A pragmatic randomised controlled trial of preferred intensity exercise in depressed adult women in the United Kingdom: secondary analysis of individual variability of depression

Background This study is a secondary analysis of the trial by Callaghan et al. (2011), which reported higher antidepressant effects for preferred intensity (n = 19) vs. prescribed intensity (n = 19) exercise of three sessions/week over four weeks in depressed women. In particular, the present study sought to examine whether greater clinically significant individual change/recovery was observed in the preferred compared to the prescribed exercise group. Methods The reliable change index and the Ccutoff score criteria described by Jacobson and Truax (1991) were employed to determine clinical significance. These criteria examined if individual change in depression scores from pre- to post-intervention in the preferred intensity group were statistically significant beyond the standard error of difference derived from the active comparator prescribed group, and subsequently within a normal population range. Patients fulfilling the first or both criteria were classified as improved or recovered, respectively. Results Post-intervention depression scores of six patients in the preferred intensity exercise group (32%) demonstrated statistically reliable improvement (p  0.05), although eight of them showed a non-significant improvement in post-intervention depression scores and three could not technically show an improvement in depression due to floor effects (baseline depression within normal range). Conclusions Preferred intensity exercise of three sessions/week over four weeks led almost a third of the patients to record scores consistent with recovery from depression. Health professionals may consider that short-term preferred intensity exercise provides clinically significant antidepressant effects comparing favourably to exercise on prescription

Severity of sports-related concussion and neuropsychological test performance

Concussion severity grades according to the Cantu, Colorado Medical Society, and American Academy of Neurology systems were not clearly related to the presence or duration of impaired neuropsychological test performance in 21 professional rugby league athletes. The use of concussion severity guidelines and neuropsychological testing to assist return to play decisions requires further investigation

Specificity of reliable change models and review of the within-subjects standard deviation as an error term

There is an ongoing debate over the preferred method(s) for determining the reliable change (RC) in individual scores over time. In the present paper, specificity comparisons of several classic and contemporary RC models were made using a real data set. This included a more detailed review of a new RC model recently proposed in this journal, that used the within-subjects standard deviation (WSD) as the error term. It was suggested that the RCWSD was more sensitive to change and theoretically superior. The current paper demonstrated that even in the presence of mean practice effects, false-positive rates were comparable across models when reliability was good and initial and retest variances were equivalent. However, when variances differed, discrepancies in classification across models became evident. Notably, the RC using the WSD provided unacceptably high false-positive rates in this setting. It was considered that the WSD was never intended for measuring change in this manner. The WSD actually combines systematic and error variance. The systematic variance comes from measurable between-treatment differences, commonly referred to as practice effect. It was further demonstrated that removal of the systematic variance and appropriate modification of the residual error term for the purpose of testing individual change yielded an error term already published and criticized in the literature. A consensus on the RC approach is needed. To that end, further comparison of models under varied conditions is encouraged

Presentation and mechanisms of concussion in professional Rugby League football

The present study prospectively recorded the circumstances, incidence, mechanisms, injury detection and presentation of concussion in Rugby League. Forty-three consecutive concussions were recorded over three competitive seasons in 175 professional Rugby League players. Data showed (i) the incidence of concussion ranged from 5.9 to 9.8 injuries/1000 player hours across grades - except when age-group players were mismatched (18.4); (ii) 'head-high tackles' accounted for a significant number of concussions; (iii) concussion rarely involved a loss of consciousness with the most common indicators of concussion being amnesia, headache and unsteadiness, with the mechanism of injury often missed; and (iv) concussion often occurs concurrently with other injuries. Concussion (including repeated episodes) is a common injury in Rugby League. Systematic mental status questioning is warranted whenever concussion is suspected. Coaches, trainers and players need more education in the recognition and management of concussion. Stricter penalties for illegal 'head-high' tackling are strongly recommended