Prediction of Acute and Recurrent Ankle Sprains in Athletes

Ankle sprains are not only among the most common sport-related injuries, but also associated with a high rate of recurrence. While prevention is a favorable approach to reducing the incidence of index and recurrent ankle sprains, identifying individuals at greater risk may improve allocation of preventative resources. This dissertation aimed to accomplish the following through three aims: 1) determine the ability of baseline clinical tests to predict acute lateral ankle sprain (LAS) in an understudied athletic population, 2) describe the degree of residual impairments and activity limitations in athletes returning to play from a LAS, and 3) determine the ability of patient- and disease-oriented outcomes to predict recurrent ankle sprains in athletes returning to play in the same competitive season. In the first aim, baseline anterior star excursion balance test scores (SEBT-ANT) and isometric hip extension strength (HEXT) were not useful predictors of LAS in collegiate women’s soccer players. Participant height produced a prediction model for LAS with excellent sensitivity (0.88) and moderate specificity (0.51). The diagnostic odds ratio (DOR=7.50) and area under the receiver operating characteristic curve (AUROC=0.73) further established the predictive utility of height for injury. Taller collegiate women’s soccer players may be less able to resist external moments exerted on the body, potentially increasing LAS risk. For the second aim, athletes returning to play from a LAS reported low selfreported function based on scores from the Foot and Ankle Ability Measure activity of daily living (FAAM-ADL) and sport (FAAM-S) subscales. Additionally, participants demonstrated significantly lower ankle dorsiflexion range of motion and SEBT-ANT scores, and significantly greater ankle joint swelling and ligamentous laxity of the involved limb compared to the uninvolved limb. The residual impairments and activity limitations exhibited by athletes returning to play may offer a means of identifying individuals at increased risk for recurrent injury and chronic ankle instability. In the third aim, athletes that sustained a recurrent ankle sprain in the same competitive sport season exhibited greater height, mass, and body mass index (BMI) compared to those that did not sustain a recurrent injury. ROC curve analyses and DORs further validated the predictive utility of height (AUROC=0.71, DOR=4.93), mass (AUROC=0.75, DOR=12.21) and BMI (AUROC=0.71, DOR=9.48). A clinical evaluation of pain, ankle joint swelling, ligamentous laxity, ankle dorsiflexion range of motion, SEBT-ANT scores, FAAM-ADL scores, and FAAM-S scores at return to play (RTP) failed to predict recurrent injury status. Similar to the first study, athletes with larger stature may have decreased ability to reverse momentum in the presence of injurious forces. Athletic trainers can use information from this dissertation to determine which athletes are at elevated risk for an acute and recurrent ankle sprain, and ultimately facilitate improved allocation of resources for injury prevention

Cross-Education Balance Effects After Unilateral Rehabilitation in Individuals With Chronic Ankle Instability: A Systematic Review

Objective: To conduct a systematic review of existing literature on cross-education balance effects after unilateral training in the population with chronic ankle instability (CAI). Data Sources: PubMed, SPORTDiscus, CINAHL Plus. Study Selection: To be included in the systematic review, studies were required to have been published in English, included participants with CAI, had participants undergo a unilateral therapeutic exercise for the lower extremity, and measured balance performance of the untrained lower extremity before and after the intervention. Data Extraction: The certainty of evidence in each included study was assessed via the Downs and Black checklist. A score of 24 to 28 indicated excellent or very low risk of bias; 19 to 23, good or low risk of bias; 14 to 18, fair or moderate risk of bias; and poor or high risk of bias. We extracted information from each study regarding design, participant characteristics, inclusion criteria, independent and dependent variables, intervention, and results. Baseline and postintervention balance performance data for participants\u27 untrained limbs were used to calculate the Hedges g effect sizes and 95% CIs. Data Synthesis: Our search returned 6 studies that met the inclusion criteria. The articles\u27 risk of bias ranged from high to low (11–19). In 4 of 5 studies that examined unilateral balance training, the authors reported a cross-education effect. In the lone study that examined resistance training at the ankle joint, a cross-education effect was also present. Several cross-education effects were associated with large effect sizes. This systematic review was limited by a small number of studies that varied in methods and quality. Conclusions: Our results suggest that unilateral therapeutic exercise can improve balance performance of the untrained limb of individuals with CAI. More work is needed to determine which training protocols are most effective for generating a cross-education effect

Relationships Between Injury-Related Fear, Balance Self-Efficacy, and Dynamic Balance Performance in Those With Chronic Ankle Instability

Interactions between sensory-perceptual and motor-behavioral impairments in individuals with chronic ankle instability (CAI) are important for successful assessment and treatment of CAI. One of the most consistently reported motor-behavioral impairments is poor reach performance in a dynamic balance task. Injury-related fear is recognized as an important sensory-perceptual impairment, and those with injury-related fears may engage in protective movement strategies found to be associated with reach deficits. Injury-related fear may also impact one’s perception of ability, or self-efficacy, which has demonstrated positive associations with balance performance in other populations, but these relationships have yet to be investigated in the CAI population. Objective: To examine the relationships between injury-related fear, self-efficacy, and dynamic balance performance in those with CAI. Methods: 33 individuals with CAI (F:18, M:15, 22.8±3.3yrs, 170.2±8.5cm, 78.0±13.6kg) reported their level of injury-related fear via the Tampa Scale of Kinesiophobia (TSK-11). The Self-Efficacy of Balance Scale (SEBS) was utilized to capture participants’ level of balance self-efficacy. Dynamic balance performance was assessed on the involved limb with the Star-Excursion Balance Test in the anterior, posteromedial (SEBT-PM), and posterolateral (SEBT-PL) directions and a composite (SEBT-COMP) score was calculated for overall performance. Pearson correlations were used to analyze associations between these outcomes with significance set at P PResults: Significant negative correlations were identified between TSK-11 and SEBS scores (r=-0.34, P=0.050), indicating those with higher levels of kinesiophobia demonstrated lower levels of balance self-efficacy. Significant positive correlations were identified between SEBS scores and SEBT-COMP (r=0.48, P=0.005), SEBT-PM (r=0.42, P=0.016), and SEBT-PL (r=0.48, P=0.005), indicating that individuals who perceived themselves as more confident in their balance ability demonstrated better balance performance. Conclusions: Injury-related fear did not have a direct relationship with dynamic reach performance in individuals with CAI, but may have an indirect relationship with dynamic balance performance by impacting one’s balance self-efficacy.https://digitalcommons.odu.edu/gradposters2020_healthsciences/1004/thumbnail.jp

Corticospinal Activity During A Single-Leg Stance In People With Chronic Ankle Instability

Purpose: The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls. Methods: Twenty-three participants with CAI, 23 lateral ankle sprain copers, and 24 healthy control participants volunteered. Active motor threshold (AMT), normalized motor-evoked potential (MEP), and cortical silent period (CSP) were evaluated by transcranial magnetic stimulation while participants performed a single-leg standing task. Results: Participants with CAI had significantly longer CSP at 100% of AMT and lower normalized MEP at 120% of AMT compared to lateral ankle sprain copers (CSP100%: p = 0.003, MEP120%: p = 0.044) and controls (CSP 100%: p = 0.041, MEP120%: p = 0.006). Conclusion: This investigation demonstrated altered corticospinal excitability and inhibition of the tibialis anterior during single-leg standing in participants with CAI. Further research is needed to examine the effects of corticospinal maladaptations to motor control of the tibial anterior on postural control performance in those with CAI

Corticospinal Activity during a Single-Leg Stance in People with Chronic Ankle Instability

PURPOSE: The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability (CAI), lateral ankle sprain copers, and healthy controls. METHODS: Twenty-three participants with CAI, 23 lateral ankle sprain copers, and 24 healthy control participants volunteered. Active motor threshold (AMT), normalized motor-evoked potential (MEP), and cortical silent period (CSP) were evaluated by transcranial magnetic stimulation while participants performed a single-leg standing task. RESULTS: Participants with CAI had significantly longer CSP at 100% of AMT and lower normalized MEP at 120% of AMT compared to lateral ankle sprain copers (CSP100%: p = 0.003; MEP120%: p = 0.044) and controls (CSP100%: p = 0.041; MEP120%: p = 0.006). CONCLUSION: This investigation demonstrated altered corticospinal excitability and inhibition of the tibialis anterior during single-leg standing in participants with CAI. Further research is needed to examine the effects of corticospinal maladaptations to motor control of the tibial anterior on postural control performance in those with CAI

Perceived Instability, Pain, and Psychological Factors Predict Function and Disability in Individuals with Chronic Ankle Instability

Context: Chronic ankle instability (CAI) is associated with residual instability, pain, decreased function, and increased disablement. Injury-related fear has been associated with CAI, although its relationship to other impairments is unclear. The Fear-Avoidance Model is a theoretical framework hypothesizing a relationship between injury-related fear, chronic pain, pain catastrophizing, and disability. It has been useful in understanding fear\u27s influence in other musculoskeletal conditions but has yet to be studied in those with CAI. Objective: To explore relationships between instability, pain catastrophizing, injury-related fear, pain, ankle function, and global disability in individuals with CAI. Design: Cross-Sectional Study Setting: Anonymous online survey Patients or Other Participants: A total of 259 people, recruited via e-mail and social media, with a history of ankle sprain completed the survey; of those, 126 participants (age=32.69±4.38, female=84.92%, highly active=73.81%) were identified to have CAI and were included in the analysis. Main Outcome Measure(s): Demographics included gender identity, age, and physical activity level. Assessments encompassed the Identification of Functional Ankle Instability (instability), the Pain Catastrophizing Scale (pain catastrophizing), the Tampa Scale of Kinesiophobia-11 (injury-related fear), a numeric pain rating scale and activity-based question (pain presence), the Quick-FAAM (ankle function), and the modified Disablement in the Physically Active Scale (disability). Relationships between variables were explored through correlation and regression analyses. Results: After controlling for instability and pain, pain catastrophizing and injury-related fear were significantly related to function and disability ratings in individuals with CAI. Together, the variables predicted 48.7% (P\u3c.001) variance in function and 44.2% (P\u3c.001) variance in disability. Conclusions: Greater instability, pain, greater pain catastrophizing, and greater injury-related fear were predictive of decreased function and greater disability in those with CAI. This is consistent with the hypothesized relationships in the Fear-Avoidance Model, although further investigation is needed to determine causality of these factors in the development of CAI

Lumbopelvic Stability and Trunk Muscle Contractility of Individuals with Chronic Ankle Instability

# Background Chronic ankle instability (CAI) results in hip neuromuscular impairments that can perpetuate dysfunction through reduced lumbopelvic stability and subsequent malpositioning of the lower body during functional movement. Lumbopelvic stability might be further impaired through changes in trunk muscular contractility. However, lumbopelvic stability and trunk muscle morphology have not been compared between individuals with and without CAI. # Purpose To compare lumbopelvic stability and trunk muscle contractility between individuals with and without chronic ankle instability (CAI) and determine if lumbopelvic stability and trunk muscle contractility are associated with self-reported function. # Study Design Case-control study. # Methods Ten individuals with CAI, 10 ankle sprain copers (COP), and 10 healthy controls (CON) participated. Diagnostic ultrasound imaging was used to assess transversus abdominis (TrA) and lumbar multifidus (LM) muscle contractility. A percent change in contraction thickness from rested to contracted conditions was calculated for each muscle. Lumbopelvic stability was assessed using unilateral hip bridge, trunk flexion endurance, Biering-Sorensen, and side plank tests. Self-reported function was measured with the Foot and Ankle Ability Measure Activity of Daily Living (FAAM-ADL) and Sport (FAAM-S) subscales. One-way ANOVAs and Cohen’s d effect sizes compared scores on clinician and patient-reported outcomes between groups. Pearson product moment correlations analyzed associations between self-reported function and trunk muscle contractility and lumbopelvic stability. Significance was set *a priori* at P\<0.05 # Results COP had significantly greater TrA contractility than CAI (P\<0.01, *d*=2.65$$1.45,3.85$$) and CON (P=0.03, *d*=1.05$$0.08,1.94$$). Although not statistically significant, a large effect size suggest that CAI had lower TrA contractility than CON (P=0.12, *d*=0.92$$-0.03,1.80$$). No differences existed for LM contractility or lumbopelvic stability tests. A moderate direct correlation (r=0.65, P=0.04) existed between CON’s TrA contractility and FAAM-ADL scores. # Conclusion Deficits in TrA contractility are a novel finding among individuals with CAI. While LM contractility and lumbopelvic stability did not differ between groups, future research should continue to examine their relevance to CAI. # Level of Evidence 3

Safety and security policies on psychiatric acute admission wards: results from a London-wide survey

Very little research evidence is available regarding current safety and security procedures on acute psychiatric wards. This includes controversial areas such as the temporary removal of personal property, the searching of patients and visitors, the use of alarms and modern technology, and locking of entrances to regulate those entering and leaving. This is also despite widening dismay over increasing violence within a variety of hospital settings, the comparatively high risk of physical assault faced by mental health professionals and an abundance of literature and training in regards to violence management and prevention. To gain an understanding of current safety and security measures, a London-wide survey of acute admission wards was undertaken revealing a wide variety of measures and policies in operation. Over 100 NHS and private wards were sent questionnaires; there was a response rate of 70%. Results show that a significant proportion of acute admission wards are now locked at all times and a small proportion of units have 24-hour security/reception staff on-site and a low level of modern technology usage such as CCTV and electronic access systems. There is wide variation in items banned, restrictions placed on inpatients, and the searching of patients and visitors. Two independently varying emphases of ward security policies were identifiable, the first aimed at preventing harm to patients using door security, banning of item and restrictions on inpatients. The other is aimed at reducing risks to staff via searching of patients, use of security guards and sophisticated alarm systems. There is some preliminary evidence that these security policies are differentially associated with levels of absconding and violent incidents. Further research to guide practice is urgently required

Reproducible protocols for metagenomic analysis of human faecal phageomes

peer-reviewedAll sequence data used in the analyses were deposited in the Sequence read Archive (SRA) (http://www.ncbi.nlm.nih.gov/sra) under BioProject PRJNA407341. Sample IDs, meta data and corresponding accession numbers are summarised in Additional file 2: Table S2. All raw count tables, 16S taxonomic assignments, BLAST top hits for viral contigs and R code used for the analysis are available at (https://figshare.com/s/71163558b4f78e3e7ed6).Background Recent studies have demonstrated that the human gut is populated by complex, highly individual and stable communities of viruses, the majority of which are bacteriophages. While disease-specific alterations in the gut phageome have been observed in IBD, AIDS and acute malnutrition, the human gut phageome remains poorly characterised. One important obstacle in metagenomic studies of the human gut phageome is a high level of discrepancy between results obtained by different research groups. This is often due to the use of different protocols for enriching virus-like particles, nucleic acid purification and sequencing. The goal of the present study is to develop a relatively simple, reproducible and cost-efficient protocol for the extraction of viral nucleic acids from human faecal samples, suitable for high-throughput studies. We also analyse the effect of certain potential confounding factors, such as storage conditions, repeated freeze-thaw cycles, and operator bias on the resultant phageome profile. Additionally, spiking of faecal samples with an exogenous phage standard was employed to quantitatively analyse phageomes following metagenomic sequencing. Comparative analysis of phageome profiles to bacteriome profiles was also performed following 16S rRNA amplicon sequencing. Results Faecal phageome profiles exhibit an overall greater individual specificity when compared to bacteriome profiles. The phageome and bacteriome both exhibited moderate change when stored at + 4 °C or room temperature. Phageome profiles were less impacted by multiple freeze-thaw cycles than bacteriome profiles, but there was a greater chance for operator effect in phageome processing. The successful spiking of faecal samples with exogenous bacteriophage demonstrated large variations in the total viral load between individual samples. Conclusions The faecal phageome sequencing protocol developed in this study provides a valuable additional view of the human gut microbiota that is complementary to 16S amplicon sequencing and/or metagenomic sequencing of total faecal DNA. The protocol was optimised for several confounding factors that are encountered while processing faecal samples, to reduce discrepancies observed within and between research groups studying the human gut phageome. Rapid storage, limited freeze-thaw cycling and spiking of faecal samples with an exogenous phage standard are recommended for optimum results

Patient information leaflets (PILs) for UK randomised controlled trials : a feasibility study exploring whether they contain information to support decision making about trial participation

Peer reviewedPublisher PD