Comparison Between Single and Combined Clinical Postural Stability Tests in Individuals With and Without Chronic Ankle Instability

Objective: To determine if a single or/and combined clinical tests match group membership based on self-reported ankle function. Design: Cross-sectional. Setting: Biomechanics Laboratory. Participants: From participants, 58 meeting inclusion/exclusion criteria were divided into a chronic ankle instability (CAI) group (n = 25) who reported ≤25 on the Cumberland Ankle Instability Tool (CAIT) and a history of moderate–severe ankle sprain(s) and a control group (n = 33) who reported ≥29 on the CAIT and no history of ankle sprain(s). Interventions: Participants completed the following clinical tests: Foot Lift Test (FLT), the Star Excursion Balance Test (SEBT), the Single-Leg Hop Test (SLHT), and the Time in Balance Test (TIB) in a randomized order. A linear regression model was applied to determine measures that matched ankle group membership. Main Outcome Measures: The mean of SEBT reach distance was normalized to percentage leg length. The mean of number of errors in the FLT was recorded. The SLHT and TIB were reported as time in seconds, and the means were calculated. Results: The most parsimonious combination of tests (SLHT and SEBT) resulted in correctly matching 70.69% (41/58) of participants into groups, which was significantly better than chance. The multiple correlation coefficients (R value) for combining the SLHT and SEBT was 0.39. Conclusions: Using SLHT and SEBT resulted in improved recognition of participants designated into the CAI or control groups. Self-report perception of ankle function provides limited information for clinicians and researchers. Using multiple clinical function tests may be more helpful in determining deficits and intervention effectiveness

The relationship between acute pain and dynamic postural stability indices in individuals with patellar tendinopathy

Background Patellar tendinopathy is a common condition resulting in persistent pain, frequently reported during physical activity. The relationship between dynamic postural stability and pain in these individuals is unclear and how it may affect postural stability. Research Question Is there a relationship between acute pain and dynamic postural stability indices in individuals with patellar tendinopathy? Methods Twenty-two recreationally active individuals with patellar tendinopathy participated. Participants performed a two-legged jump and landed on a single test-limb on a force platform. They completed 100 mm visual analogue scales (VAS) before and after landing trials. Anterior-posterior (APSI), medial-lateral (MLSI), vertical (VSI), and composite (DPSI) stability indices were calculated from ground reaction force data. The relationship between stability indices and VAS for pain as well as pain change scores were assessed via non-parametric Spearman’s rho (ρ) rank correlations (p≤.05). Results Baseline pain was not significantly correlated with any stability indices. Post-landing pain was significantly correlated with MLSI (ρ = 0.540, p = 0.004) while, VSI (ρ = 0.353, p = 0.053) and DPSI (ρ = 0.347, p = 0.057) had moderate, yet insignificant correlations. Pain change scores demonstrated a large correlation with MLSI (ρ = 0.598, p = 0.002). Significance As pain increased in individuals with patellar tendinopathy, dynamic postural stability indices values increased, indicating more difficulty transitioning from a dynamic to static state. Although balance deficits are not typically associated with patellar tendinopathy, it appears pain and dynamic postural stability may be related in these individuals

Single-limb landing biomechanics are altered and patellar tendinopathy related pain is reduced with acute infrapatellar strap application

Background Patellar tendinopathy, a common condition of the knee, is often treated with patellar tendon straps to control pain during dynamic activity. Little is known regarding their effect on pain, landing kinematics and kinetics with their application. The purpose of this study was to determine if patellar tendon straps influenced pain, kinematics at landing and ground reaction forces in individuals with patellar tendinopathy versus healthy controls. Methods Thirty participants with patellar tendinopathy and 30 controls participated. They completed single-limb landings with and without patellar tendon straps while pain, three-dimensional kinematics and vertical ground reaction forces were measured. A multivariate analysis of variance was completed to determine the differences in strapping condition and group for the dependent variables. Results Individuals with patellar tendinopathy demonstrated a significant decrease in pain (no strap = 37.1 ± 22.1 mm (mean ± SD), strap = 28.0 ± 18.5 mm (mean ± SD)). With the strap at landing all participants displayed less hip rotation (F = 7.16, p = .01), knee adduction (F = 10.20, p = .002), ankle inversion (F = 4.60, p = .04), and peak vertical ground reaction force (F = 7.30, p = .009). Conclusions Patellar tendon straps reduced pain in those with patellar tendinopathy. Additionally, with the strap, individuals landed in a more neutral alignment and decreased landing forces which could provide a benefit to those with patellar tendinopathy

Cross-cultural adaptation, reliability, and validation of the Korean version of the identification functional ankle instability (IdFAI)

Purpose: To cross-culturally adapt the Identification Functional Ankle Instability for use with Korean-speaking participants. Methods: The English version of the IdFAI was cross-culturally adapted into Korean based on the guidelines. The psychometric properties in the Korean version of the IdFAI were measured for test-retest reliability, internal consistency, criterion-related validity, discriminative validity, and measurement error 181 native Korean-speakers. Results: Intra-class correlation coefficients (ICC2,1) between the English and Korean versions of the IdFAI for test–retest reliability was 0.98 (standard error of measurement = 1.41). The Cronbach’s alpha coefficient was 0.89 for the Korean versions of IdFAI. The Korean versions of the IdFAI had a strong correlation with the SF-36 (rs = −0.69, p \u3c .001) and the Korean version of the Cumberland Ankle Instability Tool (rs = −0.65, p \u3c .001). The cutoff score of \u3e10 was the optimal cutoff score to distinguish between the group memberships. The minimally detectable change of the Korean versions of the IdFAI score was 3.91. Conclusion: The Korean versions of the IdFAI have shown to be an excellent, reliable, and valid instrument. The Korean versions of the IdFAI can be utilized to assess the presence of Chronic Ankle Instability by researchers and clinicians working among Korean-speaking populations. Implications for rehabilitation The high recurrence rate of sprains may result into Chronic Ankle Instability (CAI). The Identification of Functional Ankle Instability Tool (IdFAI) has been validated and recommended to identify patients with Chronic Ankle Instability (CAI). The Korean version of the Identification of Functional Ankle Instability Tool (IdFAI) may be also recommend to researchers and clinicians for assessing the presence of Chronic Ankle Instability (CAI) in Korean-speaking population

Functional performance deficits in adolescent athletes with a history of lateral ankle sprain(s)

Objective To determine if adolescent athletes with a history of lateral ankle sprain(s) (LAS) displayed deficits on functional performance tests (FPTs) and if deficits on FPT were related to the number of previous LAS. Design Cross-sectional study. Setting Biomechanics Laboratory. Participants The injured group (n = 24) had a history of ≥1 moderate-severe LAS. The uninjured group (n = 34) had no history of LAS. Main outcome measure(s) The average reach distance of three trials in each direction of the star excursion balance test (SEBT) was normalized to leg length (%). The average of two trials of single-leg-hop test (SLHT) was calculated in seconds. Results The injured group performed significantly worse in 3 directions of SEBT than the uninjured group (P \u3c 0.05). SLHT was significantly slower in the injured group compared to the uninjured group (P \u3c 0.05). Statistically significant, strong to moderate inverse relationships were found between the numbers of LAS and each of the three directions of the SEBT (P ≤ 0.01). No relationship was revealed between the number of LAS and the SLHT (P \u3e 0.05). Conclusion(s) Adolescent athletes with a history of LAS exhibit functional performance deficits on the SEBT and SLHT. Therefore, the SEBT and SLHT may provide clinicians cost- and time-effective objective tools

Ability of Functional Performance Tests to Identify Individuals With Chronic Ankle Instability: A Systematic Review With Meta-Analysis

Objective: The purpose of this systematic review with meta-analysis was to determine the effectiveness of functional performance tests (FPTs) in differentiating between individuals with chronic ankle instability (CAI) and healthy controls. Data Sources: The National Library of Medicine Catalog (PubMed), the Cumulative Index for Nursing and Allied Health Literature (CINAHL), and the SPORTDiscus, from inception to June 2017 were searched. Search terms consisted of: “Functional Performance Test*” OR “Dynamic Balance Test*” OR “Postural Stability Test*” OR “Star Excursion Balance Test*” OR “Hop Test*” AND “Ankle Instability” OR “Ankle Sprain.” Included articles assessed differences in FPTs in patients with CAI compared with a control group. Main Results: Included studies were assessed for methodological quality and level of evidence. Individual and mean effect sizes were also calculated for FPTs from the included articles. Twenty-nine studies met the criteria and were analyzed. The most common FPTs were timed-hop tests, side-hop, multiple-hop test, single-hop for distance, foot-lift test, and the Star Excursion Balance Tests (SEBTs). The side-hop (g = −1.056, P = 0.009, n = 7), timed-hop tests (g = −0.958, P = 0.002, n = 9), multiple-hop test (g = 1.399, P \u3c 0.001, n = 3), and foot-lift tests (g = −0.761, P = 0.020, n = 3) demonstrated the best utility with large mean effect sizes, whereas the SEBT anteromedial (g = 0.326, P = 0.022, n = 7), medial (g = 0.369, P = 0.006, n = 7), and posteromedial (g = 0.374, P \u3c 0.001, n = 13) directions had moderate effects. Conclusions: The side-hop, timed-hopping, multiple-hop, and foot-lift seem the best FPTs to evaluate individuals with CAI. There was a large degree of heterogeneity and inconsistent reporting, potentially limiting the clinical implementation of these FPTs. These tests are cheap, effective, alternatives compared with instrumented measures

The Effect of Telehealth Interventions on Quality of Life of Cancer Patients: A Systematic Review and Meta-Analysis

Introduction:In 2016, ∼1.7 million new cases of cancer were diagnosed. Cancer patients can have physical, functional, and psychosocial issues when dealing with cancer treatment. Telehealth has been effectively introduced to help deliver treatment to patients suffering from chronic disease; however, there is little consensus on its effectiveness in administering sociobehavioral cancer treatments. Thus, this study determines the benefits of telehealth-based interventions providing emotional and symptom support in improving quality of life (QOL) among cancer patients. Methods:Two researchers conducted comprehensive searches on PubMed, SCOPUS, Medline, PsycINFO, ERIC, Psychology and Behavioral Collection, and Medline Complete. Key search terms included telehealth or telemedicine and QOL and cancer. Articles were included if they assessed a telehealth-delivered intervention for adult cancer patients and provided a QOL assessment. Data were extracted to calculate mean effect sizes for QOL measures on the effectiveness of telehealth relative to usual care (UC) for cancer treatments. Results:Out of 414 articles identified in our initial search, nine articles fit our inclusion criteria. Both telehealth (Hedges g = 0.211, p = 0.016) and standard of care (Hedges g = 0.217, p \u3c 0.001) cancer treatment delivery methods demonstrated small, but statistically significant improvements in QOL measures. However, there were no statistically significant differences in effectiveness between the telehealth interventions and UC (p = 0.76). Conclusions:The results indicate that telehealth interventions are as effective at improving QOL scores in patients undergoing cancer treatment as in-person UC. Further studies should be undertaken on different modalities of telehealth to determine its appropriate and effective use in interventions to improve the QOL for cancer patients undergoing treatment

Diagnosis of a Chiari Malformation After a Concussion in a Junior College Football Player With a History of Chronic Headaches: A Case Report

The purpose of this report is to present the case of a National Junior Collegiate Athletic Association football player diagnosed with Chiari malformation postconcussion. A Chiari malformation is characterized by the cerebellum presenting below the level of the foramen. The uniqueness of this case stems from the patient’s health history, length of symptoms, and diagnosis. The effectiveness of treatment options, and the primary means to reduce the risk of catastrophic head injury in those with Chiari malformations are debatable. Clinicians should be familiar with the potential for the presence of a Chiari malformation with persistent symptoms postconcussion

Clinical Measures and Their Contribution to Dysfunction in Individuals With Patellar Tendinopathy

Context: Patellar tendinopathy is prevalent in physically active populations and it affects their quality of living, performance of activity, and may contribute to the early cessation of their athletic careers. A number of previous studies have identified contributing factors for patellar tendinopathy however their contributions to self-reported dysfunction remain unclear. Objective: The purpose of this investigation was to determine if strength, flexibility, and various lower extremity static alignments contributed to self-reported function and influence the severity of patellar tendinopathy. Design: Cross sectional research design. Setting: University Laboratory. Participants: 30 participants with patellar tendinopathy volunteered for this study (age: 23.4±3.6 years, height: 1.8±0.1m, mass: 80.0±20.3kg, BMI: 25.7±4.3). Main outcome measures: Participants completed seven different patient-reported outcomes. Isometric knee extension and flexion strength, hamstring flexibility and alignment measures of rearfoot angle, navicular drop, tibial torsion, q angle, genu recurvatum, pelvic tilt, and leg length differences were assessed. Pearson’s correlation coefficients were assessed to determine significantly correlated outcome variables with each of the patient-reported outcomes. The factors with the highest correlations were used to identify factors that contribute the most to pain and dysfunction using backward selection, linear regression models. Results: Correlation analysis found significant relationships between questionnaires and BMI (r=-0.35-0.46), normalized knee extension (r=0.38-0.50) and flexion strength (r=-0.34-0.50), flexibility (r=0.32- -0.38, q angle (r=0.38-0.56) and pelvic tilt (r=-0.40). Regression models (R2= 0.22-0.54) identified thigh musculature strength and supine q angle to have greatest predictability for severity in patient-reported outcomes. Conclusions: These findings put an emphasis of bodyweight management, improving knee extensor and flexor strength, posterior flexibility in patellar tendinopathy patients

Patellar tendon straps decrease pre-landing quadriceps activation in males with patellar tendinopathy

Objective: To determine if patellar tendon straps altered quadriceps’ muscle activity during a drop-jump landing in males with and without patellar tendinopathy. Design: Case-control. Settings: Biomechanics Research Laboratory. Participants: Twenty recreationally-active males participated: ten (age=21.3±2.4 years, height=182.8±5.3cm, mass=81.7±8.6kg) with patellar tendinopathy; ten (age=22.0±1.6 years, height=185.7±4.5 cm, mass=82.2±9.8kg) were healthy with no history of tendinopathy. Main Outcome Measures: Electromyography (EMG) data for the vastus medialis (VM), rectus femoris (RF), and vastus lateralis (VL) muscles were collected. Five 2-legged 40cm drop-jumps were performed wearing a patellar tendon strap and 5 with no-strap in a counterbalanced order. Root-mean square EMG (REMG) values of the VM, RF, and VL were averaged for a pre-landing and post-landing interval. Multiple mixed-model two-way ANOVAs were performed to determine the effect of tendinopathy and strapping condition on REMG values for each muscle. Results: For the pre-landing interval, all participants displayed lesser VL EMG activation (0.44±0.19%, 0.53±0.27%, respectively; p=.007, d=0.39) in the no-strap compared with the strap condition. Conclusions: When wearing a strap, all participants demonstrated lower VL activation prior to landing which may be helpful in reducing tensile stress at the tendon. These effects may be clinically important in modulating pain in those with patellar tendinopathy