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Context: Pertrochanteric hip fractures in sportive young adults are mainly caused by a high-energy trauma and treated in the same way as in the older population, using an osteosynthesis immediately followed by a rehabilitation program for several months. The current standard is not to remove osteosynthesis material, similar to the case of older patients. CasePresentation: A 45-year-old male cyclist experienced a right pertrochanteric femoral fracture, treated with cephalomedullary nails. After 9 months of adequate rehabilitation, weakness of the quadriceps musculature and functional complaints persisted, objectified through an isokinetic strength test and a significantly reduced score on the Hip Disability and Osteoarthritis Outcome Score questionnaire. The patient was unable to return to his previous level of cycling performance. Management and Outcome: After exclusion of structural bone complications, nerve injury, and central sensitization, the functional complaints and strength deficiency were hypothesized to be related to the osteosynthesis material. Therefore, the hardware was removed 9 months after the first surgery, and the rehabilitation was continued for another 20 weeks. Very soon after the removal of the hardware, the functional complaints disappeared with a remarkable improvement of the Hip Disability and Osteoarthritis Outcome Score. The isokinetic strength test showed complete recovery of muscle strength 20 weeks after osteosynthesis removal, and preinjury cycling performance values were obtained 9 months posthardware removal. Conclusion: Despite an adequate rehabilitation following a hip fracture, sporty young adults may fail to reach their previous level of functioning. Osteosynthesis removal may be indicated in this sportive population to reach complete muscle strength and functional recovery. The management of hip fractures in the sportive young adult and the identification of patients who may benefit from removal of the hardware require more research. [ABSTRACT FROM AUTHOR]

Context: The Upper Limb Functional Index (ULFI) is a popular tool with valid psychometric properties to assess upper limb function in patients with musculoskeletal conditions. The aim of the study was to cross-culturally adapt and validate the German version of the ULFI. Design: Cross-cultural validation. Methods: A 2-stage cross-cultural adaptation of the ULFI was performed according to international guidelines through consecutive forward and backward translations. Psychometric properties of internal consistency, test–retest reliability, criterion, face and content validity, and factor structure were determined from the included German participants suffering from upper limb conditions (n = 100), who fulfilled the following inclusion criteria: (1) older than 18 years old, (2) German as native language, and (3) medical diagnosis of musculoskeletal upper limb condition. Participants completed the ULFI; Disabilities of the Arm, Shoulder, and Hand; EuroQol Health Questionnaire 5 Dimensions; and Short Form-12 questionnaires. Results: The ULFI-G showed good internal consistency (α =.88); excellent test–retest reliability (intraclass correlation coefficient2:1 =.98); directly strong correlation with Disabilities of the Arm, Shoulder, and Hand (r =.84); fair correlation with Disabilities of the Arm, Shoulder, and Hand-sport (r =.54); inversely fair correlation with EuroQol Health Questionnaire 5 Dimensions (r = −.62); and Short Form 12's physical health domain (r = −.7). A single-factor structure was revealed. Conclusions: The ULFI-G showed adequate psychometric properties and proved to be a valid tool for upper limb functional assessment in German population. [ABSTRACT FROM AUTHOR]

Maximum running speed is a performance determinant in para-athletics and cerebral palsy football. Sixty international para-athletes with brain impairments completed five activity-limitation tests (standing broad jump, four bounds for distance, split jumps, 10-m speed skip, and running in place) and two criterion tests (40-m sprint and modified agility test). The same three tests (standing broad jump, four bounds for distance, and 10-m speed skip) that correlated with running performance in nondisabled runners (.67 < r < −.82; p <.05; 75% of variance) also correlated in para-athletes with brain impairments (.41 < r < −.62; p <.01; 55% of variance). Standing broad jump, four bounds for distance, split jumps, and running in place also correlated with change-of-direction speed (.43 < r < −.63; p <.01; 58% of variance). Results indicate that methods of classification for para-athletics with nondisabled runners are also valid with para-athletes with brain impairments, and new sport-specific relationships were found for assessing the performance of rapid and short sprints toward different directions, specific of a team para-sport like cerebral palsy football. [ABSTRACT FROM AUTHOR]

The Performance Index (P-Index) is a measure for evaluating mobility-related dual-task performance in older adults. The identification of specific clinicodemographic factors predictive of P-Index scores, however, remains unclear. This cross-sectional study analyzed data from 120 community-dwelling older adults (average age 71.3 ± 11.23 years) to explore clinicodemographic variables that influence P-Index scores during the instrumented timed up and go test. Unadjusted analyses suggested several factors, including age, gender, body mass index, Mini-Mental Status Examination scores, functional reach test performance, history of falls, ethnicity, Geriatric Depression Scale scores, alcohol consumption, and educational levels, as potential predictors of P-Index. However, adjusted multinomial multiple regression analysis revealed Geriatric Depression Scale and Mini-Mental Status Examination scores as the exclusive independent predictors of P-Index classifications, segmented into high, intermediate, or low (percentiles ≤ 25, 26–74, or ≥ 75, respectively). A significant association was observed between the manifestation of depressive symptoms, lower Mini-Mental Status Examination scores, and reduced cognitive–motor performance. The findings implicate depressive symptoms and low cognitive performance as substantial impediments to optimal dual-task mobility within this cohort. Further studies are warranted to examine the efficacy of cognitive stimulation and antidepressant therapy, in augmenting mobility-related dual-task performance among older adults. [ABSTRACT FROM AUTHOR]

Context: High secondary injury rates after orthopedic surgeries have motivated concern toward the construct validity of return-to-sport test batteries, as it is evident that common strength and functional assessments fail to elicit pertinent behaviors like visual search and reactive decision making. This study aimed to establish the test–retest reliability of 2 reactive agility tasks and evaluate the impact of visual perturbation on physical performance. Methods: Fourteen physically active individuals completed 2 agility tasks with reaction time (ie, 4 corner agility), working memory, and pathfinding (ie, color recall) components. Participants completed both tasks 4 times in 2 sessions scheduled 7 days apart. Outcomes included performance metrics of reaction time, time to target, number of targets, and total time assessed with reactive training timing gates. To assess test–retest reliability, we used intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC). Stroboscopic goggles induced visual perturbation during the fourth trial of each task. To assess the effect of visual perturbation, we used paired t tests and calculated performance costs. Results: The 4-corner agility task demonstrated excellent reliability with respect to reaction time (ICC3,1 =.907, SEM = 0.13, MDC = 0.35 s); time to light (ICC3,1 =.935, SEM = 0.07, MDC = 0.18 s); and number of lights (ICC3,1 =.800, SEM = 0.24, MDC = 0.66 lights). The color recall task demonstrated good-to-excellent test–retest reliability for time to lights (ICC3,1 =.818–.953, SEM = 0.07–0.27, MDC = 0.19–0.74 s); test time (ICC3,1 =.969, SEM = 5.43, MDC = 15.04 s); and errors (ICC3,1 =.882, SEM = 0.19, MDC = 0.53 errors). Visual perturbation resulted in increased time to target (P =.022–.011), number of targets (P =.039), and total test time (P =.013) representing moderate magnitude degradation of performance (d = 0.55–0.87, performance costs = 5%–12%). Conclusions: Both tasks demonstrated acceptable test–retest reliability. Performance degraded on both tasks with the presence of visual perturbation. These results suggest standardized reactive agility tasks are reliable and could be developed as components of dynamic RTS testing. [ABSTRACT FROM AUTHOR]

Context: Sports-related concussions are commonly occurring injuries as a result of sports and recreation that may cause alterations in brain functioning. It is important to be able to evaluate the impact of these injuries on function to manage the injury recovery and ensure recovery. Recent literature suggests the use of objective evaluation strategies in a multifaceted approach to evaluate and manage these injuries. It is important to understand the relationships between the assessments and how best to utilize each assessment. The purpose of this study was to investigate if relationships exist between measures of vestibular function at baseline in assessments that may be used following sports-related concussions. Additionally, a secondary purpose was to determine if self-reported symptoms were related to performance on the assessments. This study aimed to identify if these assessments measured independent functions of the vestibulo–ocular reflex or if some redundancy existed among the assessment strategies. Design: A cross-sectional study design was used in a cohort of collegiate athletes ages 18–24. Methods: Participants completed demographics questionnaires, the Post-Concussion Symptom Scale, Gaze Stabilization Test, and Concussion Balance Test. Spearman rho correlations were used to examine the relationships between the measures. Results: One hundred and thirty-five collegiate athletes (82 males and 53 females) were included, representative of 3 sports (cheerleading, soccer, and football) with a mean age of 19.77 (1.42) years old. There were weak to moderate, significant relationships between measures of Gaze Stabilization Test and Concussion Balance Test errors (r =.20–.31, P =.001–.03). Conclusions: The direction of these relationships indicated that greater Concussion Balance Test errors were associated with greater Gaze Stabilization Test performance. These relationships may be attributed to the difficulty created by the foam conditions and the integration of more complex sensory tasks required to maintain balance during the more difficult conditions. [ABSTRACT FROM AUTHOR]

Context: Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. Case Presentation: Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). Management and Outcomes: The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. Conclusions: This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term. [ABSTRACT FROM AUTHOR]

Context: Injury-related fear and quadriceps strength are independently associated with secondary anterior cruciate ligament (ACL) injury risk. It is not known whether injury-related fear and quadriceps strength are associated, despite their individual predictive capabilities of secondary ACL injury. The purpose of this study was to examine the association between injury-related fear and quadriceps strength in individuals at least 1 year after ACL reconstruction (ACLR). Design: Cross-sectional study. Methods: Forty participants between the ages of 18 and 35 years at least 1 year post unilateral primary ACLR. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) and a standard isokinetic quadriceps strength assessment using the Biodex Isokinetic Dynamometer. Pearson Product-Moment correlations were used to examine the linear association between the TSK-11 scores and peak torque (in nanometers per kilogram) for each limb and between the TSK-11 scores and limb symmetry indices for each limb. Pearson Product-Moment correlation coefficients (r) were interpreted as very high (.90--1.00), high (.70--.90), moderate (.50--.70), low (.30--.50), and no correlation (.00--.30). Results: The average TSK-11 score was 18.2 (5.3), average ACLR peak quadriceps torque was 1.9 (0.50) N·m/kg, average contralateral peak quadriceps torque was 2.3 (0.48) N·m/kg, and average limb symmetry index was 85.3% (12.6%). There was no statistically significant correlation between the TSK-11 and peak quadriceps torque on the ACLR limb (r = .12, P = .46), the TSK-11 and contralateral limb (r = .29, P = .07), or the TSK-11 and limb symmetry index (r = -.18, P = .27). Conclusions: There was no association between kinesiophobia and peak isokinetic quadriceps strength in individuals at least 1 year post-ACLR. Both factors, independently, have been shown to influence risk of secondary injury in patients after ACLR. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether transcranial direct-current stimulation (tDCS) optimizes the performance of a wheelchair basketball player on precision tasks. Methods: A right-handed wheelchair basketball player (1.5 points functional class) with myelomeningocele (low lumbar level) participated in this case study. The tDCS neuromodulation protocol was applied throughout 10 interventions of 20 minutes with a current intensity of 2 mA, simultaneously with sport-specific training, 3 times a week for 4 weeks. Anodic stimulation was performed on the right cerebellar hemisphere (CB2) and cathodic stimulation in the left dorsolateral prefrontal cortex. A control participant was submitted to a sham-tDCS stimulation protocol for the same period. Functional performance was assessed before the intervention and after the 5th and 10th interventions using "pass accuracy," "free-throw shooting," and "spot shot" tests. Outcome measures were compared using percentage differences between preintervention, intermediate intervention, and postintervention values. Results: There was a gradual increase in the athlete's total and average scores in all tests performed, with an overall improvement of 78% between the baseline and final assessments, while the control participant had an overall improvement of 6.5%. Conclusion: The tDCS protocol was effective in improving performance in precision activities in a wheelchair basketball player. [ABSTRACT FROM AUTHOR]

We tested if a dance trial yielded improvements in physical function and cardiorespiratory fitness (CRF) in middle-aged/older Latino adults. Physical activity was assessed using the Community Healthy Activities Model Program for Seniors, physical function with the Short Physical Performance Battery (SPPB) protocol, and estimated CRF with the Jurca nonexercise test model. Multivariate analysis of covariance models found significant change in SPPB protocol total scores, F(1, 329) = 4.23, p =.041, and CRF, F(1, 329) = 5.16, p =.024, between the two study arms in favor of the dance group. Mediation models found moderate- to vigorous-intensity physical activity to mediate to mediate between group and SPPB scores (β = 0.054, 95% confidence interval [0.0142, 0.1247]). Moderate- to vigorous-intensity physical activity and total physical activity were found to partially mediate between group and CRF (β = 0.02, 95% confidence interval [−0.0261, 0.0751]), with the direct pathway no longer being significant (p >.05). This provides support for Latin dance programs to have an effect on SPPB protocol and CRF. [ABSTRACT FROM AUTHOR]

Androgen deprivation therapy (ADT) forms the cornerstone in the treatment of advanced prostate cancer. However, by suppressing testosterone ADT results in a decrease of skeletal muscle mass. In this narrative review, we explore the magnitude and mechanisms of ADT-induced muscle mass loss and the consequences for muscle strength and physical performance. Subsequently, we elucidate the effectiveness of supervised resistance exercise training as a means to mitigate these adverse effects. Literature shows that resistance exercise training can effectively counteract ADT-induced loss of appendicular lean body mass and decline in muscle strength, while the effect on physical performances is inconclusive. As resistance exercise training is feasible and can be safely implemented during ADT (with special attention for patients with bone metastases), it should be incorporated in standard clinical care for prostate cancer patients (starting) with ADT. [ABSTRACT FROM AUTHOR]

Objective: To rate athletes' functional ability and return to sport (RTS) success at the end of their individual, formal, medically prescribed rehabilitation after anterior anterior cruciate ligament (ACL) reconstruction. Methods: In our prospective multicenter cohort study, 88 (42 females) adults aged 18-35 years after acute unilateral ACL rupture and subsequent hamstring grafting were included. All patients were prospectively monitored during their rehabilitation and RTS process until the end of their formal rehabilitation and RTS release. As outcome measures, functional hop and jump tests (front hop, balance hops, and drop jump screening test) and self-report outcomes (Knee Injury and Osteoarthritis Outcome Score, ACL-RTS after injury) were assessed. Literature-based cut-off values were selected to rate each performance as fulfilled or not. Results: At 7.5 months (SD 2.3 months) after surgery, the percentage of participants meeting the functional thresholds ranged from 4% (Knee Injury and Osteoarthritis Outcome Score SPORT) and over 44% (ACL-RTS after injury sum score) to 59% (Knee Injury and Osteoarthritis Outcome Score activities of all daily living) in the self-report and from 29% (Balance side hop) to 69% (normalized knee separation distance) in performance testing. Only 4% fulfilled all the cut-offs, while 45% returned to the same type and level of sport. Participants who successfully returned to their previous sport (type and level) were more likely to be "over-cut-off-performers." Conclusions: The low share of the athletes who fulfilled the functional RTS criteria highlights the importance of continuing the rehabilitation measures after the formal completion to assess the need for and success of, inter alia, secondary-preventive therapies. [ABSTRACT FROM AUTHOR]

Context: The purpose of this study was to compare short-term clinical outcomes between meniscus procedures performed with anterior cruciate ligament reconstruction (ACLR), ACLR (ACLR-only), ACLR with meniscectomy/resection (ACLR-resect), and ACLR with meniscal repair (ACLR-repair) for bone patellar tendon bone grafts (BPTB) and hamstring tendon grafts, separately. Design: This was a cross-sectional study conducted in a controlled laboratory setting as part of a large point-of-care collaborative research program. Methods: This study included 314 participants (168 females; mean [SD]: age, 19.7 [4.8]) with primary unilateral ACLR with a BPTB or hamstring tendon. Patients were divided into 3 groups depending on meniscal procedure (ACLR-only, ACLR-resect, and ACLR-repair). Postsurgical testing included: isokinetic assessment of knee extension and flexion, single-leg hop tests, and patient-reported outcomes. Multivariate analysis of covariance compared differences between meniscal procedures on the battery of tests, and for each statistically significant variable an analysis of covariance assessed the effect of meniscal procedure within each graft type. Chi-square analysis assessed the influence of meniscal procedure on tests' pass rates defined as 90% of limb symmetry index. Results: BPTB: ACLR-only had greater hamstring strength than ACLR-resect (P = .05) and ACLR-repair (P = .005). ACLR-only had the highest proportion of participants to pass the hamstring strength test (P=.02). amstring tendon: ACLR-only (P=.03) and ACLR-resect (P=.003) had higher International Knee Documentation Committee scale scores than ACLR-repair. There was a significant difference in the proportion of participants who scored >90% limb symmetry index on the timed hop test (P = .05). Conclusions: The influence of meniscal repair on clinical outcomes is dependent on the graft choice. Following an ACLR with BPTB and a meniscal procedure, hamstring function should be more closely monitored for optimal short-term recovery. [ABSTRACT FROM AUTHOR]

The study compared superficial trunk muscle activity and postural control among an active extension subgroup of people with nonspecific chronic low back pain (AE-NSCLBP) with painfree controls during functional tasks. Thirty-two people (17 people with low back pain [LBP] and 15 painfree controls) participated in this study. Muscle activity of 5 trunk muscles and postural control were investigated during both standing tasks (eyes open/closed; single/double-leg balance) and dynamic functional tasks (spinal forward flexion and return, and a sit to stand transfer). Results showed that during single-leg standing, people with AE-NSCLBP exhibit higher muscle activity than painfree controls for 3 trunk muscles, especially with their eyes closed. There were no significant differences in muscle activity between eye conditions during double-leg standing and sit to stand transfer, forward flexion, and return from flexion. The AE-NSCLBP subgroup also demonstrated significantly impaired postural control (lower time to boundary) in 4 of 8 conditions, especially during single-leg standing and with their eyes closed. These findings show people with LBP typically demonstrated greater trunk muscle activity and poorer postural control while maintaining standing posture. This pattern was most evident when the postural challenge was higher, such as single-leg standing or with eyes closed. While this study design cannot infer causality, these findings have implications for LBP rehabilitation, particularly regarding approaches which seek to alter muscle activation among people with LBP. [ABSTRACT FROM AUTHOR]

There is mixed evidence on the role that biological sex plays in shoulder biomechanics despite known differences in musculoskeletal disorder prevalence between males and females. Additionally, advancing age may contribute to shoulder kinematic changes. The purpose of this study was to determine if sex and age influenced scapular and thoracohumeral kinematics during a range of functional tasks. Sixty healthy participants aged 19–63 years (30 males; 30 females) completed a functional task protocol while their upper limb motion was recorded. Scapular and humeral angles were calculated and compared with multiple linear regressions to assess the interaction effects of sex and age. Shoulder kinematics were not different between sex and age groups for many of the functional tasks. However, females had lower humeral external rotation in the overhead lift task (15°, P <.001), and less scapular anterior tilt angles in the forward transfer task (6°, P <.001) than males. Age was positively associated with humeral elevation (R2 =.330, P <.001) and scapular rotation (R2 =.299, P <.001) in the Wash Axilla task. There exist some kinematic differences between sex and with advancing age for select functional tasks, which should be considered for musculoskeletal disorder development. [ABSTRACT FROM AUTHOR]

Most people with intellectual disabilities have comorbid health conditions, which will impact optimization of sporting performance. Classification is used in Paralympic events to ensure that those with similar levels of functional ability compete fairly against each other. An evidence-based approach needs to be developed for athletes with intellectual disabilities to be classified in relation to their overall functional capacity into competition groups of similar ability. This research builds on previous work using the taxonomy of The International Classification of Functioning, Disability and Health (ICF) to group athletes with intellectual disabilities into comparable competition groups as an approach to Paralympic classification. Three groups of athletes—Virtus, Special Olympics, and Down syndrome—are compared using the ICF questionnaire indicating functional health status in relation to sporting performance. The questionnaire was found to discriminate between athletes with Down syndrome and other athletes, and an approach to using a cutoff score to develop competition classes is explored. [ABSTRACT FROM AUTHOR]

To reduce the spread of COVID-19, in March of 2020, the state of Virginia issued a stay-at-home order requiring fitness center closures for 2.4 months. The purpose of this study was to explore how the fitness center closures influenced physical activity (PA) in older adults who previously participated in the centers' exercise classes. Eleven older adults (69.0 ± 6.6 years) completed semistructured interviews, which were transcribed and analyzed to identify emergent themes. Ten participants reported engaging in PA during the stay-at-home order; four participants maintained/increased PA compared to prepandemic levels. Four themes emerged regarding PA are as follows: recognition of the value of PA, high self-efficacy in regard to PA, adaptation to circumstances, and functional limitations. Findings suggest that prior exercise class participation positively influenced PA. While most participants did not maintain prepandemic PA levels, they remained active because they recognized the benefits of PA, had high self-efficacy for exercise, and adapted to their circumstances. [ABSTRACT FROM AUTHOR]

Background: Exercise with blood-flow restriction (BFR) is being increasingly used by practitioners working with athletic and clinical populations alike. Most early research combined BFR with low-load resistance training and consistently reported increased muscle size and strength without requiring the heavier loads that are traditionally used for unrestricted resistance training. However, this field has evolved with several different active and passive BFR methods emerging in recent research. Purpose: This commentary aims to synthesize the evolving BFR methods for cohorts ranging from healthy athletes to clinical or load-compromised populations. In addition, real-world considerations for practitioners are highlighted, along with areas requiring further research. Conclusions: The BFR literature now incorporates several active and passive methods, reflecting a growing implementation of BFR in sport and allied health fields. In addition to low-load resistance training, BFR is being combined with high-load resistance exercise, aerobic and anaerobic energy systems training of varying intensities, and sport-specific activities. BFR is also being applied passively in the absence of physical activity during periods of muscle disuse or rehabilitation or prior to exercise as a preconditioning or performance-enhancement technique. These various methods have been reported to improve muscular development; cardiorespiratory fitness; functional capacities; tendon, bone, and vascular adaptations; and physical and sport-specific performance and to reduce pain sensations. However, in emerging BFR fields, many unanswered questions remain to refine best practice. [ABSTRACT FROM AUTHOR]

The H2O and H2O2 molecules resemble each other in a multitude of ways as has been noted in the literature. Here, we present density functional theory (DFT) calculations for the H2O2(s) and H2O2·2H2O(s) crystals and make selected comparisons with ice polymorphs. The performance of a number of dispersion-corrected density functionals—both self-consistent and a posteriori ones—are assessed, and we give special attention to the D3 correction and its effects. The D3 correction to the lattice energies is large: for H2O2(s) the D3 correction constitutes about 25% of the lattice energy using PBE, much more for RPBE, much less for SCAN, and it primarily arises from non-H-bonded interactions out to about 5 Å.The large D3 corrections to the lattice energies are likely a consequence of several effects: correction for missing dispersion interaction, the ability of D3 to capture and correct various other kinds of limitations built into the underlying DFT functionals, and finally some degree of cell-contraction-induced polarization enhancement. We find that the overall best-performing functionals of the twelve examined are optPBEvdW and RPBE-D3. Comparisons with DFT assessments for ices in the literature show that where the same methods have been used, the assessments largely agree. [ABSTRACT FROM AUTHOR]

This systematic meta-review evaluated the effects of exercise with and without protein interventions on muscle strength and function in older adults with sarcopenic obesity. PubMed, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, Scopus, and SPORTDiscus databases were searched through February 2021 for relevant systematic reviews and meta-analyses with aerobic, resistance, and/or combined training interventions with and without protein supplementation in older adults ≥ 65 years with sarcopenic obesity. This meta-review showed that exercise with and without protein supplementation improved body composition (i.e., decreased percentage body fat) and functional outcomes (i.e., gait speed and grip strength). Because the current literature is limited, determining the effects of exercise and combined protein supplementation in this population requires further investigation. In the meantime, protein recommendations should align with general sarcopenia recommendations. Based upon available findings, tentative exercise recommendations to optimize health outcomes in this population are proposed. [ABSTRACT FROM AUTHOR]

The Timed Up-and-Go (TUG) test has been combined with different verbal/cognitive tasks (i.e., TUG dual task [TUGdt]) as a form of motor-cognitive testing. However, it is still unclear how different TUGdt conditions affect gait among older adults. Thirty community-dwelling older adults, with mean age of 73 years, participated in the study. Data were collected using marker-free video recordings. Gait parameters were extracted using a semiautomatic deep learning system. Comparisons of execution time and gait parameter outcomes were made under TUG and three types of TUGdt test conditions: TUGdt-naming animals, TUGdt-months backwards, and TUGdt-serial 7s. Statistical analyses were based on mean values of the gait parameters for each participant and TUG condition, including TUGdt gait cost, that is, the relative difference between TUGdt and TUG. All the investigated TUGdt conditions resulted in varying degrees of gait parameter changes. Under TUGdt conditions, participants took shorter and slower steps, with TUGdt-serial 7s causing the largest interference. [ABSTRACT FROM AUTHOR]

Purpose: To longitudinally investigate the development of physical characteristics and function during 3 years of high school among Japanese junior rugby players and examine the differences in these parameters between the positions. Methods: In 83 junior rugby players (forwards: n = 46, backs: n = 37) from one Japanese high school team who had participated in national high school competitions, anthropometric variables (height, body mass, fat and lean body mass, and body mass index), upper- and lower-body strength (eg, 1-repetition-maximum [1RM] bench press, isokinetic knee muscle strength at 60°/s and 180°/s), and sprint and jump performance were measured. Upper- and lower-body strength relative to body mass and lean body mass were also calculated. Results: All anthropometric indices improved with increasing age, and the values were higher in forwards than in backs (all P <.05). The 1-repetition maximum bench press (forwards: 40.8%, backs: 52.5%) and isokinetic knee strength (eg, extension at 60°/s, forwards: 15.4%, backs: 10.0%) improved with age (from 16 to 18 y), and they were higher in forwards than in backs (all P <.05). Meanwhile, the 1RM bench press relative to lean body mass did not differ between the positions. Isokinetic knee muscle strength at 60°/s and 180°/s relative to lean body mass and sprint and jump performance did not improve with age. Conclusion: These results indicate that Japanese junior rugby players need to develop larger physiques and continuously increase their lower-body strength to improve sprint and jump performance. [ABSTRACT FROM AUTHOR]

Background Limitations exist with current ACLR functional testing assessments that may be mitigated by including single-leg multi-directional testing. Hypothesis/Purpose To compare Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI) scores, limb symmetry index (LSI) of the single-leg vertical jump (SLVJ), single-leg medial rotation hop (SLMRH), single-leg lateral hop (SLLH), and isokinetic quadriceps strength between participants with an ACLR and healthy controls and assess predictors of quadriceps strength asymmetry. It was hypothesized that ACL-RSI scores and LSIs for all tests would differ between ACLR and healthy control groups and within the ACLR group a strong correlation would exist between all outcome measures and quadriceps strength. Study Design Cross-Sectional Study Methods Twenty-six participants with an ACLR (median 13 months after surgery) and twenty-six matched healthy controls were recruited to participate in this study. Performance was assessed via SLVJ, SLMRH, SLLH, and isokinetic quadriceps strength. Between-group comparisons were made with independent t-tests and Mann-Whitney U test. Within the ACLR group, bivariate correlation and multivariate regression analysis were performed to assess the relationship between the outcome measures and quadriceps strength asymmetry. Results Significant between-limb differences were only identified in the ACLR group (p< 0.05): SLVJ LSI: 88.5%, SLMRH LSI: 93.6%, SLLH LSI: 92.7%, quadriceps strength LSI 80.9% - 83.9%, which were significantly lower (p <0.05) than the healthy control group. Within the ACLR group, a moderate-strong significant (p < 0.05) correlations existed with quadriceps strength and SLVJ (r=0.44-0.65), SLMRH (r =0.43-0.83), and SLLH (r=0.54-0.63); while ACL-RSI had a weak non-significant (p > 0.05) correlation with quadriceps strength (r= 0.12-0.30). Conclusion Single-leg multidirectional test LSIs were less in ACLR participants than matched healthy controls and all were directly related to quadriceps strength. Psychological readiness to return to sport was not related to quadriceps strength. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to compare the effects of home exercise alone and telerehabilitation combined with home exercise in individuals with transtibial amputation. Materials and methods: The telerehabilitation group (n = 24) received telerehabilitation combined with home exercise, while the control group (n = 24) received home exercise alone. Outcomes included the timed up-and-go (TUG) test and the 30-second chair-stand test (30CST), the Activities-specific Balance Confidence (ABC) Scale, the Trinity Amputation and Prosthesis Experience Scales (TAPES), the Amputee Body Image Scale (ABIS), and the Nottingham Health Profile (NHP). The analysis used a 2 × 2 mixed repeated measures ANOVA. Results: The group-by-time interactions were significant for TUG (p = 0.002, F[1;41] = 10.74) and 30CST (p = 0.001, F[1;41] = 11.48). The mean difference (6th week-baseline) was −0.49 for TUG and 0.95 for 30CST in the telerehabilitation group and −0.14 for TUG and 0.13 for 30CST in the control group. There were statistically meaningful group-by-time interactions on the ABC (p = 0.0004, F[1;41] = 14.47), the TAPES-activity restriction (p = 0.0001, F[1;41] = 28.96), TAPES-prosthesis satisfaction (p = 0.004, F[1;41] = 9.19), and the NHP (p = 0.0002, F[1;41] = 16.07) favoring the telerehabilitation group. Conclusions: Telerehabilitation combined with home exercise can offer greater benefits in improving gait, muscle strength, balance confidence, activity restriction, prosthesis satisfaction, and quality of life compared to home exercise alone for individuals with transtibial amputation. Implications for rehabilitation: Exercise helps individuals with lower limb amputation overcome their physical limitations and enables them to use their prostheses effectively. Physiotherapy and rehabilitation after amputation are not at the desired level, and individuals with lower limb amputation encounter various difficulties in accessing physiotherapy. Telerehabilitation has great potential to facilitate access to physiotherapy for individuals with amputation and reduce resource utilization. In a relatively small sample of amputees, this study shows that telerehabilitation-based exercise improves physical health and quality of life. [ABSTRACT FROM AUTHOR]

Purpose: To investigate how functional cognition of people post-stroke is evaluated and reported by occupational therapists in Ireland. Functional cognition refers to the use and integration of cognitive skills for daily function. Methods: This study used a qualitative design. Six focus groups and one individual interview were conducted with 20 occupational therapists purposively sampled for variation across different clinical grades. Data were analysed according to the Braun and Clark thematic analysis framework. Results: Participants felt that assessment of functional cognition was an integral feature of occupational therapy assessment in stroke care but acknowledged that terminology used by occupational therapists for functional cognition was inconsistent. Non-standardised observational assessment was routinely used by participants. Challenges were reported with respect to written documentation of non-standardised observations. Participants reported that use of standardised cognitive assessments required considered clinical reasoning before administration. Standardised performance-based assessments were not widely implemented by participants. Conclusion: Occupational therapists in Ireland reported a multi-component assessment process to evaluate functional cognition post-stroke. Establishing practice guidelines for the assessment of functional cognition may be of benefit to occupational therapists working in stroke care. Further research is needed to quantify procedures in this assessment process to account for variation in practice. IMPLICATIONS FOR REHABILITATION: The assessment of functional cognition in stroke rehabilitation is integral to occupational therapy practice. Occupational therapists described the assessment of functional cognition as a multi-component assessment drawing from three main modalities: standardised cognitive assessments; non-standardised observations; and performance-based assessments. Professional education in, and practice guidelines, for the assessment and reporting of functional cognition could be beneficial for occupational therapists in stroke care to streamline their assessment and reporting of functional cognition. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the data on the psychometric properties of the Neck Disability Index (NDI). Materials and methods: Medline, Embase, PsychINFO, Web of Science, and Scopus were searched in April 2023. The random effects meta-analysis was conducted when possible. Results: Of 492 identified records, 79 were included. 70 studies were considered to be of low risk of systematic bias. Alpha was >0.81. Pooled test-retest intraclass correlation coefficient was 0.91 (95% CI 0.90–0.93). The NDI correlations with pain rating scales varied from 0.38 to 0.89. 13 studies found the NDI to be unidimensional and 15 – two- or three-dimensional. The minimal detectable change varied from 3% to 27% and minimal clinically important difference from 5% to 33%. Pooled area under the curve was 0.74 (95% CI 0.68–0.80). Most studies have not detected floor or ceiling effect. Sex-related differential item functioning has been present in one study. Conclusions: The NDI demonstrated good internal consistency and test-retest reliability without floor or ceiling effect. In most situations, the NDI could be considered a unidimensional scale. The NDI well correlated with the common scales of pain and disability. The minimal clinically important difference and minimal detectable change were around 15% (7.5/50 points). IMPLICATIONS FOR REHABILITATION: Based on the 79 observational studies of mostly low risk of systematic bias, the Neck Disability Index demonstrated overall good psychometric properties The Neck Disability Index is a reliable scale to assess the severity of disability caused by neck pain of different musculoskeletal aetiology [ABSTRACT FROM AUTHOR]

Purpose: To investigate the test-retest reliability and construct validity of the LCADL scale applied via online form in individuals after hospitalization for COVID-19. Methods: Methodological study. After hospitalization for COVID-19 individuals completed the LCADL via online form at two separate times. They also answered the post-COVID-19 Functional Status Scale (PCFS), dyspnea, fatigue, and health perception scales, modified Medical Research Council (MRCm), Short Form Health Survey 36 (SF-36). Hospitalization data were collected from the individual's medical record. Results: 104 individuals participated in the study (57 men, 45.2 ± 11.9 years). The LCADL showed moderately to high test-retest reliability (ICC: 0.73–0.86; p < 0.001), there was no difference in scores between test and retest (p > 0.05), the mean difference between the applications was smaller than the standard error of measurement and the internal consistency was adequate (Cronbach's α = 0.70–0.94). In addition, it demonstrated adequate construct validity, showing correlations with PCFS, dyspnea perception, fatigue and health scales, mMRC, SF-36, and length of stay in the Intensive Care Unit (p < 0.05). The LCADL as percentage of the total score presented a significant floor effect (25%). Conclusion: The LCADL applied online was reliable and valid for assessing limitations due to dyspnea in ADL in individuals after hospitalization for COVID-19. IMPLICATIONS FOR REHABILITATION: The London Chest Activity of Daily Living Scale applied online is a method of evaluation of dyspnea-related ADL limitations that is valid and reliable after hospitalization for COVID-19 and can be used both in the telerehabilitation environment and in-person rehabilitation; The online form provides a more sustainable means of data storage, since no paper is needed, and saves time during in-person rehabilitation. [ABSTRACT FROM AUTHOR]

Earth's ecological assemblages are rapidly being driven towards unprecedented, novel states. We know little about ecological novelty in our oceans, limiting our ability to detect, contextualise, and manage substantive anthropogenic change. This is especially true for novel states with altered functional compositions. Here, we provide a quantitative assessment of taxonomic and functional ecological novelty in historical coral communities across the east Australian coast, capturing changes in the composition of coral taxa and their traits over the past 1500 years. Taxonomically novel communities emerged more frequently and often unaccompanied by substantial trait compositional change while functional novelty was commonly observed alongside significant genus turnover. Novel coral communities themselves were rare, context‐dependent, and often associated with transitions in dominant genera. Our preliminary trait‐based community classifications complement classical taxonomic methods to uncover a history of ecological change in east Australian coral communities, helping provide important context for their present states and inform future responses under ongoing and intensifying human‐driven change. [ABSTRACT FROM AUTHOR]

Lateral ankle sprain (LAS) is one of the most common types of injury in professional football (soccer) players with high risk of recurrence. The rehabilitation after LAS in professional football players is often still time-based and relies on anecdotal experience of clinicans. There is still a lack of utilization of criteria-based rehabilitation concepts after LAS in professional football. The aims of this clinical commentary are (1) to critically discuss the need for criteria-based rehabilitation concepts after LAS in professional football players, (2) to highlight the current lack of these approaches and (3) to present a novel clinical guideline-based rehabilitation algorithm. Short time-loss (15 days) and high recurrence rate (17%) raise the question of trivialization of LAS in professional football. Despite consequences for many stakeholders involved (players, teams, clubs, insurers), there is still a lack of of criteria-based, step-by-step approaches. The use of a criteria-based rehabilitation approach might reduce the high recurrence rate after LAS in professional football players and will lead, in turn, to increased long-term player availability. Practical experiences of he authors demonstrate the feasibility of such an approach. The effectiveness of this novel rehabilitation algorithm remains to be evaluated in future studies. Level of Evidence: 5 INTERNATIONAL JOURNAL OT SPOKR PHYSICAL TOEBAfY [ABSTRACT FROM AUTHOR]

Background The Functional Movement Screen™ (FMS™) is widely used to assess functional movement patterns and illuminate movement dysfunctions that may have a role in injury risk. However, the association between FMS™ scores and LBP remains uncertain. Objective The purpose of this systematic review and meta-analysis was to examine functional movement scores among patients with low back pain (LBP) and healthy subjects with no LBP and review the validity of the FMS™ tool for screening functional movement among LBP patients. Methods The systematic review and meta-analysis included papers assessing functional movement among adult patients with LBP using the FMS™ through a literature review of five databases. The search strategy focused used relevant keywords: Functional movement screen AND low back pain. The review included all papers assessing functional movement among LBP adult patients (>18 years old) using the FMS™ published between 2003 to 2023. The risk of bias in the involved studies was evaluated using the updated Cochrane ROB 2 tool. Statistical analysis was conducted using Review Manager software, version 5.4. The meta-analysis included the total FMS™ score and the scores of the seven FMS™ movement patterns. Results Seven studies were included in this systematic review were considered to have low to unclear risk of bias. The meta-analysis revealed that the LBP group had a significantly lower total FMS™ score than the control group by 1.81 points (95% CI (-3.02, -0.59), p= 0.004). Patients with LBP had a significantly lower score than the control group regarding FMS™ movement patterns, the deep squat (p <0.01), the hurdle step (p <0.01), the inline lunge (P value <0.01), the active straight leg raise (p <0.01), the trunk stability push-up (p=0.02), and the rotational stability screens (p <0.01). Conclusion Lower scores on the FMS™ are associated with impaired functional movement. Identifying the specific functional movement impairments linked to LBP can assist in the creation of personalized treatment plans and interventions. Further research is needed to assess the association of cofounders, such as age, gender, and body mass index, with the FMS™ score among LBP patients and controls. [ABSTRACT FROM AUTHOR]

Background: Complex Regional Pain Syndrome type 1 (CRPS-1) is severely debilitating and painful disease that is difficult to treat. Objective: The objective was to evaluate the long-term residual disability of patients with CRPS-1 following parenteral neridronate treatment. Design: This is real-life retrospective observational study. Methods: Patients affected by CRPS-1 of the upper limb were treated with neridronate infusions (400 mg over 10 days) between February 2017 and December 2021 for whom clinical and demographic information was collected. From November 2022, patients treated ⩾1 year previously were recalled for clinical evaluation. A dedicated instrument (DASH questionnaire, Disabilities of the Arm, Shoulder and Hand) was employed to assess residual disability. Multivariate logistic regression analysis was used to investigate predictors of disability. Results: Forty-nine patients aged 61.1 ± 11.5 years and 73.5% female with CRPS-1 of the upper limb were included. Disease duration before treatment was 9.9 ± 8.0 weeks, and the mean length of follow-up was 4 years (47.7 ± 22.0 months). The disease had fully resolved in 46 patients (93.9%) for whom the diagnostic criteria were no longer recognized. According to the DASH score, 38 patients (77.6%) resulted free of functional limitations, whereas 11 patients (22.4%) were still suffering from disability. The DASH score was positively correlated with residual visual analogue scale (VAS; Spearman's Rho = 0.61; P <.001). Predictors of residual disability were younger age (odds ratio [OR]: 0.77, 95% CI: 0.63-0.93; P =.012) and delay between disease onset and treatment (OR: 1.45, 95% CI: 1.13-1.96; P =.004). Conclusions: In this real-life study, neridronate parenteral treatment provided a full recovery of CRPS-1 in over 3 quarters of patients, provided they are treated early. [ABSTRACT FROM AUTHOR]

Background: Calcaneal fractures are the most common type of tarsal fractures. The sustentaculum tali (ST) offers anatomical stability in calcaneal fractures, and recently, ST screws have been widely used in their treatment. This study aimed to investigate the clinical efficacy and value of ST screw fixation via a modified sinus tarsi approach (MSTA) for treating displaced intraarticular calcaneal fractures (DIACFs). Methods: This study enrolled 64 patients (64 feet): 32 patients in the calcaneal locking plate combined with the ST screw group (CLP-STS Group) and 32 patients in the simple calcaneal locking plate internal fixation group (CLP Group). The minimum follow-up duration was 18 months. Ankle function was evaluated using VAS, AOFAS, and Short Form-36 scores. Imaging evaluation included the Böhler angle, Gissane angle, length, height, and width of the calcaneus, and the Böhler angle in both groups 1 year after surgery. Results: Functional evaluation revealed that postoperative AOFAS and VAS scores in the CLP-STS Group were significantly better than those in the CLP Group. After surgery, the Böhler angle, Gissane angle, and length, height, and width of the calcaneus were significantly corrected compared to the preoperative values; however, the difference in these indicators between the two groups was not significant. Nevertheless, at the 1-year postoperative follow-up, the calcaneal Böhler angle loss in the CLP-STS Group was significantly better than that in the CLP Group. Conclusion: Compared to simple calcaneal locking plate internal fixation, combining the plate with the additionally free ST screw can resolve the limited intraoperative exposure of MSTA, reduce postoperative foot pain in patients, and improve clinical efficacy. [ABSTRACT FROM AUTHOR]

Background: Resting heart rate (HR) and HR variability (HRV) are widely used parameters to assess cardiac autonomic nervous system function noninvasively. While resting assessments can be performed during sleep or after awakening, it would be relevant to know how interchangeable the results of these measurements are. This study aimed at examining the alignment between nocturnal and morning assessments during regular endurance training and in response to intensive training. A total of 24 recreational runners performed a 3-week baseline period (BL) and a 2-week overload (OL) period (Lucia's training impulse + 80%). Their running performance was assessed with a 3000-m running test after the BL and OL. The participants recorded daily their nocturnal HR and HRV (the natural logarithm of the root mean square of successive differences; LnRMSSD) with a photoplethysmography-based wrist device and performed an orthostatic test (2-min supine, 2-min standing) every morning with a chest-strap HR sensor. The HR and LnRMSSD segments that were analyzed from the nocturnal recordings included start value (SleepStart), end value (SleepEnd), first 4-h segment 30 min after detected sleep onset (Sleep4h), and full sleep time (SleepFull). The morning segments consisted of the last-minute average in both body positions. All segments were compared at BL and in response to the 3000-m test and OL. Results: All nocturnal HR and LnRMSSD segments correlated with supine and standing segments at BL (r = 0.42 to 0.91, p < 0.05). After the 3000-m test, the HR increased and LnRMSSD decreased only in the SleepStart, Sleep4h, and SleepFull segments (p < 0.05). In response to the OL, the standing HR decreased (p < 0.01), while the LnRMSSD increased (p < 0.05) in all segments except for SleepStart. The Pearson correlations between relative changes in nocturnal and morning segments were − 0.11 to 0.72 (3000-m) and − 0.25 to 0.79 (OL). The OL response in Sleep4h HR and LnRMSSD correlated with the relative change in 3000-m time (r = 0.63, p = 0.001 and r=-0.50, p = 0.013, respectively). Conclusions: Nocturnal and morning HR and LnRMSSD correlated moderately or highly in the majority of cases during the BL, but their responses to intensive training were not similarly aligned, especially in LnRMSSD. The nocturnal segments seemed to be sensitive to physical loading, and their responses were associated with the performance-related training responses. Key Points: • Moderate-to-high correlations were found between nocturnal and morning assessments of HR and HRV during regular endurance training in recreational runners. • In their responses to maximum exercise, nocturnal and morning HR and HRV were not necessarily aligned, as nocturnal segments seemed more responsive to such a stimulus. • While lower HR and higher HRV were associated with better endurance performance in all recording segments, changes in these parameters after the overload period correlated only in nocturnal segments. [ABSTRACT FROM AUTHOR]

AbstractMeasures of complex functional decision-making capacity can greatly aid in assessing mild cognitive impairment (MCI) and facilitating early intervention in dementia care. We examined the ability of the Assessment of Functional Capacity Interview (AFCI) to detect functional differences among older adults who were cognitively unimpaired (CU), or who presented with subjective cognitive decline (SCD) or MCI. A sample of 97 older adults (CU; n = 30, Mage = 74.64 ± 7.42 years; SCD; n = 34, Mage = 72.56 ± 6.43 years; MCI; n = 33, Mage = 78.28 ± 7.55 years) underwent neuropsychological testing and responded to the Financial Capacity Instrument (FCI-SF). Informants completed the Assessment of Functional Capacity (AFCI), an instrument of functional decision-making capacity, and responded to the Social Vulnerability Scale (SVS15) and Amsterdam Instrumental Activity of Daily Living (A-IADL-Q-SV), a measure of functional status, for comparison. According to informant-reported responses, the CU group had significantly lower AFCI total (and domain) scores, H(2) = 27.59, p<.001, relative to MCI. Additionally, the CU group had significantly lower AFCI scores in the Home and Personal Safety domain relative to the SCD group, H(2) = 14.06, p<.05. In the overall sample, AFCI total scores were associated with FCI-SF, SVS15, and A-IADL-Q-SV scores and cognitive measures. Our results demonstrate that the AFCI is sensitive to impairment in safety, social, financial, and medical functioning in MCI and is associated with measures of cognitive functioning and social vulnerability in older adults. Incorporating this instrument as a supplement to cognitive screening instruments may aid in the prevention of hazardous decision-making in older adults. [ABSTRACT FROM AUTHOR]

Background: Diaphyseal radius and ulna fractures require surgical fixation in adults. Open reduction and internal fixation (ORIF) have been considered the gold standard of treatment. The recent development of an interlocking intramedullary nail (IMN) has provided an alternative treatment method for these fractures. The objective of this meta-analysis is to compare the outcomes and complications of IMN versus ORIF for diaphyseal forearm fractures in adults. Methods: MEDLINE and Embase were searched from January 1, 2000, through January 7, 2024. All English-language studies were included comparing radiographic and functional outcomes for interlocking IMN fixation and ORIF of diaphyseal forearm fractures in adults (age ≥ 18 years). Study demographics, fracture data, functional outcomes, radiographic outcomes, and complications were extracted. Study quality was determined using the ROBINS-I criteria for cohort studies and the Cochrane risk of bias 2.0 (RoB 2) tool for randomized controlled trials. Meta-analysis of included studies used odds ratios and standardized mean difference when appropriate. Data was analyzed using subgroups of all diaphyseal fractures (including isolated radius or ulna fractures) and those with BBFFs. Results: Nine studies were included for analysis. There were 42 isolated radius, 80 isolated ulna, and 116 both-bone fractures (BBFF) treated with IMN and 36 radius, 81 ulna, and 116 both-bone fractures treated with ORIF. Compared to ORIF, IMN of diaphyseal forearm fractures appeared to be associated with shorter operative times and a lower overall complication rate. Time-to-union and the rate of nonunion following IMN were similar to ORIF. According to the Grace–Eversmann score, functional outcomes tended to be better following IMN, but DASH scores were similar between fixation strategies. Conclusions: Our findings suggest that interlocking IMN can be a safe and effective treatment option for simple and complex diaphyseal forearm fractures in adults. Further high-quality studies are needed to define indications for treating diaphyseal fractures with an interlocking IMN. Level of Evidence: Therapeutic Level IV. [ABSTRACT FROM AUTHOR]

Background: Recent advancements in artificial intelligence have proven their effectiveness in orthopaedic settings, especially in tasks like medical image analysis. This study compares human musculoskeletal radiologists to artificial intelligence in a novel, detailed, short, and cost-effective examination of Achilles tendon magnetic resonance images to uncover potential disparities in their reasoning approaches. Aiming to identify relationships between the structured assessment of the Achilles tendon and its function that could support injury prevention. We examined 72 athletes to investigate the link between Achilles tendon structure, as visualised in magnetic resonance images using a precise T2*-weighted gradient echo sequence with very short echo times, and its functional attributes. The acquired data were analysed using advanced artificial intelligence techniques and reviewed by radiologists. Additionally, we conducted statistical assessments to explore relationships with functional studies in four meaningful groups: dynamic strength, range of motion, muscle torque and stabilography. Results: The results show notable linear or non-linear relationships between functional indicators and structural alterations (maximal obtained Spearman correlation coefficients ranged from 0.3 to 0.36 for radiological assessment and from 0.33 to 0.49 for artificial intelligence assessment, while maximal normalised mutual information ranged from 0.52 to 0.57 for radiological assessment and from 0.42 to 0.6 for artificial intelligence assessment). Moreover, when artificial intelligence-based magnetic resonance assessment was utilised as an input, the associations consistently proved more robust, or the count of significant relationships surpassed that derived from radiological assessment. Ultimately, utilising only structural parameters as inputs enabled us to explain up to 59% of the variance within specific functional groups. Conclusions: This analysis revealed that structural parameters influence four key functional aspects related to the Achilles tendon. Furthermore, we found that relying solely on subjective radiologist opinions limited our ability to reason effectively, in contrast to the structured artificial intelligence assessment. Study Design: Cross-sectional studies. Key Points: •Establishment of a relationship between magnetic resonance imaging-based structural features and functional characteristics of the Achilles tendon, emphasising non-linear connections. •Introduction of a fast and efficient magnetic resonance imaging protocol for concurrent evaluation of structural and functional aspects, alongside a comparative analysis of artificial intelligence and radiologist reasoning capabilities. •Highlighting the advantages of artificial intelligence-driven reasoning in identifying structural biomarkers, offering potential enhancements for injury prevention strategies and personalised treatment approaches. [ABSTRACT FROM AUTHOR]

Background: Impaired health states can limit a person's mobility, often progressively for people with life-limiting illnesses. Quantifying mobility changes is crucial for individual clinical care and service planning. Objective: To explore any correlation between EQ-5D-5L's mobility dimension ratings and Life-Space Assessment (LSA) from a population sample. Methods: An online population survey of Australian adults, nationally-representative by key demographics. An analysis of variance examined each level of the EQ-5D-5L mobility dimension rating against its LSA scores; Kendall's Tau assessed correlation. Results: Participants (n = 6366) were 53% women, mean age 46.1 years (SD 18.6), and mean LSA score 78.0 (SD = 27.5; possible range 0–120). At each EQ-5D-5L mobility dimension level there was a significant difference between LSA scores (p < 0.001), and a moderate negative correlation (Kendall's tau b = −0.342) between the two measures. Conclusion: Given the relationship defined, EQ-5D-5L mobility dimension ratings may prompt clinicians to consider further evaluation with the more detailed Life-Space Assessment.. [ABSTRACT FROM AUTHOR]

Background: Multiple ligament knee injuries (MLKI) are a complex group of injuries ideally treated in the acute phase, though delayed presentation is common. Chronic MLKI varies in presentation, requiring individualized management strategies. This review aims to differentiate chronic MLKI types and propose an algorithm that facilitates a tailored treatment plan. Methods: Chronic MLKI is classified into three types based on knee joint status and limb alignment. Type 1 involves ligament deficiency in a reduced knee with normal alignment, treated with soft-tissue ligament reconstruction. Type 2 includes ligament deficiency with malalignment, where deformity correction precedes ligament surgery. Type 3 entails chronic unreduced knee dislocations, necessitating open reduction and extensive release prior to reconstruction. Results: Treatment depends on classification, emphasizing realignment for Type 2 and reduction for Type 3 before soft-tissue procedures. Individualized approaches are critical due to the complexity and variability of chronic MLKI. Conclusion: A treatment algorithm is essential to manage chronic MLKI. Joint reduction, limb realignment, and ligament reconstruction are important to ensure optimal functional outcomes. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Multiligament injuries (MLKI) of the knee mainly result from high-velocity impacts. This study was done to analyse multilgament knee reconstructions done in a single setting at a minimum 12 month follow-up with objective gait, squat, stability and fluoroscopic examination along with PROMs and compare the individual KD categories. Also, the study analyses the difference between < 30- and > 30-year-olds as well as those who had sporting injuries versus RTAs. Methodology: All cruciate ligaments were reconstructed arthroscopically. Collateral ligaments were reconstructed using autografts and fixed with interference screws. All were kept non-weight-bearing for 6 weeks on a brace. ROM exercises were begun at the earliest. Gait analysis, stability, balance, squat analysis and fluoroscopic analysis were used to determine the objective outcomes during follow-ups. PROMs were analysed pre- and postoperatively to document the functional activity of the patient. The analysis of the various parameters with objective measurements of the clinical, functional and patient-reported measures was done to assess the outcome in multiligament knee injury patients. Results: ACL with MCL was the most common presenting multiligament-involved presentation, with KD3 being the most common pattern of injury. The parameters for contact time, step length, ROM at knee and hip on the normal and operated limbs were near normal and same at a minimum 1-year follow-up with a good stability index. The PROMs improved significantly postop. There was no difference in the results of sporting versus non-sporting injuries, those < 30 and > 30 years and between the individual KD groups. Conclusion: The results showed statistically significant improvement in stability and PROMs at follow-up in multiligament reconstructions, but no difference comparing individual KD groups, < 30 and > 30 years age and those injured by RTA s and sporting injuries. [ABSTRACT FROM AUTHOR]

Introduction: Our understanding of antero-lateral rotatory instability (ALRI) has evolved considerably, with a shift towards a combined procedure of ACL reconstruction and lateral extra-articular procedure (LEAP) to reduce ALRI and decrease graft re-rupture rates. Despite mounting evidence for the same in high-pivot and high-contact athletes in the West, there is a paucity of data for regional sports such as kabbadi. To the authors best knowledge, this is the first such study to track the outcomes of the combined procedure (ACLR and LEAP) in kabbadi players. Methods: Ethics approval was obtained from the institutional ethics review committee. A total of 93 consecutive kabbadi players with ALRI were recruited for undergoing the combined procedure of ACLR with lateral extra-articular tenodesis. Demographical variables (age and gender) and functional outcome scores (IKDC, Lysholm, VAS, AOFAS, and FADI) were recorded pre-operatively and followed up at 6 week, 3 month, 6 month and 1 year post-surgery. In addition, complications (pain, stiffness, residual laxity, re-rupture, and infection) and return to sport were recorded. Results: All 93 patients completed the prospective cohort study with no drop-outs. The mean age of the study population was 22.4 ± 2.7 years and 84% were males. VAS, IKDC and Lysholm scores showed significant improvement at each time frame during the study period and significant improvement at end of the study period versus baseline. AOFAS and FADI scores showed no significant difference between baseline and end of study period. There was no significant difference with respect to age and gender for knee (IKDC and Lysholm) or ankle (AOFAS and FADI) scores. Return to sport was achieved in 99% of study participants with return to pre-injury level was 86%. Re-rupture rate was low (n = 2 patients) and the majority of complications related to the LET (either a complaint of swelling or shape change phenomenon). Conclusion: The present study shows that ACLR with LET provides a safe and effective option for treating kabbadi players engaged in an inherently high-pivot and high-contact sport. Knee outcomes (VAS, IKDC and Lysholm scores) showed substantial improvement versus baseline with a high degree of return to sport at pre-injury level and low re-rupture rate. [ABSTRACT FROM AUTHOR]

Previous studies have reported that mode of delivery, particularly cesarean delivery (CD), is associated with neurodevelopmental outcomes in children. This study evaluates behavioral and neuropsychological test scores in children based on mode of delivery. Children enrolled in the Raine Study from Western Australia, born between 1989 and 1992 by instrumental vaginal delivery (IVD), elective CD, and non-elective CD, were compared to those with spontaneous vaginal delivery (SVD). The primary outcome was the Child Behavior Checklist (CBCL) administered at age 10. Secondary outcomes included evaluations of language, motor function, cognition, and autistic traits. Multivariable linear regression was used to evaluate score differences by mode of delivery adjusted for sociodemographic and clinical characteristics, and Poisson regression was used to evaluate for increased risk of clinical deficit. Of 2,855 children, 1770 (62.0 %) were delivered via SVD, 480 (16.8 %) via IVD, 346 (12.1 %) via elective CD, and 259 (9.1 %) via non-elective CD. Non-elective CD was associated with higher (worse) CBCL Internalizing (+2.09; 95 % CI 0.49, 3.96; p=0.01) scores, and elective CD was associated with lower (worse) McCarron Assessment of Neuromuscular Development (MAND) (−3.48; 95 % CI −5.61, −1.35; p=0.001) scores. Differences were not seen in other outcomes, and increased risk of clinical deficit was not observed with either the CBCL Internalizing or MAND scores. Differences in behavior and motor function were observed in children delivered by CD, but given that score differences were not associated with increased incidence of clinical deficit, clinical significance may be limited. [ABSTRACT FROM AUTHOR]

Background: Recent advancements in cervical interlaminar epidural steroid injections have given rise to the modified paramedian interlaminar (mPIL) approach. The objective of this study was to perform an analysis of the contrast spread pattern within the cervical epidural space, taking into account different needle tip positions in the mPIL approach. Methods: A total of 48 patients were included in the study and randomly assigned to either the medial or lateral group based on the needle tip's position in the anterior–posterior view. The primary outcome measured was the contrast flow under fluoroscopic visualization. As a secondary outcome, we analyzed the location of the needle tip position in both lateral and contralateral oblique views. Clinical effectiveness was assessed by measuring pain intensity and functional disability post‐procedure. Results: Significant disparities were noted in the ventral distribution of contrast between the medial and lateral groups. In the lateral images, needle tips in the lateral group were positioned more ventrally compared to those in the medial group. Both groups exhibited statistically significant improvements in neck and radicular pain, as well as functional status, 4 weeks after treatment, with no significant differences between them. Conclusions: Our results suggest that the ventral dispersion of contrast material during cervical interlaminar epidural steroid injections using the mPIL approach may vary depending on the needle tip location. [ABSTRACT FROM AUTHOR]

Cross‐cultural adaptation and validation of measures are necessary to provide evidence‐based educational intervention services among children with autism spectrum disorder (ASD) across countries. Language plays an integral role in the cross‐cultural adaptation and validation process of measures. Currently, there are limited validated tools in Chinese available to assess special education teachers' skills in functional behavior assessments and interventions in Mainland China to effectively support students with ASD. This study aimed to validate a Chinese version of the Skills and Needs Inventories in Functional Behavior Assessments and Interventions (SNI‐FBAI‐CN) in mainland China. The SNI‐FBAI, originally developed and validated in Singapore, in the English language, was translated, culturally adapted, and then administered to 239 special education teachers in two schools for children with ASD in China. Results show that the SNI‐FBAI‐CN has a three‐factor structure (i.e., skills in behavioral assessment, skills in behavioral interventions, and needs for training) that fits the data well, with good reliability for the overall scale, as well as the three subscales. Partial measurement invariance was established between the Chinese and the original Singapore samples, providing additional construct validity evidence for this tool. Limitations of this study and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Since its inception, modifications to experimental functional analyses have been conducted to improve contextual fit. One variation, a trial‐based functional analysis (TBFA), naturally embeds conditions within the environment, has been used across diverse participants (e.g., neurotypical development, autism spectrum disorder [ASD], etc.) and settings. Although interest in TBFA has grown, few TBFA literature reviews have been conducted. Detailed participant characteristics, reliability measures across dependent and independent variables, social validity, and details of function‐based interventions have yet to be reported. Therefore, the purpose of the literature review was to replicate and extend past TBFA reviews by assessing publication characteristics (e.g., authors, year), participant characteristics, procedures (e.g., number of trials), validation across comparison FAs, function‐based interventions, reliability (interobserver agreement [IOA] and procedural integrity) measures, social validity, and intervention details (type. Implementer, setting, and outcomes. We identified 32 articles across 88 participants. Strengths of TBFA research include usability across a range of problem behaviors in natural settings (i.e., in classrooms or in homes) by teachers and direct service providers, IOA, and the inclusion of effective function‐based interventions. Most research included preschoolers with ASD and other disabilities. Limitations and areas for future research are discussed. [ABSTRACT FROM AUTHOR]

Background: Whether cognitive and functional recovery in skilled nursing facilities (SNF) following hospitalization differs by delirium and Alzheimer's disease related dementias (ADRD) has not been examined. Objective: To compare change in cognition and function among short‐stay SNF patients with delirium, ADRD, or both. Design: Retrospective cohort study using claims data from 2011 to 2013. Setting: Centers for Medicare and Medicaid certified SNFs. Participants: A total of 740,838 older adults newly admitted to a short‐stay SNF without prevalent ADRD who had at least two assessments of cognition and function. Measurements: Incident delirium was measured by the Minimum Data Set (MDS) Confusion Assessment Method and ICD‐9 codes, and incident ADRD by ICD‐9 codes and MDS diagnoses. Cognitive improvement was a better or maximum score on the MDS Brief Interview for Mental Status, and functional recovery was a better or maximum score on the MDS Activities of Daily Living Scale. Results: Within 30 days of SNF admission, the rate of cognitive improvement in patients with both delirium/ADRD was half that of patients with neither delirium/ADRD (HR = 0.45, 95% CI:0.43, 0.46). The ADRD‐only and delirium‐only groups also were 43% less likely to have improved cognition or function compared to those with neither delirium/ADRD (HR = 0.57, 95% CI:0.56, 0.58 and HR = 0.57, 95% CI:0.55, 0.60, respectively). Functional improvement was less likely in patients with both delirium/ADRD, as well (HR = 0.85, 95% CI:0.83, 0.87). The ADRD only and delirium only groups were also less likely to improve in function (HR = 0.93, 95% CI:0.92, 0.94 and HR = 0.92, 95% CI:0.90, 0.93, respectively) compared to those with neither delirium/ADRD. Conclusions: Among older adults without dementia admitted to SNF for post‐acute care following hospitalization, a positive screen for delirium and a new diagnosis of ADRD, within 7 days of SNF admission, were both significantly associated with worse cognitive and functional recovery. Patients with both delirium and new ADRD had the worst cognitive and functional recovery. [ABSTRACT FROM AUTHOR]

Purpose: Respiratory-swallow coordination (RSC) frequently changes in people with Parkinson's disease (PwPD). Little is known about how these changes relate to impairments in swallowing safety (penetration and aspiration) and efficiency (pharyngeal residue). Therefore, the aims of this study were to assess the relationships between RSC, pharyngeal residue, penetration, and aspiration in PwPD. Method: Twenty-four PwPD were recruited to undergo simultaneous assessment of RSC, swallowing safety, and swallowing efficiency. RSC was assessed using respiratory inductive plethysmography and nasal airflow and included measurements of respiratory pause duration, respiratory phase patterning, and lung volume during swallowing. Swallowing safety and efficiency were assessed using flexible endoscopic evaluation of swallowing, analyzed using the Visual Analysis of Swallowing Efficiency and Safety, and included measurements of pharyngeal residue, penetration, and aspiration. All data were blindly analyzed, with 20% of the data repeated for interrater reliability assessment. Multilevel statistical models were used to examine the relationships between RSC and swallowing. Results: A total of 812 swallows were analyzed from 24 participants. Only 33.4% of swallows exhibited the typical exhale-swallow-exhale pattern. Additionally, 95% of participants exhibited abnormal swallow function. More severe hypophar-yngeal residue ratings were associated with inhaling before the swallow compared to exhaling before the swallow. Additionally, more severe events of penetration and aspiration were associated with (a) inhaling before the swallow compared to exhaling before the swallow, (b) inhaling after the swallow compared to exhaling after the swallow, and (c) longer swallow-related respiratory pause durations. Inhaling after the swallow exhibited the strongest relationship with impairments in swallowing safety when compared to all other RSC variables. Conclusions: RSC exhibited significant relationships with pharyngeal residue, penetration, and aspiration in these PwPD. Clinicians should attend to RSC when assessing swallowing in PwPD. Future research is needed to examine if training an exhale-swallow-exhale pattern can be used to improve disordered swallowing in PwPD. [ABSTRACT FROM AUTHOR]

Objectives: The endoscopic pressure study integrated system (EPSIS) represents an innovative approach for evaluating lower esophageal sphincter function by monitoring intragastric pressure using diagnostic gastroscopes. This study aimed to assess the feasibility and validity of employing ultrathin gastroscopes for EPSIS. Methods: A retrospective analysis was conducted on a database of consecutive patients who underwent EPSIS using both ultrathin and regular gastroscopes between September 2021 and October 2023. The study compared EPSIS parameters between the two gastroscope types to evaluate the correlation of key metrics. Results: Thirty patients underwent EPSIS with both ultrathin and regular gastroscopes. Significant positive correlations were observed in the pressure waveform: maximum intragastric pressure (mmHg) (ρ = 0.82, P < 0.001) and intragastric pressure gradient (mmHg/s) (ρ = 0.80, P < 0.001) when comparing the two gastroscopes. Maximum intragastric pressure (15.5 [5.3–20.3] vs. 18.5 [3.4–21.6], P < 0.001) and pressure gradient (0.16 [0.013–0.41] vs. 0.24 [0.0039–1.13], P < 0.001), (median [range]) were significantly lower with ultrathin gastroscopes. Conclusions: This study establishes that EPSIS parameters obtained with an ultrathin gastroscope exhibit a significant correlation with those obtained using a regular gastroscope, with each EPSIS parameter consistently lower. These findings support the viability of EPSIS for ultrathin gastroscopy and highlight its potential as a diagnostic tool for assessing lower esophageal sphincter function. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Police, fire, emergency medical services, and military personnel encompass a tactical population practice setting in athletic training. Due to occupational demands within this demographic, these patients experience musculoskeletal or career-altering injuries at an alarming rate. A main contributor to the incidence of musculoskeletal injury is a lack of functional movement. Clinical Question: What parameters of corrective exercise programming improve tactical participants' functional movement scores on the Functional Movement Screen? Summary of Key Findings: Three studies met the inclusion criteria set forth by the authors. Two studies used an 8-week regimented corrective exercise program while one study used a 4-week corrective exercise program. Two of three corrective exercise programs utilized progressions. All corrective exercise programs noted statistically significant improvements in Pre- and Post-functional Movement Screen scores. Clinical Bottom Line: Functional movement is essential to effective occupational interventions in tactical medicine; therefore, corrective exercise programs should be regimented for a minimum of 4 weeks, 3 days a week to show improvement in functional movement. Available evidence to answer this clinical question met a 2B minimum. Collective findings to answer this clinical question align with letter B strength of recommendation. [ABSTRACT FROM AUTHOR]

Background: Short-term results after arthroscopic/endoscopic lateral ligament repair for chronic lateral ankle instability have been satisfactory, although medium- to longer-term results are lacking. Purpose/Hypothesis: The purpose of this study was to report the medium-term results of an all-inside endoscopic classic Bröstrom-Gould procedure where both the both lateral ligaments and the inferior extensor retinaculum can be approached directly, interchanging between arthroscopy for intracapsular structures and endoscopy for extracapsular structures. It was hypothesized that the all-inside endoscopic classic Bröstrom-Gould procedure would produce sustainable good outcomes at a medium term of 5 years. Study Design: Case series; Level of evidence, 4 Methods: A prospective database for 43 patients who underwent an all-inside endoscopic classic Bröstrom-Gould repair of the anterior talofibular ligament and calcaneofibular ligament with inferior extensor retinaculum augmentation was reviewed. Patient details, American Orthopaedic Foot & Ankle Society score, Karlsson score, ankle activity score (AAS), and patient satisfaction were collected and analyzed. Results: The study cohort of 43 patients with a mean age of 29.4 years (SD, 11.9 years) were reviewed at a mean follow-up of 63.1 months (SD, 8.5 months). The American Orthopaedic Foot & Ankle Society scores showed significant improvement from a mean of 69.6 (SD, 13.9) to 93.7 (SD, 10.7), while the Karlsson score improved from 59.7 (SD, 14.5) to 91.5 (SD, 14.5) at the final follow-up. The AAS showed that 32 (74.4%) patients maintained or had improvement in the AAS, from a mean of 5.38 (SD, 2.8) to 5.41 (SD, 2.8), with a mean satisfaction rate of 9.1 (SD, 1.3). Although the remaining 11 patients had a reduced AAS, at a mean of 4.6 (SD, 2.6), they reported a mean satisfaction rate of 7.4 (SD, 2.9). There were no surgical complications or reoperations reported in this cohort, although there were 3 patients with recurrent instability at their last follow-up, resulting in a failure rate of 7%. Conclusion: The current study is the first to report the medium-term outcomes of an all-inside endoscopic classic Bröstrom-Gould procedure. Overall, 93% of the patients had good functional outcomes, but approximately 25% of patients had decreased ankle activity levels at a mean of 5 years postoperatively, albeit with good satisfaction rates. [ABSTRACT FROM AUTHOR]

Motor-evoked potential (MEP) monitoring by transcranial electrical stimulation (TES) is important for intraoperative motor function assessment in neurosurgery; however, false-negative results sometimes occur, and these findings should be interpreted with caution. Herein, we report an interesting MEP change resulting from a pons transection. The patient was a boy aged 5 years and 2 months. He underwent multiple craniotomies for cerebellar anaplastic ependymoma and was already paralyzed in the right upper and lower limbs. Therefore, we decided to remove the recurrent lesion from the left anterior pons. MEPs were recorded on both the right and left sides after the start of surgery but disappeared 1 h 30 min after the start of surgery in the TES on the operative side, even when the stimulation intensity was increased. The contralateral TES consistently recorded stable MEPs throughout the surgery. The tumor was completely resected on imaging. Immediately postoperatively, the patient experienced flaccid paralysis on the right side of the body, which recovered to preoperative levels over time. A transcranial MEP cannot be derived if the corticospinal tract is transected at the pons. Transcranial MEP findings may accurately reflect the corticospinal tract function if the injury is caudal to the pons. [ABSTRACT FROM AUTHOR]