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Hussein HM, Kamel WM, Kamel EM, Attyia MR, Acar T, Kanwal R, Ibrahim AA. The Effect of Kinesio Taping on Balance and Dynamic Stability in College-Age Recreational Runners with Ankle Instability. Healthcare (Basel) 2023; 11:1749. [PMID: 37372867 DOI: 10.3390/healthcare11121749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Running is one of many sports that have increased in popularity since it can be conducted at any time or anywhere. Ankle instability is a common injury that usually occurs during running and is usually associated with abnormalities in postural stability. Recently, kinesio taping has gained increasing interest as a tool that can be used in rehabilitation, to improve stability, and to help in injury prevention. This study aimed to investigate the effect of Kinesio taping on balance and dynamic stability in recreational runners with ankle instability. (2) Methods: This randomized controlled trial recruited 90 RRs with ankle instability. The participants were randomly divided into three equal groups: a KT group (KTG) who received Kinesio taping on their ankle joints; a mixed group (MG) who received Kinesio taping and exercises; and an exercise group (EG) who received exercises only. Outcome measures (balance and dynamic stability) were assessed before and after the end of an 8-week treatment program using a Biodex balance system and a star excursion balance test, respectively. (3) Results: Within-group comparisons showed statistically significant improvements in most of the outcome values when compared to baseline. Overall stability index was statistically significantly better (with a high effect size) in the MG compared to KTG or EG (p = 0.01, Cohen's d = 1.6, and p < 0.001, Cohen's d = 1.63, respectively). A similar finding was evident in the anteroposterior stability index (p = 0.02, Cohen's d = 0.95, and p < 0.001, Cohen's d = 1.22, respectively). The mediolateral stability index of the KTG was statistically significantly better with a high effect size when compared to MG or EG (p = 0.04, Cohen's d = 0.6, and p < 0.01, Cohen's d = 0.96, respectively). The star excursion balance test values were statistically significant with high effect sizes in the posterior (p = 0.002, Cohen's d = 1.2) and lateral (p < 0.02, Cohen's d = 0.92) directions in the MG compared to KTG and EG. (4) Conclusions: Kinesiotape with exercises is superior to either kinesiotape alone or exercises alone in improving postural stability indices and dynamic stability in recreational runners with ankle instability. Recreational runners with ankle instability should be educated about practicing balance exercises and applying kinesiotape.
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Affiliation(s)
- Hisham M Hussein
- Department of Physical Therapy, College of Applied Medical Sciences, University of Hail, Ha'íl 81451, Saudi Arabia
- Department of Basic Sciences for Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - Walid M Kamel
- Critical Care Department, Faculty of Medicine, Cairo University, Giza 11435, Egypt
| | - Ehab M Kamel
- Department of Public Health, College of Public Health and Health Informatics, University of Ha'íl, Ha'íl 81451, Saudi Arabia
| | - Mohamed R Attyia
- Department of Physical Therapy, College of Applied Medical Sciences, University of Hail, Ha'íl 81451, Saudi Arabia
| | - Tolgahan Acar
- Department of Physical Therapy, College of Applied Medical Sciences, University of Hail, Ha'íl 81451, Saudi Arabia
| | - Raheela Kanwal
- Department of Physical Therapy, College of Applied Medical Sciences, University of Hail, Ha'íl 81451, Saudi Arabia
| | - Ahmed A Ibrahim
- Department of Physical Therapy, College of Applied Medical Sciences, University of Hail, Ha'íl 81451, Saudi Arabia
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De Oliveira Silva D, Johnston RTR, Mentiplay BF, Haberfield MJ, Culvenor AG, Bruder AM, Semciw AI, Girdwood M, Pappalardo PJ, Briggs C, West TJ, Hill JP, Patterson BE, Barton CJ, Sritharan P, Alexander JL, Carey DL, Schache AG, Souza RB, Pedoia V, Oei EH, Warden SJ, Telles GF, King MG, Hedger MP, Hulett M, Crossley KM. Trajectory of knee health in runners with and without heightened osteoarthritis risk: the TRAIL prospective cohort study protocol. BMJ Open 2023; 13:e068040. [PMID: 36759025 PMCID: PMC9923264 DOI: 10.1136/bmjopen-2022-068040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Running is one of the most popular recreational activities worldwide, due to its low cost and accessibility. However, little is known about the impact of running on knee joint health in runners with and without a history of knee surgery. The primary aim of this longitudinal cohort study is to compare knee joint structural features on MRI and knee symptoms at baseline and 4-year follow-up in runners with and without a history of knee surgery. Secondary aims are to explore the relationships between training load exposures (volume and/or intensity) and changes in knee joint structure and symptoms over 4 years; explore the relationship between baseline running biomechanics, and changes in knee joint structure and symptoms over 4 years. In addition, we will explore whether additional variables confound, modify or mediate these associations, including sex, baseline lower-limb functional performance, knee muscle strength, psychological and sociodemographic factors. METHODS AND ANALYSIS A convenience sample of at least 200 runners (sex/gender balanced) with (n=100) and without (n=100) a history of knee surgery will be recruited. Primary outcomes will be knee joint health (MRI) and knee symptoms (baseline; 4 years). Exposure variables for secondary outcomes include training load exposure, obtained daily throughout the study from wearable devices and three-dimensional running biomechanics (baseline). Additional variables include lower limb functional performance, knee extensor and flexor muscle strength, biomarkers, psychological and sociodemographic factors (baseline). Knowledge and beliefs about osteoarthritis will be obtained through predefined questions and semi-structured interviews with a subset of participants. Multivariable logistic and linear regression models, adjusting for potential confounding factors, will explore changes in knee joint structural features and symptoms, and the influence of potential modifiers and mediators. ETHICS AND DISSEMINATION Approved by the La Trobe University Ethics Committee (HEC-19524). Findings will be disseminated to stakeholders, peer-review journals and conferences.
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Affiliation(s)
- Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Richard T R Johnston
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Melissa J Haberfield
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Andrea M Bruder
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Michael Girdwood
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Paula J Pappalardo
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Connie Briggs
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Thomas J West
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Joshua P Hill
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Prasanna Sritharan
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - James L Alexander
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - David L Carey
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Richard B Souza
- Department of Radiology and Biomedical Imagining, University of California San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imagining, University of California San Francisco, San Francisco, California, USA
| | - Edwin H Oei
- Department of Radiology & Nuclear Medicine, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Stuart J Warden
- Department of Physical Therapy, Indiana University, Indianapolis, Indiana, USA
| | - Gustavo F Telles
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre, Rio de Janeiro, Brazil
| | - Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Michael P Hedger
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
| | - Mark Hulett
- Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Australian International Olympic Committee (IOC) Research Centre, Melbourne, Victoria, Australia
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Garcia MC, Pexa BS, Ford KR, Rauh MJ, Bazett-Jones DM. Quantification method influences training load change in high school cross-country runners across a competitive season. J Athl Train 2021; 57:672-677. [PMID: 34902855 DOI: 10.4085/1062-6050-523-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Running programs traditionally monitor external loads (e.g., time, distance). There has been a recent movement to encompass a more comprehensive approach to also monitor training loads that account for internal loads (e.g., intensity, measured as session rating of perceived exertion [sRPE]). The combination of an external and internal load accounts for the potential interaction between these loads. While differences in weekly change in training loads have been reported between external loads and the combination of an external and internal load during 2- and 4-week training cycles, there are no reports whether these differences are apparent during an entire cross-country season in high school runners. OBJECTIVE To compare change in training loads, as measured by external loads and combinations of an external and internal load, in high school runners during an interscholastic cross-country season. DESIGN Case-series. SETTING Community-based with daily online surveys. PARTICIPANTS Twenty-four high school cross-country runners (female=14, male=10, age=15.9±1.1 years, running experience=9.9±3.2 years). MAIN OUTCOME MEASURE(S) Week-to-week percent change in training load when measured by external loads (time, distance) and the combination of an external and internal load (timeRPE, distanceRPE). RESULTS Overall, the average weekly change was 7.1% greater for distanceRPE compared to distance (p=.04, d=0.18). When decreasing weekly running duration, the average weekly change was 5.2% greater for distanceRPE compared to timeRPE (p=.03, d=0.24). When maintaining or increasing weekly running duration, the average weekly change was 10-15% greater when an external load was combined with an internal load compared to external loads alone, but these differences were non- significant (p=.11-.22, d=0.19-0.34). CONCLUSIONS Our results demonstrate that progression in training load may be underestimated when relying solely on external loads. The interaction between internal loads (sRPE) and external loads (distance or time) appears to provide a different measure of training stresses experienced by runners than external loads alone.
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Affiliation(s)
- Micah C Garcia
- † College of Health and Human Services, Motion Analysis and Integrative Neurophysiology Lab, University of Toledo, Toledo, OH, , , Twitter: @run_mcg, @DrBazettJones
| | - Brett S Pexa
- ‡ Cogdon School of Health Sciences, Department of Athletic Training, High Point University, High Point, North Carolina, , Twitter: brexa17
| | - Kevin R Ford
- § Cogdon School of Health Sciences, Department of Physical Therapy, High Point University, High Point, North Carolina, , Twitter: @ford_kr
| | - Mitchell J Rauh
- ‖ Doctor of Physical Therapy Program, San Diego State University, San Diego, CA,
| | - David M Bazett-Jones
- † College of Health and Human Services, Motion Analysis and Integrative Neurophysiology Lab, University of Toledo, Toledo, OH, , , Twitter: @run_mcg, @DrBazettJones
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Ramskov D, Rasmussen S, Sørensen H, Parner ET, Lind M, Nielsen R. Interactions between running volume and running pace on injury occurrence in recreational runners: A secondary analysis. J Athl Train 2021; 57:557-563. [PMID: 34543419 DOI: 10.4085/1062-6050-0165.21] [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: 11/09/2022]
Abstract
Context The combination of an excessive increase in running pace and volume is essential to consider when investigating associations between running and running-related injury. Objectives The purpose of the present study was to complete a secondary analysis on a dataset from a randomized trial, to investigate the interactions between relative or absolute weekly changes in running volume and running pace on running injury occurrence among a cohort of injury-free recreational runners in Denmark. Design Prospective cohort study Setting Running volume and pace were collected during a 24-week follow-up using global positioning systems (GPS) data. Training data was used to calculate relative and absolute weekly changes in running volume and pace. Patients or Other Participants A total of 586 recreational runners were included in the analysis. All participants were injury-free at inclusion. Main Outcome Measure(s) Running-related injury was the outcome. Injury data were collected weekly using a modified version of the OSTRC questionnaire. Risk difference (RD) was the measure of injury risk. Results A total of 133 runners sustained a running-related injury. A relative weekly change of progression >10% in running volume and progression in running pace (RD=8.1%, 95%CI: - 9.3;25.6%) and an absolute weekly change of progression >5km in running volume and progression in running pace (RD=5.2%, 95%CI: -12.0;22.5%), were not associated with a statistically significant positive interaction. Conclusions As coaches, clinicians and athletes may agree that excessive increase in running pace and excessive increase in running volume are important contributors to injury development, we analyzed the interaction between them. Although a statistically significant positive interaction on an additive scale in runners who progressed both running pace and running volume were not identified in the present study, readers of scientific articles should be aware that interaction is an important analytical approach that could be applied to other datasets in future publications.
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Affiliation(s)
- Daniel Ramskov
- aDepartment of Public Health, Aarhus University, Aarhus 8000, DK.,dDepartment of Physiotherapy, University College Northern Denmark, Aalborg 9220, DK
| | - Sten Rasmussen
- bOrthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg 9000, DK.,eDepartment of Clinical Medicine, Aalborg University, Aalborg 9220, DK
| | - Henrik Sørensen
- aDepartment of Public Health, Aarhus University, Aarhus 8000, DK
| | | | - Martin Lind
- cDepartment of Orthopaedics, Aarhus University Hospital, Aarhus 8000, DK
| | - Rasmus Nielsen
- aDepartment of Public Health, Aarhus University, Aarhus 8000, DK
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Knee Injuries in Normal-Weight, Overweight, and Obese Runners: Does Body Mass Index Matter? J Orthop Sports Phys Ther 2020; 50:397-401. [PMID: 32605464 DOI: 10.2519/jospt.2020.9233] [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: 02/07/2023]
Abstract
OBJECTIVE To investigate whether the proportion of running-related knee injuries differed in normal-weight, overweight, and obese runners. DESIGN Comparative study. METHODS Data from 4 independent prospective studies were merged (2612 participants). The proportion of running-related knee injuries out of the total number of running-related injuries was calculated for normal-weight, overweight, and obese runners, respectively. The measure of association was absolute difference in proportion of running-related knee injuries with normal-weight runners as the reference group. RESULTS A total of 571 runners sustained a running-related injury (181 running-related knee injuries and 390 running-related injuries in other anatomical locations). The proportion of running-related knee injuries was 13% lower (95% confidence interval: -22%, -5%; P = .001) among overweight runners compared with normal-weight runners. Similarly, the proportion of running-related knee injuries was 12% lower (95% confidence interval: -23%, -1%; P = .042) among obese runners compared with normal-weight runners. CONCLUSION Overweight and obese runners had a lower proportion of running-related knee injuries than normal-weight runners. J Orthop Sports Phys Ther 2020;50(7):397-401. doi:10.2519/jospt.2020.9233.
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Abstract
BACKGROUND Runners experience a high proportion of overuse injuries, with extended recovery periods involving a gradual, progressive return to preinjury status. A running-specific patient-reported outcome (PRO) measure does not exist, and a questionnaire assessing critical elements of runners' recovery processes may have excellent psychometric properties. OBJECTIVES To develop a valid, reliable, and responsive evaluative PRO measure to assess longitudinal change in running ability after running-related injury (RRI) for clinical practice and research applications. METHODS Self-identified runners and selected experts participated in an iterative, 6-step development process of the University of Wisconsin Running Injury and Recovery Index (UWRI) in this longitudinal clinical measurement study. Content-related validity was assessed using open comments. Reproducibility was assessed using Cronbach's alpha, the intraclass correlation coefficient (ICC), and standard error of measurement (SEM). An anchor-based construct validity assessment measured the association between the change in UWRI score and global rating of change (GROC). Responsiveness assessments included floor and ceiling effects. RESULTS The 9-item UWRI assesses running ability following an RRI, with the maximum score of 36 indicating a return to preinjury running ability. The UWRI demonstrated acceptable internal consistency (α = .82), test-retest reliability (ICC = 0.93), and SEM (1.47 points). Change in UWRI score was moderately correlated with the GROC (r = 0.61; 95% confidence interval: 0.4, 0.76). Floor and ceiling effects were absent. Completion required 3 minutes 15 seconds. CONCLUSION The UWRI is a reliable PRO measure and is responsive to changes in running function following an RRI, with minimal administrative burden. LEVEL OF EVIDENCE Therapy, level 2c. J Orthop Sports Phys Ther 2019;49(10):751-760. Epub 3 Aug 2019. doi:10.2519/jospt.2019.8868.
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Nielsen RO, Bertelsen ML, Ramskov D, Damsted C, Verhagen E, Bredeweg SW, Theisen D, Malisoux L. Randomised controlled trials (RCTs) in sports injury research: authors—please report the compliance with the intervention. Br J Sports Med 2019; 54:51-57. [DOI: 10.1136/bjsports-2019-100858] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 11/03/2022]
Abstract
BackgroundIn randomised controlled trials (RCTs) of interventions that aim to prevent sports injuries, the intention-to-treat principle is a recommended analysis method and one emphasised in the Consolidated Standards of Reporting Trials (CONSORT) statement that guides quality reporting of such trials. However, an important element of injury prevention trials—compliance with the intervention—is not always well-reported. The purpose of the present educational review was to describe the compliance during follow-up in eight large-scale sports injury trials and address compliance issues that surfaced. Then, we discuss how readers and researchers might consider interpreting results from intention-to-treat analyses depending on the observed compliance with the intervention.MethodsData from seven different randomised trials and one experimental study were included in the present educational review. In the trials that used training programme as an intervention, we defined full compliance as having completed the programme within ±10% of the prescribed running distance (ProjectRun21 (PR21), RUNCLEVER, Start 2 Run) or time-spent-running in minutes (Groningen Novice Running (GRONORUN)) for each planned training session. In the trials using running shoes as the intervention, full compliance was defined as wearing the prescribed running shoe in all running sessions the participants completed during follow-up.ResultsIn the trials that used a running programme intervention, the number of participants who had been fully compliant was 0 of 839 (0%) at 24-week follow-up in RUNCLEVER, 0 of 612 (0%) at 14-week follow-up in PR21, 12 of 56 (21%) at 4-week follow-up in Start 2 Run and 8 of 532 (1%) at 8-week follow-up in GRONORUN. In the trials using a shoe-related intervention, the numbers of participants who had been fully compliant at the end of follow-up were 207 of 304 (68%) in the 21 week trial, and 322 of 423 (76%), 521 of 577 (90%), 753 of 874 (86%) after 24-week follow-up in the other three trials, respectively.ConclusionThe proportion of runners compliant at the end of follow-up ranged from 0% to 21% in the trials using running programme as intervention and from 68% to 90% in the trials using running shoes as intervention. We encourage sports injury researchers to carefully assess and report the compliance with intervention in their articles, use appropriate analytical approaches and take compliance into account when drawing study conclusions. In studies with low compliance, G-estimation may be a useful analytical tool provided certain assumptions are met.
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Nielsen RØ, Bertelsen ML, Ramskov D, Damsted C, Brund RK, Parner ET, Sørensen H, Rasmussen S, Kjærgaard S. The Garmin-RUNSAFE Running Health Study on the aetiology of running-related injuries: rationale and design of an 18-month prospective cohort study including runners worldwide. BMJ Open 2019; 9:e032627. [PMID: 31494626 PMCID: PMC6731941 DOI: 10.1136/bmjopen-2019-032627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Running injuries affect millions of persons every year and have become a substantial public health issue owing to the popularity of running. To ensure adherence to running, it is important to prevent injuries and to have an in-depth understanding of the aetiology of running injuries. The main purpose of the present paper was to describe the design of a future prospective cohort study exploring if a dose-response relationship exists between changes in training load and running injury occurrence, and how this association is modified by other variables. METHODS AND ANALYSIS In this protocol, the design of an 18-month observational prospective cohort study is described that will include a minimum of 20 000 consenting runners who upload their running data to Garmin Connect and volunteer to be a part of the study. The primary outcome is running-related injuries categorised into the following states: (1) no injury; (2) a problem; and (3) injury. The primary exposure is change in training load (eg, running distance and the cumulative training load based on the number of strides, ground contact time, vertical oscillation and body weight). The change in training load is a time-dependent exposure in the sense that progression or regression can change many times during follow-up. Effect-measure modifiers include, but is not limited to, other types of sports activity, activity of daily living and demographics, and are assessed through questionnaires and/or by Garmin devices. ETHICS AND DISSEMINATION The study design, procedures and informed consent have been evaluated by the Ethics Committee of the Central Denmark Region (Request number: 227/2016 - Record number: 1-10-72-189-16).
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Affiliation(s)
| | | | - Daniel Ramskov
- Section for Sports Science, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
| | - Camma Damsted
- Section for Sports Science, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
| | | | - Erik Thorlund Parner
- Department of Public Health, Aarhus University, Section for Biostatistics, Aarhus, Denmark
| | - Henrik Sørensen
- Section of Sports, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Sten Rasmussen
- Orthopaedic Surgery Research Unit, Aarhus University Hospital - Aalborg Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Søren Kjærgaard
- Section for Environment, Occupation and Health, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
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Nielsen RO, Bertelsen ML, Ramskov D, Møller M, Hulme A, Theisen D, Finch CF, Fortington LV, Mansournia MA, Parner ET. Time-to-event analysis for sports injury research part 2: time-varying outcomes. Br J Sports Med 2018; 53:70-78. [PMID: 30413427 PMCID: PMC6317441 DOI: 10.1136/bjsports-2018-100000] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Time-to-event modelling is underutilised in sports injury research. Still, sports injury researchers have been encouraged to consider time-to-event analyses as a powerful alternative to other statistical methods. Therefore, it is important to shed light on statistical approaches suitable for analysing training load related key-questions within the sports injury domain. CONTENT In the present article, we illuminate: (i) the possibilities of including time-varying outcomes in time-to-event analyses, (ii) how to deal with a situation where different types of sports injuries are included in the analyses (ie, competing risks), and (iii) how to deal with the situation where multiple subsequent injuries occur in the same athlete. CONCLUSION Time-to-event analyses can handle time-varying outcomes, competing risk and multiple subsequent injuries. Although powerful, time-to-event has important requirements: researchers are encouraged to carefully consider prior to any data collection that five injuries per exposure state or transition is needed to avoid conducting statistical analyses on time-to-event data leading to biased results. This requirement becomes particularly difficult to accommodate when a stratified analysis is required as the number of variables increases exponentially for each additional strata included. In future sports injury research, we need stratified analyses if the target of our research is to respond to the question: 'how much change in training load is too much before injury is sustained, among athletes with different characteristics?' Responding to this question using multiple time-varying exposures (and outcomes) requires millions of injuries. This should not be a barrier for future research, but collaborations across borders to collecting the amount of data needed seems to be an important step forward.
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Affiliation(s)
| | | | - Daniel Ramskov
- Department of Public Health, Section for Sports Science, Aarhus University, Aarhus, Denmark.,Department of Physiotherapy, University College Northern Denmark, Aalborg, Denmark
| | - Merete Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Adam Hulme
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Lauren Victoria Fortington
- Australian Centre for Research into Injury in Sport and its Prevention, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.,Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria, Australia
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Erik Thorlund Parner
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
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Mulvad B, Nielsen RO, Lind M, Ramskov D. Diagnoses and time to recovery among injured recreational runners in the RUN CLEVER trial. PLoS One 2018; 13:e0204742. [PMID: 30312310 PMCID: PMC6193581 DOI: 10.1371/journal.pone.0204742] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 09/13/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of the present study was to describe the incidence proportion of different types of running-related injuries (RRI) among recreational runners and to determine their time to recovery. METHODS A sub-analysis of the injured runners included in the 839-person, 24-week randomized trial named Run Clever. During follow-up, the participants reported levels of pain in different anatomical areas on a weekly basis. In case injured, runners attended a clinical examination at a physiotherapist, who provided a diagnosis, e.g., medial tibial stress syndrome (MTSS), Achilles tendinopathy (AT), patellofemoral pain (PFP), iliotibial band syndrome (ITBS) and plantar fasciopathy (PF). The diagnose-specific injury proportions (IP) and 95% confidence intervals (CI) were calculated using descriptive statistics. The time to recovery was defined as the time from the first registration of pain until total pain relief in the same anatomical area. It was reported as medians and interquartile range (IQR) if possible. RESULTS A total of 140 runners were injured at least once leading to a 24-week cumulative injury proportion of 32% [95% CI: 26%; 37%]. The diagnoses with the highest incidence proportion were MTSS (IP = 16% [95% CI: 9.3%; 22.9%], AT (IP = 8.9% [95% CI: 3.6%; 14.2%], PFP (IP = 8% [95% CI: 3.0%; 13.1%]. The median time to recovery for all types of injuries was 56 days (IQR = 70 days). Diagnose-specific time-to-recoveries included 70 days (IQR = 89 days) for MTSS, 56 days (IQR = 165 days) for AT, 49 days (IQR = 63 days) for PFP. CONCLUSION The most common running injuries among recreational runners were MTSS followed by AT, PFP, ITBS and PF. In total, 77 injured participants recovered their RRI and the median time to recovery for all types of injuries was 56 days and MTSS was the diagnosis with the longest median time to recovery, 70 days.
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Affiliation(s)
- Benjamin Mulvad
- Division of Sports Traumatology, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Martin Lind
- Division of Sports Traumatology, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel Ramskov
- Section for Sports Science, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
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Progression in Running Intensity or Running Volume and the Development of Specific Injuries in Recreational Runners: Run Clever, a Randomized Trial Using Competing Risks. J Orthop Sports Phys Ther 2018; 48:740-748. [PMID: 29895234 DOI: 10.2519/jospt.2018.8062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND It has been proposed that training intensity and training volume are associated with specific running-related injuries. If such an association exists, secondary preventive measures could be initiated by clinicians, based on symptoms of a specific injury diagnosis. OBJECTIVES To test the following hypotheses: (1) a running schedule focusing on running intensity (S-I) would increase the risk of sustaining Achilles tendinopathy, gastrocnemius injuries, and plantar fasciitis compared with hypothesized volume-related injuries; and (2) a running schedule focusing on running volume (S-V) would increase the risk of sustaining patellofemoral pain syndrome, iliotibial band syndrome, and patellar tendinopathy compared with hypothesized intensity-related injuries. METHODS In this randomized clinical trial and etiology study, healthy recreational runners were included in a 24-week follow-up, divided into 8-week preconditioning and 16-week specific-focus training periods. Participants were randomized to 1 of 2 running schedules: S-I or S-V. The S-I group progressed the amount of high-intensity running (88% maximal oxygen consumption [VO2max] or greater) each week, and the S-V group progressed total weekly running volume. A global positioning system watch or smartphone collected data on running. Running-related injuries were diagnosed based on a clinical examination. Estimates were reported as risk difference and 95% confidence interval (CI). RESULTS Of 447 runners, a total of 80 sustained an injury (S-I, n = 36; S-V, n = 44). Risk differences (95% CIs) of intensity injuries in the S-I group were -0.8% (-5.0%, 3.4%) at 2 weeks, -0.8% (-6.7%, 5.1%) at 4 weeks, -2.0% (-9.2%, 5.2%) at 8 weeks, and -5.1% (-16.5%, 6.3%) at 16 weeks. Risk differences (95% CIs) of volume injuries in the S-V group were -0.9% (-5.0%, 3.2%) at 2 weeks, -2.0% (-7.5%, 3.5%) at 4 weeks, -3.2% (-9.1%, 2.7%) at 8 weeks, and -3.4% (13.2%, 6.2%) at 16 weeks. CONCLUSION No difference in risk of hypothesized intensity- and volume-specific running-related injuries exists between the 2 running schedules focused on progression in either running intensity or volume. LEVEL OF EVIDENCE Etiology, level 1b. J Orthop Sports Phys Ther 2018;48(10):740-748. Epub 12 Jun 2018. doi:10.2519/jospt.2018.8062.
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Ramskov D, Rasmussen S, Sørensen H, Parner ET, Lind M, Nielsen RO. Run Clever - No difference in risk of injury when comparing progression in running volume and running intensity in recreational runners: A randomised trial. BMJ Open Sport Exerc Med 2018. [PMID: 29527322 PMCID: PMC5841490 DOI: 10.1136/bmjsem-2017-000333] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background/aim The Run Clever trial investigated if there was a difference in injury occurrence across two running schedules, focusing on progression in volume of running intensity (Sch-I) or in total running volume (Sch-V). It was hypothesised that 15% more runners with a focus on progression in volume of running intensity would sustain an injury compared with runners with a focus on progression in total running volume. Methods Healthy recreational runners were included and randomly allocated to Sch-I or Sch-V. In the first eight weeks of the 24-week follow-up, all participants (n=839) followed the same running schedule (preconditioning). Participants (n=447) not censored during the first eight weeks entered the 16-week training period with a focus on either progression in intensity (Sch-I) or volume (Sch-V). A global positioning system collected all data on running. During running, all participants received real-time, individualised feedback on running intensity and running volume. The primary outcome was running-related injury (RRI). Results After preconditioning a total of 80 runners sustained an RRI (Sch-I n=36/Sch-V n=44). The cumulative incidence proportion (CIP) in Sch-V (reference group) were CIP2 weeks 4.6%; CIP4 weeks 8.2%; CIP8 weeks 13.2%; CIP16 weeks 28.0%. The risk differences (RD) and 95% CI between the two schedules were RD2 weeks=2.9%(−5.7% to 11.6%); RD4 weeks=1.8%(−9.1% to 12.8%); RD8 weeks=−4.7%(−17.5% to 8.1%); RD16 weeks=−14.0% (−36.9% to 8.9%). Conclusion A similar proportion of runners sustained injuries in the two running schedules.
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Affiliation(s)
- Daniel Ramskov
- Section for Sports Science, Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Physiotherapy, University College Northern Denmark, Aalborg, Denmark
| | - Sten Rasmussen
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Sørensen
- Section for Sports Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Erik Thorlund Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Martin Lind
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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