Predictors of Orthopaedic Surgery in NCAA Athletes

Objectives: Orthopaedic injury and surgery is relatively common in National Collegiate Athletic Association (NCAA) athletes and can have devastating career consequences. However, there is a paucity of data regarding predictors of orthopaedic surgery in collegiate athletes. The purpose of this study was to analyze player-related predictors of orthopaedic surgery, including that of the shoulder, hip, and knee, in NCAA athletes. Methods: All NCAA Division I collegiate athletes at a single institution who began participation from the 2003-2004 through 2008-2009 seasons were retrospectively identified. Player-related factors, including gender, sport, and any pre-college upper or lower extremity orthopaedic surgery, were elicited through pre-participation evaluations (PPEs). Athletes who underwent an orthopaedic surgery in college were identified through the Sports Injury Monitoring System and medical records. All patient-related independent variables were included in a multiple Cox regression model. Exposure time was calculated from the date of PPE to the date of surgery (event) or to the end of the collegiate athletic career (censored). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Significance was set at P \u3c 0.05. Results: In total, 1,142 athletes in 12 sports (baseball/softball, basketball, football, golf, gymnastics, rowing, swimming & diving, soccer, tennis, track & field/cross country, volleyball, water polo) were identified. There were 262 documented orthopaedic surgeries, including those involving the shoulder (n = 34), hip (n = 25), and knee (n = 72), in 182 athletes. Using the multiple Cox regression model, pre-college lower extremity surgery was an independent predictor of orthopaedic (P = 0.004, HR = 1.88) and knee (P \u3c 0.001, HR = 3.91) surgery, and type of sport was an independent predictor of orthopaedic (P \u3c 0.001), shoulder (P = 0.002), and knee surgery (P \u3c 0.001) (Table 1). Participation in gymnastics, basketball, and volleyball were the strongest predictors of orthopaedic surgery. Similarly, participation in volleyball, gymnastics, and baseball/softball were the strongest predictors of shoulder surgery, and participation in basketball, football, and volleyball were the strongest predictors of knee surgery. Lastly, athletes with a history of a pre-college orthopaedic surgery were more susceptible to another surgery in the same extremity during college (P = 0.046, HR = 2.18). Gender was not a significant predictor of any surgery. No independent predictors of hip surgery were identified. Conclusion: NCAA athletes who underwent a pre-college lower extremity surgery were more likely to undergo orthopaedic and knee surgery during their collegiate careers. Those in overhead sports (e.g., volleyball, baseball/softball) were more likely to undergo shoulder surgery, and those in cutting and jumping sports (e.g., basketball, football) were more likely to undergo knee surgery. Furthermore, athletes with a history of a pre-college orthopaedic surgery were more likely to undergo another surgery in the same extremity during college, suggesting inadequate rehabilitation or less than full return of function after surgery. The time lost from athletic participation due to an orthopaedic surgery and its potential career impact underscores the need for injury prevention and improved surgical outcomes in the amateur athlete

Faculty-Librarian Collaboration in Building the Curriculum for the Millennium: The US Experience

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68104/2/10.1177_034003529902500402.pd

Healthcare assistants in general practice : a qualitative study of their experiences

Aim To explore the experiences of healthcare assistants (HCAs) working in general practice (GP). Background HCAs increasingly play an important role in UK GP teams. The role is relatively new and little is known about how HCAs feel about their work in GP, and the challenges that they face. Methods Semi-structured interviews were undertaken with 14 HCAs from two Primary Care Trusts in the West Midlands, United Kingdom. Transcriptions were analysed using the framework analysis approach. Findings Overall, HCAs reported that they enjoyed their work, and particularly appreciated the patient contact and positive feedback gained. Attitudes to the role were affected by previous position, experience, and length of time working within the practice. The HCAs felt accepted and supported by GP team members and valued the support they were receiving. Key sources of frustration included the poor salary, the lack of initial clarity with regard to role definition, and the constraints of their scope of practice. Role boundaries between HCAs and practice nurses were experienced as well defined, and no perceptions of role ambiguity were reported. HCAs considered their work to be of relatively low status, with its main purpose being to ease the practice nurse’s workload. Although many had the desire to train as nurses, few saw it as a realistic possibility. Conclusions Although HCAs appear to be satisfied overall, the elements of dissatisfaction relate to status, pay, and career progression, which may limit the retention of individuals in this role. Practices should consider the importance of recognising and valuing the work of HCAs and of providing protected time and resources for mentorship and career progression

The Impact of Prior Upper-Extremity Surgery on Orthopedic Injury and Surgery in Collegiate Athletes

Background: The influence of prior upper-extremity (UE) surgery on a collegiate athletic career is poorly understood. This study aimed to investigate the impact of prior UE surgery on participation, injury, and surgery rates in collegiate athletes. Methods: Division I athletes who commenced collegiate athletics from 2003-2009 were retrospectively identified. Pre-participation evaluation forms were queried for the history of pre-collegiate UE surgery. Data on sport played, seasons played, injuries, days missed, and orthopedic imaging and surgical procedures were collected through athletic and medical records and compared with those of athletes without prior UE surgery. Subgroup analysis was performed for shoulder surgery, elbow surgery, and wrist and/or hand surgery. Results: Between 2003 and 2009, 1145 athletes completed pre-participation evaluations. Of these athletes, 77 (6.7%) underwent at least 1 pre-collegiate UE surgical procedure. Prior UE surgery was most common in men\u27s water polo (15.0%), baseball (14.9%), and football (12.6%). The UE surgery group had a higher rate of collegiate UE injury (hazard ratio, 4.127; P \u3c .01) and missed more days per season because of UE injury (16.5 days vs. 6.7 days, P = .03) than controls. Athletes with prior shoulder surgery (n = 20) also experienced more UE injuries compared with controls (hazard ratio, 15,083; P = .02). They missed more days per season (77.5 days vs. 29.8 days, P \u3c .01), underwent more magnetic resonance imaging scans (0.96 vs. 0.40, P \u3c .01), and underwent more orthopedic surgical procedures per season (0.23 vs. 0.08, P \u3c .01). The elbow subgroup and wrist and/or hand subgroup were comparable with controls on all measures. Conclusions: Collegiate athletes with prior shoulder surgery missed more days and underwent more magnetic resonance imaging scans and surgical procedures in college, whereas those with prior elbow surgical procedures and wrist and/or hand surgical procedures were comparable with controls

Lower Quarter Y-Balance Test Scores and Lower Extremity Injury in NCAA Division I Athletes.

BackgroundFunctional movement tests that are predictive of injury risk in National Collegiate Athletic Association (NCAA) athletes are useful tools for sports medicine professionals. The Lower Quarter Y-Balance Test (YBT-LQ) measures single-leg balance and reach distances in 3 directions.PurposeTo assess whether the YBT-LQ predicts the laterality and risk of sports-related lower extremity (LE) injury in NCAA athletes.Study designCase-control study; Level of evidence, 3.MethodsThe YBT-LQ was administered to 294 NCAA Division I athletes from 21 sports during preparticipation physical examinations at a single institution. Athletes were followed prospectively over the course of the corresponding season. Correlation analysis was performed between the laterality of reach asymmetry and composite scores (CS) versus the laterality of injury. Receiver operating characteristic (ROC) analysis was used to determine the optimal asymmetry cutoff score for YBT-LQ. A multivariate regression analysis adjusting for sex, sport type, body mass index, and history of prior LE surgery was performed to assess predictors of earlier and higher rates of injury.ResultsNeither the laterality of reach asymmetry nor the CS correlated with the laterality of injury. ROC analysis found optimal cutoff scores of 2, 9, and 3 cm for anterior, posteromedial, and posterolateral reach, respectively. All of these potential cutoff scores, along with a cutoff score of 4 cm used in the majority of prior studies, were associated with poor sensitivity and specificity. Furthermore, none of the asymmetric cutoff scores were associated with earlier or increased rate of injury in the multivariate analyses.ConclusionYBT-LQ scores alone do not predict LE injury in this collegiate athlete population. Sports medicine professionals should be cautioned against using the YBT-LQ alone to screen for injury risk in collegiate athletes

Lower Quarter Y-Balance Test Scores and Lower Extremity Injury in NCAA Division I Athletes

BackgroundFunctional movement tests that are predictive of injury risk in National Collegiate Athletic Association (NCAA) athletes are useful tools for sports medicine professionals. The Lower Quarter Y-Balance Test (YBT-LQ) measures single-leg balance and reach distances in 3 directions.PurposeTo assess whether the YBT-LQ predicts the laterality and risk of sports-related lower extremity (LE) injury in NCAA athletes.Study designCase-control study; Level of evidence, 3.MethodsThe YBT-LQ was administered to 294 NCAA Division I athletes from 21 sports during preparticipation physical examinations at a single institution. Athletes were followed prospectively over the course of the corresponding season. Correlation analysis was performed between the laterality of reach asymmetry and composite scores (CS) versus the laterality of injury. Receiver operating characteristic (ROC) analysis was used to determine the optimal asymmetry cutoff score for YBT-LQ. A multivariate regression analysis adjusting for sex, sport type, body mass index, and history of prior LE surgery was performed to assess predictors of earlier and higher rates of injury.ResultsNeither the laterality of reach asymmetry nor the CS correlated with the laterality of injury. ROC analysis found optimal cutoff scores of 2, 9, and 3 cm for anterior, posteromedial, and posterolateral reach, respectively. All of these potential cutoff scores, along with a cutoff score of 4 cm used in the majority of prior studies, were associated with poor sensitivity and specificity. Furthermore, none of the asymmetric cutoff scores were associated with earlier or increased rate of injury in the multivariate analyses.ConclusionYBT-LQ scores alone do not predict LE injury in this collegiate athlete population. Sports medicine professionals should be cautioned against using the YBT-LQ alone to screen for injury risk in collegiate athletes