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.

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.

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.

Foot impairments contribute to functional limitation in individuals with ankle sprain and chronic ankle instability.

PURPOSE: To investigate the clinical measures of foot posture and morphology, multisegmented joint motion and play, strength, and dynamic balance in recreationally active young adults with and without a history of a lateral ankle sprain (LAS), copers, and chronic ankle instability (CAI). METHODS: Eighty recreationally active individuals (healthy: n = 22, coper: n = 21, LAS: n = 17, CAI: n = 20) were included. Foot posture index (FPI), morphologic measures, joint motion (weight-bearing dorsiflexion (WBDF), rearfoot dorsiflexion, plantar flexion, inversion, eversion; forefoot inversion, eversion; hallux flexion, extension), joint play (proximal and distal tibiofibular; talocrural and subtalar, forefoot; 1st tarsometatarsal and metatarsophalangeal), strength (dorsiflexion, plantar flexion, inversion, eversion, hallux flexion, lesser toe flexion), and Star Excursion Balance Test (SEBT) (anterior, posteromedial, posterolateral) were assessed. RESULTS: There were no group differences in FPI or morphological measures. LAS and CAI groups had decreased ankle dorsiflexion (p = 0.001) and greater frontal plane motion (p < 0.001), first MT plantar flexion, and sagittal excursion (p < 0.001); increased talocrural glide (p = 0.02) and internal rotation (p < 0.001) and decreased forefoot inversion joint play (p < 0.001); and decreased strength in all measures (p < 0.001) except dorsiflexion compared to healthy controls. The LAS group also demonstrated decreased distal tibiofibular (p = 0.04) and forefoot general laxity (p = 0.05) and SEBT performance (anterior: p = 0.02; posteromedial: p < 0.001; posterolateral: p < 0.001). CONCLUSION: Individuals with LAS or CAI have increased pain, impaired physiologic and accessory joint motion, ligamentous tenderness, and strength in the foot and ankle. Clinicians should assess the multiple segments of the ankle-foot complex when caring for individuals with an LAS or CAI. LEVEL OF EVIDENCE: II.

Ultrasound examination of intrinsic foot muscles in patients with 1st metatarsophalangeal joint arthrodesis.

1st MTP arthrodesis often alleviates pain in osteoarthritis of hallux, long term outcomes vary, yet there is little known about potentially modifiable changes in the small muscles of the foot and hallux. This study was performed to determine the changes in the size of the Intrinsic Foot Muscles (IFMs) after the arthrodesis of the 1st metatarsophalangeal (MTP) joint by comparing the cross-sectional area (CSA) and muscle thickness (MT) of Abductor Hallucis (AbH), Flexor Digitorum Brevis (FDB) and Flexor Hallucis Brevis (FHB) between surgical and non-surgical feet. A convenience sample of 18 feet of 9 subjects (age: 57.56±9.07, weight: 81.33±1.32kg, height: 163.26±11.03cm) with a unilateral history of 1st MTP arthrodesis was recruited. B-mode ultrasound images were collected during sitting and standing positions with a wireless 8-MHz transducer. Hand-held dynamometer was used to measure toe flexion strength. CSA and MT of the surgical feet were significantly lower (P<0.05) for AbH and FHB in both positions. For FDB, the significant difference (P<0.05) was smaller MT in standing. Significantly lower (P<0.05) toe strength was observed in involved toe compared to uninvolved. Greater correlations were seen between toe strength and CSA of FHB and AbH in uninvolved toes compared with involved toes. IFMs in the surgical foot exhibited reduced CSA and MT. Weak core muscles of the foot may result in transmission of shock and forces to the foot skeleton which can lead to skeletal problems such as metatarsalgia, IP joint arthritis etc. that are seen as post-surgical complications. There is nothing in literature that delineates the rehabilitation of foot in this group of patients after surgery. This directs surgeons and clinicians to integrate IFM training in the rehabilitation programs after surgery. Developing appropriate rehabilitation protocols for these patients may help in preventions of post-surgical complications.

THE DYNAMIC LEAP AND BALANCE TEST (DLBT): A TEST-RETEST RELIABILITY STUDY.

BACKGROUND: There is a need for new clinical assessment tools to test dynamic balance during typical functional movements. Common methods for assessing dynamic balance, such as the Star Excursion Balance Test, which requires controlled movement of body segments over an unchanged base of support, may not be an adequate measure for testing typical functional movements that involve controlled movement of body segments along with a change in base of support. PURPOSE/HYPOTHESIS: The purpose of this study was to determine the reliability of the Dynamic Leap and Balance Test (DLBT) by assessing its test-retest reliability. It was hypothesized that there would be no statistically significant differences between testing days in time taken to complete the test. STUDY DESIGN: Reliability study. METHODS: Thirty healthy college aged individuals participated in this study. Participants performed a series of leaps in a prescribed sequence, unique to the DLBT test. Time required by the participants to complete the 20-leap task was the dependent variable. Subjects leaped back and forth from peripheral to central targets alternating weight bearing from one leg to the other. Participants landed on the central target with the tested limb and were required to stabilize for two seconds before leaping to the next target. Stability was based upon qualitative measures similar to Balance Error Scoring System. Each assessment was comprised of three trials and performed on two days with a separation of at least six days. RESULTS: Two-way mixed ANOVA was used to analyze the differences in time to complete the sequence between the three trial averages of the two testing sessions. Intraclass Correlation Coefficient (ICC3,1) was used to establish between session test-retest reliability of the test trial averages. Significance was set a priori at p ≤ 0.05. No significant differences (p > 0.05) were detected between the two testing sessions. The ICC was 0.93 with a 95% confidence interval from 0.84 to 0.96. CONCLUSION: This test is a cost-effective, easy to administer and clinically relevant novel measure for assessing dynamic balance that has excellent test-retest reliability. CLINICAL RELEVANCE: As a new measure of dynamic balance, the DLBT has the potential to be a cost-effective, challenging and functional tool for clinicians. LEVEL OF EVIDENCE: 2b.