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Sheikhi B, Rabiei P, Letafatkar A, Rossettini G. Is Adding Education to Trunk and Hip Exercises Beneficial for Patellofemoral Pain? A Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:217-226. [PMID: 37717685 DOI: 10.1016/j.apmr.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/03/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To investigate the effect of adding education to trunk and hip exercises in patients with patellofemoral pain (PFP). DESIGN A randomized controlled trial. SETTING Research laboratory. PARTICIPANTS Sixty patients with PFP (N=60) were randomly assigned to either an experimental group (education followed by trunk and hip exercises, n=30) or a control group (trunk and hip exercises, n=30). INTERVENTIONS Both groups received 8 weeks of trunk and hip exercises, while patients in the experimental group participated in 3 prior education sessions. MAIN OUTCOME MEASURES The primary outcome was pain; secondary outcomes were pain catastrophizing, kinesiophobia, function, and muscle strength. Outcomes were assessed at baseline, after 8 weeks (post-intervention), and 3 months post-intervention (follow-up). RESULTS No significant between-group differences were observed for pain outcome post-intervention. The experimental group showed superiority over the control group in the improvement of pain catastrophizing (mean difference: -2.32; 95% confidence interval [CI] -1.059 to 0.028) and kinesiophobia (mean difference: -3.56; 95% CI -1.067 to -0.035) at post-intervention. In the experimental group, improvements were maintained at follow-up assessment for all outcomes, except muscle strength. CONCLUSION Adding education to trunk and hip exercises was associated with greater improvements in psychological outcomes than trunk and hip exercises alone after the intervention. Education can be incorporated when designing trunk and hip exercises for patients with PFP.
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Affiliation(s)
- Bahram Sheikhi
- Department of Biomechanics and Sports Injuries, Kharazmi University, Tehran, Iran.
| | - Pouya Rabiei
- Faculty of Medicine, Laval University, Quebec City, Canada; Interdisciplinary Center for Research in Rehabilitation and Social Integration (Cirris), Quebec City, Canada
| | - Amir Letafatkar
- Department of Biomechanics and Sports Injuries, Kharazmi University, Tehran, Iran
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Selhorst M, Hoehn J, Schmitt L, Benedict J, Fernandez-Fernandez A. The Effect of a Psychologically Informed Video Series to Treat Adolescents With Patellofemoral Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2023; 53:634–642. [PMID: 37706686 DOI: 10.2519/jospt.2023.12041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE: To test whether a series of brief, psychologically informed educational videos added to physical therapy improved function among adolescents with patellofemoral pain. The secondary aims were to assess pain and psychological beliefs. DESIGN: A double-blinded randomized controlled trial. METHODS: Sixty-eight adolescents with patellofemoral pain were randomly assigned to view brief, psychologically informed videos (n = 34) or control videos (n = 34) in addition to usual care physical therapy. The psychologically informed videos targeted fear-avoidance beliefs, kinesiophobia, and pain catastrophizing. The control videos conveyed basic anatomy, biomedical factors, and lower extremity mechanics. Outcomes were assessed at baseline, 3 weeks, 6 weeks (primary end point), and 3 months. The primary outcome was change in the Anterior Knee Pain Scale. Secondary outcomes were changes in Numeric Pain-Rating Scale and psychological beliefs (Modified Fear-Avoidance Beliefs Questionnaire-Physical Activity, Tampa Kinesiophobia Scale-11, and Pain Catastrophizing Scale-Child). RESULTS: Adolescents in the psychologically informed group experienced significantly greater improvements in function (Anterior Knee Pain Scale mean difference = 8 points; 95% CI: 2.2, 13.2; P = .01) and pain (Numeric Pain-Rating Scale mean difference = 1.2 points; 95% CI: 0.1, 2.4; P = .04) at 6 weeks compared to the control group. The psychologically informed group had significantly greater reductions in psychological beliefs over time than the control group (P≤.001; partial η2 = 0.32). CONCLUSION: Incorporating psychologically informed education into physical therapy care improved function, pain, and psychological beliefs to a greater extent than the control group. J Orthop Sports Phys Ther 2023;53(10):1-9. Epub: 14 September 2023. doi:10.2519/jospt.2023.12041.
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Jaffri A, Baellow A. Poor Mental Health Indicators in Individuals With Patellofemoral Pain. J Athl Train 2023; 58:849-854. [PMID: 37965988 PMCID: PMC11215708 DOI: 10.4085/1062-6050-0584.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
CONTEXT Patellofemoral pain (PFP) is a common source of knee pain in active individuals, accounting for a large number of knee injuries examined in sports medicine clinics. As a chronic condition, PFP can affect mental health. However, this effect has not yet been studied in individuals with PFP. OBJECTIVE To determine how subjective physical and mental health measures in individuals with PFP differed from those measures in pain-free individuals. DESIGN Case-control study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Volunteers for the study were 30 people with PFP (19 women, 11 men; age = 20.23 ± 3.32 years, height = 166.69 ± 6.41 cm, mass = 69.55 ± 13.15 kg) and 30 matched pain-free individuals (19 women, 11 men; age = 20.33 ± 3.37 years, height = 169.31 ± 9.30 cm, mass = 64.02 ± 11.00 kg). MAIN OUTCOME MEASURE(S) Current and worst pain levels in the past 24 hours were determined using a visual analog scale (VAS). The Anterior Knee Pain Scale, Fear Avoidance Belief Questionnaire, and Lower Extremity Functional Scale were administered. Physical and mental health measures were obtained using a modified 12-item Short Form Health Survey. Scores for 2 subscales on the modified Short Form-12 were weighted and calculated: physical component and mental component.Independent t tests were calculated to compare variables between groups. Coefficient correlations were used to measure the associations between the variables. RESULTS Individuals with PFP reported lower levels of physical (pain free: 56.13 ± 1.63, PFP: 50.54 ± 7.10, P < .001) and mental (pain-free: 53.32 ± 4.71, PFP: 48.64 ± 10.53, P = .03) health. In the PFP group, we found moderate negative correlations between the VAS score for current pain and mental health (r = -0.52, P < .01) and between the VAS score for worst pain in the past 24 hours and mental health (r = -0.46, P = .01) and between activity limitations in individuals with PFP and fear avoidance beliefs (r = -0.61, P < .01). CONCLUSIONS Our results should encourage clinicians, especially musculoskeletal rehabilitation professionals, to acknowledge the importance of a whole-person approach when treating or planning rehabilitation programs for individuals with PFP.
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Affiliation(s)
- Abbis Jaffri
- Department of Physical Therapy, Creighton University, Omaha, NE
| | - Andrea Baellow
- Department of Kinesiology, University of Virginia, Charlottesville
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Rethman KK, Mansfield CJ, Moeller J, De Oliveira Silva D, Stephens JA, Di Stasi S, Briggs MS. Kinesiophobia Is Associated With Poor Function and Modifiable Through Interventions in People With Patellofemoral Pain: A Systematic Review With Individual Participant Data Correlation Meta-Analysis. Phys Ther 2023; 103:pzad074. [PMID: 37354454 PMCID: PMC10517194 DOI: 10.1093/ptj/pzad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 02/27/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE The aim of this systematic review and correlation meta-analysis was to identify factors associated with kinesiophobia in individuals with patellofemoral pain (PFP) and to identify interventions that may reduce kinesiophobia in individuals with PFP. METHODS Seven databases were searched for articles including clinical factors associated with kinesiophobia or interventions that may reduce kinesiophobia in individuals with PFP. Two reviewers screened articles for inclusion, assessed risk of bias and quality, and extracted data from each study. A mixed-effects model was used to calculate correlations of function and pain with kinesiophobia using individual participant data. Meta-analyses were performed on interventional articles; Grading of Recommendations, Assessment, Development, and Evaluation was used to evaluate certainty of evidence. Results were reported narratively when pooling was not possible. RESULTS Forty-one articles involving 2712 individuals were included. Correlation meta-analyses using individual participant data indicated a moderate association between self-reported function and kinesiophobia (n = 499; r = -0.440) and a weak association between pain and kinesiophobia (n = 644; r = 0.162). Low-certainty evidence from 2 articles indicated that passive treatment techniques were more effective than minimal intervention in reducing kinesiophobia (standardized mean difference = 1.11; 95% CI = 0.72 to 1.49). Very low-certainty evidence from 5 articles indicated that interventions to target kinesiophobia (psychobehavioral interventions, education, and self-managed exercise) were better in reducing kinesiophobia than physical therapist treatment approaches not specifically targeting kinesiophobia (standardized mean difference = 1.64; 95% CI = 0.14 to 3.15). CONCLUSION Higher levels of kinesiophobia were moderately associated with poorer function and weakly associated with higher pain in individuals with PFP. Taping and bracing may reduce kinesiophobia immediately after use, and specific kinesiophobia-targeted interventions may reduce kinesiophobia following the full intervention; however, the certainty of evidence is very low. IMPACT Assessment of kinesiophobia in clinical practice is recommended, on the basis of the relationships identified between kinesiophobia and other important factors that predict outcomes in individuals with PFP.
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Affiliation(s)
- Katherine K Rethman
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Ohio State University Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cody J Mansfield
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Ohio State University Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Josh Moeller
- Department of Biology, The Ohio State University, Columbus, Ohio, USA
| | - Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Julie A Stephens
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Division of Physical Therapy, School of Health & Rehabilitation Sciences, College of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Matthew S Briggs
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, USA
- Ohio State University Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Lee JH, Rhim HC, Jang KM. Effect of Adding Kinesio Taping to Exercise Therapy in the Treatment of Patellofemoral Pain Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040754. [PMID: 37109711 PMCID: PMC10142653 DOI: 10.3390/medicina59040754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
Background and objectives: Patellar taping has been widely used for the primary or adjunctive treatment of patellofemoral pain syndrome (PFPS); however, there are limited data in terms of functional outcomes. This study aimed to investigate whether there is any beneficial effect of adding Kinesio Taping® (KT) to exercise therapy in the treatment of PFPS. Materials and Methods: Twenty patients (27.5 ± 5.4 years) with PFPS who applied KT and 19 patients (27.3 ± 7.4 years) who did not were included in this study. Quadriceps muscle strength and acceleration time (AT) were assessed using an isokinetic device. Patient-reported outcomes were evaluated using the Kujala anterior knee pain scale (AKPS). Both groups underwent one-month exercise therapy. Results: There was no significant difference in quadriceps strength, AT, and AKPS at baseline and at 1 month between the taping and non-taping groups (p > 0.05). However, for quadriceps muscle strength, the effect of time*group interaction was statistically significant (F(1.37) = 4.543, p < 0.05, partial eta squared 0.109), showing that improvement in the quadriceps strength was higher in the non-taping group than that in the taping group. Conclusions: Adding KT to exercise therapy did not elicit extra benefits in quadriceps muscle strength and AT, and AKPS among PFPS with abnormal patellar tracking at one month.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA 02115, USA
| | - Ki-Mo Jang
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
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Zuk EF, Kim S, Burland JP, Glaviano NR. The Comparison of Psychological Barriers Between Individuals with a History of Anterior Knee Pain, Anterior Cruciate Ligament Reconstruction, and Healthy Individuals. Int J Sports Phys Ther 2023; 18:92-101. [PMID: 36793558 PMCID: PMC9897036 DOI: 10.26603/001c.68045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 11/03/2022] [Indexed: 02/05/2023] Open
Abstract
Background Psychological barriers due to anterior knee pain (AKP) and anterior cruciate ligament reconstruction (ACLR) may have a direct impact on an individual's return to physical activity. A comprehensive understanding of these psychological barriers in individuals with AKP and ACLR may help clinicians to develop and implement better treatment strategies to address deficits that may exist in these individuals. Hypothesis/Purpose The primary purpose of this study was to evaluate fear-avoidance, kinesiophobia, and pain catastrophizing in individuals with AKP and ACLR compared with healthy individuals. The secondary purpose was to directly compare psychological characteristics between the AKP and ACLR groups. It was hypothesized that 1) individuals with AKP and ACLR would self-report worse psychosocial function than healthy individuals and 2) the extent of the psychosocial impairments between the two knee pathologies would be similar. Study Design Cross-sectional study. Methods Eighty-three participants (28 AKP, 26 ACLR, and 29 healthy individuals) were analyzed in this study. Fear avoidance belief questionnaire (FABQ) with the physical activity (FABQ-PA) and sport (FABQ-S) subscales, Tampa scale of Kinesiophobia (TSK-11) and pain catastrophizing scale (PCS) assessed psychological characteristics. Kruskal-Wallis tests were used to compare the FABQ-PA, FABQ-S, TSK-11, and PCS scores across the three groups. Mann-Whitney U tests were performed to determine where group differences occurred. Effect sizes (ES) were calculated with the Mann-Whitney U z-score divided by the square root of the sample size. Results Individuals with AKP or ACLR had significantly worse psychological barriers compared to the healthy individuals for all questionnaires (FABQ-PA, FABQ-S, TSK-11, and PCS) (p<0.001, ES>0.86). There were no differences between the AKP and ACLR groups (p≥0.67), with a medium ES (-0.33) in the FABQ-S between AKP and ACLR groups. Conclusion Greater psychological scores indicate impaired psychological readiness to perform physical activity. Clinicians should be aware of fear-related beliefs following knee-related injuries and are encouraged to measure psychological factors during the rehabilitation process. Level of Evidence 2.
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Affiliation(s)
- Emma F Zuk
- Department of Kinesiology University of Connecticut
- Institute for Sports Medicine University of Connecticut
| | - Sungwan Kim
- Department of Kinesiology University of Connecticut
- Institute for Sports Medicine University of Connecticut
| | - Julie P Burland
- Department of Kinesiology University of Connecticut
- Institute for Sports Medicine University of Connecticut
| | - Neal R Glaviano
- Department of Kinesiology University of Connecticut
- Institute for Sports Medicine University of Connecticut
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Kasitinon D, Williams R, Gharib M, Flowers R, Raiser S, Jain NB. What's New in Orthopaedic Rehabilitation. J Bone Joint Surg Am 2022; 104:1961-1967. [PMID: 36126120 DOI: 10.2106/jbjs.22.00732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Donald Kasitinon
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Reed Williams
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mahmood Gharib
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Ryan Flowers
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sara Raiser
- Department of Orthopaedics, Emory Healthcare, Atlanta, Georgia
| | - Nitin B Jain
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
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Six Treatments Have Positive Effects at 3 Months for People With Patellofemoral Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2022; 52:750-768. [PMID: 36070427 DOI: 10.2519/jospt.2022.11359] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To determine the effects of nonsurgical treatments on pain and function in people with patellofemoral pain (PFP). DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: We searched MEDLINE, Web of Science, and Scopus databases from their inception until May 2022 for interventional randomized controlled trials (RCTs) in people with PFP. STUDY SELECTION CRITERIA: We included RCTs that were scored ≥7 on the PEDro scale. DATA SYNTHESIS: We extracted homogenous pain and function data at short- (≤3 months), medium- (>3 to ≤12 months) and long-term (>12 months) follow-up. Interventions demonstrated primary efficacy if outcomes were superior to sham, placebo, or wait-and-see control. Interventions demonstrated secondary efficacy if outcomes were superior to an intervention with primary efficacy. RESULTS: We included 65 RCTs. Four interventions demonstrated short-term primary efficacy: knee-targeted exercise therapy for pain (standardized mean difference [SMD], 1.16; 95% CI: 0.66, 1.66) and function (SMD, 1.19; 95% CI: 0.51, 1.88), combined interventions for pain (SMD, 0.79; 95% CI: 0.26, 1.29) and function (SMD, 0.98; 95% CI: 0.47, 1.49), foot orthoses for global rating of change (OR = 4.31; 95% CI: 1.48, 12.56), and lower-quadrant manual therapy for function (SMD, 2.30; 95% CI: 1.60, 3.00). Two interventions demonstrated short-term secondary efficacy compared to knee-targeted exercise therapy: hip-and-knee-targeted exercise therapy for pain (SMD, 1.02; 95% CI: 0.58, 1.46) and function (SMD, 1.03; 95% CI: 0.61, 1.45), and knee-targeted exercise therapy and perineural dextrose injection for pain (SMD, 1.34; 95% CI: 0.72, 1.95) and function (SMD, 1.21; 95% CI: 0.60, 1.82). CONCLUSIONS: Six interventions had positive effects at 3 months for people with PFP, with no intervention adequately tested beyond this time point. J Orthop Sports Phys Ther 2022;52(11):750-768. Epub: 8 September 2022. doi:10.2519/jospt.2022.11359.
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Patankar AG, Christino MA, Milewski MD. Psychological Aspects of Adolescent Knee Injuries. Clin Sports Med 2022; 41:595-609. [DOI: 10.1016/j.csm.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Huang J, Xu Y, Xuan R, Baker JS, Gu Y. A Mixed Comparison of Interventions for Kinesiophobia in Individuals With Musculoskeletal Pain: Systematic Review and Network Meta-Analysis. Front Psychol 2022; 13:886015. [PMID: 35846681 PMCID: PMC9277051 DOI: 10.3389/fpsyg.2022.886015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022] Open
Abstract
Objective This systematic review aims to make a mixed comparison of interventions for kinesiophobia and individuals with musculoskeletal pain. Methods A comprehensive search strategy was conducted in the database of PubMed, MEDLINE, and Web of Science with the inclusion criteria: (1) randomized controlled design; (2) patients with musculoskeletal pain as participants; (3) treatments protocols of kinesiophobia as interventions or comparisons; (4) the score of Tampa Scale Kinesiophobia (TSK) as outcome measures. A network meta-analysis was used to synthesize the data after checking the model consistency. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Assessment Tool. Results Thirty-one studies were included in this review after a comprehensive search strategy with a low risk of bias and good consistency. According to the results of the network meta-analysis, a multi-modal treatment protocol had the highest probability to become the best choice in dealing with kinesiophobia caused by musculoskeletal pain, whereas psychological treatment protocols also showed a potentially positive effect on musculoskeletal pain-induced kinesiophobia. Conclusion Multi-modal protocols could be recommended as the preferred option when dealing with kinesiophobia caused by musculoskeletal pain. However, it is still worth mentioning that there are also potentially positive therapeutic effects of psychological interventions. Since the concept of kinesiophobia is based on the fear-avoidance model, the psychological mechanism should be paid enough attention to during treatment. Registration Number CRD42021286450.
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Affiliation(s)
- Jialu Huang
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Yining Xu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Rongrong Xuan
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Julien S. Baker
- Department of Sport and Physical Education, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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