Management of sport-related concussion in emergency departments in England: a multi-center study.

OBJECTIVE: To establish the current knowledge of sport-related concussion (SRC) management of clinicians in emergency departments in the North West of England. METHODS: A cross-sectional, multi-center study design was used and included emergency department clinicians (EDCs) across 15 centers in the North West of England. A 22-question survey was issued with questions focused on the 5th International Conference on Concussion Consensus Statement. Absolute and percentages were presented, and comparisons in knowledge of guidelines and confidence between EDCs were made using the Kruskal-Wallis test. RESULTS: Of an estimated 300 EDCs, 111 (37%) responded. Thirty (27%) were aware of the guidelines, whilst 63 (57%) had heard of a graduated return-to-sport protocol. Physical rest was advised by 106 (95%) respondents, with 68 (61%) advising cognitive rest and 47 (42%) providing written advice. There was no difference (p > .05) in awareness of SRC guidelines or confidence between clinician grade, with most receiving no SRC training. CONCLUSIONS: There is a lack of knowledge amongst EDCs in the North West of England in managing and providing discharge advice to patients with SRC. This is likely due to the limited awareness of guidelines and training, and therefore further education delivery on SRC management guidelines is required.

Concurrent Validity of a Rugby-Specific Yo-Yo Intermittent Recovery Test (Level 1) for Assessing Match-Related Running Performance.

ABSTRACT: Dobbin, N, Highton, J, Moss, SL, Hunwicks, R, and Twist, C. Concurrent validity of a rugby-specific Yo-Yo intermittent recovery test (level 1) for assessing match-related running performance. J Strength Cond Res 35(1): 176-182, 2021-This study investigated the concurrent validity of a rugby-specific high-intensity intermittent running test against the internal, external, and perceptual responses to simulated match play. Thirty-six rugby league players (age 18.5 ± 1.8 years; stature 181.4 ± 7.6 cm; body mass 83.5 ± 9.8 kg) completed the prone Yo-Yo Intermittent Recovery Test (Yo-Yo IR1), of which 16 also completed the Yo-Yo IR1, and 2 × âˆ¼20 minute bouts of a simulated match play (rugby league match simulation protocol for interchange players [RLMSP-i]). Most likely reductions in relative total, low-speed and high-speed distance, mean speed, and time above 20 W·kg-1 (high metabolic power [HMP]) were observed between bouts of the RLMSP-i. Likewise, rating of perceived exertion (RPE) and percentage of peak heart rate (%HRpeak) were very likely and likely higher during the second bout. Pearson's correlations revealed a large relationship for the change in relative distance (r = 0.57-0.61) between bouts with both Yo-Yo IR1 tests. The prone Yo-Yo IR1 was more strongly related to the RLMSP-i for change in repeated sprint speed (r = 0.78 cf. 0.56), mean speed (r = 0.64 cf. 0.36), HMP (r = 0.48 cf. 0.25), fatigue index (r = 0.71 cf. 0.63), %HRpeak (r = -0.56 cf. -0.35), RPEbout1 (r = -0.44 cf. -0.14), and RPEbout2 (r = -0.68 cf. -0.41) than the Yo-Yo IR1, but not for blood lactate concentration (r = -0.20 to -0.28 cf. -0.35 to -0.49). The relationships between prone Yo-Yo IR1 distance and measures of load during the RLMSP-i suggest that it possesses concurrent validity and is more strongly associated with measures of training or match load than the Yo-Yo IR1 using rugby league players.

The influence of` preseason training phase and training load on body composition and its relationship with physical qualities in professional junior rugby league players.

This study investigated changes in body composition in relation to training load determined using RPE and duration (sRPE), and its relationship with physical qualities over a preseason period. Sixteen professional academy players (age = 17.2 ± 0.7 years; stature = 179.9 ± 4.9 cm; body mass = 88.5 ± 10.1 kg) participated in the study. Body composition was assessed before and after each training phase and physical qualities assessed at the start and end of preseason. Across the whole preseason period, skinfold thickness, body fat percentage and fat mass were most likely lower (ES = -0.73 to -1.00), and fat free mass and lean mass were likely to most likely higher (ES = 0.31 to 0.40). Results indicated that the magnitude of change appeared phase-dependent (ES = -0.05 to -0.85) and demonstrated large individual variability. Changes in physical qualities ranged from unclear to most likely (ES = -0.50 to 0.64). Small to moderate correlations were observed between changes in body composition, and TL with changes in physical qualities. This study suggests training phase and TL can influence a player's body composition; that large inter-participant variability exists; and that body composition and TL are related to the change in physical qualities.

A Reliable Testing Battery for Assessing Physical Qualities of Elite Academy Rugby League Players.

Dobbin, N, Hunwicks, R, Highton, J, and Twist, C. A reliable testing battery for assessing physical qualities of elite academy rugby league players. J Strength Cond Res 32(11): 3232-3238, 2018-This study assessed the interday reliability of a testing battery for the assessment of physical qualities of rugby league players. Fifty players (age 17.1 ± 1.1 years; stature 181.3 ± 6.3 cm; and body mass 89.0 ± 11.6 kg) from 3 Super League academies participated in this study. Tests of countermovement jump performance, 10- and 20-m sprint performance, change of direction, medicine ball throw, and a modified Yo-Yo Intermittent Recovery Test Level 1 (prone Yo-Yo IR1) were completed on 3 separate occasions. Between-day intraclass correlation coefficient, typical error (TE), coefficient of variation, and the smallest worthwhile change (SWC) were calculated to determine the reliability and sensitivity of each measure. Individual tests (except medicine ball throw) were not systematically different between trials (p > 0.05), with an interday variability that was <10%. In all instances, the TE was larger than the calculated SWC change, although variability was less than that typically observed after a training intervention or specific training period (i.e. preseason). Using a magnitude-based inference approach, we present the required change for all performance tests to be 75% confident and the change is beneficial. This simple and time efficient testing battery is sufficiently reliable to detect previously observed changes in a range of physical qualities of rugby league players.

Validity of an Isometric Midthigh Pull Dynamometer in Male Youth Athletes.

Till, K, Morris, R, Stokes, K, Trewartha, G, Twist, C, Dobbin, N, Hunwicks, R, and Jones, B. Validity of an isometric midthigh pull dynamometer in male youth athletes. J Strength Cond Res 32(2): 490-493, 2018-The purpose of this study was to investigate the validity of an isometric midthigh pull dynamometer against a criterion measure (i.e., 1,000-Hz force platform) for assessing muscle strength in male youth athletes. Twenty-two male adolescent (age 15.3 ± 0.5 years) rugby league players performed 4 isometric midthigh pull efforts (i.e., 2 on the dynamometer and 2 on the force platform) separated by 5-minute rest in a randomized and counterbalanced order. Mean bias, typical error of estimate (TEE), and Pearson correlation coefficient for peak force (PF) and peak force minus body weight (PFBW) from the force platform were validated against peak force from the dynamometer (DynoPF). When compared with PF and PFBW, mean bias (with 90% confidence limits) for DynoPF was very large (-32.4 [-34.2 to -30.6] %) and moderate (-10.0 [-12.8 to -7.2] %), respectively. The TEE was moderate for both PF (8.1 [6.3-11.2] %) and PFBW (8.9 [7.0-12.4]). Correlations between DynoPF and PF (r 0.90 [0.79-0.95]) and PFBW (r 0.90 [0.80-0.95]) were nearly perfect. The isometric midthigh pull assessed using a dynamometer underestimated PF and PFBW obtained using a criterion force platform. However, strong correlations between the dynamometer and force platform suggest that a dynamometer provides an appropriate alternative to assess isometric midthigh pull strength when a force platform is not available. Therefore, practitioners can use an isometric midthigh pull dynamometer to assess strength in the field with youth athletes but should be aware that it underestimates peak force.

Validity of a Jump Mat for assessing Countermovement Jump Performance in Elite Rugby Players.

This study determined the validity of the Just Jump System® (JJS) for measuring flight time, jump height and peak power output (PPO) in elite rugby league players. 37 elite rugby league players performed 6 countermovement jumps (CMJ; 3 with and 3 without arms) on a jump mat and force platform. A sub-sample (n=28) was used to cross-validate the equations for flight time, jump height and PPO. The JJS systematically overestimated flight time and jump height compared to the force platform (P<0.05), but demonstrated strong associations for flight time (with R2=0.938; without R2=0.972) and jump height (with R2=0.945; without R2=0.987). Our equations revealed no systematic difference between corrected and force platform scores and an improved the agreement for flight time (Ratio limits of agreement: with 1.00 vs. 1.36; without 1.00 vs. 1.16) and jump height (with 1.01 vs. 1.34; without 1.01 vs. 1.15), meaning that our equations can be used to correct JJS scores for elite rugby players. While our equation improved the estimation of PPO (with 1.02; without 1.01) compared to existing equations (Harman: 1.20; Sayers: 1.04), this only accounted for 64 and 69% of PPO.

Estimates of Energy Intake and Expenditure in Elite Female Touch Players During an International Tournament.

This study assessed energy intake and expenditure of international female touch players during an international tournament. Energy intake (food diary) and expenditure (accelerometer, global positioning system) were recorded for 16 female touch players during a four-day tournament, competing in 8.0 ± 1.0 matches; two on Days 1, 2, and 4, and three on Day 3. Total daily energy expenditure (43.6 ± 3.1 Kcal·kg-1 body mass (BM)) was not different (p > .05) from energy intake (39.9 ± 9.4 Kcal·kg-1 BM). Carbohydrate intakes were below current recommendations (6-10 g·kg-1 BM) on Days 1 (4.4 ± 0.6 g·kg-1 BM) and 3 (4.7 ± 1.0 g·kg-1 BM) and significantly below (p < .05) on Day 2 (4.1 ± 1.0 g·kg-1 BM). Protein and fat intakes were consistent with recommendations (protein, 1.2-2.0 g·kg-1 BM: fat, 20-35% total Kcal) across Days 1-3 (protein, 1.9 ± 0.8, 2.2 ± 0.8, and 2.0 ± 0.7 g·kg-1 BM; fat, 35.6 ± 6.8, 38.5 ± 6.4, and 35.9 ± 5.4% total Kcal). Saturated fat intakes were greater (p < .05) than recommendations (10% total Kcal) on Days 1-3 (12.4 ± 2.9, 14.2 ± 5.1, and 12.7 ± 3.5% total Kcal). On average, female touch players maintained energy balance. Carbohydrate intakes appeared insufficient and might have contributed to the reduction (p < .05) in high-intensity running on Day 3. Further research might investigate the applicability of current nutrition recommendations and the role of carbohydrate in multimatch, multiday tournaments.

Factors associated with non-specific low back pain in field hockey: A cross-sectional study of Premier and Division One players.

OBJECTIVE: To determine the extent to which various factors are associated with greater or lesser odds of reporting non-specific low back pain (NS-LBP) in field hockey. METHODS: To meet the objective of the study, a cross-sectional study design was used with a purposive sampling strategy. A total of 194 responses (~18% of those accessible) from Premier and Division One players within the UK were received using a UK-based online survey. Data collected included information on NS-LBP, participant characteristics, injury history, training related factors, and work and personal factors. The overall and category-specific prevalence of NS-LBP was calculated. Univariable and multivariable logistic regression was used in conjunction with clinical value to identify associations. RESULTS: The overall prevalence of NS-LBP was 44.0%, with this varying from 23.5 to 70.0% for categories with responses of "yes" and "no" to experiencing NS-LBP. A total of ten individual factors associated with a greater odds ratio (OR) of reporting NS-LBP (OR = 1.43-7.39) were identified in Premier and Division One players. Five individual factors were associated with reduced odds (OR = 0.11-0.60) of reporting NS-LBP. Seven factors (age, stature, playing position, playing internationally, performing a drag flick, low back stiffness/tightness and occupational factors) were deemed particularly pertinent to those working in field hockey given the magnitude of association and clinical value to clinicians. CONCLUSIONS: Clinicians working in field hockey can consider the key risk factors identified in this study that are associated with NS-LBP when assessing injury risk, movement screening approaches, and overall athlete management.

The effects of person-centred active rehabilitation on symptoms of suspected Chronic Traumatic Encephalopathy: A mixed-methods single case design.

OBJECTIVE: The objective was to investigate the effectiveness of a person-centred active rehabilitation programme on symptoms associated with suspected Chronic Traumatic Encephalopathy (CTE). This was accomplished by (1) assessing the effect that a person-centred active rehabilitation programme had on participant symptoms, and (2) exploring how temporal contextual factors affected the participants' experience with, and perceived effectiveness of, the active rehabilitation programme. METHODS: A twelve-month mixed-methods single case experimental research design was used with six cases (participants). Individual cases were involved in a 51-week study period including an initial interview and three-week baseline phase. Cases were then randomly allocated to one of two n-of-1 study designs (i.e., A-B, B-A, B-A, A-B or B-A, A-B, A-B, B-A) where A and B represent a non-intervention and intervention phase, respectively. Interviews were conducted regularly throughout the study whilst outcome measures were assessed at each follow-up. Analysis of the data included visual, statistical, and qualitative analysis. RESULTS: Visual and statistical analysis of cognitive and executive function, and mindful attention, demonstrated trivial-to-large effects with the summary reflecting positive or unclear results. A mixed picture was observed for mood and behaviour with effects considered trivial-to-large, and the summary demonstrating positive, unclear and negative effects. Qualitative analysis indicated a perceived improvement in outcome measures such as memory, attention, anxiety, and emotional control despite mixed quantitative findings whilst a clear impact of contextual factors, such as COVID-19, the political atmosphere, exercise tolerance, programme progression, and motivation were evident during the intervention. CONCLUSIONS: This study has provided primary-level evidence to suggest active rehabilitation as a potential intervention for the management of suspected CTE symptoms. This study has also demonstrated the benefit of a person-centred approach to both clinical research and practice, particularly by considering contextual factors for a better understanding of an intervention effect.

A international cross-sectional study examining knowledge and attitudes towards sport-related concussion in Touch.

OBJECTIVE: To determine the current level of knowledge and attitudes towards sport-related concussion (SRC) amongst key stakeholders in touch rugby. DESIGN: An international cross-sectional study. Participants n = 141 (male, n = 88; female, n = 53) from 15 Touch Associations. MAIN OUTCOME MEASURE: Online questionnaire including non-validated sections captured participant characteristics, first aid training, previous concussion, awareness of SRC guidelines, combined with Rosenbaum Concussion Knowledge and Attitudes Survey. Distributed online to Touch athletes internationally. Concussion knowledge index (CKI) and attitude index (CAI) scores were calculated. A linear regression was performed to determine whether awareness of concussion, previous concussion and role affected CKI and CAI scores. RESULTS: Median CKI and CAI scores were 21 ± 2.0 and 67 ± 6.3, respectively, across all key stakeholders. 39% of participants reported a previous SRC and 32% of respondents were aware of concussion guidelines form their Association. Regression analysis showed minimal influence of key contextual information on CKI and CAI. CONCLUSIONS: Findings suggest that key stakeholders in Touch have high to very high knowledge and safe attitudes towards SRC. However, there were some areas where further improvement could be targeted by those involved in Touch such as individual associations at the direction of the sport's governing body.

A cross-sectional study examining Nigerian footballers' knowledge and attitudes towards sport-related concussion and associated contextual factors.

OBJECTIVE: To examine Nigerian footballers' knowledge and attitudes towards sport-related concussion (SRC) and associated contextual factors. METHODS: A cross-sectional study design was used with an online questionnaire distributed to Nigerian footballers affiliated with a registered team. The questionnaire included demographic information and the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS-ST). The concussion knowledge index (CKI, 0-25) and attitude index (CAI, 15-75) were calculated. The association between various contextual factors with "high" knowledge and attitude were determined. RESULTS: A total of 331 participants completed the questionnaire from 10 football clubs. Mean CKI and CAI scores were 14.0 ± 3.0 (56.2 ± 13.2%) and 54.5 ± 9.4 (72.6 ± 12.5%), respectively, and the association between scores was considered large (r = 0.530; 28%). A small proportion (n = 25; 7.6%) of participants reported a previous diagnosis of an SRC, with a further 40 (12.1%) suspecting they have suffered SRC. Thirty-five participants (10.6%) reported sustaining a SRC but did not seek medical help. Results indicated that men were at 4.8 times greater odds of having a "high[er]" CKI than women, and that those with 5-10 years playing experience had lower odds of a "high" CKI than those with >10 years' experience. Men had 7 times greater odds of having a "high" CAI than women. CONCLUSION: The results of this study suggest that Nigerian footballers have a moderate level of SRC knowledge, satisfactory symptom recognition, and high SRC attitudes. Those working with Nigerian football may consider these findings when seeking strategies to improve concussion knowledge, potentially by improving attitudes and considering sex and playing experience.

The Effect of Dietary Nitrate on the Contractile Properties of Human Skeletal Muscle: A Systematic Review and Meta-Analysis.

The propose of this study was to systematically review the current literature and meta-analyse the effects of dietary nitrate (NO3-) supplementation on the contractile properties of skeletal muscle. A literature search of three databases was conducted in June 2021, with 19 studies meeting the inclusion criteria. Studies were included if a placebo versus dietary NO3--only supplementation protocol was used in healthy human, assessed muscle contraction or activities that was < 3 minutes in duration and focused on the lower-body. For the meta-analysis, a pooled standardised mean difference (SMD) was determined for maximum voluntary contraction (MVC) (n = 11), cycling, running and inertial load squad peak power output (PPO) (n = 8), mean power output (MPO) (n = 6) and time to PPO (n = 4). NO3- supplementation demonstrated a small improvement in PPO (SMD = 0.25, P = 0.030) and MPO (SMD = 0.28, P = 0.030) when compared to the placebo. NO3- also resulted in an enhanced time to PPO (SMD = -0.78, P < 0.001). There was no clear effect of NO3- on isometric MVC (SMD = 0.03, P = 0.758). This review reports that NO3- supplementation may have potential to enhance PPO, MPO and time to PPO during dynamic exercise, which may transfer to brief explosive actions commonly observed in sporting activities. Due to the variability in studies, we encourage researchers to use this work to explore areas where evidence in lacking and standardize the study design and procedures.Key teaching pointsFindings from this meta-analysis highlight the potential positive ergogenic effect of dietary NO3-supplementation on PPO, MPO and time to PPO during short duration (<10 s) dynamic exercise.NO3- supplementation might be considered as an ergogenic aid when executing power-based actions (e.g., 100 m sprinter or weightlifter).This review highlights that further research is required to address some of the contrasting findings presented here using a standardised procedure to allow for improved synthesis.

Perspectives on relative energy deficiency in sport (RED-S): A qualitative case study of athletes, coaches and medical professionals from a super league netball club.

BACKGROUND: Research into relative energy deficiency in sport (RED-S) has increased substantially over recent years given the impact on athletes' health and performance. Most studies have considered sports that place emphasis on the aesthetics, endurance, or weight-restriction. Fewer studies exist in team sports. Netball is a team sport yet to be explored despite players potentially being at risk of RED-S given the high training volumes, sporting culture, internal and external pressures, and small network of coaches and medical professionals. A qualitative case study was used to explore the perspective of athletes, coaches, and medical professionals on RED-S. METHODS: Semi-structured interviews were conducted with 13 players, 4 coaches and 4 medical professionals affiliated to a Super League club. Interviews were recorded and transcribed verbatim. The data was analysed using thematic analysis. RESULTS: Five main themes were identified in this study. Awareness of RED-S amongst athletes and coaches was generally inadequate whereas medical professionals had some awareness of RED-S. Some athletes used contraception to reduce discomfort/pain during menstruation whilst others expressed concerns around long-term contraceptive use and previous menstrual cycle disturbance. Sporting demands, individual and contextual factors, and a preoccupation with body image were associated with nutritional restriction, whilst appearance was a source of internal and external pressure. External pressures also extended to coaches, assessments/feedback, social media, and commentary. Strategies suggested to reduce the risk of RED-S included "hard hitting cases", multidisciplinary team involvement, and support from the governing body. CONCLUSION: The findings of this study provide insight into factors potentially associated with the risk of RED-S from an athletes, coaches, and medical professional perspective. This insight can be used to increase overall awareness of RED-S in key stakeholders as well as improve the recognition for the pressures netball athletes face that might alter the level of risk.

Individual and situational factors affecting the movement characteristics and internal responses to Touch match-play during an international tournament.

PURPOSE: To examine the influence of individual and situational factors on the movement characteristics and internal responses of players to an international Touch tournament. METHODS: Using 47 International Touch players (25 men and 22 women), the associations between the movement characteristics and internal responses with individual (sprint, glycolytic test, Yo-Yo intermittent recovery test level 1 [Yo-Yo IR1], jump performance and well-being) and situational (sex, squad, position, competition day, points scored/conceded, result, and opposition rank) factors were examined using linear mixed modelling. RESULTS: Yo-Yo IR1 distance was associated with all movement characteristics and internal responses (r = -0.29 to 0.37), whilst sprint and glycolytic times only influenced mean heart rate (HRmean) (r = 0.15) and high-speed distance (r = 0.10), respectively. Sex influenced high-speed distance (r = -0.41), whilst squad was associated with playing time and HRmean (r = -0.10-0.33). Other associations included: playing position with all movement characteristics (r = -0.67-0.81); points conceded with relative distance (r = -0.14); winning with high metabolic power and session RPE (r = -0.07-0.09), and opposition rank with HRmean and RPE (r = 0.11-0.35). CONCLUSIONS: Individual and situational factors can influence the movement characteristics and internal responses to Touch and should be considered when developing the characteristics of players and interpreting responses to match-play.

Sprint mechanical properties of professional rugby league players according to playing standard, age and position, and the association with key physical characteristics.

BACKGROUND: This study determined the influence of playing standard, age, and position on the horizontal force-velocity (FV) properties of rugby league players, and the association with other physical characteristics. METHODS: This observational study used a cross-sectional study design with a range of physical characteristics recorded from 132 players from 5 Super League clubs. Sprint data was used to derived theoretical maximal force (F0) and velocity (V0), power (Pmax), maximal rate of force (RFmax) and the rate of decrease in RFmax (DRF). Differences between playing standard, age groups and playing positions were determined (P value and standardized mean difference [SMD]) along with correlational analysis to assess the relationship between FV properties and key physical characteristics. RESULTS: Senior players reported lower split times (SMD=-0.26-0.59, P=0.002-0.017), and higher absolute F0, Pmax and V0 (SMD=0.47-0.78, P<0.001-0.010). Players aged <21 years reported higher split times and lower absolute F0 compared to 21-26 years (SMD=-0.84-0.56, P<0.001-0.04) and a lower V0 than >26 years (SMD=-0.40, P=0.002). Hit-up forwards were slower than outside backs (SMD=-0.30-0.89, P<0.001-0.042), though produced the highest absolute F0 and Pmax. Sprit times, F0, V0, Pmax and RFmax were associated with change of direction and countermovement jump performance, whilst FVslope and DRF were associated with countermovement jump performance only. F0 and Pmax were associated with medicine ball throw distance (r=0.302-0371, P≤0.001). There was no association with prone Yo-Yo IR1 distance (r=-0.16-0.09, P=0.060-0.615). CONCLUSIONS: These results provide insight into the horizontal FV properties with reference to key subgroups and highlights several associations with other characteristics across large sample of rugby league players. The result of this study should be used when interpreting the sprint ability of rugby league players, planning the long-term development of youth players, and inform program design for all.

Deteriorations in physical qualities during a 10-week unsupervised off-season period in academy rugby union players.

PURPOSE: To determine the changes in physical qualities of academy rugby union players over a 10-week unsupervised off-season period. METHODS: Body mass, jump height, sprint performance, and intermittent running (30:15 IFT) of 64 academy rugby union players (age = 17.2 ± 0.4 y) were recorded before and after the off-season. RESULTS: Changes in body mass (+1.4 ± 1.3 kg), countermovement jump (-2.2 ± 1.2 cm), squat jump (-1.5 ± 1.8 cm), 10 m sprint (+0.06 ± 0.05 s), 40 m sprint (+0.13 ± 0.11 s) and 30:15 IFT (-0.8 ± 0.8 kmYh-1) were observed (P < 0.001, d = -1.77 to 0.47). Only changes in body mass were greater in forwards than backs (P = 0.036, d = 0.46). Players with higher end-of-season body mass, squat jump and 30:15 IFT had greater off-season changes (P = < 0.001 to 0.044; d = 0.63 to 0.94), whilst the pre-post difference in body mass influenced CMJ (P = 0.005, d = 0.75) and 10 m momentum change (P < 0.001, d = 1.61). CONCLUSION: Understanding the individuality of the changes in physical qualities of academy rugby union players during the off-season is important to ensure players return safely to pre-season training loads.

The effects of active rehabilitation on symptoms associated with tau pathology: An umbrella review. Implications for chronic traumatic encephalopathy symptom management.

OBJECTIVE: This review sought to address an evidence gap and lay a foundation for future Chronic Traumatic Encephalopathy (CTE) management studies by evaluating and appraising the literature which reports the effect that active rehabilitation has on other tauopathies, a group of conditions with hyperphosphorylation and aggregation of tau protein that can lead to neurodegeneration. DESIGN: Umbrella review. DATA SOURCE: Meta-analyses and systematic reviews were identified using CINAHL, Medline, Cochrane, Web of Science, PubMed, and SPORTDiscus. ELIGIBILITY: Systematic review or meta-analyses that examine the effect active rehabilitation has on outcome measures of symptoms associated with CTE. Studies with men and women diagnosed with Alzheimer's disease, Parkinson's disease, Lewy Body dementia, Frontotemporal degeneration/dementia or Corticobasal degeneration. All types of active rehabilitation were included. Control group was usual care, no intervention, or light-intensity physical activity. RESULTS: Twelve reviews were included. A large pooled standardized mean difference (SMD) was observed for balance (SMD = 0.88, P<0.001) and motor function (SMD = 0.83, P<0.001). A moderate pooled SMD was observed for cognitive function (SMD = 0.66, P<0.116). A small pooled SMD was observed for mobility (SMD = 0.45, P = 0.002). A trivial pooled SMD was observed for gait speed/velocity (SMD = 0.11, P = 0.372). No findings for mood/behavioral symptoms. All pooled effects demonstrated substantial to considerable heterogeneity (74.3% to 91.9%, P<0.001). CONCLUSIONS: A positive effect of active rehabilitation was observed in patients with tau pathologies suffering from motor, vestibular and cognitive impairments supporting the use of active rehabilitation for CTE management; however, the findings need to be considered with caution given the limited research in some of the tau pathologies, large between-study heterogeneity and wide 95% prediction intervals.

Predictors of time to return to play and re-injury following hamstring injury with and without intramuscular tendon involvement in adult professional footballers: A retrospective cohort study.

OBJECTIVES: In one English Premier League football club over four seasons, 1) describe the number of hamstring strain injuries (HSI) sustained using the British Athletics Muscle Injury Classification (BAMIC); 2) determine if intramuscular tendon HSI influenced the time to return to play (TTRTP) and reinjury rate; 3) determine the predictors of TTRTP and reinjury. DESIGN: Retrospective cohort design. METHODS: All first team players who sustained a HSI between 2014 and 2018 were included. Players underwent an MRI scan that was graded by a Radiologist using the BAMIC (0a-4) criteria. TTRTP, reinjury rate and information on suspected predictors were recorded. RESULTS: Thirty-five HSI experienced by 24 players (age = 26 ±â€¯4 years) were recorded over the 4 seasons. There was a difference in TTRTP between grades 1a and 2c (P = 0.007), but not between 2b and 2c (P = 0.845). Grade of HSI (P ≤ 0.001) and removal of the player (P < 0.001) were predictors of TTRTP, with each increase in grade resulting in an additional 3 days of TTRTP, and being removed, an additional 11 days. Grade and all other predictors did not influence reinjury rate, albeit higher odds were evident for previous HSI, experiencing the HSI during sprinting, passing a ball or stretching, and reported increase days of pain during walking. CONCLUSIONS: HSIs extending into the intramuscular tendon (2b cf. 2c) did not influence TTRTP or re-injury, albeit TTRTP was affected by the BAMIC grade and if the player was removed from activity.

The effects of a group exercise and education programme on symptoms and physical fitness in patients with fibromyalgia: a prospective observational cohort study.

PURPOSE: Given the limited attention on a combined exercise and education approach for those with chronic musculoskeletal pain disorder such as fibromyalgia, the purpose of this was to evaluate the efficacy of a combined exercise and education programme on symptoms and physical fitness in participants with fibromyalgia. MATERIALS AND METHODS: Using a prospective observational cohort study, participants with fibromyalgia (n = 75) volunteered. The 6-minute-walk-test (6MWT) and revised-fibromyalgia-impact-questionnaire (FIQR) were used before, after (6 weeks) and 6-months post an exercise and education programme. RESULTS: Forty-three participants (age = 49.7 ± 15.2 y) completed the 6-week programme, with improvements observed for the 6MWT (67 m, p < 0.001) and FIQR (11 AU, p < 0.001), though only two (6MWT) and five (FIQR) participants, respectively, achieved the minimal clinically important difference (MCID). Using 74% of the intial sample, a small-to-moderate improvement in scores were observed across the 6-month period for the 6MWT (37 m, p = 0.002) and FIQR (3 AU, p = 0.01), with only two participants achieving the MCID for the 6MWT. CONCLUSIONS: The results in this study indiciate small-to-moderate improvements in the 6MWT and FIQR after a combined exercise and education programme, with direct delivery being more effective.Implications for rehabilitationA six-week exercise and education programme elicited moderate, short-term (6 weeks) benefits on physical fitness and key symptoms in patients with fibromyalgia.On average, these benefits were sustained in the long-term (6 months) following the programme but were small-to-moderate and lower than the MCID.Regular follow-up may be required to improve adherence to the education and exercise programme and maintain or increase the observed improvements in 6MWT and FIQR.

Effects of a 12% carbohydrate beverage on tackling technique and running performance during rugby league activity: A randomised, placebo-controlled trial.

The purpose of this study was to investigate the effects of a 12% carbohydrate (CHO) beverage on tackling technique and running performance during rugby league activity. Using a double-blind, placebo-controlled, randomised, crossover design, 15 academy rugby league players ingested a 250 ml bolus of a 12% CHO solution (30 g maltodextrin and 30 g sucrose in 500 ml) 15 minutes before two bouts of rugby activity. The rugby league match simulation for interchange players was used to standardise the movement patterns of activity and provide reliable outcome measures, whilst also reflecting the duration of a typical field-based conditioning session. Measures of tackling technique, external responses (e.g., fatigue index from sprint data) and rating of perceived exertion (RPE) were recorded throughout. Gut discomfort was measured before each bout. The interaction effect was largely compatible with the hypothesis for relative distance (P<0.001, η2 = 0.217) and fairly compatible for tackling technique (P = 0.068, η2 = 0.0640). The time effect for tackling technique, relative and high-intensity distance, sprint, and sprint to contact velocity, time at high metabolic power, PlayerLoad™, and RPE (all P<0.05; η2 = 0.131-0.701) was compatible with the hypothesis. Data for tackling technique, relative and high-intensity distance, sprint, and sprint to contact velocity, sprint, and sprint to contact fatigue index (all P<0.05; η2 = 0.189-0.612) was compatible with a supplement effect overall despite few differences in the pattern of change (interaction). Minimal gut discomfort was reported for the CHO (bout 1 = 27 ± 17; bout 2 = 23 ± 17 AU) and placebo (bout 1 = 23 ± 18 AU; bout 2 = 24 ± 13) trials. This study shows that a 12% CHO beverage before two bouts of standardised rugby activity is a practical and effective strategy for retaining tackling technique, increasing external responses, and reducing RPE without compromising gut comfort.