Prospective Assessment of Return to Pre-Injured Levels of Activity

Determining return to pre-injured levels of play following athletic injury can be challenging. The current practice of making decisions following rehabilitation as to whether or not a patient has returned to pre-injured levels of activity is potentially inaccurate because initial assessments of perceived physical capability are performed at a time of relative dysfunction or are based on patient recall. Since there is no true baseline of perceived and physical function prior to injury it is difficult to determine if an athlete has return to baseline or is simply better than they were at the time of injury. Therefore, it is unclear whether a true link can be established between rehabilitation and the restoration of pre-injured physical function. Therefore, the purpose of this dissertation was to obtain values of perceived and demonstrable physical function in collegiate prior to the occurrence of injury and following rehabilitation to determine if physical function was restored prior to permitting the athletes to return to activity. Patient opinion about the ability to perform athletic maneuvers is important following injury; however, prospective assessment of self-perceived physical function for athletes prior to the beginning of a season before injury occurrence is lacking. Baseline values of self-reported physical function relative to the perceived state of the knee, shoulder, and elbow in a wide array of athletes before the commencement of injury exposure were obtained. It was determined that 1) overall, collegiate athletes report upper level scores on selected knee, shoulder, and elbow outcome questionnaires and 2) athletes with previous injury to these joints have perceived lower physical function prior to a competitive season although they were medically cleared to participate in sport. Previous reports have noted that the closed kinetic chain upper extremity stability test (CKCUEST) and traditional strength testing maneuvers have excellent test/re-test reliability in asymptomatic individuals but no information existed for individuals with shoulder symptoms. Therefore, subjects with and without current shoulder symptoms were recruited to determine if the CKCUEST and traditional strength testing maneuvers had similar reliability and if the CKCUEST could distinguish between persons with and without shoulder symptoms. Using traditional strength measures and the CKCUEST did not reveal meaningful differences although there was a trend towards a difference with the CKCUEST. This area certainly needs further study to identify functional measures of strength specific to the upper extremity. The findings from the first and second study guided me to the primary purpose of this dissertation which was to assess perceived and demonstrable physical function in collegiate athletes in a longitudinal manner in order to trace the natural history of physical function from a pre-injured time point to a post-injured time point. It was determined that not all athletes perceive their physical function as restored to baseline levels when discharged from rehabilitation to return to sport. Additionally, previous injury history negatively affects perceived physical function at both baseline and post-rehabilitation time points for persons who previously sustained a knee injury but not persons who previously sustained an ankle injury. Demonstrable physical function was not back to baseline at time of discharge but was restored within 1 month after return to activity was permitted and was not affected by a previous injury history with this sample of subjects

Occupational Therapy Students’ Test/Re-Test Reliability of the Readiness for Interprofessional Education Learning Scale and Interdisciplinary Education Perception Scale

The purpose of this study was to establish the test/re-test reliability of two interprofessional education (IPE) instruments, the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS) among occupational therapy (OT) graduate students. The intent was to compare results based on previous IPE experience and year in the program. The RIPLS and IEPS were distributed to 111 OT students at one university. Both instruments were distributed a second time 10-14 days later. Cronbach’s alpha, weighted Kappas, intraclass correlation coefficients (ICC), standard error of measurement, and minimal detectable change were calculated for each instrument. Assessments occurred for all subjects, between students with and without previous IPE experience, and first and second-year students in the program. Overall and between group composite score reliability for the RIPLS and IEPS were fair to excellent (ICC≥0.72). RIPLS subscale ICC’s were variable per previous IPE experience and year in program, ranging from fair-excellent (ICC=0.45-0.93). IEPS subscale ICC’s were excellent for second-year students (ICC≥0.79), and fair-excellent for students with or without previous experience and first-year students (ICC=0.50-0.84). There were no differences for the RIPLS within or between sessions or groups. First-year students had significantly higher scores compared to second-year students within sessions for the IEPS composite score, Competency and Autonomy subscale, and Perception of Actual Cooperation subscale (p≤0.035). Both instruments have acceptable test-re-test reliability; however, previous IPE experience and year in program should be accounted for when distributing the instruments and interpreting the results

Conservative Treatment for Patients with Suspected SLAP Tears: A Case Series

Objective: Outcome following non-operative management of superior labral anterior to posterior (SLAP) lesions has been under reported with little empirical data demonstrating the effectiveness of conservative treatment. Material and Methods: 10 patients, 5 matched pairs, presenting with symptoms consistent with a SLAP lesion performed a standardized phased rehabilitation program completing patient reported outcome (PRO) and pain measures before and following rehabilitation. Physical therapy notes and home exercise logs were reviewed and all exercises were recorded and coded using the phased rehabilitation protocol as a guide. At followup, patients were divided into two groups; responders and non-responders to treatment based on PRO. The volume of exercise and type of exercise performed for each patient were compared using frequency counts. Results: The non-responders did on average 33 more stretching exercises than the responders. The non-responders did on average 21 more scapular orientation exercises than the responders. There were few to no differences in the volume of strengthening exercises between the two groups except responders performed 38 more scapular retraction exercises at shoulder level while non-responders performed 49 more scapular retraction exercises below shoulder level. Conclusions: This case series identified few exercises that were beneficial to patients\u27 responding to conservative intervention but more often identified exercises that were performed that did not facilitate an improved patient outcome. Therapeutic exercises are often the cornerstone of a rehabilitation program, yet limited evidence exists in which specific exercises are beneficial or not beneficial in patients with symptoms consistent with a SLAP lesion

Increasing Ball Velocity in the Overhead Athlete: A Meta-Analysis of Randomized Controlled Trials

Overhead athletes routinely search for ways to improve sport performance, and one component of performance is ball velocity. The purpose of this meta-analysis was to investigate the effect of different strengthening interventions on ball and serve velocity. A comprehensive literature search with pre-set inclusion and exclusion criteria from 1970 to 2014 was conducted. Eligible studies were randomized control trials including the mean and SDs of both pretest and posttest ball velocities in both the experimental and the control groups. The outcome of interest was ball/serve velocity in baseball, tennis, or softball athletes. Level 2 evidence or higher was investigated to determine the effect different training interventions had on velocity. Pretest and posttest data were extracted to calculate Hedges\u27s g effect sizes with 95% confidence intervals (CIs). Methodological qualities of the final 13 articles within the analysis were assessed using the Physiotherapy Evidence Database scale. The majority of the articles included in this analysis had an effect on velocity with the strongest effect sizes found in periodized training (Hedges\u27s g = 3.445; 95% CI = 1.976-4.914). Six studies had CI that crossed zero, indicating that those specific interventions should be interpreted with caution. Consistent and high-quality evidence exists that specific resistance training interventions have an effect on velocity. These findings suggest that interventions consisting of isokinetic training, multimodal training, and periodization training are clinically beneficial at increasing velocity in the overhead athlete over different windows of time

“Where I am weak, they are strong”: Students’ Perceptions and Attitudes Toward Interprofessional Education

Purpose: Healthcare professionals strive for interprofessional practice to achieve optimal patient care. Extant research suggests that to best prepare students for interprofessional practice, interprofessional education (IPE) should be a key element in curriculum. The purpose of this mixed-methods study was to evaluate the impact of an IPE activity on participants’ attitudes and perceptions of IPE across five academic programs. Methods: This study utilized a modified version of the Readiness for Interprofessional Learning Scale Questionnaire (RIPLS) pre and post IPE and reflective essays. Participants included 67 students from nursing, occupational therapy, athletic training, dietetics, and speech-language pathology programs. After reviewing a hypothetical case study, participants collaboratively developed assessment and treatment recommendations. Questionnaires were analyzed using statistical procedures and reflective essays underwent thematic analysis. Results: Collectively, data revealed significant changes in participants’ perceptions, attitudes, and implementation readiness. Occupational therapy student participants had statistically significant increases in the RIPLS composite score, Teamwork and Collaboration, and the Positive Professional Identity components (p≤0.03). Participants with previous IPE experience scored 4-points higher on the RIPLS composite score (p=0.03). The reflective essays revealed the themes of barriers associated with collaboration, a deeper understanding and appreciation of other discipline’s roles and the value of teamwork in achieving optimal patient care. Participants reported beginning the interprofessional education experience with anxiety and uncertainty about not only their involvement but also the roles of other healthcare professionals. Throughout the experience, participants emerged with an increased knowledge of their role, others’ roles, and the value of working together within a professional setting to achieve the same goal, optimal patient care. Conclusions: Our findings reveal the benefits of interprofessional education and the necessity to include several healthcare professionals associated with rehabilitation in interprofessional research and education. With more disciplines represented, students receive a broader, more in-depth understanding of not only patient care but also the roles of multiple disciplines they will collaborate with during actual rehabilitative practice

More Elevated Fastballs Associated with Placement on the Injured List Due to Shoulder Injury

Purpose To evaluate whether impending shoulder injury was associated with changes in pitch location or velocity immediately preceding injury. Methods Pitchers placed on the injured list (IL) due to a shoulder injury between 2015 and 2020 were identified in the Major League Baseball transactions database. Four-seam fastball velocity and frequency of pitch location for each pitch type was collected for each player in the season before placement on the IL and within 1 month of placement on the IL with a minimum of 55 pitches thrown of 1 type. Pitch locations were collected as identified by Baseball Savant’s Game-Day Zones. Game-Day Zones were consolidated into high (above the strike zone midpoint) versus low, arm side (closer to the pitcher’s arm side of the plate) versus opposite side, and within the strike zone versus out of zone. Repeated measures analysis of variance determined differences in four-seam velocity and the location distribution of 4-seam fastballs, change-ups, and breaking balls among each group. Results In total, 267 pitchers were placed on the IL for a shoulder injury with the majority diagnosed with inflammation (89/267) followed by strain or sprain (69/267). Four-seam fastball locations significantly increased above the mid-point of the zone (45.9% vs 42.4%, P = .008) and out of the strike zone (48.5% vs 46.5%, P = .011) within a month before IL placement. There was no significant change in 4-seam fastball velocity immediately before IL placement. Conclusions Pitchers threw more elevated 4-seam fastballs and out-of-zone 4-seam fastballs in the month before IL placement for shoulder injury. These findings suggest that a loss of 4-seam fastball command decreases with impending shoulder injury. Level of Evidence IV, prognostic case series

Injury Rates in Major League Baseball during the 2020 COVID-19 Season

Background: The 2020 Major League Baseball (MLB) season was drastically altered because of the COVID-19 pandemic. The changes included an extended layoff between March and July as well as a shortened preseason. Purpose/Hypothesis: To determine the incidence and epidemiology of MLB injuries in the abbreviated 2020 season compared with prior seasons. We hypothesized that there was an increase in the overall injury rate in the 2020 season compared with the 2018-2019 seasons and that it equally affected all body regions. Study Design: Descriptive epidemiology study. Methods: The MLB transactions database was queried to find players who had been placed on the injury list between 2018 and 2020. Injuries were categorized into upper extremity, lower extremity, spine/core, and other injuries. Incidence per 1000 athlete-exposures was calculated for the prior 2 seasons (2018-2019) and for the 2020 season separately. Incidence for each category was also calculated separately for pitchers and fielders. Incidence rate ratios (IRRs) and confidence intervals were used to compare injury rates in 2018-2019 versus 2020. The z test for proportions was used to determine significant differences between injury incidences. Results: In 2020, the overall incidence rate per 1000 athlete-exposures was almost twice the rate compared with the 2 seasons before COVID-19 (8.66 vs 5.13; IRR, 1.69 [95% CI, 1.53-1.87]; P \u3c .001). Injury incidence increased similarly in 2020 for both pitchers (IRR, 1.68 [95% CI, 1.47-1.91]; P \u3c .001) and fielders (IRR, 1.68 [95% CI, 1.45-1.96]; P \u3c .001). Increases in injury incidence were seen in the upper extremity, spine/core, and other injury categories; however, the incidence of the lower extremity did not change significantly. Conclusion: There was a significant increase in injury incidence for both pitchers and fielders in 2020. Injury rates increased in anatomic zones of the upper extremity and spine/core but were not significantly changed in the lower extremity. The overall increase in injury rate suggests that irregular or insufficient sport-specific preparation prior to the start of the season placed athletes at a greater risk of injury when play resumed

Using a neuro-imaging technique to improve shoulder function

A 46 year-old male patient presented with severe scapular pain and inability to use his right arm in forward flexion or during overhead activities. An evaluation by an orthopedic surgeon who specialized in scapular conditions determined he had detachment of various scapular muscles. Surgical reattachment of the lower trapezius and rhomboids was performed. The surgical intervention and post-operative rehabilitation reduced the pain however; 18 months following surgery, the patient developed kinesiophobic traits and hypersensitivity with low-level nocioception. In an attempt to alleviate the pain and fear of movement, neuroimaging was utilized by employing a mirror-box regimen. The patient was instructed to focus on the reflection of the non-involved limb in the mirrors so it appeared as though he was looking at a full image of his body. When the patient signaled that the image looked complete, he was instructed to elevate both arms to numerous angles for approximately 20-30 repetitions. With the use of the mirrors, the patient could raise both arms equally to approximately 110 degrees of forward elevation with little reported pain. When the mirrors were taken away, the patient began to become inhibited again only being able to perform 5 repetitions of elevation before pain prohibited him from continuing. The patient was instructed to perform a similar regimen for 20 minutes a day/5 days a week until his next follow-up 3 months later. On the next follow-up, the patient had full arm elevation (160 degrees) with little to no pain and without use of the mirrors

Using a neuro-imaging technique to improve shoulder function

A 46 year-old male patient presented with severe scapular pain and inability to use his right arm in forward flexion or during overhead activities. An evaluation by an orthopedic surgeon who specialized in scapular conditions determined he had detachment of various scapular muscles. Surgical reattachment of the lower trapezius and rhomboids was performed. The surgical intervention and post-operative rehabilitation reduced the pain however; 18 months following surgery, the patient developed kinesiophobic traits and hypersensitivity with low-level nocioception. In an attempt to alleviate the pain and fear of movement, neuroimaging was utilized by employing a mirror-box regimen. The patient was instructed to focus on the reflection of the non-involved limb in the mirrors so it appeared as though he was looking at a full image of his body. When the patient signaled that the image looked complete, he was instructed to elevate both arms to numerous angles for approximately 20-30 repetitions. With the use of the mirrors, the patient could raise both arms equally to approximately 110 degrees of forward elevation with little reported pain. When the mirrors were taken away, the patient began to become inhibited again only being able to perform 5 repetitions of elevation before pain prohibited him from continuing. The patient was instructed to perform a similar regimen for 20 minutes a day/5 days a week until his next follow-up 3 months later. On the next follow-up, the patient had full arm elevation (160 degrees) with little to no pain and without use of the mirrors.https://encompass.eku.edu/swps_facultygallery/1002/thumbnail.jp