Metastatic gastric adenocarcinoma with appendiceal phlegmon: a case report.

BACKGROUND: Gastric carcinoma is one of the most frequent malignancies worldwide. Gastric cancer metastasis to the appendix is uncommon in incidence, and has been rarely described in acute-appendicitis-related literature reviews. In this presented case, we have reported a rare case of appendiceal phlegmon, due to a diagnosis of metastatic gastric adenocarcinoma with uncommon symptoms. CASE PRESENTATION: A 79-year-old Caucasian male presented to the emergency department with history of weakness, anorexia, lethargy, and mood changes for 2 months. Abdominopelvic computed tomography showed an abscess in right iliac muscle. After percutaneous drainage of the abscess and 6 weeks antibiotic therapy, an appendectomy was done for the patient. Histopathologic findings revealed the involvement of the appendiceal wall by adenocarcinoma, most probably with gastrointestinal origin. Gastric cancer was confirmed later by upper endoscopy and pathologic report. CONCLUSIONS: Although the presence of tumor in appendectomy specimens is rare, and metastasis to appendix is even rarer, it should be considered as a cause of appendicitis, especially in elderly patients.

Protective Effect of the Hydroalcoholic Extract of Pelargonium Graveolens L. on Rats with Acetaminophen- Induced Nephrotoxicity.

INTRODUCTION: Geranium has various antioxidant, anti-inflammatory, and anti-microbial effects. Prescribing glutathione probably enhances the protective mechanisms of nephrons against oxidative stresses. This study aimed to evaluate the protective effect of geranium on acetaminophen-induced nephrotoxic rats. METHODS: In the present study, 70 mice were divided into seven groups. In five groups (T1, T2, T3, T4, and T5), different doses of geranium were given by gavage to the mice for seven days, then on the 8th day, a high dose of acetaminophen was administered intraperitoneally. Group T5 only received geranium extract. The control group received neither acetaminophen nor the extract while the last group received only a toxic dose of acetaminophen. Twenty-four hours after the last drug administration, blood samples were taken to check the levels of uric acid, blood nitrogen, and creatinine. The data were analyzed in SPSS version 25. To investigate the between-group factors' effects, one-way ANOVA with Tukey's post hoc test was performed at the alpha level of < 0.05. RESULTS: The differences between the levels of blood creatinine, urea, and uric acid were significant (P < .001) among the groups. The mean blood urea for groups T3 and T4 were similar, and they had a significant difference in comparison with the control group (P < .05). The mean creatinine levels were similar between T4, T5, and the control groups and were significantly different from the other groups (P < .05). Blood uric acid for groups T1 and T2 were similar to Group B and higher than the other groups (P < .05). CONCLUSION: The results showed that by strengthening cell protection mechanisms against oxidative stress, geranium extract reduces the toxic effects of acetaminophen on mice's kidney function and thus ameliorates the damage. As a result, the geranium extract has no adverse effects on kidney function.  DOI: 10.52547/ijkd.6679.

An updated min-review on environmental route of the SARS-CoV-2 transmission.

The risk of newly emerging diseases is constantly present in a world where changes occur significantly in climatic, commercial, and ecological conditions, in addition to the development of biomedical investigations in new situations. An epidemic respiratory disease instigated by a new coronavirus was initially identified in and has resulted in the current global dissemination. This viral strain and its related disease has been termed "SARS-CoV-2" and "coronavirus disease 2019" (abbreviated "COVID-19" or "2019-nCoV"), respectively, which is transmitted simply between individuals. The World Health Organization (WHO) announced the COVID-19 outburst as a pandemic on March 11, which necessitates a cooperative endeavour globally for mitigating the spread of COVID-19. The absence of previous, and minimum present-day information, particularly concerning the path of contagion have precluded the control of this disease. The present article, therefore, describes the SARS-CoV-2 paths of contagion such as drinking water, solid waste, sewer water, ambient air, and the rest of emerging likely paths.

Access Recirculation in Permanent Catheters of Hemodialysis Patients.

Treatment for end stage renal disease patients is based on dialysis; however, the presence of access recirculation (AR) decreases dialysis efficiency and adequacy. This study was conducted to determine the recirculation rate in dialysis patients undergoing hemodialysis through using a permanent catheter. 60 patients including 23 males and 37 females were enrolled. Mean age of the participants was 57.66 (± 14.08) years. Mean AR in the subjects was 9.36%, and 16 (27%) of patients had mean AR above 10%. Moreover, there was a significant correlation between AR and catheter longevity (P < .001). It is suggested to limit the use of permanent catheters to specific cases and not to use them in place of arteriovenous fistulas.

Topical Effects of Artemisia Absinthium Ointment and Liniment in Comparison with Piroxicam Gel in Patients with Knee Joint Osteoarthritis: A Randomized Double-Blind Controlled Trial.

BACKGROUND: Pain alleviation and improvement of functional status are the main objectives in the treatment of osteoarthritis. Artemisia absinthium (AA) was used traditionally in reducing pain and inflammation. The aim of the present study was to compare the effects of topical formulations of AA and piroxicam gel (PG) among patients with knee osteoarthritis. METHODS: In total, 90 outpatients aged 30-70 years with the diagnosis of primary osteoarthritis in at least one knee were enrolled in a randomized double-blind clinical trial. The patients referred to the Rheumatology Clinic at Shahid Beheshti Hospital in Hamadan province during 2012-2013. The patients were randomly assigned into three groups, 30 patients per group, and respectively received AA ointment (AAO) 3%, AA liniment (AAL) 3%, and PG; three times daily (TID) for 4 weeks. The patients were visited at baseline, week 4, and week 6. The effectiveness criteria were pain severity which was assessed with a 10-point visual analog scale (VAS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for total pain score (WTPS), total physical function score (WTPFS), and total stiffness score (WTSS). Repeated measure ANOVA, paired t test and post hoc were used to compare variables. Statistical analysis was performed using the SPSS software, version 13.0 (SPSS Inc., Chicago, Illinois). RESULTS: All groups had similar patient demographics. The administration of PG significantly improved all tested criteria with no recurrence after discontinuing the treatment protocol. AAO alleviated all tested factors except for WTSS. Alleviation was comparable to PG. AAL only reduced pain factors (VAS, WTPS) in week 4 with recurrence in week 6. CONCLUSION: Administration of Artemisia ointment may have beneficial effects in the treatment of osteoarthritis. Trial Registration Number: IRCT201202123109N3.

Motor switching and motor adaptation deficits contribute to freezing of gait in Parkinson's disease.

BACKGROUND: Patients with freezing of gait (FOG) have more difficulty with switching tasks as well as controlling the spatiotemporal parameters of gait than patients without FOG. Objective. To compare the ability of patients with and without FOG to adjust their gait to sudden speed switching and to prolonged walking in asymmetrical conditions. METHODS: Gait characteristics of 10 freezers, 12 non-freezers, and 12 controls were collected during tied-belt conditions (3 and 4 km/h), motor switching and reswitching (increase of speed in one belt from 3 to 4 km/h and vice versa), and adaptation (adjustment to asymmetrical gait) and re-adaptation (returning to symmetrical gait) on a split-belt treadmill. RESULTS: Following switching, freezers showed the largest increase of step length asymmetry (P = .001). All groups gradually adapted their gait to asymmetrical conditions, but freezers were slower and demonstrated larger final asymmetry than the other 2 groups (P = .001). After reswitching, freezers again showed the largest step length asymmetry (P = .01). During re-adaptation, both controls and non-freezers reached symmetrical levels, but freezers did not. Interestingly, only immediately after switching did one episode of FOG and one episode of festination occur in 2 different patients. CONCLUSIONS: Freezers have more difficulties adapting their gait during both suddenly triggered and continued gait speed asymmetry. The impaired ability of freezers during both switching and reswitching would suggest that they have an adaptive deficit rather than difficulties with asymmetry per se. Future work needs to address whether these adaptation problems can be ameliorated with rehabilitation.

Intra- and Inter-session Reliability of Static and Dynamic Postural Control in Participants with and without Patellofemoral Pain Syndrome.

PURPOSE: To determine the intra- and inter-session reliability of balance performance in people with patellofemoral pain syndrome (PFPS) and matched controls. METHODS: In this methodological study, single-leg-stance performance of 15 participants with unilateral PFPS and 15 healthy matched controls was assessed using the Biodex Balance System (BBS) under 4 task difficulty levels (static and dynamic, with and without visual feedback). Intra-class correlation coefficients (ICCs), standard errors of measurement, and coefficients of variation were calculated for the overall stability index, anterior-posterior stability index, and medial-lateral stability index. RESULTS: Static and dynamic postural performance during single-leg stance showed moderate to very high reliability in the PFPS group (ICCs=0.53-0.96) and in healthy control participants (ICCs=0.51-0.91). Both measures were more reliable with eyes closed than with eyes open. CONCLUSION: BBS stability indices appear to have acceptable reliability in people with PFPS, particularly in more challenging conditions, and may be incorporated into the evaluation and rehabilitation of this patient group.

Objet : La présente étude avait pour objectif de déterminer la fiabilité intra et intersessionnelle de la performance de l'équilibre chez des sujets qui ont un syndrome fémoro-rotulien douloureux (SFRD) et chez un nombre équivalent de sujets en santé. Méthodes : Dans cette étude méthodologique, la performance lors d'un exercice debout sur une seule jambe a été examinée chez 15 sujets ayant un SFRD unilatéral et chez 15 témoins en santé, à l'aide d'un appareil Biodex Balance System (BBS) à quatre niveaux de difficulté différents (statique, dynamique, avec rétroaction visuelle et sans rétroaction visuelle). Le coefficient de corrélation intraclasse (CCI), l'erreur type de mesure (ETM) et le coefficient de variation (CV) ont été calculés pour l'indice de stabilité global (ISG), l'indice de stabilité antérieure et postérieure (ISAP) et l'indice de stabilité médio-latérale (ISML). Résultats : La performance de l'équilibre postural statique et dynamique lors d'un exercice debout sur une seule jambe a donné des résultats de fiabilité moyenne à très élevée chez les sujets ayant un SFRD (CCI=de 0,53 à 0,96) et les témoins en santé (CCI=de 0,51 à 0,91). Les mesures étaient plus fiables lorsque les participants avaient les yeux fermés comparativement à lorsqu'ils avaient les yeux ouverts. Conclusion : Les indices de stabilité calculés par l'appareil Biodex Balance System semblent présenter une fiabilité acceptable chez les sujets ayant un SFRD, surtout dans les conditions plus difficiles. Cet appareil pourrait être intégré dans l'évaluation et la réadaptation de ce groupe de patients.

Reliability of dynamic balance simultaneously with cognitive performance in patients with ACL deficiency and after ACL reconstructions and in healthy controls.

PURPOSE: To determine the intra- and inter-session reliability of balance and cognitive performance in anterior cruciate ligament-deficient (ACLD) and ACL-reconstructed (ACLR) and matched athletes. METHODS: Using SMART EquiTest, recovery reactions of the groups were assessed during single-leg standing, following medium and large forward perturbations with and without performing a cognitive (Stroop) task. The outcomes included reaction time (RT), latency and amplitude for balance and error ratio (ER) and RT for cognitive performance. The participants of each group repeated the tests 2-7 days after the first session. Intraclass correlation coefficient (ICC) and standard error of measurement were computed in order to assess relative and absolute reliability, respectively. RESULTS: Single- and dual-task balance measures had moderate to very high reliability in ACLD (ICC = 0.63-0.88), ACLR (ICC = 0.62-0.93) and control (ICC = 0.69-0.98) athletes. The ICCs for RT of Stroop were between 0.87 and 0.90 in ACLD, between 0.70 and 0.74 in ACLR and between 0.66 and 0.70 in controls and for ER of Stroop were between 0.36 and 0.90 in ACLD, between 0.42 and 0.49 in ACLR and between 0.41 and 0.51 in controls. CONCLUSIONS: Balance measures and RT of the cognitive task in single- and dual-task conditions have acceptable reliability and may be incorporated into the evaluation of physical and mental function of athletes following ACL injury and reconstruction. ER of the cognitive task is less reliable which needs to be considered in future research. LEVEL OF EVIDENCE: Prognostic study, case-control, Level III.

Which Aspects of Postural Control Differentiate between Patients with Parkinson's Disease with and without Freezing of Gait?

This exploratory study aimed to identify which aspects of postural control are able to distinguish between subgroups of patients with Parkinson's disease (PD) and controls. Balance was tested using static and dynamic posturography. Freezers (n = 9), nonfreezers (n = 10), and controls (n = 10) stood on a movable force platform and performed 3 randomly assigned tests: (1) sensory organization test (SOT) to evaluate the effective use of sensory information, (2) motor control test (MCT) to assess automatic postural reactions in response to platform perturbations, and (3) rhythmic weight shift test (RWS) to evaluate the ability to voluntarily move the center of gravity (COG) mediolaterally and anterior-posteriorly (AP). The respective outcome measures were equilibrium and postural strategy scores, response strength and amplitude of weight shift. Patients were in the "on" phase of the medication cycle. In general, freezers performed similarly on SOT and MCT compared to nonfreezers. Freezers showed an intact postural strategy during sensory manipulations and an appropriate response to external perturbations. However, during voluntary weight shifting, freezers showed poorer directional control compared to nonfreezers and controls. This suggests that freezers have adequate automatic postural control and sensory integration abilities in quiet stance, but show specific directional control deficits when weight shifting is voluntary.

Military exercises, knee and ankle joint position sense, and injury in male conscripts: a pilot study.

CONTEXT: The high incidence of lower limb injuries associated with physical exercises in military conscripts suggests that fatigue may be a risk factor for injuries. Researchers have hypothesized that lower limb injuries may be related to altered ankle and knee joint position sense (JPS) due to fatigue. OBJECTIVE: To evaluate if military exercises could alter JPS and to examine the possible relation of JPS to future lower extremity injuries in military service. DESIGN: Cohort study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 50 male conscripts (age = 21.4 ± 2.3 years, height = 174.5 ± 6.4 cm, mass = 73.1 ± 6.3 kg) from a unique military base were recruited randomly. main outcome measure(s): Participants performed 8 weeks of physical activities at the beginning of a military course. In the first part of the study, we instructed participants to recognize predetermined positions before and after military exercises so we could examine the effects of military exercise on JPS. The averages of the absolute error and the variable error of 3 trials were recorded. We collected data on the frequency of lower extremity injuries over 8 weeks. Next, the participants were divided into 2 groups: injured and uninjured. Separate 2 × 2 × 2 (group-by-time-by-joint) mixed-model analyses of variance were used to determine main effects and interactions of these factors for each JPS measure. In the second part of the study, we examined whether the effects of fatigue on JPS were related to the development of injury during an 8-week training program. We calculated Hedges effect sizes for JPS changes postexercise in each group and compared change scores between groups. RESULTS: We found group-by-time interactions for all JPS variables (F range = 2.86-4.05, P < .01). All participants showed increases in JPS errors postexercise (P < .01), but the injured group had greater changes for all the variables (P < .01). CONCLUSIONS: Military conscripts who sustained lower extremity injuries during an 8-week military exercise program had greater loss of JPS acuity than conscripts who did not sustain injuries. The changes in JPS found after 1 bout of exercise may have predictive ability for future musculoskeletal injuries.

Comparison of functional outcome measures after ACL reconstruction in competitive soccer players: a randomized trial.

BACKGROUND: The choice of graft for anterior cruciate ligament (ACL) reconstruction remains controversial. Although many outcome studies comparing bone-patellar tendon-bone and semitendinosus and gracilis tendon grafts have been performed, most have not included tests of functional outcomes that challenge the graft. The objective of the current study was to compare the functional performances of soccer players after ACL reconstruction that was performed with either a bone-patellar tendon-bone or a semitendinosus and gracilis tendon graft. METHODS: Forty-two soccer players with unilateral ACL injury were prospectively randomized to a bone-patellar tendon-bone group (BPTB group; twenty-one subjects) or a semitendinosus and gracilis tendon group (STG group; twenty-one subjects) and followed a rehabilitation protocol. At the time of return to sports, the patients were asked to execute strength, hop, and jump tests and the results were compared between the groups. Twenty-one healthy athletes were recruited as the control group to evaluate their performance of the same tests. RESULTS: The limbs with the ACL reconstruction in the STG group had greater values for quadriceps torque as well as on the triple-hop, crossover-hop, and jump-landing test (p < 0.01), but the STG and BPTB groups showed similar results in terms of hamstrings peak torque and the results of two other hop tests (p > 0.05). Moreover, the subjects with ACL reconstruction had significantly lower values with regard to quadriceps and hamstrings peak torques and the results of the hop and jump tests compared with the healthy athletes (p < 0.01). CONCLUSIONS: At the time of return to sports, the STG group had better performance in terms of quadriceps strength and the results of the triple-hop, crossover-hop, and jump-landing tests compared with the BPTB group. Compared with controls, soccer players who had undergone ACL reconstruction had less quadriceps and hamstrings strength and inferior hop performance and jump-landing strategy.

Validation of the Persian version of Functional Index Questionnaire (FIQ) and Modified FIQ in patients with patellofemoral pain syndrome.

The aim of this investigation was to culturally translate and validate the Functional Index Questionnaire (FIQ) and Modified FIQ (MFIQ) in patients with patellofemoral pain syndrome (PFPS). A sample of 100 patients with PFPS completed the FIQ and MFIQ, and Short-Form 36 (SF-36) Health Survey in the first session. The FIQ and MFIQ were re-administered to a sample of 47 patients to evaluate test-retest reliability. Test-retest reliability and internal consistency were evaluated by the intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient, respectively. Corrected item-total correlations and construct validity were assessed by Spearman's rank correlation. Factor analysis was performed on all items of the Persian FIQ and MFIQ to determine the number of underlying factors and the items which load on each factor. An acceptable level of test-retest reliability (ICC = 0.84, 0.85) and internal consistency (Cronbach's alpha = 0.79, 0.82) was obtained for both the Persian FIQ and MFIQ, respectively. Item-total correlations were greater than 0.40 for all but two questions of the Persian FIQ and all but four questions of the Persian MFIQ. A total of two factors were detected for each questionnaire. There were moderate to low correlations between the Persian FIQ/MFIQ and SF-36. Persian FIQ and MFIQ are two reliable and valid outcome measures of functional limitation and it seems that they are suitable for use in clinical practice of patients with chronic PFPS.

Static and dynamic postural control in competitive athletes after anterior cruciate ligament reconstruction and controls.

PURPOSE: To evaluate the test-retest reliability and compare the static and dynamic postural control values in competitive athletes following anterior cruciate ligament (ACL) reconstruction and controls. METHODS: Thirty athletes, 8.4 ± 1.8 months after ACL reconstruction, and thirty healthy matched controls were asked to execute single-leg stance and single-legged drop jump tests onto a force plate. Amplitude and velocity in anteroposterior and mediolateral directions, and mean total velocity were measured for static evaluation. Peak vertical ground reaction force (PVGRF) during landing and takeoff and loading rate were measured for dynamic evaluation. To evaluate test-retest reliability, 15 participants of each group repeated the tests 6-8 days after the first session. Mixed model of analysis of variance was used to determine differences between the involved, uninvolved, and control limbs. The test-retest reliability was measured using intraclass correlation coefficient and standard error of measurement. RESULTS: Greater postural sway has been observed in the operated leg of ACL-reconstructed athletes compared with the non-operated side (P < 0.01) and the matched limb of the control group (P < 0.01). During landing, PVGRF and loading rate on the uninvolved limb of the athletes who had undergone ACL reconstruction were greater in comparison with those of the control group (P < 0.001). Both static and dynamic postural measures have high test-retest reliability, ranging from 0.73 to 0.88. CONCLUSIONS: Static and dynamic postural measures are reliable tests to evaluate functional performance of athletes following ACL reconstruction. Eight months postsurgery, competitive athletes still demonstrated postural asymmetries, compared to matched controls, which might result in their susceptibility to future ACL injury. LEVEL OF EVIDENCE: Prognostic study, case-control, Level III.

Effects of fatigue due to contraction of evertor muscles on the ankle joint position sense in male soccer players.

BACKGROUND: The high incidence of ankle sprains that occur later in matches suggests that fatigue may contribute to altered neuromuscular control of the ankle. Moreover, deficits in ankle joint position sense (JPS) were seen in patients with a history of recurrent ankle sprains. It has been hypothesized that ankle sprains may be related to altered ankle JPS as a consequence of fatigue. PURPOSE: To evaluate if fatiguing contractions of evertor muscles alter the ankle JPS. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty-six soccer players (age, 24.7 +/- 1.3 years; height, 183.7 +/- 8.2 cm; weight, 78.9 +/- 7.9 kg) were recruited. Subjects were asked to recognize 2 positions (15 degrees of inversion and maximal active inversion minus 5 degrees ) for 2 conditions: normal and fatigue. Muscular fatigue was induced in evertor muscles of the dominant leg by using isometric contractions. The average of the absolute and variable errors of 3 trials were recorded for both fatigue and nonfatigue conditions. A matched control group of 36 soccer players (age, 23.9 +/- 0.9 years; height, 181.2 +/- 6.9 cm; weight, 77.8 +/- 6.5 kg) was asked to recognize the same positions, before a soccer match and after 45 minutes of playing, and their same scores were recorded. Finally, results of the 2 groups were compared. RESULTS: There was significant decrease in subjects' ability to recognize passive and active repositioning of their ankle after a fatigue protocol (P <.001). Passive and active JPS were reduced after playing (P <.001). There was no significant difference between 2 groups in the results of JPS before and after the intervention (P > .1). CONCLUSION: The acuity of the ankle JPS is reduced subsequent to a fatigue protocol and after a soccer match. CLINICAL RELEVANCE: Evaluation of athletes' ankle JPS before returning to physical activity may prevent further injuries.

Effect of static stretching of muscles surrounding the knee on knee joint position sense.

BACKGROUND: Muscle stretching is widely used in sport training and in rehabilitation. Considering the important contribution of joint position sense (JPS) to knee joint stability and function, it is legitimate to question if stretching might alter the knee JPS. OBJECTIVE: To evaluate if a stretch regimen consisting of three 30 s stretches alters the knee JPS. DESIGN AND SETTING: A blinded, randomised design with a washout time of 24 h was used. SUBJECTS: 39 healthy students (21 women, 18 men) volunteered to participate in this study. METHODS AND MAIN OUTCOME MEASURES: JPS was estimated by the ability to reproduce the two target positions (20 degrees and 45 degrees of flexion) in the dominant knee. The absolute angular error (AAE) was defined as the absolute difference between the target angle and the subject perceived angle of knee flexion. AAE values were measured before and immediately after the static stretch. Measurements were repeated three times. The static stretch comprised a 30 s stretch followed by a 30 s pause, three times for each muscle. RESULTS: The AAE decreased significantly after the stretching protocols for quadriceps (3.5 (1.3) vs 0.7 (2.4); p<0.001), hamstring (3.6 (2.2) vs 1.6 (3.1); p = 0.016) and adductors (3.7 (2.8) vs 1.7 (2.4); p = 0.016) in 45 degrees of flexion, but no differences were found for values of the gastrocnemius and popliteus muscles in this angle and for the values of all muscles in 20 degrees of flexion (p>0.05). CONCLUSION: The accuracy of the knee JPS in 45 degrees of flexion is improved subsequent to a static stretch regimen of quadriceps, hamstring and adductors in healthy subjects.

Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players.

BACKGROUND: Ankle sprains are frequent injuries in soccer. Several strategies can be used to prevent further ankle sprains in athletes: the most common are proprioceptive training, strength training, and orthoses. OBJECTIVE: To investigate which of these 3 interventions is the most effective in preventing ankle sprains in athletes with previous ankle inversion sprain. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS AND MEASURES: Eighty male soccer players (age, 24.6 +/- 2.63 years; height, 175.60 +/- 4.36 cm; weight, 64.26 +/- 8.37 kg) in the first division of a men's league who had experienced previous ankle inversion sprain were randomly selected from an original population of 120 players. The subjects were individually and randomly assigned to 4 study groups: group 1 (n = 20) followed the proprioceptive program, group 2 (n = 20) followed the strength program, group 3 (n = 20) used orthoses, and group 4 (n = 20) was the control group. Data on the frequency of ankle sprain reinjury were collected at the end of the session. RESULTS: There were no significant differences among the groups in the number of exposures. The incidence of ankle sprains in players in the proprioception training group was significantly lower than in the control group (relative risk of injury, 0.13; 95% confidence interval, 0.003-0.93; P = .02). The findings with respect to the strength and orthotic groups in comparison with the control group were not significant (relative risk of injury, 0.5; 95% confidence interval, 0.11-1.87; P = .27 for strength; relative risk of injury, 0.25; 95% confidence interval, 0.03-1.25; P = .06 for orthotic group). CONCLUSION: Proprioceptive training, compared with no intervention, was an effective strategy to reduce the rate of ankle sprains among male soccer players who suffered ankle sprain.