. In the PFP group, we found moderate negative correlations between the VAS score for current pain and mental health (r = -0.52, P < .01) and between the VAS score for worst pain in the past 24 hours and mental health (r = -0.46, P = .01) and between activity limitations in individuals with PFP and fear avoidance beliefs (r = -0.61, P < .01). CONCLUSIONS: Our results should encourage clinicians, especially musculoskeletal rehabilitation professionals, to acknowledge the importance of a whole-person approach when treating or planning rehabilitation programs for individuals with PFP.

Local microvascular tissue oxygenation of the intrinsic foot muscles in patients with diabetes: A cross-sectional case-comparison study.

BACKGROUND: Foot-related complications including impaired peripheral circulation and lower limb ulceration are severe consequences for those with diabetes mellitus. This study aimed to assess differences in tissue oxygenation and oxygen utilization of the plantar surface intrinsic foot muscles between diabetic participants and healthy comparisons following short foot exercise and a standard walking protocol. METHODS: Eighteen participants, 9 with diabetes and 9 healthy age- and sex-matched comparisons, completed two interventions in a randomized order. For the short foot exercise intervention, participants completed 5 sets of 15 intrinsic foot muscle contractions. For the walking intervention, participants completed a modified six-minute walk test. Tissue oxygenation variables including oxygenated hemoglobin, deoxygenated hemoglobin, and tissue saturation index were measured using near-infrared spectroscopy in quiet stance and during intrinsic foot muscle contraction cycles following each intervention. Means, standard deviations, 95 % confidence intervals, mean differences, and Cohen's d effect sizes were calculated for each tissue oxygenation variable. RESULTS: The results of this study indicated no significant group differences in quiet standing tissue oxygenation measures at baseline and following each intervention. Participants in the diabetic group had significantly less change in tissue saturation index during intrinsic foot muscle contractions compared to healthy participants after the short foot exercise intervention (ES= 4.00, P = .0002) and walking intervention (ES= 1.33, P = .015). CONCLUSIONS: By utilizing wireless NIRS and novel research methodology, this study was able to explore changes in plantar surface tissue oxygenation of the intrinsic foot muscles following a targeted short foot exercise intervention as well as a standard walking protocol in patients diagnosed with diabetes compared to age- and sex- matched individuals without diabetes. We identified that diabetic participants presented with less oxygen utilization during intrinsic foot muscle contractions performed following both exercise interventions compared to their healthy age- and sex- matched comparisons.

Association of Non-traditional Indicators of Readers' Engagement With Traditional Dissemination Metrics of COVID-19-Related Research.

INTRODUCTION:  Researchers are increasingly interested in appraising the impact of their research work, which eventually drives public perception. The overall impact of a study can only be gauged if we consider both traditional and non-traditional dissemination patterns. Hence, we preferred to study the association between the non-traditional reader engagement metrics and traditional dissemination metrics in relation to coronavirus disease 2019 (COVID-19)-related research published in five high-impact peer-reviewed medical journals. METHOD:  This observational study was conducted using data sourced from Altmetric, including the Altmetric attention score (AAS), an aggregate score of an article's dissemination. New England Journal of Medicine (NEJM), Lancet Infectious Diseases, Clinical Infectious Diseases (CID), Chest Journal (CHEST), and Journal of the American Medical Association (JAMA) were included in the study based on the prevalence of COVID-19-related original research published in each of them. The number of citations was framed as the reference for traditional metrics. To avoid artificial variance, data were collected on the same day, November 13, 2022. Correlational analyses were performed using the Pearson correlation coefficient using Minitab 17 (Minitab Inc., State College, PA). The relationship between the variables was considered very weak if r<0.3, weak if r: 0.3 to 0.5, moderate if r: 0.5 to 0.7, and strong for r>0.7. RESULTS:  We found a very weak correlation between citations and AAS for Clinical Infectious Diseases, Lancet Infectious Diseases, and CHEST, whereas the correlation was moderate for NEJM and JAMA. The correlation between citations and Twitter mentions was very weak for Clinical Infectious Disease, Lancet Infectious Disease, and CHEST, but it improved for NEJM and JAMA. There was a very weak correlation between citations and news mentions for Clinical Infectious Diseases, Lancet Infectious Diseases, and CHEST. CONCLUSION:  Our study highlights that the traditional indicator, i.e., citation has a very weak to moderate correlation with the AAS and it doesn't capture the entire influence of a research publication. Also, the current method of determining a journal's impact factor doesn't take this disparity into consideration. Hence, there needs to have a more inclusive strategy to define the impact of scientific research on the general population in real-time.

Participant-Level Analysis of the Effects of Interventions on Patient-Reported Outcomes in Patients With Chronic Ankle Instability.

CONTEXT: Intervention studies for chronic ankle instability (CAI) often focus on improving physical impairments of the ankle complex. However, using an impairments-focused approach may miss psychological factors that may mediate function and recovery. Patient-reported outcome (PRO) measures can be used to assess several dimensions of the health-related quality of life (HRQoL) and deliver enhanced patient-centered care. Therefore, the purpose of this investigation was to evaluate group-level improvements in HRQoL and treatment response rates following various interventions in patients with CAI. DESIGN: Cross-sectional. METHODS: Data from 7 previous studies were pooled by the chronic ankle instability outcomes network for participant-level analysis, resulting in 136 patients with CAI. Several interventions were assessed including balance training, gait biofeedback, joint mobilizations, stretching, and strengthening, with treatment volume ranging from 1 to 4 weeks. Outcome measures were PROs that assessed ankle-specific function (Foot and Ankle Ability Measure), injury-related fear (Tampa Scale of Kinesiophobia and Fear Avoidance Belief Questionnaire), and global well-being (Disablement in the Physically Active); the PROs assessed varied between studies. Preintervention to postintervention changes were evaluated using separate Wilcoxon signed-rank tests and effect sizes, and a responder analysis was conducted for each PRO. RESULTS: Significant, moderate to large improvements were observed in PROs that assessed ankle-specific function, injury-related fear, and global well-being following intervention (P < .001). Responder rates ranged from 39.0% to 53.3%, 12.8% to 51.4%, and 37.8% for ankle specific function, injury-related fear, and global well-being, respectively. CONCLUSIONS: Various interventions can lead to positive improvements in HRQoL in patients with CAI. Treatment response rates at improving HRQoL are similar to response rates at improving impairments such as balance, further reinforcing the need for individualized treatment approaches when treating a patient with CAI.

The Effects of Minimalist Shoes on Plantar Intrinsic Foot Muscle Size and Strength: A Systematic Review.

Minimalist shoes are proposed to prevent injury and enhance performance by strengthening intrinsic foot muscles, yet there is little consensus on the effectiveness of minimalist shoes in increasing muscle strength or size. This systematic review assesses using minimalist shoes as an intervention on changes in plantar intrinsic foot muscle size and strength. PubMed, CINHAL, Scopus, and SPORT Discus were systematically searched for articles from January 2000 to March 2022. Studies were included if they had an intervention of at least 2 weeks with a control group and examined the effect of minimalist shoes on plantar intrinsic foot strength or size (either volume, cross-sectional area, or thickness). Nine studies were included. There were significant increases and percent changes in foot muscle strength, volume, cross-sectional area, and thickness. Strength increased between 9-57%, and size increased between 7.05-10.6%. Minimalist shoes may effectively increase intrinsic foot muscle size and strength in healthy individuals, and they may also be more convenient than implementing time-intensive physical therapy programs. Future research is needed to explore using minimalist shoes as an intervention in clinical populations who would benefit from increased IFM strength and function. It will also be vital to improve upon IFM assessment methods.

A new dawn in internal medicine education curriculum-a project by the residents, with the residents, for the residents.

The academic half-day (AHD) curriculum is an alternative to the noon conference (NC) approach. To date, there is little literature evaluating the transition from NC to AHD in internal medicine residency programs. We investigated the effectiveness of AHD by comparing in-training exam (ITE) and American Board of Internal Medicine (ABIM) certifying exam scores of residents before and after implementation of AHD. In 2019, we transitioned to the AHD curriculum. Averages of three consecutive years of NC (2016-2018) and AHD (2019-2021) were used for statistical testing to determine ITE and ABIM score changes. The class of 2018 experienced both approaches. Cohen's d effect sizes were calculated to assess the magnitude of change in ITE and ABIM scores between NC (2016-2018) and AHD (2019-2021) cohorts. Residents' performance significantly improved (P < 0.05) on ABIM scores (513.80 ± 48.34) on average from 2019 to 2021 compared to ABIM scores (452.42 ± 49.72) on average from 2016 to 2018 with a large effect size of 1.27. Similarly, a significant (P = 0.005) improvement in ITE scores was observed from 2019 to 2021 with implementation of AHD compared to preceding NC scores (2016-2018) with a moderate effect size of 0.52. Participating residents in AHD sessions had higher ITE and ABIM scores compared to those in hourly NC didactic sessions with significantly improved resident attendance and overall satisfaction.

Effects of Midfoot Joint Mobilization on Perceived Ankle-Foot Function in Chronic Ankle Instability: A Crossover Clinical Trial.

CONTEXT: To investigate the effects of midfoot joint mobilization and a 1-week home exercise program, compared with a sham intervention, and home exercise program on pain, patient-reported outcomes, ankle-foot joint mobility, and neuromotor function in young adults with chronic ankle instability. DESIGN: Crossover clinical trial. METHODS: Twenty participants with chronic ankle instability were instructed in a stretching, strengthening, and balance home exercise program and were randomized a priori to receive either midfoot joint mobilizations (forefoot supination, cuboid glide, and plantar first tarsometatarsal) or a sham laying of hands on the initial visit. Changes in foot morphology, joint mobility, strength, dynamic balance, and patient-reported outcomes assessing pain, physical, and psychological function were assessed pre to post treatment and 1 week following post treatment. Participants crossed over to receive the alternate treatment and were assessed pre to post treatment and 1 week following. Linear modeling was used to assess changes in outcomes. RESULTS: Participants demonstrated significantly greater perceived improvement immediately following midfoot mobilization in the single assessment numeric evaluation (sham: 5.0% [10.2%]; mobilization: 43.9% [26.2%]; ß: 6.8; P < .001; adj R2: .17; Hedge g: 2.09), and global rating of change (sham: -0.1 [1.1]; mobilization: 1.1 [3.0]; ß: 1.8; P = .01; adj R2: .12; Hedge g: 0.54), and greater improved 1-week outcomes in rearfoot inversion mobility (sham: 4.4° [8.4°]; mobilization: -1.6° [6.1°]; ß: -6.37; P = .01; adj R2: .19; Hedge g: 0.81), plantar flexion mobility (sham: 2.7° [6.4°]; mobilization: -1.7° [4.3°]; ß: -4.36; P = .02; adj R2: .07; Hedge g: 0.80), and posteromedial dynamic balance (sham: 2.4% [5.9%]; mobilization: 6.0% [5.4%]; ß: 3.88; P = .04; adj R2: .10; Hedge g: 0.59) compared to the sham intervention. CONCLUSION: Greater perceived improvement and physical signs were observed following midfoot joint mobilization.

Evidence of Intrinsic Foot Muscle Training in Improving Foot Function: A Systematic Review and Meta-analysis.

OBJECTIVE: To critically assess the literature focused on strength training of the intrinsic foot muscles (IFM) and resulting improvements in foot function. DATA SOURCES: A search of electronic databases PubMed, CINHAL, Scopus, and SPORT Discus was completed between January 2000 to March 2022. STUDY SELECTION: Randomized control trials (RCTs) with an outcome of interest with at least two weeks of IFM exercise intervention were included. Outcomes of interest were broadly divided in to five categories of foot posture (navicular drop (ND) and Foot Posture Index (FPI)), balance, strength, patient-reported outcomes (PROs), sensory function, and motor performance. The PEDro scale was used to assess the methodological quality of included studies with two independent reviewers rating each study. Studies with a PEDro score greater than 4/10 were included. DATA EXTRACTION: Data from the included studies were extracted by two independent reviewers. These data included design, participant characteristics, inclusion and exclusion criteria, type of intervention, outcomes, and the primary results. Random effects meta-analysis was performed to analyze difference between intervention and control groups for each outcome when there were at least two studies. Standardized mean differences (SMD) describe effect size with a 95% confidence interval (SMD range). When the confidence interval crossed zero the effect was not significant. DATA SYNTHESIS: Thirteen studies were included and IFM exercise interventions were associated with decreasing ND (SMD range=0.37,1.83), and FPI (SMD range=1.03,1.69), improving balance (SMD range=0.18,1.86), strength (SMD range=0.06,1.52) and PROs for disability (SMD range=0.12,1.00) with pooled effect sizes favoring IFM intervention over control. There was no superiority of IFM exercises (SMD range=-0.15,0.66) seen in reducing pain. We could not perform meta-analysis for sensory function and motor performance as there was only study reporting each outcome, however, these results supported the use of IFM strength training. CONCLUSION: IFM strength training is helpful for patients in improving foot and ankle outcomes.

Association of Ankle Sprain Frequency With Body Mass and Self-Reported Function: A Pooled Multisite Analysis.

CONTEXT: Ankle sprains result in pain and disability. While factors such as body mass and prior injury contribute to subsequent injury, the association of the number of ankle sprains on body anthropometrics and self-reported function are unclear in this population. Therefore, the purpose of this investigation was to assess differences in anthropometric measurements and self-reported function between the number of ankle sprains utilizing a large, pooled data set. DESIGN: Cross-sectional. METHODS: Data were pooled from 14 studies (total N = 412) collected by the Chronic Ankle Instability Outcomes Network. Participants were categorized by the number of self-reported sprains. Anthropometric data and self-reported function were compared between those who reported a single versus >1 ankle sprain as well as among groups of those who had 1, 2, 3, 4, and ≥5 ankle sprains, respectively. RESULTS: Those who had >1 ankle sprain had higher mass (P = .001, d = 0.33) and body mass index (P = .002, d = 0.32) and lower Foot and Ankle Ability Measure-Activities of Daily Living (P < .001, r = .22), Foot and Ankle Ability Measure-Sport (P < .001, r = .33), and Cumberland Ankle Instability Tool (P < .001, r = .34) scores compared to the single ankle sprain group. Those who had a single ankle sprain weighed less than those who reported ≥5 sprains (P = .008, d = 0.42) and had a lower body mass index than those who reported 2 sprains (P = .031, d = 0.45). CONCLUSIONS: Some individuals with a history of multiple ankle sprains had higher body mass and self-reported disability compared to those with a single sprain, factors that are likely interrelated. Due to the potential for long-term health concerns associated with ankle sprains, clinicians should incorporate patient education and interventions that promote physical activity, healthy dietary intake, and optimize function as part of comprehensive patient-centered care.

Intrinsic foot muscle size and quality in a single leg weight bearing position across foot posture types in individuals with Patellofemoral Pain compared to healthy.

OBJECTIVE: To identify if any differences exist in IFM size and quality in single leg weight bearing position between healthy and PFP participants based on foot posture. DESIGN: Cross-sectional, matched case-comparison study SETTING: University Laboratory Setting PARTICIPANTS: 35 PFP (age:20.46 ± 3.79yrs, mass:73.28 ± 26.58 kg, height:170.80 ± 11.91 cm) and 35 healthy (age:20.40 ± 3.16yrs, mass:64.76 ± 11.52 kg, height:169.55 ± 9.10 cm) participants METHODS: After measuring Foot Posture Index (FPI), ultrasound images (USI) of Abductor Hallucis (AH), Flexor Digitorum Brevis (FDB) and Quadratus Plantae (QP) were taken in a single limb weight bearing position. Cross-sectional area (CSA) and echogenicity were measured on the USI. RESULTS: FPI was not different between groups (PFP:2.34 ± 3.76, Healthy:2.34 ± 3.10, 9 pronated and 26 non-pronated in both groups). AH CSA was smaller in PFP than healthy group (PFP:0.030 ± 0.01 cm (Smith et al., 2018)/kg, Healthy:0.042 ± 0.01 cm (Smith et al., 2018)/kg, P < 0.001) with a large effect (d = -1.20(-1.71, -0.69). There were no other significant group main effects or group-by-FP interactions in AH/FDB/QP CSA or echogenicity. CONCLUSION: AH CSA was smaller in PFP than healthy controls, but no difference in CSA or echogenicity of FDB/QP exist, as well as no difference in foot posture between groups. While single limb weight bearing, the PFP group presented with a smaller IFM which provides eccentric control of medial longitudinal arch, which may have implications up the chain during weight bearing functional tasks.

Gluteal Activity During Gait in Patients With Chronic Ankle Instability Following Rehabilitation: A Randomized Controlled Trial.

CONTEXT: Ankle positioning gait biofeedback (GBF) has improved ankle inversion for patients with chronic ankle instability. However, the effects on proximal deficits remain unknown. The purpose of this study was to determine the effects of impairment-based rehabilitation with GBF and without biofeedback on gluteal activity during walking in patients with chronic ankle instability. DESIGN: Randomized controlled trial. METHODS: Eighteen patients with chronic ankle instability (14 women and 4 men; age 22 [4] y; height 171 [10] cm; mass 71.6 [13.8] kg) were recruited from a university setting, following International Ankle Consortium guidelines. Patients were randomly allocated to GBF or without biofeedback groups (N = 9 per group). Both groups performed 4 weeks of exercises and treadmill walking. The GBF group alone received feedback on frontal ankle positioning at initial contact during walking. Ultrasound videos of the gluteus maximus and medius were recorded during walking at baseline and follow-up by a blinded clinician. Gluteal activity ratios were obtained at each 10% of the gait cycle. Statistical parametric mapping repeated-measures analysis of variance were used to compare groups and time points. RESULTS: Both groups demonstrated significantly increased gluteus medius activity across the gait cycle compared with baseline (P < .01, mean differences: 0.13-0.21, Hedge g: 0.97-1.89); however, there were no significant between-group differences. There were no statistically significant changes noted for the gluteus maximus. No adverse events were observed. CONCLUSIONS: Impairment-based rehabilitation led to increased gluteus medius activity, but GBF did not provide any additional improvement to this parameter. Clinicians may consider implementing impairment-based strengthening interventions to improve gluteus medius function during gait for patients with CAI.

Does verbal encouragement change dynamic balance? The effect of verbal encouragement on Star Excursion Balance Test performance in chronic ankle Instability.

BACKGROUND: The Star Excursion Balance Test (SEBT) is commonly used for testing dynamic balance in chronic ankle instability (CAI) in both clinical and research settings. However, the effect of verbal encouragement (VE) on the SEBT performance is not known. OBJECTIVE: To investigate the effects of VE on maximum reach distance performance between CAI and healthy participants on the SEBT. METHOD: Thirty-four college-aged adults, 17 with CAI and 17 healthy controls, performed the SEBT in the anterior, posteromedial, and posterolateral reach directions. Independent variables (VE versus No-VE) and group (CAI versus healthy) were analyzed using Analysis of Variance (ANOVA) to determine whether VE and group affected reach performance. RESULTS: There was a significant group-by-condition interaction (p = 0.02) for the anterior as well as for the posteromedial reach (p = 0.04). There was no statistically significant interaction (p = 0.48) for the posterolateral reach. There were moderate to large effect sizes in the reach distances found in the No-VE condition between the CAI and healthy controls, but with VE, the range of effect sizes from No-VE to VE were diminished. CONCLUSION: There was a significant group by condition interaction for anterior and posteromedial reaches which shows that providing VE resulted in a greater increase in performance for participants with CAI compared to healthy controls. Psychological constraints need to be considered while performing and interpreting the results of the SEBT.

Quadriceps Oxygenation During Exercise in Patients With Anterior Cruciate Ligament Reconstruction.

CONTEXT: The causes of persistent muscle weakness after anterior cruciate ligament reconstruction (ACLR) are not well known. Changes in muscle oxygenation have been proposed as a possible mechanism. OBJECTIVE: To investigate changes in quadriceps muscle oxygenation during knee extension in ACLR-involved and ACLR-uninvolved limbs. DESIGN: Case-control study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 20 individuals: 10 patients with primary, unilateral ACLR (7 women, 3 men; age = 22.90 ± 3.45 years, height = 170.81 ± 7.93 cm, mass = 73.7 ± 15.1 kg) and 10 matched control individuals (7 women, 3 men; age = 21.50 ± 2.99 years, height = 170.4 ± 10.7 cm, mass = 68.86 ± 9.51 kg). INTERVENTION(S): Each participant completed a single data-collection session consisting of 5-second isometric contractions at 25%, 50%, and 75% of the volitional maximum followed by a 30-second maximal isometric knee-extension contraction. MAIN OUTCOME MEASURE(S): Oxygenated hemoglobin (O2Hb) measures in the reconstructed thigh were continuously recorded (versus the uninvolved contralateral limb as well as the nondominant thigh of healthy control individuals) using 3 wearable, wireless near-infrared spectroscopy units placed superficially to the vastus medialis, vastus lateralis, and rectus femoris muscles. Relative changes in oxygenation were ensemble averaged and plotted for each contraction intensity with associated 90% CIs. Statistical significance occurred where portions of the exercise trials with CIs on the O2Hb graph did not overlap. Effect sizes (Cohen d, 90% CI) were determined for statistical significance. RESULTS: We observed less relative change in O2Hb in patients with ACLR than in healthy control participants in the rectus femoris at 25% (d = 2.1; 90% CI = 1.5, 2.7), 50% (d = 2.8; 90% CI = 2.6, 2.9), and 75% (d = 2.0; 90% CI = 1.9, 2.2) and for the vastus medialis at 75% (d = 1.5; 90% CI = 1.4, 1.5) and 100% (d = 2.6; 90% CI = 2.5, 2.7). Less relative change in O2Hb was also noted for the vastus medialis in ACLR-involved versus ACLR-uninvolved limbs at 100% (d = 2.62; 90% CI = 2.54, 2.70). CONCLUSIONS: Quadriceps muscle oxygenation during exercise differed between patients with ACLR and healthy control individuals. However, not all portions of the quadriceps were affected uniformly across contraction intensities.

Gait biofeedback and impairment-based rehabilitation for chronic ankle instability.

Our purpose was to analyze the effects of 4 weeks of visual gait biofeedback (GBF) and impairment-based rehabilitation on gait biomechanics and patient-reported outcomes (PROs) in individuals with chronic ankle instability (CAI). Twenty-seven individuals with CAI participated in this randomized controlled trial (14 received no biofeedback (NBF), 13 received GBF). Both groups received 8 sessions of impairment-based rehabilitation. The GBF group received visual biofeedback to reduce ankle frontal plane angle at initial contact (IC) during treadmill walking. The NBF group walked for equal time during rehabilitation but without biofeedback. Dependent variables included three-dimensional kinematics and kinetics at the ankle, knee, and hip, electromyography amplitudes of 4 lower extremity muscles (tibialis anterior, fibularis longus, medial gastrocnemius, and gluteus medius), and PROs (Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL), FAAM-Sport, Tampa Scale of Kinesiophobia (TSK), and Global Rating of Change (GROC)). The GBF group significantly decreased ankle inversion at IC (MD:-7.3º, g = 1.6) and throughout the entire stride cycle (peak inversion: MD:-5.9º, g = 1.2). The NBF group did not have significantly altered gait biomechanics. The groups were significantly different after rehabilitation for the FAAM-ADL (GBF: 97.1 ± 2.3%, NBF: 92.0 ± 5.7%), TSK (GBF: 29.7 ± 3.7, NBF: 34.9 ± 5.8), and GROC (GBF: 5.5 ± 1.0, NBF:3.9 ± 2.0) with the GBF group showing greater improvements than the NBF group. There were no significant differences between groups for kinetics or electromyography measures. The GBF group successfully decreased ankle inversion angle and had greater improvements in PROs after intervention compared to the NBF group. Impairment-based rehabilitation combined with visual biofeedback during gait training is recommended for individuals with CAI.

Walking Gait Mechanics and Gaze Fixation in Individuals With Chronic Ankle Instability.

CONTEXT: Many individuals who suffer a lateral ankle sprain will develop chronic ankle instability (CAI). Individuals with CAI demonstrate kinematic differences in walking gait, as well as somatosensory alterations compared with healthy individuals. However, the role of vision during walking gait in this population remains unclear. OBJECTIVE: To evaluate ankle kinematics, gaze deviations, and gaze velocity between participants with CAI and healthy controls while walking on a treadmill during 3 separate visual conditions (no target, fixed target, and moving target). DESIGN: Case-control study. SETTING: Laboratory. Patients (or Other Participants): Ten CAI participants and 10 healthy matched controls participated. MAIN OUTCOME MEASURES: Ankle sagittal and frontal plane kinematics were analyzed for the entire gait cycle. Average and standard deviation (SD) for gaze deviation and gaze velocity were calculated in the horizontal (X) and vertical (Y) planes. RESULTS: No significant differences were found between groups for either ankle kinematics or gaze variables; however, large effect sizes were found in the no target condition for average deviation of X (healthy 0.05 [0.02], CAI 0.12 [0.11]). Moderate effect sizes were identified in the no target condition for SD of Y (healthy 0.04 [0.03], CAI 0.11 [0.15]) and the moving target condition for average velocity of X (healthy 1.56 [0.73], CAI 2.27 [1.15]) and Y (healthy 1.07 [0.51], CAI 1.47 [0.52]). CONCLUSIONS: Although no significant differences were found between groups, it is possible that the role of vision in individuals with CAI may be altered with a more difficult task.

The interrater reliability of dynamic leap and balance test in healthy and chronic ankle instability.

The primary aim of this study was to assess the interrater reliability of the Dynamic Leap and Balance Test (DLBT) in chronic ankle instability (CAI) and healthy groups. The secondary aim was to assess the differences in errors and time taken to complete the DLBT between the two groups for both raters and to identify cutoff scores to distinguish between patients with CAI and healthy controls. This was a controlled laboratory reliability analysis study. Fourteen healthy college-aged subjects (9 women 5 men; weight = 62.10 ± 8.03; height = 168.35 ± 6.0) and sixteen with a history of CAI (9 women, 7 men; weight = 68.01 ± 10.74; height = 172.08 ± 11.37) participated. Interrater reliability was determined by independent raters for both total time taken to complete the task and errors made. The most optimal score to discriminate between two groups was determined by receiver operator curve analysis. Total time taken and errors made were also documented for group differences as secondary analysis. A strong agreement was found between the two raters for time and errors with intraclass correlation coefficient >0.80. Significantly (P < .05) higher number of errors were made and greater time taken by the CAI subjects when compared with healthy for both raters. The most optimal score to discriminate between CAI and healthy control was 43.28s and 4 errors. Excellent interrater reliability substantiates that it can be used confidently by different clinicians for testing dynamic balance. CAI group took more time and made more errors to complete the DLBT.

Dynamic Leap and Balance Test: Ability to Discriminate Balance Deficits in Individuals With Chronic Ankle Instability.

CONTEXT: The Dynamic Leap Balance Test (DLBT) is a new dynamic balance task that requires serial changes in base of support with alternating limb support and recovery of dynamic stability, as compared with the Y modification of the Star Excursion Balance Test (Y-SEBT), which assesses dynamic stability over an unchanging base of support. OBJECTIVES: To assess the dynamic balance performance in 2 different types of dynamic balance tasks, the DLBT and the SEBT, in subjects with unilateral chronic ankle instability (CAI) when compared with matched controls. The authors hypothesized that the DLBT score would significantly differ between the CAI involved and uninvolved limbs (contralateral and healthy matched) and demonstrate a modest (r = .50) association with the SEBT scores. DESIGN: Case-control. SETTING: Controlled laboratory. PARTICIPANTS: A total of 36 physically active adults, 18 with history of unilateral CAI and 18 without history of ankle injury, were enrolled in the study. CAI subjects were identified using the Identification of Functional Ankle Instability questionnaire. INTERVENTIONS: The DLBT and the SEBT were performed in a randomized order on a randomly selected limb in CAI and healthy subjects. MAIN OUTCOME MEASURES: Time taken to complete the DLBT and the reach distances performed on the SEBT were compared between the CAI and the healthy subjects. RESULTS: There were no statistically significant differences (P < .05) in SEBT reach distances between groups. The DLBT time was greater (P < .01) for unstable ankles compared with the stable ankle. The authors found no correlation (P > .05) between DLBT time and any of the SEBT reach distances suggesting that the DLBT provides unique information in the assessment of patients with CAI. CONCLUSION: The DLBT challenges the ability to maintain postural control in CAI subjects differently than the SEBT. There is a need of more dynamic balance assessment tools that are functional and clinically relevant.