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Agel J, Schisel J, Harvey E, Rockwood T. Return to activity is a multi-faceted variable, not a discrete yes-no. J ISAKOS 2024; 9:100297. [PMID: 39067522 DOI: 10.1016/j.jisako.2024.07.005] [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: 05/06/2024] [Revised: 07/08/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES To develop a patient-reported outcome that allows for tracking of return to activity after injury. By acknowledging that return to activity is not a discrete Yes/No question where participants return to their baseline activity may be unrelated to their treatment a more comprehensive understanding and measurement of the outcome of treatment after injury as it relates to activity participation was developed and evaluated. METHODS Item development and evaluation were undertaken with the final version tested in an ongoing observational clinical trial. Descriptive statistics and test-re-test analysis using intra-class correlation and percent agreement were used. RESULTS A 5-item set of questions was identified that assess return to activity from a multi-faceted perspective. The final 5 items record preferred activity, days and hours per week of participation, impact of change in participation in activity, degree of limitation in participation and if it is related to injury or external factors. Over 30% of the population reported that their participation in their preferred activity was no longer active and not related to their injury but other factors demonstrating the importance of documenting more than one variable. CONCLUSION The Minnesota Activity Scale provides standardized questions to comprehensively assess return to activity as a marker of treatment effectiveness. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Julie Agel
- Department of Orthopedics, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN, USA.
| | - Jessica Schisel
- Department of Orthopedics, University of Washington, 325 Ninth Ave, Seattle, WA, USA
| | - Edward Harvey
- Department of Surgery, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Ave, Montreal, Quebec, CA, Canada
| | - Todd Rockwood
- Division of Health Policy and Management, University of Minnesota, 420 Delaware St. SE, MMC 729 Mayo, Minneapolis, MN, USA
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Murray IR, Makaram NS, Geeslin AG, Chahla J, Moatshe G, Crossley K, Kew ME, Davis A, Tuca M, Potter H, Janse van Rensburg DC, Emery CA, Eun S, Grindem H, Noyes FR, Marx RG, Harner C, Levy BA, King E, Cook JL, Whelan DB, Hatch GF, Wahl CJ, Thorborg K, Irrgang JJ, Pujol N, Medvecky MJ, Stuart MJ, Krych AJ, Engebretsen L, Stannard JP, MacDonald P, Seil R, Fanelli GC, Maak TG, Shelbourne KD, Verhagen E, Musahl V, Hirschmann MT, Miller MD, Schenck RC, LaPrade RF. Multiligament knee injury (MLKI): an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation. Br J Sports Med 2024:bjsports-2024-108089. [PMID: 39237264 DOI: 10.1136/bjsports-2024-108089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 09/07/2024]
Abstract
Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with British Journal of Sports Medicine guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined 'a priori' if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI.
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Affiliation(s)
- Iain Robert Murray
- Edinburgh Orthopaedics, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | - Navnit S Makaram
- Edinburgh Orthopaedics, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | | | | | - Gilbert Moatshe
- Orthopaedic Division, Oslo University Hospital, Oslo, Norway
- Oslo Sports Trauma Research Center, Oslo, Norway
| | - Kay Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australian IOC Research Centre, Melbourne, Victoria, Australia
| | | | | | - Maria Tuca
- Pontificia Universidad Catolica De Chile School of Medicine, Santiago, Chile
| | - Hollis Potter
- Weill Cornell Medical College, New York, New York, USA
| | - Dina C Janse van Rensburg
- Section Sports Medicine, University of Pretoria Faculty of Health Sciences, Pretoria, Gauteng, South Africa
- Chair, Medical Advisory Panel, World Netball, Manchester, UK
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - SeungPyo Eun
- Dr. Eun's Korea Orthopaedic Clinic, Seoul, The Republic of Korea
| | - Hege Grindem
- Oslo Sports Trauma Research Center, Oslo, Norway
| | - Frank R Noyes
- Department of Orthopedic Surgery, Mercyhealth-Cincinnati Sports Medicine and Orthopedics, Cincinnati, Ohio, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
| | - Chris Harner
- Office of Orthopedic Devices, Office of Health Technology 6, Silverspring, Maryland, USA
| | - Bruce A Levy
- Jewett Orthopedic Institute, Orlando Health, Orlando, Florida, USA
| | - Enda King
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, Mizzou Joint & Limb Preservation Center, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
| | - Daniel B Whelan
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - George F Hatch
- USC Keck School of Medicine, Los Angeles, California, USA
| | - Christopher J Wahl
- Surgical Sports Medicine and Trauma, Proliance Orthopedics & Sports Medicine, Seattle, Washington, USA
| | - Kristian Thorborg
- Orthopedic Department, Sports Orthopedic Research Center - Copenhagen (SORC-C), Amager - Hvidovre Hospital, Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - James J Irrgang
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicolas Pujol
- Department of Orthopedics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Michael J Medvecky
- Section of Sports Medicine, Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | - Lars Engebretsen
- Orthopaedic Division, Oslo University Hospital, Oslo, Norway
- Oslo Sports Trauma Research Center, Oslo, Norway
| | - James P Stannard
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | | | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hopsitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods (HOSD), Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
| | - Gregory C Fanelli
- Geisinger Orthopaedics and Sports Medicine, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania, USA
| | - Travis G Maak
- University of Utah Health, Salt Lake City, Utah, USA
| | | | - Evert Verhagen
- Department of Public and Occupational Health, Amsterdam Collaboration on Health & Safety in Sports, Amsterdam, Netherlands
- Movement Sciences, Amsterdam, University Medical Centres - Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Mark D Miller
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Robert C Schenck
- Department of Orthopedic Surgery and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Robert F LaPrade
- Orthopedic Surgery, Twin Cities Orthopedics Edina-Crosstown, Edina, Minnesota, USA
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Emirzeoğlu M, Ülger Ö. SUPER rehabilitation of hamstring strain injuries in soccer players: Delphi consensus study. Physiother Theory Pract 2024; 40:2083-2093. [PMID: 37341645 DOI: 10.1080/09593985.2023.2226732] [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: 01/13/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Hamstring strain injuries (HSI) are one of the most common injuries for soccer players and there is a need for new clinical-based studies on the rehabilitation of these injuries. OBJECTIVE This study aimed to create a consensus on physiotherapy and rehabilitation approaches used in HSI by physiotherapists with super league experience in Turkey. METHODS Twenty-six male physiotherapists (duration of experience in professional life, on athlete health, and in the super league: 12.84 ± 6.04 years, 12.19 ± 5.96 years, 8.71 ± 5.31 years, respectively) from different institutions participated in the study. The research was carried out in three rounds using the Delphi method. RESULTS Data collected using LimeSurvey and Google Forms were analyzed using the Microsoft Excel and SPSS 22 software. The response rates over the three rounds were 100%, 96%, and 96%, respectively. The 10 main items that were agreed upon in Round 1 were divided into 93 sub-items. Their numbers in the second and third Rounds were 60 and 53, respectively. At the end of Round 3, the highest consensus was on eccentric exercise, dynamic stretching, interval running, and movement-enhancing field training. All sub-items at this round were classified as SUPER (S: Soft tissue restoration techniques; U: Using supportive approaches; P: Physical fitness exercises; E: Electro-hydro-thermal methods; and R: Return to sport activities). CONCLUSION SUPER rehabilitation provides a new conceptual framework in terms of approaches used by clinicians in rehabilitation for athletes with HSI. Recognizing the lack of evidence for the various approaches involved, clinicians can modify their practice and researchers can explore whether these approaches are scientifically correct.
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Affiliation(s)
- Murat Emirzeoğlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Özlem Ülger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Fontanier V, Bruchard A, Tremblay M, Mohammed R, da Silva-Oolup S, Suri-Chilana M, Pasquier M, Hachem S, Meyer AL, Honoré M, Vigne G, Bermon S, Murnaghan K, Lemeunier N. Classification of myo-connective tissue injuries for severity grading and return to play prediction: A scoping review. J Sci Med Sport 2024:S1440-2440(24)00257-3. [PMID: 39232948 DOI: 10.1016/j.jsams.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/28/2024] [Accepted: 07/25/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVES To conduct a systematic literature search to identify currently used classifications of acute non-contact muscle injuries in sporting adults. DESIGNS Scoping review. METHODS A systematic literature search from January 1, 2010 to April 19, 2022 of Medline and SPORTDiscus yielded 13,426 articles that were screened for eligibility. Findings from included studies were qualitatively synthesized. Classifications and their grading, as well as outcomes and definitions were extracted. RESULTS Twenty-four classifications were identified from the 37 included studies, most of which had low evidence study designs. Majority (57 %) of classifications were published after 2009 and were mostly developed for hamstring or other lower limb injuries. The six most cited classifications accounted for 70 % of the reports (BAMIC, modified Peetrons, Munich, Cohen, Chan and MLG-R). Outcome reporting was sparse, making it difficult to draw conclusions. Still, significant relationships between grading and time to return to play were reported for the BAMIC, modified Peetrons, Munich and Cohen classifications. Other classifications either had a very low number of reported associations, reported no associations, reported inconclusive associations, or did not report an assessment of the association. Other outcomes were poorly investigated. CONCLUSIONS There is no agreed-upon use of muscle classification, and no consensus on definitions and terminology. As a result, reported outcomes and their relationship to severity grading are inconsistent across studies. There is a need to improve the generalizability and applicability of existing classifications and to refine their prognostic value. High-level evidence studies are needed to resolve these inconsistencies.
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Affiliation(s)
| | | | - Mathieu Tremblay
- Groupe de Recherche sur les Affections Neuromusculosquelettiques, Université du Québec à Trois-Rivières, Canada
| | | | - Sophia da Silva-Oolup
- Undergraduate and Graduate Education Departments: Canadian Memorial Chiropractic College, Canada
| | - Minisha Suri-Chilana
- Undergraduate and Graduate Education Departments: Canadian Memorial Chiropractic College, Canada
| | | | - Sarah Hachem
- Paris-Saclay University, Inserm, "Exposome and Heredity" Team, CESP, France
| | | | | | | | - Stéphane Bermon
- Health and Science Department, World Athletics, Monaco; LAMHESS, Université Côte d'Azur, France
| | - Kent Murnaghan
- Library Services, Canadian Memorial Chiropractic College, Canada
| | - Nadège Lemeunier
- Medinetic Learning, Research Department, France; UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, France; Faculty of Health Sciences, Ontario Tech University, Canada
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Silvers-Granelli H, Silverman R, Bizzini M, Thorborg K, Brophy RH. The 11+ injury prevention programme decreases rate of hamstring strain injuries in male collegiate soccer players. Br J Sports Med 2024; 58:701-708. [PMID: 38599679 DOI: 10.1136/bjsports-2023-107323] [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] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES To investigate if the 11+ injury prevention programme decreases the risk of hamstring injury and improves recovery time and determine whether compliance with the 11+ affects hamstring injury risk. METHODS This study is a secondary analysis from a prospective cluster randomised controlled trial that included 65 National Collegiate Athletic Association (NCAA) division I and II men's soccer teams over the fall 2012 season. Thirty-one teams were randomised to the intervention group that were using the 11+ as their warm-up and 35 teams to the control group that continued to use their traditional warm-up. Each certified athletic trainer (ATC) collected data on demographics, hamstring injury (HSI), mechanism of injury, position, playing surface, time lost due to injury and compliance to the 11+ programme. RESULTS The 11+ decreased the risk of HSI by 63% compared with the control group (RR=0.37, 95% CI 0.21 to 0.63). Difference in return to play after HSI between the control (9.4±11.2 days) and intervention groups (10.2±11.3 days) was not significant (p=0.8). High compliance (>2 or more doses on average per week) reduced the risk of HSI by 78% (RR=0.22, 95% CI 0.06 to 0.87) compared with low compliance (<1 dose on average per week), and moderate compliance (1 to <2 doses on average per week) decreased the risk of HSI by 67% (RR=0.33, 95% CI 0.11 to 0.97) compared with low compliance. There was no significant difference between high and moderate compliance. CONCLUSION The 11+ decreased the risk of HSI by 63% but did not improve recovery time. High to moderate compliance is essential and makes the programme more effective at reducing HSI.
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Affiliation(s)
- Holly Silvers-Granelli
- Velocity Physical Therapy, Santa Monica, California, USA
- Research, Major League Soccer, New York, New York, USA
| | - Richard Silverman
- Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Mario Bizzini
- Research, Schulthess Klinik Human Performance Lab, Zurich, Switzerland
- Swiss Sport Physiotherapy Association, Leukerbad, VS, Switzerland
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Hvidovre Hospital, Hvidovre, Denmark
| | - Robert H Brophy
- Orthopaedic Surgery, Washington University in Saint Louis School of Medicine, Chesterfield, Missouri, USA
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Dunlop G, Ivarsson A, Andersen TE, Brown S, O'Driscoll G, Lewin C, Dupont G, Ardern CL, Delecroix B, Podlog L, McCall A. Examination of the validity of the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale in male professional football players: A worldwide study of 29 professional teams. J Sports Sci 2023; 41:1906-1914. [PMID: 38269550 DOI: 10.1080/02640414.2024.2307764] [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: 08/03/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Abstract
Perceived confidence is an important dimension of an athlete's psychological readiness to return-to-play. However, there is no established and validated tool to evaluate confidence in professional football. This study aimed to provide preliminary evaluation of the internal structure of the Injury-Psychological Readiness to Return-to-Sport scale (I-PRRS) in a cohort of injured male professional footballers. Over an 18-month period, 29 teams from 17 leagues participated. Players sustaining injuries eliciting ≥ 3 weeks' time-loss were recruited. Cross culturally adapted to 4 further languages, the I-PRRS was administered on two occasions: 1) day before returning-to-training and 2) day before returning-to-match-play. In total, 113 injuries were recorded with 96 completed I-PRRS data sets collected. Confirmatory factor analysis indicated the I-PRRS was a unidimensional scale, with all items measuring the same construct. The scale demonstrated good internal consistency (ω = .88). When examining longitudinal invariance of the I-PRRS across administration time-points, indices of model fit supported scalar invariance. There was preliminary evidence of good internal structure for the I-PRRS in professional male footballers. However, before further research involving the I-PRRS can be endorsed, efforts to confirm or refute empirical developments pertaining to psychological readiness are necessary.
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Affiliation(s)
- Gordon Dunlop
- Arsenal Performance and Research Team, Arsenal Football Club, London Colney, UK
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Andreas Ivarsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Susan Brown
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Gary O'Driscoll
- Medical Department, Manchester United Football Club, Manchester, United Kingdom
| | | | - Gregory Dupont
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Clare L Ardern
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Sport & Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | | | - Leslie Podlog
- School of Kinesiology and Physical Activity Sciences, University of Montreal, Montreal, Québec, Canada
- CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Alan McCall
- Arsenal Performance and Research Team, Arsenal Football Club, London Colney, UK
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
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Fandim JV, Hinman RS, Øverås CK, Sharma S, Belton J, Oliveira VC, Dear BF, Parker R, Ghai B, Bennell KL, Ferreira P, Hartvigsen J, Saragiotto BT. One step at a time. Shaping consensus on research priorities and terminology in telehealth in musculoskeletal pain: an international modified e-Delphi study. BMC Musculoskelet Disord 2023; 24:783. [PMID: 37789304 PMCID: PMC10546725 DOI: 10.1186/s12891-023-06866-0] [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: 05/26/2023] [Accepted: 09/08/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Telehealth has emerged as an alternative model for treatment delivery and has become an important component of health service delivery. However, there is inconsistency in the use of terminologies and a lack of research priorities in telehealth in musculoskeletal pain. The purpose of this international, multidisciplinary expert panel assembled in a modified three-round e-Delphi survey is to achieve a consensus on research priorities and for the standard terminology for musculoskeletal pain telehealth practice. METHODS In this international modified e-Delphi survey, we invited an expert panel consisting of researchers, clinicians, consumer representatives, industry partners, healthcare managers, and policymakers to participate in a three-round e-Delphi. Expert panels were identified through the Expertscape website, PubMed database, social media, and a snowball approach. In Round 1, potential research priorities and terminologies were presented to panel members. Panel members rated the agreement of each research priority on a 5-point Likert scale and an 11-point numerical scale, and each terminology on a 5-point Likert scale for the "telehealth in musculoskeletal pain " field over rounds. At least 80% of the panel members were required to agree to be deemed a consensus. We analyzed the data descriptively and assessed the stability of the results using the Wilcoxon matched-pairs signed rank test. RESULTS We performed an international e-Delphi survey from February to August 2022. Of 694 invited people, 160 panel members participated in the first round, 133 in the second round (83% retention), and 134 in the third round (84% retention). Most of the panel members were researchers 76 (47%), clinicians 57 (36%), and consumer representatives 9 (6%) of both genders especially from Brazil 31 (19%), India 22 (14%), and Australia 19 (12%) in the first round. The panel identified fourteen telehealth research priorities spanned topics including the development of strategies using information and communication technology, telehealth implementation services, the effectiveness and cost-effectiveness of telehealth interventions, equity of telehealth interventions, qualitative research and eHealth literacy in musculoskeletal pain conditions from an initial list of 20 research priorities. The consensus was reached for "digital health" and "telehealth" as standard terminologies from an initial list of 37 terminologies. CONCLUSION An international, multidisciplinary expert consensus recommends that future research should consider the 14 research priorities for telehealth musculoskeletal pain reached. Additionally, the terms digital health and telehealth as the most appropriate terminologies to be used in musculoskeletal telehealth research. REGISTER Open Science Framework ( https://osf.io/tqmz2/ ).
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Affiliation(s)
- Junior V Fandim
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Rua Cesário Galeno, 448, Tatuapé, CEP 03071-000, São Paulo, SP, Brasil.
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
| | - Cecilie K Øverås
- Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Saurab Sharma
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Joletta Belton
- IASP Global Alliance of Partners for Pain Advocacy (GAPPA), Washington D.C, USA
| | - Vinícius C Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (UFVJM), Diamantina, MG, Brazil
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Macquarie Park, Australia
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Babita Ghai
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
| | - Paulo Ferreira
- Faculty of Medicine and Health, The University of Sydney, Charles Perkins Centre, Sydney School of Health Sciences, Camperdown, NSW, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Bruno T Saragiotto
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Rua Cesário Galeno, 448, Tatuapé, CEP 03071-000, São Paulo, SP, Brasil
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Thoomes E, Falla D, Cleland JA, Fernández-de-Las-Peñas C, Gallina A, de Graaf M. Conservative management for lumbar radiculopathy based on the stage of the disorder: a Delphi study. Disabil Rehabil 2023; 45:3539-3548. [PMID: 36205564 DOI: 10.1080/09638288.2022.2130448] [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: 05/17/2022] [Accepted: 09/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR. MATERIALS AND METHODS Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round. RESULTS Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, individualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with individualized vocational, ergonomic and postural advice. CONCLUSIONS Experts agree effectiveness of interventions differs through the evolution of LR.IMPLICATIONS FOR REHABILITATIONTo date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition.Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support individualized physical activity with pain medication.Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered.Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity.
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Affiliation(s)
- Erik Thoomes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
- Research Department, Fysio-Experts, Hazerswoude, Netherlands
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
| | - Joshua A Cleland
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Alessio Gallina
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
| | - Marloes de Graaf
- Research Department, Fysio-Experts, Hazerswoude, Netherlands
- Department of Manual Therapy, Breederode University of Applied Science, Rotterdam, Netherlands
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Aiello F, McCall A, Brown SJ, Serner A, Fortington LV, Huurman SAE, Lewin C, Nagao M, O'Brien J, Panossian A, Pruna R, Ramos GP, Whalan M, Impellizzeri FM. Development of a Standardised System to Classify Injury-Inciting Circumstances in Football: the Football Injury Inciting Circumstances Classification System (FIICCS). Sports Med 2023; 53:1805-1818. [PMID: 37233947 PMCID: PMC10432371 DOI: 10.1007/s40279-023-01857-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND A comprehensive examination of the sport-specific activities and circumstances being performed at the time of injury is important to hypothesise mechanisms, develop prevention strategies and inform future investigations. Results reported in the literature are inconsistent because inciting activities are reported using different classifications. Hence the aim was to develop a standardised system for the reporting of inciting circumstances. METHODS The system was developed using a modified Nominal Group Technique. The initial panel included 12 sports practitioners and researchers from four continents with respectively ≥ 5 years of experience working in professional football and/or conducting injury research. The process consisted of six phases: idea generation, two surveys, one online meeting and two confirmations. For answers to the closed questions, consensus was deemed achieved if ≥ 70% of respondents agreed. Open-ended answers were qualitatively analysed and then introduced in subsequent phases. RESULTS Ten panellists completed the study. The risk of attrition bias was low. The developed system includes a comprehensive range of inciting circumstances across five domains: contact type, ball situation, physical activity, session details, contextual information. The system also distinguishes between a core set (essential reporting) and an optional set. The panel deemed all the domains to be important and easy to use both in football and in research environments. CONCLUSION A system to classify inciting circumstances in football was developed. Given the extent of reporting inconsistency of inciting circumstances in the available literature, this can be used while further studies evaluate its reliability.
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Affiliation(s)
- Francesco Aiello
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Alan McCall
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK.
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK.
| | - Susan J Brown
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Lauren V Fortington
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Suzanne Afra Elisabeth Huurman
- Medical Department Real Madrid CF, Madrid, Spain
- Sports Medicine Department, St Antonius Hospital, Utrecht, The Netherlands
| | - Colin Lewin
- The Lewin Sports Injury Clinic, East London, UK
| | - Masashi Nagao
- Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Sports Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - James O'Brien
- Red Bull Athlete Performance Center, Salzburg, Austria
| | | | | | - Guilherme Passos Ramos
- Brazilian Football Confederation (CBF), Rio de Janeiro, RJ, Brazil
- Endocrinology and Metabolism Laboratory, Department of Physiology and Biophysics, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Matthew Whalan
- Centre of Medical and Exercise Physiology, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Football Australia, Sydney, Australia
| | - Franco M Impellizzeri
- Faculty of Health, Sport and Exercise Discipline Group, University of Technology Sydney, Sydney, Australia
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10
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Jankaew A, Chen JC, Chamnongkich S, Lin CF. Therapeutic Exercises and Modalities in Athletes With Acute Hamstring Injuries: A Systematic Review and Meta-analysis. Sports Health 2023; 15:497-511. [PMID: 35996322 PMCID: PMC10293564 DOI: 10.1177/19417381221118085] [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: 11/16/2022] Open
Abstract
CONTEXT Hamstring strain is a common injury to the lower limbs. Early intervention in the acute phase aids with restoring hamstring function and prevents secondary related injury. OBJECTIVE To systematically review and summarize the effectiveness of exercise-based interventions combined with physical modalities currently used in athletes with acute hamstring injuries. DATA SOURCES Five databases (EMBASE, Medline, Cochrane Library, SPORTDiscus, and Web of Science) were searched from inception to July 2021. STUDY SELECTION A total of 4569 studies were screened. Nine randomized controlled trials (RCTs) on the effect of therapeutic exercise programs with and without physical agents in athletes with acute hamstring injuries were identified for meta-analysis. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION The studies were screened, and the evidence was rated using the PEDro scale. Nine RCTs with PEDro scores ranging between 3 and 9 were included and extracted pain intensity, time to return to play (TTRTP), and reinjury rate in the study. RESULTS Loading exercises during extensive lengthening were shown to facilitate TTRTP at P < 0.0001 but did not prevent recurrence (P = 0.17), whereas strengthening with trunk stabilization and agility exercise did not reduce the duration of injury recurrence (P = 0.16), but significantly reduced the reinjury rate (P < 0.007) at a 12-month follow-up. The results of the stretching programs and solely physical modalities could not be pooled in the statistical analysis. CONCLUSION The meta-analysis indicated that a loading program helps athletes to return to sports on a timely basis. Although strengthening with trunk stabilization and agility exercise cannot significantly reduce recovery time, the program can prevent reinjury. The clinical effects of stretching programs and pure physical modality interventions could not be concluded in this study due to limited evidence. PROSPERO REGISTRATION CRD42020183035.
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Affiliation(s)
- Amornthep Jankaew
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jih-Ching Chen
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Samatchai Chamnongkich
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Cheng-Feng Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Physical Therapy Center, National Cheng Kung University Hospital, Tainan, Taiwan
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11
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Paton BM, Court N, Giakoumis M, Head P, Kayani B, Kelly S, Kerkhoffs GMMJ, Moore J, Moriarty P, Murphy S, Plastow R, Pollock N, Read P, Stirling B, Tulloch L, van Dyk N, Wilson MG, Wood D, Haddad F. London International Consensus and Delphi study on hamstring injuries part 1: classification. Br J Sports Med 2023; 57:254-265. [PMID: 36650035 DOI: 10.1136/bjsports-2021-105371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/19/2023]
Abstract
Muscle injury classification systems for hamstring injuries have evolved to use anatomy and imaging information to aid management and prognosis. However, classification systems lack reliability and validity data and are not specific to individual hamstring muscles, potentially missing parameters vital for sport-specific and activity-specific decision making. A narrative evidence review was conducted followed by a modified Delphi study to build an international consensus on best-practice decision-making for the classification of hamstring injuries. This comprised a digital information gathering survey to a cohort of 46 international hamstring experts (sports medicine physicians, physiotherapists, surgeons, trainers and sports scientists) who were also invited to a face-to-face consensus group meeting in London . Fifteen of these expert clinicians attended to synthesise and refine statements around the management of hamstring injury. A second digital survey was sent to a wider group of 112 international experts. Acceptance was set at 70% agreement. Rounds 1 and 2 survey response rates were 35/46 (76%) and 99/112 (88.4%) of experts responding. Most commonly, experts used the British Athletics Muscle Injury Classification (BAMIC) (58%), Munich (12%) and Barcelona (6%) classification systems for hamstring injury. Issues identified to advance imaging classifications systems include: detailing individual hamstring muscles, establishing optimal use of imaging in diagnosis and classification, and testing the validity and reliability of classification systems. The most used hamstring injury classification system is the BAMIC. This consensus panel recommends hamstring injury classification systems evolve to integrate imaging and clinical parameters around: individual muscles, injury mechanism, sporting demand, functional criteria and patient-reported outcome measures. More research is needed on surgical referral and effectiveness criteria, and validity and reliability of classification systems to guide management.
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Affiliation(s)
- Bruce M Paton
- Institute of Sport Exercise and Health, University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Babar Kayani
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Gino M M J Kerkhoffs
- Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - James Moore
- Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ricci Plastow
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Noel Pollock
- Institute of Sport Exercise and Health, University College London, London, UK.,British Athletics, London, UK
| | - Paul Read
- Institute of Sport Exercise and Health, University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,School of Sport and Exercise, University of Goucester, Gloucester, UK
| | | | | | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew G Wilson
- Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK
| | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Fares Haddad
- Institute of Sport Exercise and Health, University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK.,Princess Grace Hospital, London, UK
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12
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Paton BM, Read P, van Dyk N, Wilson MG, Pollock N, Court N, Giakoumis M, Head P, Kayani B, Kelly S, Kerkhoffs GMMJ, Moore J, Moriarty P, Murphy S, Plastow R, Stirling B, Tulloch L, Wood D, Haddad F. London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport. Br J Sports Med 2023; 57:278-291. [PMID: 36650032 DOI: 10.1136/bjsports-2021-105384] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/19/2023]
Abstract
Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.
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Affiliation(s)
- Bruce M Paton
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK
| | - Paul Read
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew G Wilson
- Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK
| | - Noel Pollock
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,British Athletics, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Babar Kayani
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sam Kelly
- Salford City Football Club, Salford, UK.,Blackburn Rovers Football Club, Blackburn, UK
| | - Gino M M J Kerkhoffs
- Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - James Moore
- Sports & Exercise Medicine, Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Simon Murphy
- Medical Services, Arsenal Football Club, London, UK
| | - Ricci Plastow
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Fares Haddad
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK.,Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
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13
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Plastow R, Kerkhoffs GMMJ, Wood D, Paton BM, Kayani B, Pollock N, Court N, Giakoumis M, Head P, Kelly S, Moore J, Moriarty P, Murphy S, Read P, Stirling B, Tulloch L, van Dyk N, Wilson M, Haddad F. London International Consensus and Delphi study on hamstring injuries part 2: operative management. Br J Sports Med 2023; 57:266-277. [PMID: 36650033 DOI: 10.1136/bjsports-2021-105383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
The key indications for surgical repair of hamstring injuries (HSIs) remain unclear in the literature due to a lack of high-level evidence and expert knowledge. The 2020 London International Hamstring Consensus meeting aimed to highlight clear surgical indications and to create a foundation for future research. A literature review was conducted followed by a modified Delphi process, with an international expert panel. Purposive sampling was used with two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering (round 1) questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15) comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion of each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. The consensus threshold was set a priori at 70% agreement. Rounds 1 and 2 survey respondents were 35/46 (76%) and 99/112 (88.4%), respectively. The consensus group agreed that the indications for operative intervention included: gapping at the zone of tendinous injury (87.2% agreement) and loss of tension (70.7%); symptomatic displaced bony avulsions (72.8%); and proximal free tendon injuries with functional compromise refractory to non-operative treatment (72.2%). Other important considerations for operative intervention included: the demands of the athlete/patient and the expected functional outcome (87.1%) based on the anatomy of the injury; the risk of functional loss/performance deficit with non-operative management (72.2%); and the capacity to restore anatomy and function (87.1%). Further research is needed to determine whether surgery can reduce the risk of reinjury as consensus was not reached within the whole group (48.2%) but was agreed by surgeons (70%) in the cohort. The consensus group did not support the use of corticosteroids or endoscopic surgery without further evidence. These guidelines will help standardise treatment of HSIs, specifically the indications and decision-making for surgical intervention.
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Affiliation(s)
- Ricci Plastow
- Trauma & Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicin, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Bruce M Paton
- Division of Medicine, Institute of Sport Exercise Health, University College London, London, UK.,Physiotherapy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Babar Kayani
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Noel Pollock
- British Athletics Medical Team, London, UK.,Sports Medicine, Institute of Sport Exercise and Health, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Sam Kelly
- Salford City Football Club, Salford, UK.,Blackburn Rovers FC, Blackburn, Lancashire, UK
| | - James Moore
- Sports & Exercise Medicine, Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Simon Murphy
- Sports Medicine, Arsenal Football Club, London, UK
| | - Paul Read
- Institute of Sport Exercise & Health, London, UK.,Princess Grace Hospital, London, London, UK
| | | | | | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew Wilson
- Princess Grace Hospital, London, London, UK.,Targeted Intervention, University College London, London, UK
| | - Fares Haddad
- Trauma & Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Sport Exercise & Health, London, UK
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14
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Page RM, Field A, Langley B, Harper LD, Julian R. The Effects of Fixture Congestion on Injury in Professional Male Soccer: A Systematic Review. Sports Med 2023; 53:667-685. [PMID: 36527592 PMCID: PMC9758680 DOI: 10.1007/s40279-022-01799-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Professional soccer teams are often required to compete with ≤ 4 days recovery between matches. Since congested schedules reduce recovery time between matches, players are possibly at an increased injury risk. To date, there are no published systematic reviews on the impact of match congestion on injuries during professional male soccer. OBJECTIVE The aim of this systematic review was to assess the effects of fixture congestion on injuries during professional soccer. METHODS Following pre-registration on the Open Science Framework ( https://osf.io/86m25/ ) and conforming with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, systematic searches of four electronic databases (PubMed, Scopus, SPORTDiscus, and Web of Science) were conducted by independent researchers from inception until February 2022. Articles were included if they were original articles written in English and contained relevant time-loss injury data (injury that results in unavailability for training and/or match-play) for male professional soccer players regarding periods of fixture congestion (a minimum of two matches with ≤ 4 days recovery). RESULTS A total of eight articles were included in the review. Five studies identified that congested fixture schedules expose players to increased match injury incidence, although layoff duration was typically lower during congested periods. Two studies identified that training and overall injury incidence were higher during congested periods, with another study identifying a lower training injury incidence during congested periods. CONCLUSION Injury risk is, overall, increased during fixture-congested periods; however, the layoff duration is typically shorter. The current findings have implications for practitioners regarding the management, periodisation, monitoring, and design of training and competition schedules.
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Affiliation(s)
- Richard Michael Page
- Department of Sport and Physical Activity, Edge Hill University, St. Helens Road, Ormskirk, Lancashire, L39 4QP, UK.
| | - Adam Field
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, M15 6BH, UK
| | - Ben Langley
- Department of Sport and Physical Activity, Edge Hill University, St. Helens Road, Ormskirk, Lancashire, L39 4QP, UK
| | - Liam David Harper
- Department of Life Sciences, Manchester Metropolitan University, Manchester, M15 6BH, UK
| | - Ross Julian
- Institute of Sport and Exercise Sciences, University of Muenster, 48149, Muenster, Germany.,School of Sport and Exercise, Exercise and Sport Research Centre, University of Gloucestershire, The Park, Cheltenham, GL50 2RH, UK
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15
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Li J, Xu M, Jiang Y. Building a personalized patient education model for general practice by Delphi method. Fam Pract 2023; 40:105-112. [PMID: 35809033 DOI: 10.1093/fampra/cmac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As one of the 3 strategic measures for disease prevention and control in the 21st century identified by WHO, patient education is the most effective measure to change people's behaviour and lifestyle. However, there are many problems with patient education in general practice in China. Because there is no suitable and uniform mode of patient education for the busy and crowded Chinese general practice. Therefore, it is necessary to establish an appropriate personalized patient education model. METHODS There were 3 rounds of consultation of the Delphi method. Each round of consultation is adjusted, modified, or deleted based on the previous round according to the degree of concentration and coordination of expert opinions. Thus form the index system of personalized patient education model. Using Cronbach α to conduct an internal consistency test for the index system. RESULTS Twenty-three participants participated in the study. The effective recovery rate of consultation was 100%. In the third round of consultation, the variation importance coefficient was 0-0.25, the variation operability coefficient was 0.07-0.26. Kendall's W of importance and operability score was significant (Kendall's W = 0.186; P < 0.01). The chi-square test result of importance is (X2 = 232.744) and operability is (X2 = 246.156). The Cronbach α was 0.974. EFA (exploratory factor analysis) indicates the model has good construct validity. CONCLUSIONS The CAPDCA personalized patient education model was preliminarily constructed in this study. Specifically, 6 first-level indicators including collection (C), assessment (A), plan (P), do (D), check (C), aggrandizement (A), 24 second-level indicators, and 34 third-level indicators. That forms the cyclic personalized patient education paradigm which has reasonable structure and high feasibility.
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Affiliation(s)
- Jie Li
- Beijing Chao-yang Hospital, School of general practice and continuing education, Capital Medical University, Beijing, China
| | - Mu Xu
- Department of General Practice, The First Hospital of Tsinghua University, Beijing, China
| | - Yue Jiang
- Department of General Practice, The First Hospital of Tsinghua University, Beijing, China
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16
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Armitage M, McErlain-Naylor SA, Devereux G, Beato M, Buckthorpe M. On-field rehabilitation in football: Current knowledge, applications and future directions. Front Sports Act Living 2022; 4:970152. [PMID: 36544545 PMCID: PMC9760760 DOI: 10.3389/fspor.2022.970152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mark Armitage
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
- Performance Services Department, Norwich City Football Club, Norwich, United Kingdom
- Faculty of Sport, Allied Health and Performance Science, St Mary's University Twickenham, London, United Kingdom
| | - Stuart A McErlain-Naylor
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Gavin Devereux
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
| | - Marco Beato
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
| | - Matthew Buckthorpe
- Faculty of Sport, Allied Health and Performance Science, St Mary's University Twickenham, London, United Kingdom
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17
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Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts. SPORTS MEDICINE - OPEN 2022; 8:11. [PMID: 35043267 PMCID: PMC8766680 DOI: 10.1186/s40798-021-00400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022]
Abstract
Background Groin pain is a very common injury in multidirectional sports such as soccer, ice hockey, rugby and Australian football. Long-standing adductor-related groin pain is a persistent clinical condition and a frequent complaint in athletes involved in sports that require multiplanar movement patterns (change of direction, high-speed sprinting and kicking). To date, the lack of rehabilitation guidelines and return-to-play criteria makes this clinical entity difficult to manage. The aim of the present Delphi was to suggest, based on opinion and practical experience of a panel of experts, potential criteria that could be taken into consideration by clinicians in the RTP decision-making process in athletes suffering from long-standing adductor-related groin pain. Methods Thirty two out of 40 experts participated to a 3-Round Delphi questionnaire. In round 1, open-ended and closed questions about 9 different sections (palpation, flexibility, strength, patient-reported outcome measures, imaging, intersegmental control, performance tests, sport-specific skills, training load) were proposed to investigate return to play evaluation criteria used by each expert. Responses were analysed and coded to produce round 2 questionnaire that investigated only the sections and the items that reached the cut-off value (≥ 70%). Round 3 questionnaire was based on sections and items that reached cut-off value in previous rounds and experts rated their agreement for return to play criteria with a 5-point Likert Scale. Descriptive statistics enabled interpretation of consensus. Results High participation rate (80%) and response rate across the 3 rounds (100%) were recorded. 6 sections reached positive consensus in round 1, 1 section reached negative consensus. In round 2 positive consensus was confirmed only for 3 sections and negative consensus for 1 section. In round 3, positive agreement was established for strength (3 items), performance tests (3 items) and sport-specific skills (2 items) sections. Negative consensus was confirmed for imaging section. Conclusion Experts agreed that strength, performance tests and sport-specific skills can be used to support RTP decision, while imaging cannot be used. These findings could be useful in assisting clinicians in the RTP decision making. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00400-z.
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18
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McCormack S, Till K, Wenlock J, Whitehead S, Stokes KA, Bitcon M, Brown J, Cross M, Davies P, Falvey ÉC, Flahive S, Gardner A, Hendricks S, Johnston R, Mellalieu SD, Parmley J, Phillips G, Ramirez C, Stein J, Scantlebury S, West SW, Jones B. Contributors to negative biopsychosocial health or performance outcomes in rugby players (CoNBO): a systematic review and Delphi study protocol. BMJ Open Sport Exerc Med 2022; 8:e001440. [PMID: 36249486 PMCID: PMC9557262 DOI: 10.1136/bmjsem-2022-001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/13/2022] Open
Abstract
The importance of contributors that can result in negative player outcomes in sport and the feasibility and barriers to modifying these to optimise player health and well-being have yet to be established. Within rugby codes (rugby league, rugby union and rugby sevens), within male and female cohorts across playing levels (full-time senior, part-time senior, age grade), this project aims to develop a consensus on contributors to negative biopsychosocial outcomes in rugby players (known as the CoNBO study) and establish stakeholder perceived importance of the identified contributors and barriers to their management. This project will consist of three parts; part 1: a systematic review, part 2: a three-round expert Delphi study and part 3: stakeholder rating of feasibility and barriers to management. Within part 1, systematic searches of electronic databases (PubMed, Scopus, MEDLINE, SPORTDiscus, CINAHL) will be performed. The systematic review protocol is registered with PROSPERO. Studies will be searched to identify physical, psychological and/or social factors resulting in negative player outcomes in rugby. Part 2 will consist of a three-round expert Delphi consensus study to establish additional physical, psychological and/or social factors that result in negative player outcomes in rugby and their importance. In part 3, stakeholders (eg, coaches, chief executive officers and players) will provide perceptions of the feasibility and barriers to modifying the identified factors within their setting. On completion, several manuscripts will be submitted for publication in peer-reviewed journals. The findings of this project have worldwide relevance for stakeholders in the rugby codes. PROSPERO registration number CRD42022346751.
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Affiliation(s)
- Sam McCormack
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK,England Performance Unit, Rugby Football League, Manchester, UK
| | - Kevin Till
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK,Leeds Rhinos Rugby League club, Leeds, UK
| | - Jessica Wenlock
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK,Leeds Rhinos Rugby League club, Leeds, UK
| | - Sarah Whitehead
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK
| | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK,Rugby Football Union, Twickenham, UK
| | | | - James Brown
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK,Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | - Éanna C Falvey
- World Rugby Limited, Dublin, Ireland,College of Medicine and Health, University College Cork, Cork, Ireland
| | | | - Andrew Gardner
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK,Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Sharief Hendricks
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK,Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
| | - Rich Johnston
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK,School of Behavioural and Health Sciences, Australia Catholic University, Brisbane, Queensland, Australia
| | - Stephen D Mellalieu
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University—Cyncoed Campus, Cardiff, Cardiff, UK
| | - James Parmley
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK
| | - Gemma Phillips
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK,England Performance Unit, Rugby Football League, Manchester, UK,Hull Kingston Rovers Rugby League club, Hull, UK
| | - Carlos Ramirez
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK,Scottich Rugby Union, Edinburgh, UK
| | - Joshua Stein
- National Rugby League, Sydney, New South Wales, Australia
| | - Sean Scantlebury
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK,England Performance Unit, Rugby Football League, Manchester, UK
| | - Stephen W West
- Department for Health, University of Bath, Bath, UK,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University, Leeds, UK,England Performance Unit, Rugby Football League, Manchester, UK,Leeds Rhinos Rugby League club, Leeds, UK,Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa,School of Science and Technology, University of New England, Armidale, New South Wales, Australia
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19
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Lam KN, Heneghan NR, Mistry J, Ojoawo AO, Peolsson A, Verhagen AP, Tampin B, Thoomes E, Jull G, Scholten-Peeters GGM, Slater H, Moloney N, Hall T, Dedering Å, Rushton A, Falla D. Classification criteria for cervical radiculopathy: An international e-Delphi study. Musculoskelet Sci Pract 2022; 61:102596. [PMID: 35671539 DOI: 10.1016/j.msksp.2022.102596] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 03/08/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Establishing a set of uniform classification criteria (CC) for cervical radiculopathy (CR) is required to aid future recruitment of homogenous populations to clinical trials. OBJECTIVES To establish expert informed consensus on CC for CR. DESIGN A pre-defined four round e-Delphi study in accordance with the guidance on Conducting and Reporting Delphi Studies. METHODS Individuals with a background in physiotherapy who had authored two or more peer-reviewed publications on CR were invited to participate. The initial round asked opinions on CC for CR. Content analysis was performed on round one output and a list of discrete items were generated forming the round two survey. In rounds two to four, participants were asked to rate the level of importance of each item on a six-point Likert scale. Data were analysed descriptively using median, interquartile range and percentage agreement. Items reaching pre-defined consensus criteria were carried forward to the next round. Items remaining after the fourth round constituted expert consensus on CC for CR. RESULTS Twelve participants participated with one drop out. The final round identified one inclusion CC and 12 exclusion CC. The inclusion CC that remained achieved 82% agreement and was a cluster criterion consisting of radicular pain with arm pain worse than neck pain; paraesthesia or numbness and/or weakness and/or altered reflex; MRI confirmed nerve root compression compatible with clinical findings. CONCLUSIONS The CC identified can be used to inform eligibility criteria for future CR trials although caution should be practiced as consensus on measurement tools requires further investigation.
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Affiliation(s)
- Kwun N Lam
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Jai Mistry
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Adesola O Ojoawo
- Department of Medical Rehabilitation, Faculty of Basic Medical Sciences College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria
| | - Anneli Peolsson
- Dep. Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy Linköping University, Linköping, Sweden
| | - Arianne P Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Brigitte Tampin
- Faculty of Business Management and Social Sciences, Hochschule Osnabrueck, University of Applied Sciences, Osnabrück, Germany; Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Australia; Curtin Allied School of Health, Curtin University, Perth, Australia
| | - Erik Thoomes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Gwendolen Jull
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia; Department of Health, Medicine and Rehabilitation, Luleå University of Technology, Luleå, Norrbotten County, Sweden
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Helen Slater
- Curtin Allied School of Health, Curtin University, Perth, Australia
| | - Niamh Moloney
- Department of Medicine, Health and Human Performance, Macquarie University, Australia; THRIVE Physiotherapy, Guernsey
| | - Toby Hall
- Curtin Allied School of Health, Curtin University, Perth, Australia
| | - Åsa Dedering
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, Canada
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
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20
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Heyward O, Emmonds S, Roe G, Scantlebury S, Stokes K, Jones B. Applied sports science and sports medicine in women's rugby: systematic scoping review and Delphi study to establish future research priorities. BMJ Open Sport Exerc Med 2022; 8:e001287. [PMID: 35979431 PMCID: PMC9310180 DOI: 10.1136/bmjsem-2021-001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives In part 1, the objective was to undertake a systematic scoping review of applied sports science and sports medicine in women's rugby, and in part 2 to develop a consensus statement on future research priorities. Design In part 1, a systematic search of PubMed (MEDLINE), Scopus and SPORTDiscus (EBSCOhost) was undertaken from the earliest records to January 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, the PRISMA extension for Scoping Reviews, and the PRISMA extension protocols were followed. In part 2, 31 international experts in women's rugby (ie, elite players, sports scientists, medical clinicians, sports administrators) participated in a three-round Delphi consensus method. These experts reviewed the findings from part 1 and subsequently provided a list of priority research topics in women's rugby. Research topics were grouped into expert-based themes and expert-based subthemes via content analysis. Expert-based themes and expert-based subthemes were ranked from very low to very high research priority on a 1-5 Likert scale. Consensus was defined by ≥70% agreement. The median research priority agreement and IQR were calculated for each expert-based theme and subtheme. Data sources PubMed (MEDLINE), Scopus and SPORTDiscus (EBSCOhost). Eligibility criteria for selecting studies Studies were eligible for inclusion if they investigated applied sports science or sports medicine in women's rugby. Results In part 1, the systematic scoping review identified 123 studies, which were categorised into six sports science and sports medicine evidence-based themes: injury (n=48), physical performance (n=32), match characteristics (n=26), fatigue and recovery (n=6), nutrition (n=6), and psychology (n=5). In part 2, the Delphi method resulted in three expert-based themes achieving consensus on future research priority in women's rugby: injury (5.0 (1.0)), female health (4.0 (1.0)) and physical performance (4.0 (1.0)). Summary/Conclusion This two-part systematic scoping review and Delphi consensus is the first study to summarise the applied sports science and sports medicine evidence base in women's rugby and establish future research priorities. The summary tables from part 1 provide valuable reference information for researchers and practitioners. The three expert-based themes that achieved consensus in part 2 (injury, female health and physical performance) provide clear direction and guidance on future research priorities in women's rugby. The findings of this two-part study facilitate efficient and coordinated use of scientific resources towards high-priority research themes relevant to a wide range of stakeholders in women's rugby.
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Affiliation(s)
- Omar Heyward
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Rugby Football Union, Twickenham, UK
- Leeds Rhinos Rugby League Club, Leeds, UK
| | - Stacey Emmonds
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- England Performance Unit, Rugby Football League, Leeds, UK
| | - Gregory Roe
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Bath Rugby, Bath, UK
| | - Sean Scantlebury
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- England Performance Unit, Rugby Football League, Leeds, UK
| | - Keith Stokes
- Rugby Football Union, Twickenham, UK
- Department for Health, University of Bath, Bath, UK
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Leeds Rhinos Rugby League Club, Leeds, UK
- England Performance Unit, Rugby Football League, Leeds, UK
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, the University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa
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21
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Alfonso Mantilla JI. Monitorización y periodización del rendimiento desde la fisioterapia deportiva ¿Hacia dónde vamos? REVISTA IBEROAMERICANA DE CIENCIAS DE LA ACTIVIDAD FÍSICA Y EL DEPORTE 2022. [DOI: 10.24310/riccafd.2022.v11i2.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
RESUMEN
Introducción El concepto de monitorización y periodización es un visión que se ha desarrollado en la última década, donde se busca que se pueda tener un control de la carga interna y externa en los deportistas de distintas disciplinas deportivas producidas por el proceso de interacción con variables de prescripción de ejercicio que causan modificaciones a nivel fisiológico, bioquímico, biomecanico, muscular, neuromuscular ocasionando la tensión en los subsistemas del movimiento corporal humano generando adaptaciones especificas ante una carga determinada la cual puede ser medida mediante el uso de tecnología especifica o test indirectos Metodología Revisión de la literatura con la combinación de palabras clave como Monitoring, Performance, sports training load, Periodization en bases de datos como Pubmed, Ebsco, Medline, Scopus, Science Direct Resultados se pudo identificar 65 artículos que referencian la existencia de herramientas tecnológicas para realizar un proceso de monitorización y periodización desde la rehabilitación , prevención, control de carga, recuperación y readaptación deportiva que permiten la generación de datos estadísticos y crear perfiles desde cada área de actuación del fisioterapeuta deportivo. Conclusión la fisioterapia es una profesión encargada de muchos procesos deportivos que deben ser monitorizados y generen datos que permitan estandarizar procesos, crear perfiles de seguimiento específicos para facilitar la toma de decisiones desde el equipo biomédico e investigaciones en el deporte de alto rendimiento fusionando la practica con la evidencia científica.
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22
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Scantlebury S, Ramirez C, Cummins C, Stokes K, Tee J, Minahan C, Emmonds S, McCormack S, Phillips G, Jones B. Injury risk factors and barriers to their mitigation for women playing rugby league: a Delphi study. J Sports Sci 2022; 40:1436-1449. [PMID: 35694782 DOI: 10.1080/02640414.2022.2085433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to 1) develop a consensus (≥70% agreement between experts) on injury risk factors specific to women playing rugby league, 2) establish the importance of the identified injury risk factors and the feasibility of mitigating these risk factors and 3) establish context specific barriers to injury risk management. Aim 1: A Delphi panel, consisting of 12 experts in rugby league and injury (e.g., physiotherapists, research scientists) were asked to identify injury risk factors specific to women playing rugby league. Aim 2: seven coaches of women's rugby league teams were asked to rate each risk factor that achieved consensus by their importance and feasibility to manage. Aim 3: Coaches reported barriers which restrict injury risk factor mitigation. Of the 53 injury risk factors which achieved consensus, the five injury risk factors with the highest combination of importance and feasibility ratings were: "poor tackle technique", "a lack of pre-season intensity", "training session are too short", "the current medical standards", and "limited access to physiotherapists". Following the identification of injury risk factors, their feasibility to manage and context specific barriers, this study proposes three constraint driven, integrated solutions which may reduce the barriers which limit injury risk factor management.
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Affiliation(s)
- Sean Scantlebury
- Carnegie Applied Rugby Research (CARR) centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,England Performance Unit, Rugby Football League, Leeds, UK
| | - Carlos Ramirez
- Carnegie Applied Rugby Research (CARR) centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,England Performance Unit, Rugby Football League, Leeds, UK
| | - Cloe Cummins
- Carnegie Applied Rugby Research (CARR) centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,School of Science and Technology, University of New England, Armidale, Australia.,National Rugby League, Armidale, Australia
| | - Keith Stokes
- Department for Health, University of Bath, Bath, UK.,Rugby Football Union, Twickenham, UK
| | - Jason Tee
- Carnegie Applied Rugby Research (CARR) centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Clare Minahan
- Griffith Sports Science, Griffith University, Australia
| | - Stacey Emmonds
- Carnegie Applied Rugby Research (CARR) centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,England Performance Unit, Rugby Football League, Leeds, UK
| | - Sam McCormack
- Carnegie Applied Rugby Research (CARR) centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,England Performance Unit, Rugby Football League, Leeds, UK
| | - Gemma Phillips
- England Performance Unit, Rugby Football League, Leeds, UK.,Hull Kingston Rovers, Hull, UK
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,England Performance Unit, Rugby Football League, Leeds, UK.,School of Science and Technology, University of New England, Armidale, Australia.,Griffith Sports Science, Griffith University, Australia.,Leeds Rhinos Rugby League club, Leeds, UK.,Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, The University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa
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23
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Thoomes E, Thoomes-de Graaf M, Cleland JA, Gallina A, Falla D. Timing of Evidence-Based Nonsurgical Interventions as Part of Multimodal Treatment Guidelines for the Management of Cervical Radiculopathy: A Delphi Study. Phys Ther 2022; 102:pzab312. [PMID: 35079842 DOI: 10.1093/ptj/pzab312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/23/2021] [Accepted: 12/21/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Conservative management of cervical radiculopathy (CR) is a first treatment option because the risk-benefit ratio for surgery is less favorable. Systematic reviews and clinical practice guidelines reporting on the effectiveness of nonsurgical management have not considered the timing of management. The aim of this study was to establish consensus on effective nonsurgical treatment modalities at different stages (ie, acute, subacute, or chronic) of CR using the Delphi method approach. METHODS Through an iterative multistage process, experts within the field rated their agreement with a list of proposed treatment modalities according to the stage of CR and could suggest missing treatment modalities. Agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round. Consensus for Round 3 was based on ≥2 of the following: a median Likert scale value of ≥4, interquartile range value of ≤1, and/or a percentage of agreement ≥70%. RESULTS Data analysis produced a consensus list of effective treatment modalities in different stages of recovery. CONCLUSION According to experts, the focus of multimodal management in the acute stage should consist of patient education and spinal manipulative therapy, specific (foraminal opening) exercises, and sustained pain-relieving positions. In the subacute stage, increasing individualized physical activity including supervised motor control, specific exercises, and/or neurodynamic mobilization could be added. In the chronic stage, focus should shift to include general aerobic exercise as well as focused strength training. Postural education and vocational ergonomic assessment should also be considered. IMPACT Multimodal conservative management of individuals with CR should take the stage of the condition into consideration. The focus of therapeutic interventions should shift from passive pain-relieving intervention in the acute stage to increasingly more individualized physical activity and self-management in the chronic stage.
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Affiliation(s)
- Erik Thoomes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Fysio-Experts, Research Department, Hazerswoude, the Netherlands
| | | | - Joshua A Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Alessio Gallina
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Yung KK, Ardern CL, Serpiello FR, Robertson S. A Framework for Clinicians to Improve the Decision-Making Process in Return to Sport. SPORTS MEDICINE - OPEN 2022; 8:52. [PMID: 35416633 PMCID: PMC9008084 DOI: 10.1186/s40798-022-00440-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/23/2022] [Indexed: 12/14/2022]
Abstract
Return-to-sport (RTS) decisions are critical to clinical sports medicine and are often characterised by uncertainties, such as re-injury risk, time pressure induced by competition schedule and social stress from coaches, families and supporters. RTS decisions have implications not only for the health and performance of an athlete, but also the sports organisation. RTS decision-making is a complex process, which relies on evaluating multiple biopsychosocial factors, and is influenced by contextual factors. In this narrative review, we outline how RTS decision-making of clinicians could be evaluated from a decision analysis perspective. To begin with, the RTS decision could be explained as a sequence of steps, with a decision basis as the core component. We first elucidate the methodological considerations in gathering information from RTS tests. Second, we identify how decision-making frameworks have evolved and adapt decision-making theories to the RTS context. Third, we discuss the preferences and perspectives of the athlete, performance coach and manager. We conclude by proposing a framework for clinicians to improve the quality of RTS decisions and make recommendations for daily practice and research.
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Affiliation(s)
- Kate K Yung
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Clare L Ardern
- Musculoskeletal and Sports Injury Epidemiology Centre, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.,Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Fabio R Serpiello
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Sam Robertson
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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25
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Individualized Exercise Prescription for Athletes Using a Construct-Based Model. Sports Med 2022; 52:2315-2320. [DOI: 10.1007/s40279-022-01670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
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26
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Aguilaniu A, Croisier JL, Schwartz C, Dardenne N, D'Hooghe P, Martens G, Collin R, Kaux JF. Current practice for safe return-to-play after lateral ankle sprain: A survey among French-speaking physicians. Foot Ankle Surg 2022; 28:307-312. [PMID: 33858759 DOI: 10.1016/j.fas.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/03/2021] [Accepted: 03/30/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recommendations are available for assessment criteria for safe return-to-play (RTP) after a lateral ankle sprain. However, their current use among physicians is unknown. METHODS French-speaking physicians in Belgium, France and Switzerland were asked to complete an online survey and report their clinical assessment of selected RTP criteria. RESULTS The respondent sample (n=109) included physicians with and without Sports Medicine education, varied level of experience and proportion of athletes in their practice population. Pain was the most selected criterion for safe RTP (90% of physicians), followed by ability to engage in functional tasks (82%), functional instability (73%), range of motion (61%), proprioception (47%), mechanical instability (39%), strength (38%) and swelling (31%). A low proportion of physicians use quantitative measures to assess these criteria (between 4% and 53%). CONCLUSIONS A large proportion of physicians consider the recommended criteria for RTP decisions. However, physicians do not frequently use quantitative measures.
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Affiliation(s)
- Aude Aguilaniu
- University of Liège, Sports Sciences Department, Human Motion Analysis Lab, Liège, Belgium.
| | - Jean-Louis Croisier
- University of Liège, Sports Sciences Department, Human Motion Analysis Lab, Liège, Belgium; Central University Hospital of Liège, Physical Medicine and Sports Traumatology Department, SportS(2), FIFA Medical Centre of Excellence, FIMS Collaborative Centre Sports Medicine, French-speaking Research Network for Athlete Health Protection & Performance (ReFORM) - IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Liège, Belgium
| | - Cédric Schwartz
- University of Liège, Sports Sciences Department, Human Motion Analysis Lab, Liège, Belgium; Central University Hospital of Liège, Physical Medicine and Sports Traumatology Department, SportS(2), FIFA Medical Centre of Excellence, FIMS Collaborative Centre Sports Medicine, French-speaking Research Network for Athlete Health Protection & Performance (ReFORM) - IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Liège, Belgium
| | - Nadia Dardenne
- University of Liège, Public Health and Biostatistics Department, Liège, Belgium
| | - Pieter D'Hooghe
- Aspetar Hospital, Orthopaedic Surgery and Sports Medicine Department, Doha, Qatar
| | - Géraldine Martens
- Central University Hospital of Liège, Physical Medicine and Sports Traumatology Department, SportS(2), FIFA Medical Centre of Excellence, FIMS Collaborative Centre Sports Medicine, French-speaking Research Network for Athlete Health Protection & Performance (ReFORM) - IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Liège, Belgium
| | - Romain Collin
- Central University Hospital of Liège, Physical Medicine and Sports Traumatology Department, SportS(2), FIFA Medical Centre of Excellence, FIMS Collaborative Centre Sports Medicine, French-speaking Research Network for Athlete Health Protection & Performance (ReFORM) - IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Liège, Belgium
| | - Jean-François Kaux
- University of Liège, Sports Sciences Department, Human Motion Analysis Lab, Liège, Belgium; Central University Hospital of Liège, Physical Medicine and Sports Traumatology Department, SportS(2), FIFA Medical Centre of Excellence, FIMS Collaborative Centre Sports Medicine, French-speaking Research Network for Athlete Health Protection & Performance (ReFORM) - IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Liège, Belgium
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27
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Hoppen MI, Reurink G, de Boode VA, van der Kaaden L, Jagtman L, Glazenburg T, Bruning B, Tol JL. Return to match running performance after a hamstring injury in elite football: a single-centre retrospective cohort study. BMJ Open Sport Exerc Med 2022; 8:e001240. [PMID: 35309372 PMCID: PMC8883270 DOI: 10.1136/bmjsem-2021-001240] [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] [Accepted: 02/03/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives To determine the number of matches to return to pre-injury match running performance after sustaining an acute hamstring injury. Methods In this retrospective cohort study, the injuries of the players of the first, Under21, Under19, Under18 and Under17 teams of a professional football club in the period 2017-2020 were analysed. Acute hamstring injuries with a minimal absence from training or match play of 7 days were included. For running performance, we assessed the following variables: maximal velocity (km/hour), total distance, high-intensity distance (17.5-22.5 km/hour) and sprint distance (>22.5 km/hour). We calculated the average and 95% CI for these variables during the last five matches before the injury. The primary outcome was the number of matches to reach maximal velocity within the 95% CI of the player's individual pre-injury performance. Secondary outcome scores included the duration (in days and matches) to reach the other running performance variables. Results 18 hamstring injuries in 15 players were included. 15 out of 18 injuries (83%) showed a return to pre-injury maximal velocity in the second match after return to play. The median number of matches to return to pre-injury maximal velocity was 2 (IQR 1-2). In the first match after return to play, pre-injury total distance was reached in 100% of the injuries, pre-injury sprint distance was reached in 94% of the injuries and pre-injury high-intensity distance was reached in 89% of the injuries. Conclusion Following an acute hamstring injury in elite football, pre-injury match running performance is reached in the first or second match.
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Affiliation(s)
- Marloes I Hoppen
- Academic Centre for Evidence-based Sports Medicine (ACES), University of Amsterdam, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Gustaaf Reurink
- Academic Centre for Evidence-based Sports Medicine (ACES), University of Amsterdam, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands
| | - Vosse A de Boode
- Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands
| | | | - Lotte Jagtman
- Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands
| | - Tim Glazenburg
- Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands
| | - Bastiaan Bruning
- Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands
| | - Johannes L Tol
- Academic Centre for Evidence-based Sports Medicine (ACES), University of Amsterdam, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Medical-Performance-Science Department, AFC Ajax, Amsterdam, The Netherlands.,Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Dissociation between fatigued power output and traditional peak torque for isokinetic hamstring:quadriceps ratios in professional soccer players. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-021-00881-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Funabashi M, Pohlman KA, Gorrell LM, Salsbury SA, Bergna A, Heneghan NR. Expert consensus on a standardised definition and severity classification for adverse events associated with spinal and peripheral joint manipulation and mobilisation: protocol for an international e-Delphi study. BMJ Open 2021; 11:e050219. [PMID: 34764170 PMCID: PMC8587360 DOI: 10.1136/bmjopen-2021-050219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Spinal and peripheral joint manipulation (SMT) and mobilisation (MOB) are widely used and recommended in the best practice guidelines for managing musculoskeletal conditions. Although adverse events (AEs) have been reported following these interventions, a clear definition and classification system for AEs remains unsettled. With many professionals using SMT and MOB, establishing consensus on a definition and classification system is needed to assist with the assimilation of AEs data across professions and to inform research priorities to optimise safety in clinical practice. METHODS AND ANALYSIS This international multidisciplinary electronic Delphi study protocol is informed by a scoping review and in accordance with the 'Guidance on Conduction and Reporting Delphi Studies'. With oversight from an expert steering committee, the study comprises three rounds using online questionnaires. Experts in manual therapy and patient safety meeting strict eligibility criteria from the following fields will be invited to participate: clinical, medical and legal practice, health records, regulatory bodies, researchers and patients. Round 1 will include open-ended questions on participants' working definition and/or understanding of AEs following SMT and MOB and their severity classification. In round 2, participants will rate their level of agreement with statements generated from round 1 and our scoping review. In round 3, participants will rerate their agreement with statements achieving consensus in round 2. Statements reaching consensus must meet the a priori criteria, as determined by descriptive analysis. Inferential statistics will be used to evaluate agreement between participants and stability of responses between rounds. Statements achieving consensus in round 3 will provide an expert-derived definition and classification system for AEs following SMT and MOB. ETHICS AND DISSEMINATION This study was approved by the Canadian Memorial Chiropractic College Research Ethics Board and deemed exempt by Parker University's Institutional Review Board. Results will be disseminated through scientific, professional and educational reports, publications and presentations.
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Affiliation(s)
- Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Department of Chiropractic, University of Quebec in Trois Rivieres, Trois-Rivieres, Quebec, Canada
| | | | - Lindsay M Gorrell
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, ZH, Switzerland
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa, USA
| | - Andrea Bergna
- Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Predictors of time to return to play and re-injury following hamstring injury with and without intramuscular tendon involvement in adult professional footballers: A retrospective cohort study. J Sci Med Sport 2021; 25:216-221. [PMID: 34740516 DOI: 10.1016/j.jsams.2021.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In one English Premier League football club over four seasons, 1) describe the number of hamstring strain injuries (HSI) sustained using the British Athletics Muscle Injury Classification (BAMIC); 2) determine if intramuscular tendon HSI influenced the time to return to play (TTRTP) and reinjury rate; 3) determine the predictors of TTRTP and reinjury. DESIGN Retrospective cohort design. METHODS All first team players who sustained a HSI between 2014 and 2018 were included. Players underwent an MRI scan that was graded by a Radiologist using the BAMIC (0a-4) criteria. TTRTP, reinjury rate and information on suspected predictors were recorded. RESULTS Thirty-five HSI experienced by 24 players (age = 26 ± 4 years) were recorded over the 4 seasons. There was a difference in TTRTP between grades 1a and 2c (P = 0.007), but not between 2b and 2c (P = 0.845). Grade of HSI (P ≤ 0.001) and removal of the player (P < 0.001) were predictors of TTRTP, with each increase in grade resulting in an additional 3 days of TTRTP, and being removed, an additional 11 days. Grade and all other predictors did not influence reinjury rate, albeit higher odds were evident for previous HSI, experiencing the HSI during sprinting, passing a ball or stretching, and reported increase days of pain during walking. CONCLUSIONS HSIs extending into the intramuscular tendon (2b cf. 2c) did not influence TTRTP or re-injury, albeit TTRTP was affected by the BAMIC grade and if the player was removed from activity.
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Indirect Structural Muscle Injuries of Lower Limb: Rehabilitation and Therapeutic Exercise. J Funct Morphol Kinesiol 2021; 6:jfmk6030075. [PMID: 34564194 PMCID: PMC8482242 DOI: 10.3390/jfmk6030075] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022] Open
Abstract
Muscle injuries are the most common trauma in team and individual sports. The muscles most frequently affected are those of the lower limb, and in particular hamstrings, adductors, rectus femoris and calf muscles. Although several scientific studies have tried to propose different rehabilitation protocols, still too often the real rehabilitation process is not based on scientific knowledge, especially in non-elite athletes. Moreover, the growing use of physical and instrumental therapies has made it increasingly difficult to understand what can be truly effective. Therefore, the aim of the present paper is to review proposed therapeutic algorithms for muscle injuries, proposing a concise and practical summary. Following a three-phase rehabilitation protocol, this review aims to describe the conservative treatment of indirect structural muscle injuries, which are the more routinely found and more challenging type. For each phase, until return to training and return to sport are completed, the functional goal, the most appropriate practitioner, and the best possible treatment according to current evidence are expressed. Finally, the last section is focused on the specific exercise rehabilitation for the four main muscle groups with a structured explanatory timetable.
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32
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Price J, Rushton A, Tyros V, Heneghan NR. Expert consensus on the important chronic non-specific neck pain motor control and segmental exercise and dosage variables: An international e-Delphi study. PLoS One 2021; 16:e0253523. [PMID: 34197481 PMCID: PMC8248695 DOI: 10.1371/journal.pone.0253523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Chronic non-specific neck pain is highly prevalent, resulting in significant disability. Despite exercise being a mainstay treatment, guidance on optimal exercise and dosage variables is lacking. Combining submaximal effort deep cervical muscles exercise (motor control) and superficial cervical muscles exercise (segmental) reduces chronic non-specific neck pain, but evaluation of optimal exercise and dosage variables is prevented by clinical heterogeneity. OBJECTIVE To gain consensus on important motor control and segmental exercise and dosage variables for chronic non-specific neck pain. METHODS An international 3-round e-Delphi study, was conducted with experts in neck pain management (academic and clinical). In round 1, exercise and dosage variables were obtained from expert opinion and clinical trial data, then analysed thematically (two independent researchers) to develop themes and statements. In rounds 2 and 3, participants rated their agreement with statements (1-5 Likert scale). Statement consensus was evaluated using progressively increased a priori criteria using descriptive statistics. RESULTS Thirty-seven experts participated (10 countries). Twenty-nine responded to round 1 (79%), 26 round 2 (70%) and 24 round 3 (65%). Round 1 generated 79 statements outlining the interacting components of exercise prescription. Following rounds 2 and 3, consensus was achieved for 46 important components of exercise and dosage prescription across 5 themes (clinical reasoning, dosage variables, exercise variables, evaluation criteria and progression) and 2 subthemes (progression criteria and progression variables). Excellent agreement and qualitative data supports exercise prescription complexity and the need for individualised, acceptable, and feasible exercise. Only 37% of important exercise components were generated from clinical trial data. Agreement was highest (88%-96%) for 3 dosage variables: intensity of effort, frequency, and repetitions. CONCLUSION Multiple exercise and dosage variables are important, resulting in complex and individualised exercise prescription not found in clinical trials. Future research should use these important variables to prescribe an evidence-informed approach to exercise.
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Affiliation(s)
- Jonathan Price
- Musculoskeletal Physiotherapy Services, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom
- College of Life and Environmental Sciences, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alison Rushton
- College of Life and Environmental Sciences, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Physical Therapy, Western University, Ontario, Canada
| | | | - Nicola R. Heneghan
- College of Life and Environmental Sciences, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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33
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Smith MD, Vicenzino B, Bahr R, Bandholm T, Cooke R, Mendonça LDM, Fourchet F, Glasgow P, Gribble PA, Herrington L, Hiller CE, Lee SY, Macaluso A, Meeusen R, Owoeye OBA, Reid D, Tassignon B, Terada M, Thorborg K, Verhagen E, Verschueren J, Wang D, Whiteley R, Wikstrom EA, Delahunt E. Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework-an international multidisciplinary consensus. Br J Sports Med 2021; 55:1270-1276. [PMID: 34158354 DOI: 10.1136/bjsports-2021-104087] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite being the most commonly incurred sports injury with a high recurrence rate, there are no guidelines to inform return to sport (RTS) decisions following acute lateral ankle sprain injuries. We aimed to develop a list of assessment items to address this gap. METHODS We used a three-round Delphi survey approach to develop consensus of opinion among 155 globally diverse health professionals working in elite field or court sports. This involved surveys that were structured in question format with both closed-response and open-response options. We asked panellists to indicate their agreement about whether or not assessment items should support the RTS decision after an acute lateral ankle sprain injury. The second and third round surveys included quantitative and qualitative feedback from the previous round. We defined a priori consensus being reached at >70% agree or disagree responses. RESULTS Sixteen assessment items reached consensus to be included in the RTS decision after an acute lateral ankle sprain injury. They were mapped to five domains with 98% panellist agreement-PAASS: Pain (during sport participation and over the last 24 hours), Ankle impairments (range of motion; muscle strength, endurance and power), Athlete perception (perceived ankle confidence/reassurance and stability; psychological readiness), Sensorimotor control (proprioception; dynamic postural control/balance), Sport/functional performance (hopping, jumping and agility; sport-specific drills; ability to complete a full training session). CONCLUSION Expert opinion indicated that pain severity, ankle impairments, sensorimotor control, athlete perception/readiness and sport/functional performance should be assessed to inform the RTS decision following an acute lateral ankle sprain injury. TRIAL REGISTRATION NUMBER ACTRN12619000522112.
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Affiliation(s)
- Michelle D Smith
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Roald Bahr
- Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway.,Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy and Department of Clinical Research, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rosalyn Cooke
- English Institute of Sport, Manchester Institute for Health and Performance, Manchester, UK
| | - Luciana De Michelis Mendonça
- Physical Therapy Department, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil.,Graduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - François Fourchet
- Physiotherapy Department, Hôpital de La Tour, Meyrin, Switzerland.,Laboratoire Interuniversitaire de Biologie de la Motricité, UJM-Saint-Etienne, University of Lyon, Lyon, France
| | - Philip Glasgow
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,School of Sport, Ulster University, Jordanstown, UK
| | - Phillip A Gribble
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Lee Herrington
- English Institute of Sport, Manchester Institute for Health and Performance, Manchester, UK.,Centre for Health, Sport and Rehabilitation Sciences, University of Salford, Salford, UK
| | - Claire E Hiller
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Sae Yong Lee
- Department of Physical Education, Yonsei University, Seoul, South Korea.,Yonsei Institute of Sports Science and Exercise Medicine, Yonsei University, Seoul, South Korea
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Roma, Italy.,Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Roma, Italy
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Oluwatoyosi B A Owoeye
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, Saint Louis, Missouri, USA.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Duncan Reid
- Faculty of Health and Environmental Sciences, School of Clinical Sciences, AUT University, Auckland, New Zealand
| | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Masafumi Terada
- College of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre University Hospital, Copenhagen, Denmark.,Physical Medicine Rehabilitation Research-Copenhagen (PMR-C), Amager-Hvidovre University Hospital, Copenhagen, Denmark
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, VUmc site, Amsterdam, Netherlands
| | - Jo Verschueren
- Human Physiology and Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dan Wang
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China
| | - Rod Whiteley
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,School of Human Movement & Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Institute for Sport and Health, University College Dublin, Dublin, Ireland
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Return to Play After a Hamstring Strain Injury: It is Time to Consider Natural Healing. Sports Med 2021; 51:2067-2077. [PMID: 34143413 DOI: 10.1007/s40279-021-01494-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 01/15/2023]
Abstract
Return to play (RTP) criteria after hamstring strain injuries (HSIs) help clinicians in deciding whether an athlete is ready to safely resume previous sport activities. Today, functional and sport-specific training tests are the gold standard in the decision-making process. These criteria lead to an average RTP time between 11 and 25 days after a grade 1 or 2 HSI. However, the high re-injury rates indicate a possible inadequacy of the current RTP criteria. A possible explanation for this could be the neglect of biological healing time. The present review shows that studies indicating time as a possible factor within the RTP-decision are very scarce. However, studies on biological muscle healing showed immature scar tissue and incomplete muscle healing at the average moment of RTP. Twenty-five percent of the re-injuries occur in the first week after RTP and at the exact same location as the index injury. This review supports the statement that functional recovery precedes the biological healing of the muscle. Based on basic science studies on biological muscle healing, we recommend a minimum period of 4 weeks before RTP after a grade 1 or 2 HSI. In conclusion, we advise a comprehensive RTP functional test battery with respect for the natural healing process. Before deciding RTP readiness, clinicians should reflect whether or not it is biologically possible for the injured tissue to have regained enough strength to withstand the sport-specific forces. In an attempt to reduce the detrimental injury-reinjury cycle, it is time to start considering (biological healing) time.
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Villiere A, Mason B, Parmar N, Maguire N, Holmes D, Turner A. The physical characteristics underpinning performance of wheelchair fencing athletes: A Delphi study of Paralympic coaches. J Sports Sci 2021; 39:2006-2014. [PMID: 33947314 DOI: 10.1080/02640414.2021.1912454] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Wheelchair fencing (WF) is a Paralympic sport which is practised by athletes with physical disabilities and is classified into three categories according to the degree of activity limitation the impairment causes in the sport. All Paralympic sports are requested to develop their own evidence-based classification system to enhance the confidence in the classification process; however, this is yet to be achieved in WF. Research within WF is scarce; therefore, the aim of this study was to reach expert consensus on the physical characteristics that underpin performance of athletes competing in the sport as this is known as one of the initial steps required to achieve an evidence-based classification system. Sixteen Paralympic WF coaches were invited to take part in a three-round Delphi study, with experts drawing consensus on qualities of speed, strength, power, flexibility and motor control of the trunk and fencing arm being associated with increased athletic success. The required qualities of the non-fencing arm led to diverging opinions across the expert panel. This study provides clear guidance of the physical qualities to be developed to maximize athletic performance while also providing the initial framework to guide future WF classification research.
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Affiliation(s)
- Alexandre Villiere
- Faculty of Science and Technology, London Sport Institute, Middlesex University, London, UK.,International Wheelchair & Amputee Sports Federation, UK
| | - Barry Mason
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Nimai Parmar
- Faculty of Science and Technology, London Sport Institute, Middlesex University, London, UK
| | - Niamh Maguire
- Psychology and Healthcare Services, The Priory Group, London, UK
| | - Danny Holmes
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Anthony Turner
- Faculty of Science and Technology, London Sport Institute, Middlesex University, London, UK
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Thoomes E, Thoomes-de Graaf M, Cleland J, Gallina A, Falla D. Timing of evidence-based non-surgical interventions as part of multimodal treatment guidelines for the management of cervical radiculopathy: a Delphi study protocol. BMJ Open 2021; 11:e043021. [PMID: 33727266 PMCID: PMC7970254 DOI: 10.1136/bmjopen-2020-043021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Cervical radiculopathy (CR) is a clinical condition whereby motor, reflex and/or sensory changes such as radicular pain, paraesthaesia or numbness can exist. Conservative management is a preferred first treatment option as the risk-benefit ratio for surgery is less favourable. Systematic reviews and treatment guidelines gather evidence on the effectiveness of non-surgical management of patients with CR from randomised controlled trials, which do not consider the natural course of recovery to modify the management strategy accordingly. The aim of this study is to establish consensus on effective non-surgical treatment modalities for patients in different stages (acute, subacute and chronic) of CR, using the Delphi method approach. METHODS AND ANALYSIS Through an iterative multistage process, experts within the field will rate their agreement with a list of proposed treatment modalities and suggest any missing treatment modalities during each round. Agreement will be measured using a five-point Likert scale. Descriptive statistics will be used to measure agreement (median, IQR and percentage of agreement). Consensus criteria will be defined a priori for each round. Data analysis at the end of round three will produce a consensus list of effective treatment modalities for the management of patients with CR in different stages of recovery. ETHICS AND DISSEMINATION Ethical approval has been granted from the University of Birmingham ethics committee under ERN_20-1121. The study findings will be submitted to a peer-reviewed journal and to relevant conferences for dissemination of the study results.
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Affiliation(s)
- Erik Thoomes
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Research Department, Fysio-Experts, Hazerswoude Rijndijk, Netherlands
| | | | - Joshua Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Alessio Gallina
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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37
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Graham-Clarke E, Rushton A, Marriott J. A Delphi study to explore and gain consensus regarding the most important barriers and facilitators affecting physiotherapist and pharmacist non-medical prescribing. PLoS One 2021; 16:e0246273. [PMID: 33529197 PMCID: PMC7853445 DOI: 10.1371/journal.pone.0246273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/17/2021] [Indexed: 11/30/2022] Open
Abstract
Non-medical prescribing was introduced into the United Kingdom to improve patient care, but early research indicated a third of Allied Health Professionals may not use their prescribing qualification. A previous literature review, highlighting factors influencing prescribing, identified only papers with nursing and pharmacy participants. This investigation explored consensus on factors affecting physiotherapist and pharmacist non-medical prescribers. A three round Delphi study was conducted with pharmacist and physiotherapist prescribers. Round One comprised information gathering on facilitators and barriers to prescribing participants had experienced, and underwent content analysis. This was followed by two sequential consensus seeking rounds with participants asked to rate the importance of statements to themselves. Consensus criteria were determined a priori, including median, interquartile range, percentage agreement and Kendall’s Coefficient of Concordance (W). Statements reaching consensus were ranked for importance in Round Three and analysed to produce top ten ranks for all participants and for each professional group. Participants, recruited October 2018, comprised 24 pharmacists and 18 physiotherapists. In Round One, content analysis of 172 statements regarding prescribing influences revealed 24 themes. 127 statements were included in Round Two for importance rating (barriers = 68, facilitators = 59). After Round Two, 29 statements reached consensus (barriers = 1, facilitators = 28), with no further statements reaching consensus following Round Three. The highest ranked statement in Round Three overall was: “Being able to prescribe to patients is more effective and really useful working [in my area]”. Medical support and improved patient care factors appeared the most important. Differences were noted between physiotherapist and pharmacist prescribers regarding the top ten ranked statements, for example team working which pharmacists ranked higher than physiotherapists. Differences may be explained by the variety of practice areas and relative newness of physiotherapy prescribing. Barriers appear to be post or person specific, whereas facilitators appear universal.
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Affiliation(s)
- Emma Graham-Clarke
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Alison Rushton
- School of Physical Therapy, Western University, London, Canada
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Marriott
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Koch M, Klügl M, Frankewycz B, Lang S, Worlicek M, Popp D, Alt V, Krutsch W. Football-related injuries are the major reason for the career end of professional male football players. Knee Surg Sports Traumatol Arthrosc 2021; 29:3560-3568. [PMID: 34370085 PMCID: PMC8514381 DOI: 10.1007/s00167-021-06684-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/29/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Little is known about the consequences of injuries on professional male football players' career and retirement period. The aim of this study is to investigate the impact of injuries that male professional football players endure during their career, reasons for the end of their career and the post-career phase of retirement. METHODS In a retrospective cross-sectional cohort study, retired male professional football players of the German Bundesliga were investigated by a standardised questionnaire to analyse the history of injuries sustained during their professional football career, the reasons for ending their career, their current health status and their suggestions for future prevention strategies. RESULTS Most of the 116 analysed players (n = 73 (62.9%)) stated an injury as the reason for ending their professional career. Relevant injuries were mainly located in the lower extremities (n = 587 (61.3%)) with a focus on the knee (p < 0.001) and ankle (p < 0.001). A significant majority of the participants who had retired due to injury described degenerative symptoms, such as pain or instability, and were diagnosed with osteoarthritis after retirement (p < 0.001). These players had also often been affected by symptoms of depression during their career, which had decreased significantly after retirement. Moreover, players who had not retired due to injury had significantly better overall health status and quality of life after retirement. CONCLUSION Football-related injuries have a significant impact on the career end of professional male football players and their health status after retirement. Future prevention strategies need to particularly address injuries to the knees and ankles and to implement measures for preventing osteoarthritis after retirement. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Matthias Koch
- Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
| | - Martin Klügl
- herz:bewegt - Praxis für Kardiologie und Sportmedizin, Bahnhofstraße 19, 94315 Straubing, Germany
| | - Borys Frankewycz
- grid.411941.80000 0000 9194 7179Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Siegmund Lang
- grid.411941.80000 0000 9194 7179Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Michael Worlicek
- grid.411941.80000 0000 9194 7179Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Daniel Popp
- grid.411941.80000 0000 9194 7179Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Volker Alt
- grid.411941.80000 0000 9194 7179Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Werner Krutsch
- grid.411941.80000 0000 9194 7179Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany ,SportDocsFranken, Nuernberg, Germany
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Silvers-Granelli HJ, Cohen M, Espregueira-Mendes J, Mandelbaum B. Hamstring muscle injury in the athlete: state of the art. J ISAKOS 2020; 6:170-181. [PMID: 34006581 DOI: 10.1136/jisakos-2017-000145] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 08/16/2020] [Accepted: 09/26/2020] [Indexed: 11/03/2022]
Abstract
Hamstring injuries (HSI) are the source of significant impairment and disability for both professional and recreational athletes. The incidence and prevalence of HSIs has been well documented in the literature, as they are among the most common soft tissue injuries reported. The significant time loss due to injury and the inherent risk of reinjury pose a significant issue to the athlete, their career longevity and the success of their respective team. This review will deal predominantly with describing the prevalence and incidence of HSI in athletes, discuss risk factors and the mechanisms of injury for HSI, how to properly diagnose, image and prognosticate appropriate return to sport (RTS) for individuals who have sustained an HSI, prescribe treatment and prevention strategies and to discuss relevant options to decrease overall risk of primary and secondary recurrence of HSI.Current treatments of acute HSI necessitate a thorough understanding of the mechanism of injury, identifying muscle imbalances and/or weakness, inclusion of eccentric and concentric hamstring (HS) and hip extension (HE) exercises, evaluation of pathokinematic movement patterns and use non-surgical methods to promote healing and RTS. This methodology can be used prospectively to mitigate the overall risk of HSI. Injection therapies for HSI, including ultrasound-guided platelet-rich plasma and corticosteroids, may impart some short-term benefit, but the existing literature is largely inconclusive with respect to long-term functional outcomes. Future directions should prioritise injury prevention, early diagnosis and targeted interventions that combine both non-surgical and minimally invasive orthobiological approaches and identifying biomechanical risk factors prospectively to mitigate risk.
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Affiliation(s)
- Holly J Silvers-Granelli
- Musculoskeletal Research Center, Velocity Physical Therapy, Santa Monica, California, USA .,Medical Assessment Research Committee, Major League Soccer, New York, New York, USA
| | - Moises Cohen
- Orthopedic Department, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - João Espregueira-Mendes
- Dom Research Center, Clinica Espregueira Mendes, FIFA Medical Centre of Excellence, Porto, Portugal
| | - Bert Mandelbaum
- Medical Assessment Research Committee, Major League Soccer, New York, New York, USA.,Sports Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Normative data for hip strength, flexibility and stiffness in male soccer athletes and effect of age and limb dominance. Phys Ther Sport 2020; 47:53-58. [PMID: 33197873 DOI: 10.1016/j.ptsp.2020.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective was to establish normative data for hip strength, flexibility, and stiffness in male soccer athletes and to investigate the effect of age and limb dominance on these variables. DESIGN Cross-sectional. SETTING Soccer team physical therapy department. PARTICIPANTS A total of 293 asymptomatic male soccer athletes were assessed. Elite youth players aged 15-17 years and professional adult players aged 18-29 years old. MAIN OUTCOME MEASURES Rectus femoris, iliopsoas, hamstring muscle flexibility, passive hip stiffness, and isometric hip strength were measured using a goniometer, inclinometer, and handheld dynamometer, respectively. Descriptive and mixed analyses of variance were used as statistical procedures. RESULTS The dominant limb had lower iliopsoas (P = 0.010) and rectus femoris (P = 0.003) flexibility and higher external rotators torque compared to the non-dominant limb (P = 0.006) in both age groups. In adult athletes, the dominant limb had lower hip stiffness than the non-dominant limb (P = 0.002). Adults had higher hip external rotator torque than younger athletes (P < 0.0001). No differences were observed for hamstrings flexibility and hip extensors torque. CONCLUSION This study provided normative data of hip strength, flexibility, and stiffness for youth and adult male soccer athletes. In addition, there were no clinically relevant inter-limb differences.
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Improvements in Match-Related Physical Performance of Professional Soccer Players After the Application of an on-Field Training Program for Hamstring Injury Rehabilitation. J Sport Rehabil 2020; 29:1145-1150. [PMID: 31869814 DOI: 10.1123/jsr.2019-0033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 10/24/2019] [Accepted: 10/30/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Although there are multiple, validated return-to-play programs following hamstring strain injuries, no studies have evaluated their changes in match performance parameters. OBJECTIVES The aim of this study was twofold as follows: (1) to determine the changes in match-based physical performance parameters in professional soccer players before and after sustaining a hamstring strain injury and undergoing a soccer-specific rehabilitation program and (2) to observe the progress of these performance parameters 6 to 10 weeks after the player returned from injury. DESIGN Prospective, quasi-experimental longitudinal study. SETTING Soccer playing and training grounds. PARTICIPANTS Nineteen players suffering a hamstring strain injury from 2 male professional teams playing in the Spanish professional football league (La Liga) were followed during the 2015-2016, 2016-2017, and 2017-2018 seasons. INTERVENTION Participation in on-field training program following a hamstring injury. MAIN OUTCOME MEASURES Match global positioning system data were collected in the following stages: prior to injury (PRE), after return to play (RTP), program, and 6 to 10 weeks following RTP (C2). Peak velocities and distances ran at sprint velocities showed most likely improvements in C2 versus PRE, and very likely improvements in RTP versus PRE. RESULTS The distances ran at high and very high intensities, the average velocity, and work-to-rest ratio showed very likely improvements in C2 versus RTP and likely improvements in RTP versus PRE. Likely improvements were observed for all variables in C2 versus RTP. The authors' results showed an improvement of physical performance during competitive match after RTP, compared with PRE. There was a steady progression in the progress, and in 8 months following RTP, there was no injury reported in the players. CONCLUSIONS The current findings may indicate that the hamstring muscle complex not only recovered completely from the injury but could also withstand a greater training and match load reducing the risk of reinjury.
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The clinical decision making process in the use of mobilisation with movement - A Delphi survey. Musculoskelet Sci Pract 2020; 49:102212. [PMID: 32861367 DOI: 10.1016/j.msksp.2020.102212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/07/2020] [Accepted: 06/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Mobilisation with movement (MWM) is a method of treating musculoskeletal disorders. Although widely used clinically and with increasing research investigation, little is known about the decision making process for its utilization. OBJECTIVES To understand the factors experts believe important for utilization of MWM when assessing a patient, predicting responses to its delivery, responsive body areas, and expected outcomes to MWM. DESIGN A web-based Delphi study of experts in the use of MWM. METHODS Round one contained five open-ended questions regarding assessment strategies, prediction of successful and unsuccessful outcomes, body areas most responsive, and common outcome measures observed. Rounds 2 and 3 were quantitative and aimed at establishing consensus. RESULTS Thirty seven experts participated in the study and took part in round 1, thirty two in round 2, and twenty eight in round 3. The exclusion of red flags and impairment in range of motion (ROM), obtained the highest level of consensus for the item assessment strategies. Patient's presenting with a variety of issues on movement, in addition to mild to moderate levels of severity and immediately responsive to a trial MWM, were believed to respond favourably to MWM. Patients with predominant inflammatory pain, with high levels of psychosocial factors, increased central sensitization and not improving after a trial of MWM, were recognized as non-responders. Improvement of different aspects of movement (e.g. ROM, less fear) are the most common outcomes observed. CONCLUSIONS This study provides factors believed to be important in the decision making process when using MWM clinically.
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Mistry J, Falla D, Noblet T, Heneghan NR, Rushton A. Clinical indicators to identify neuropathic pain in low back related leg pain: a modified Delphi study. BMC Musculoskelet Disord 2020; 21:601. [PMID: 32900367 PMCID: PMC7487834 DOI: 10.1186/s12891-020-03600-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/18/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Neuropathic pain (NP) is common in patients presenting with low back related leg pain. Accurate diagnosis of NP is fundamental to ensure appropriate intervention. In the absence of a clear gold standard, expert opinion provides a useful methodology to progress research and clinical practice. The aim of this study was to achieve expert consensus on a list of clinical indicators to identify NP in low back related leg pain. METHODS A modified Delphi method consisting of three rounds was designed in accordance with the Conducting and Reporting Delphi Studies recommendations. Recruitment involved contacting experts directly and through expressions of interest on social media. Experts were identified using pre-defined eligibility criteria. Priori consensus criteria were defined for each round through descriptive statistics. Following completion of round 3 a list of clinical indicators that achieved consensus were generated. RESULTS Thirty-eight participants were recruited across 11 countries. Thirty-five participants completed round 1 (92.1%), 32 (84.2%) round 2 and 30 (78.9%) round 3. Round 1 identified consensus (Kendall's W coefficient of concordance 0.456; p < 0.001) for 10 clinical indicators out of the original 14, and 9 additional indicators were added to round 2 following content analysis of qualitative data. Round 2 identified consensus (Kendall's W coefficient of concordance 0.749; p < 0.001) for 10 clinical indicators out of 19, and 1 additional indicator was added to round 3. Round 3 identified consensus for 8 indicators (Kendall's W coefficient of concordance 0.648; p < 0.001). Following completion of the third round, an expert derived consensus list of 8 items was generated. Two indicators; pain variously described a burning, electric shock like and/or shooting into leg and pain in association with other neurological symptoms (e.g. pins and needles, numbness, weakness), were found to have complete agreement amongst expert participants. CONCLUSIONS Good agreement was found for the consensus derived list of 8 clinical indicators to identify NP in low back related leg pain. This list of indicators provide some indication of the criteria upon which clinicians can identify a NP component to low back related leg pain; further research is needed for stronger recommendations to be made.
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Affiliation(s)
- Jai Mistry
- St Georges Hospital NHS Foundation Trust, London, UK.,Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Tim Noblet
- St Georges Hospital NHS Foundation Trust, London, UK.,Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK.
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Price J, Rushton A, Tyros V, Heneghan NR. Consensus on the exercise and dosage variables of an exercise training programme for chronic non-specific neck pain: protocol for an international e-Delphi study. BMJ Open 2020; 10:e037656. [PMID: 32414832 PMCID: PMC7232615 DOI: 10.1136/bmjopen-2020-037656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Clinical guidelines and systematic reviews recommend exercise in the management of chronic non-specific neck pain. Although exercise training programmes that consist of both motor control exercise and exercises for the superficial cervical muscles (segmental exercises) are effective, the exercise variables including dosage vary considerably across trials or are poorly reported. This study aims to gain expert consensus on these exercise variables so that they can be described clearly using intervention reporting checklists to inform clinical practice and future clinical trials. METHODS AND ANALYSIS This protocol for an international Delphi study is informed by the Guidance on Conducting and REporting DElphi Studies recommendations and published to ensure quality, rigour and transparency. The study will consist of three rounds using anonymous online questionnaires. Expert exercise professionals (physiotherapists, strength and conditioning coaches and so on) and academics in neck pain management will be identified through literature searches, peer referral and social media calls for expression of interest. In round 1, participants will answer open-ended questions informed by intervention and exercise reporting checklists. Responses will be analysed thematically by two independent reviewers. In round 2, participants will rate their level of agreement with statements generated from round 1 and previous clinical trials using a 5-point Likert scale where 1=strongly disagree and 5=strongly agree. In round 3, participants will re-rate their agreement with statements that achieved consensus in round 2. Statements reaching consensus among participants must meet progressively increased a priori criteria at rounds 2 and 3, measured using descriptive statistics: median, IQR and percentage agreement. Inferential statistics will be used to evaluate measures of agreement between participants (Kendall's coefficient of concordance) and stability between rounds (Wilcoxon rank-sum test). Statements achieving consensus in round 3 will provide expert recommendations of the key exercise and dosage variables in the management of chronic non-specific neck pain. ETHICS AND DISSEMINATION Ethical approval was provided by the University of Birmingham Ethics Committee (Ref:ERN_19-1857). Results will be disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Jonathan Price
- Musculoskeletal Physiotherapy Services, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis. Sports Med 2020; 49:601-619. [PMID: 30747379 DOI: 10.1007/s40279-019-01071-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify prospective studies that used a criteria-based return to sport (RTS) decision-making process for patients with lateral ankle sprain (LAS) injury. DESIGN Systematic review and narrative synthesis. DATA SOURCES The PubMed (MEDLINE), Web of Science, PEDro, Cochrane Library, SPORTDiscus (EBSCO), ScienceDirect, and Scopus databases were searched to 23 November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they prospectively applied a criteria-based RTS decision-making process for patients with LAS injury, but were excluded if they merely gathered outcome measures at the RTS time point. Studies were also excluded if patients were recovering from ankle fracture, high ankle sprain, medial ankle sprain, chronic ankle instability or complex ankle injury. RESULTS No studies were identified that used a criteria-based RTS decision-making process for patients with LAS injury. We were unable to conduct a quantitative synthesis or meta-analysis, therefore we provide a narrative synthesis of relevant questionnaires, as well as clinical and functional assessments commonly used in studies retrieved in the search. CONCLUSION There are currently no published evidence-based criteria to inform RTS decisions for patients with an LAS injury. Based on our narrative synthesis, we propose a number of variables that could be used to develop a criteria-based RTS decision paradigm. Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study designs. Furthermore, we suggest that complex systems theory and the RTS continuum could be used to inform the development of an RTS decision-making paradigm for athletes with LAS injury.
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Dunlop G, Ardern CL, Andersen TE, Lewin C, Dupont G, Ashworth B, O'Driscoll G, Rolls A, Brown S, McCall A. Return-to-Play Practices Following Hamstring Injury: A Worldwide Survey of 131 Premier League Football Teams. Sports Med 2020; 50:829-840. [PMID: 31595453 PMCID: PMC7069905 DOI: 10.1007/s40279-019-01199-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Return-to-play (RTP) is an on-going challenge in professional football. Return-to-play related research is increasing. However, it is unknown to what extent the recommendations presented within research are being implemented by professional football teams, and where there are gaps between research and practice. The purposes of this study were (1) to determine if premier-league football teams worldwide follow a RTP continuum, (2) to identify RTP criteria used and (3) to understand how RTP decision-making occurs in applied practice. METHODS We sent a structured online survey to practitioners responsible for the RTP programme in 310 professional teams from 34 premier-leagues worldwide. The survey comprised four sections, based on hamstring muscle injury: (1) criteria used throughout RTP phases, (2) the frequency with which progression criteria were achieved, (3) RTP decision-making process and (4) challenges to decision-making. RESULTS One-hundred and thirty-one teams responded with a completed survey (42%). One-hundred and twenty-four teams (95%) used a continuum to guide RTP, assessing a combination of clinical, functional and psychological criteria to inform decisions to progress. One-hundred and five (80%) teams reported using a shared decision-making approach considering the input of multiple stakeholders. Team hierarchy, match- and player-related factors were common challenges perceived to influence decision-making. CONCLUSIONS General research recommendations for RTP and the beliefs and practices of practitioners appear to match with, the majority of teams assessing functional, clinical and psychological criteria throughout a RTP continuum to inform decision-making which is also shared among key stakeholders. However, specific criteria, metrics and thresholds used, and the specific involvement, dynamics and interactions of staff during decision-making are not clear.
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Affiliation(s)
- Gordon Dunlop
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK
- Edinburgh Napier University, Sport Exercise and Health Science Research Group, School of Applied Sciences, Edinburgh, UK
| | - Clare L Ardern
- Department of Medical and Health Sciences, Division of Physiotherapy, Linkoping University, Linkoping, Sweden
| | - Thor Einar Andersen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo Sports Trauma Research Centre, Oslo, Norway
| | | | - Gregory Dupont
- Medical Department, French Football Federation, Paris, France
| | - Ben Ashworth
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK
| | - Gary O'Driscoll
- Performance Department, AC Sparta Prague Football Club, Prague, Czech Republic
| | - Andrew Rolls
- Sport Science and Medical Department, Bristol City Football Club, Bristol, UK
| | - Susan Brown
- Edinburgh Napier University, Sport Exercise and Health Science Research Group, School of Applied Sciences, Edinburgh, UK
| | - Alan McCall
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK.
- Edinburgh Napier University, Sport Exercise and Health Science Research Group, School of Applied Sciences, Edinburgh, UK.
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Psychometric Analysis and Effectiveness of the Psychological Readiness of Injured Athlete to Return to Sport (PRIA-RS) Questionnaire on Injured Soccer Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051536. [PMID: 32120951 PMCID: PMC7084929 DOI: 10.3390/ijerph17051536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 11/23/2022]
Abstract
The decision-making process about when an athlete may safely return to training and competition after an injury is a difficult decision. Safe return to training and competition is characterised by physical and psychological readiness to return to the sport. The objectives of this study are (1) to assess the measurement properties of the Psychological Readiness of Injured Athlete to Return to Sport questionnaire (PRIA-RS), and (2) to analyse the effectiveness which the PRIA-RS questionnaire possesses when applied during four consecutive seasons on professional soccer players. One hundred and nine male soccer players from the Albacete Soccer Club (Spain) were involved during four consecutive seasons for the current study: 2012–2013, 2013–2014, 2014–2015 and 2015–2016. Psychometric analysis (validity, reliability, internal consistency and effectiveness) and external psychometric analysis (evaluating measures of patient-reported outcomes (EMPRO)) were confirmed and supported. The main results of the study reveal that the psychometric properties of this questionnaire are optimum for their application in a professional sports context.
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Mistry J, Falla D, Noblet T, Heneghan NR, Rushton AB. Clinical indicators to identify neuropathic pain in low back-related leg pain: protocol for a modified Delphi study. BMJ Open 2020; 10:e033547. [PMID: 32071181 PMCID: PMC7045101 DOI: 10.1136/bmjopen-2019-033547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Neuropathic low back-related leg pain (LBLP) can be a challenge to healthcare providers to diagnose and treat. Accurate diagnosis of neuropathic pain is fundamental to ensure appropriate intervention is given. However, to date there is no gold standard to diagnose neuropathic LBLP. A Delphi study will therefore be conducted to obtain an expert-derived consensus list of clinical indicators to identify a neuropathic component to LBLP. METHODS/ANALYSIS Included participants will be considered experts within the field as measured against a predefined eligibility criterion. Through an iterative multistage process, participants will rate their agreement with a list of clinical indicators and suggest any missing clinical indicators during each round. Agreement will be measured using a 5-point Likert scale. Descriptive statistics will be used to measure agreement; median, IQR and percentage of agreement. A priori consensus criteria will be defined for each round. Data analysis at the end of round three will enable a list of clinical indicators to be derived. ETHICS AND DISSEMINATION Ethical approval was gained from the University of Birmingham (ERN_19-1142). On completion of the study, findings will be disseminated in a peer-reviewed journal and presented at relevant conferences.
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Affiliation(s)
- Jai Mistry
- Physiotherapy, St Georges Hospital NHS Foundation Trust, London, UK
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Tim Noblet
- Physiotherapy, St Georges Hospital NHS Foundation Trust, London, UK
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Alison B Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Bisciotti GN, Volpi P, Alberti G, Aprato A, Artina M, Auci A, Bait C, Belli A, Bellistri G, Bettinsoli P, Bisciotti A, Bisciotti A, Bona S, Bresciani M, Bruzzone A, Buda R, Buffoli M, Callini M, Canata G, Cardinali D, Cassaghi G, Castagnetti L, Clerici S, Corradini B, Corsini A, D'Agostino C, Dellasette E, Di Pietto F, Enrica D, Eirale C, Foglia A, Franceschi F, Frizziero A, Galbiati A, Giammatei C, Landreau P, Mazzola C, Moretti B, Muratore M, Nanni G, Niccolai R, Orizio C, Pantalone A, Parra F, Pasta G, Patroni P, Pelella D, Pulici L, Quaglia A, Respizzi S, Ricciotti L, Rispoli A, Rosa F, Rossato A, Sannicandro I, Sprenger C, Tarantola C, Tenconi FG, Tognini G, Tosi F, Trinchese GF, Vago P, Zappia M, Vuckovich Z, Zini R, Trainini M, Chamari K. Italian consensus statement (2020) on return to play after lower limb muscle injury in football (soccer). BMJ Open Sport Exerc Med 2019; 5:e000505. [PMID: 31673400 PMCID: PMC6797382 DOI: 10.1136/bmjsem-2018-000505] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2019] [Indexed: 12/19/2022] Open
Abstract
Return to play (RTP) decisions in football are currently based on expert opinion. No consensus guideline has been published to demonstrate an evidence-based decision-making process in football (soccer). Our aim was to provide a framework for evidence-based decision-making in RTP following lower limb muscle injuries sustained in football. A 1-day consensus meeting was held in Milan, on 31 August 2018, involving 66 national and international experts from various academic backgrounds. A narrative review of the current evidence for RTP decision-making in football was provided to delegates. Assembled experts came to a consensus on the best practice for managing RTP following lower limb muscle injuries via the Delphi process. Consensus was reached on (1) the definitions of 'return to training' and 'return to play' in football. We agreed on 'return to training' and RTP in football, the appropriate use of clinical and imaging assessments, and laboratory and field tests for return to training following lower limb muscle injury, and identified objective criteria for RTP based on global positioning system technology. Level of evidence IV, grade of recommendation D.
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Affiliation(s)
| | - Piero Volpi
- Humanitas Clinical Institute, Rozzano, Milano, Italy.,FC Internazionale Milano, Milano, Milano, Italy
| | - Giampietro Alberti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | | | - Alessio Auci
- UOS Angiografia e Radiologia Interventistica, Ospedale delle Apuane, Massa Carrara, Massa Carrara, Italy
| | | | | | | | | | | | | | - Stefano Bona
- Humanitas Clinical Institute, Rozzano, Milano, Italy
| | | | | | - Roberto Buda
- Dipartimento di Scienze Biomediche e Neuromotorie, Università Bologna, Bologna, Italy
| | | | | | - Gianluigi Canata
- Ospedale Koelliker, Torino, Italy.,Istituto di Medicina dello Sport di Torino, Torino, Italy
| | | | | | | | | | | | | | | | | | | | | | - Cristiano Eirale
- Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Paris St Germain FC, Paris, France
| | - Andrea Foglia
- Physiotherapy, Studio Riabilita, Civitanova Marche, Italy
| | | | | | | | | | | | | | - Biagio Moretti
- Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università di Bari, Bari, Italy
| | | | - Gianni Nanni
- FIFA Medical Centre of Excellence, Bologna, Isokinetic Medical Group, Bologna, Italy.,Bologna FC, Bologna, Italy
| | | | | | - Andrea Pantalone
- Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti, Italy.,Ospedale SS Annunziata, Chieti, Italy
| | | | - Giulio Pasta
- Parma Calcio, Parma, Italy.,Studio Radiologico Pasta, Parma, Italy
| | | | | | - Luca Pulici
- FC Internazionale Milano, Milano, Milano, Italy
| | - Alessandro Quaglia
- Humanitas Clinical Institute, Rozzano, Milano, Italy.,FC Internazionale Milano, Milano, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | - Fabio Tosi
- FC Internazionale Milano, Milano, Milano, Italy
| | | | - Paola Vago
- Universita Cattolica del Sacro Cuore, Milano, Italy
| | | | | | - Raul Zini
- Villa Maria Cecilia, Cotignola, Italy
| | | | - Karim Chamari
- Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Research Lab, National Center of Science and Sports Medicine Tunis, Tunis, Tunisia
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50
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Shanks MJ, McCrory P, Davis GA, Echemendia RJ, Gray AR, Sullivan SJ. Developing common demographic data elements to include in future editions of the SCAT and Child SCAT: a modified international Delphi study. Br J Sports Med 2019; 54:906-912. [PMID: 31604697 DOI: 10.1136/bjsports-2018-100482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Sport Concussion Assessment Tool (SCAT) and Child SCAT are the 'gold standard' assessment tools for a suspected sport-related concussion (SRC). A number of 'modifiers' (eg, previous history of concussion) of a SRC have been identified. These may influence how the SCAT/Child SCAT results should be interpreted. OBJECTIVES To achieve consensus, via an international panel of SRC experts, on which athlete/player and parent/caregiver demographic variables should be considered for inclusion in future editions of the SCAT/Child SCAT respectively. METHODS A two-round modified Delphi technique, overseen by a steering committee, invited 41 panellists to achieve expert consensus (≥80% agreement). The first round utilised open questions to generate demographic variables; the second round used a five-point ordinal item to rank the importance of including each variable in future editions of the SCAT/Child SCAT. RESULTS 15 experts participated in at least one Delphi round. 29 athlete/player and eight parent/caregiver variables reached consensus for inclusion in the SCAT, whereas two parent/caregiver variables reached consensus for exclusion. 28 athlete/player and four parent/caregiver variables reached consensus for the Child SCAT, whereas two parent/caregiver variables reached consensus for exclusion. Key categories of variables included the following: concussion/sport details, personal medical conditions and family medical history. CONCLUSION This study provides a list of athlete/player and parent/caregiver demographic variables that should be considered in future revisions of the SCAT/Child SCAT. By considering (and ultimately likely including) a wider and standard set of additional demographic variables, the Concussion in Sport experts will be able to provide clinicians and researchers with data that may enhance interpretation of the individual's data and the building of larger datasets.
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Affiliation(s)
- Maxine J Shanks
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Gavin A Davis
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.,Department of Neurosurgery, Austin and Cambrini Hospitals, Melbourne, Victoria, Australia
| | - Ruben J Echemendia
- University Orthopedic Center, Concussion Care Clinic, State College, Pennsylvania, USA
| | - Andrew R Gray
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - S John Sullivan
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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