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Anderson LM, Bonanno DR, Calnin BJ, Sritharan P, Willy RW, Erbas B, Batra M, Menz HB. Is the addition of running retraining to best standard care beneficial in runners with medial tibial stress syndrome? Protocol for a randomised controlled trial. J Foot Ankle Res 2024; 17:e12029. [PMID: 38873909 PMCID: PMC11296717 DOI: 10.1002/jfa2.12029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Running retraining is commonly used in the management of medial tibial stress syndrome (MTSS) but evidence for its effectiveness is lacking. The primary aim of this study is to determine if the addition of running retraining to best standard care is beneficial in the management of runners with MTSS. METHODS This study is an assessor-blinded and participant-blinded, parallel-group, randomised controlled trial. The trial will recruit 64 participants aged between 18 and 45 years, with a clinical diagnosis of MTSS that has affected their running participation for at least four weeks. Participants will be randomised to receive best standard care (control) or running retraining and best standard care (intervention group) over an 8-week period. Best standard care will consist of load management advice, symptom management advice, footwear advice and a strengthening program. Running retraining will consist of a cue to reduce running step length. Outcomes will be measured at weeks 1, 2, 4 and 8. The primary outcome measure will be the University of Wisconsin Running Injury and Recovery Index at week 4. Secondary outcome measures include: (i) Exercise Induced Leg Pain Questionnaire-British Version, (ii) global rating of change scale, (iii) worst pain experienced during a run, (iv) weekly run volume, (v) reactive strength index score, (vi) single leg hop test, (vii) soleus single leg maximum voluntary isometric contraction, (viii) gastrocnemius single leg maximum voluntary isometric contraction, (ix) single leg plantar flexor endurance test, (x) running step length, and (xi) running step rate. Data will be analysed using the intention-to-treat principle. DISCUSSION This randomised controlled trial will evaluate if reducing running step length provides additional benefit to best standard care in the management of runners with MTSS over an 8-week period. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12624000230550.
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Affiliation(s)
- Laura M. Anderson
- The Injury ClinicSouth GeelongVictoriaAustralia
- Discipline of PodiatrySchool of Allied HealthHuman Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- La Trobe Sport and Exercise Medicine Research CentreSchool of Allied HealthHuman Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Daniel R. Bonanno
- Discipline of PodiatrySchool of Allied HealthHuman Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- La Trobe Sport and Exercise Medicine Research CentreSchool of Allied HealthHuman Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | | | - Prasanna Sritharan
- La Trobe Sport and Exercise Medicine Research CentreSchool of Allied HealthHuman Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Richard W. Willy
- School of Physical Therapy and Health SciencesUniversity of MontanaMissoulaMontanaUSA
| | - Bircan Erbas
- Department of Public HealthSchool of Psychology and Public HealthLa Trobe UniversityBundooraVictoriaAustralia
| | - Mehak Batra
- Department of Public HealthSchool of Psychology and Public HealthLa Trobe UniversityBundooraVictoriaAustralia
| | - Hylton B. Menz
- Discipline of PodiatrySchool of Allied HealthHuman Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- La Trobe Sport and Exercise Medicine Research CentreSchool of Allied HealthHuman Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
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Servant G, Pernoud A, Gojanovic B, Heiderscheit B, Fourchet F, Bothorel H. Translation and cross-cultural adaptation into French of the University of Wisconsin Running Injury and Recovery Index. Ann Phys Rehabil Med 2024; 67:101833. [PMID: 38518622 DOI: 10.1016/j.rehab.2024.101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Guillaume Servant
- Physiotherapy Department and Motion Analysis Lab, Swiss Olympic Medical Center, La Tour Hospital, CH-1217 Meyrin, Switzerland
| | - Anthony Pernoud
- Research Department, La Tour Hospital, CH-1217 Meyrin, Switzerland.
| | - Boris Gojanovic
- Sports Medicine Department, Swiss Olympic Medical Center, La Tour Hospital, CH-1217 Meyrin, Switzerland
| | - Bryan Heiderscheit
- Department of Orthopedics, Rehabilitation and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - François Fourchet
- Physiotherapy Department and Motion Analysis Lab, Swiss Olympic Medical Center, La Tour Hospital, CH-1217 Meyrin, Switzerland; French Society of Sports Physical Therapist (SFMKS Lab), Pierrefitte-sur-Seine, France
| | - Hugo Bothorel
- Research Department, La Tour Hospital, CH-1217 Meyrin, Switzerland
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Sheikhi B, Akbari H, Heiderscheit B. Cross cultural adaptation, reliability and validity of the Persian version of the university of Wisconsin running injury and recovery index. BMC Musculoskelet Disord 2024; 25:41. [PMID: 38195422 PMCID: PMC10775526 DOI: 10.1186/s12891-024-07171-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/04/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The University of Wisconsin Running Injury and Recovery Index (UWRI) was developed to evaluate running ability after a running-related injury. The aim of this study was to translate and cross-culturally adapt the UWRI into Persian (UWRI-Persian) and to investigate its psychometric properties in patients with a running-related injury. METHODS The UWRI-Persian was translated using the Beaton guidelines. One hundred and seventy-three native Persian patients with running-related injuries were participated in the study. The exploratory factor analysis was carried out using the principal component analysis method with Varimax rotation. The construct validity of the UWRI-Persian was evaluated using the Pearson correlation with the pain self-efficacy questionnaire (PSEQ), Tampa scale for Kinesiophobia (TKS), and visual analogue scale (VAS). Test-retest reliability was tested among 64 patients who completed the form again after seven days. RESULTS The UWRI-Persian showed excellent internal consistency for total score (α = 0.966). An excellent internal consistency (α = 0.922) was shown for psychological response and good internal consistency (α = 0.887) for running progression. The interclass correlation coefficient for the UWRI-Persian total scores was 0.965 (95% CI, 0.942 to 0.979), indicating high intra-rater reliability. The UWRI-Persian showed a moderate correlation with the PSEQ (r = 0.425) and the TSK (r = 0.457) and a weak correlation with the VAS (r = 0.187). These findings suggest no floor or ceiling effects. CONCLUSIONS The UWRI is a reliable and valid tool for Persian-speaking patients with running-related injuries. The UWRI was successfully translated from English to Persian and demonstrated good to excellent internal consistency, validity and reliability with no floor or ceiling effects.
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Affiliation(s)
- Bahram Sheikhi
- Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Iran.
| | - Hadi Akbari
- Department of Sport Sciences, University of Zabol, Zabol, Iran
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, US
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Crowell MS, Brindle RA, Miller EM, Reilly N, Ford KR, Goss DL. The effectiveness of telehealth gait retraining in addition to standard physical therapy treatment for overuse knee injuries in soldiers: a protocol for a randomized clinical trial. Trials 2023; 24:672. [PMID: 37845752 PMCID: PMC10580615 DOI: 10.1186/s13063-023-07502-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/07/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Running is the most common cardiovascular exercise in the military. However, there is a high incidence of running-related overuse injuries that reduces military readiness. Gait retraining is a common intervention to treat running-related injuries, but the high cost of equipment and lack of clinician expertise and availability reduces utilization. Gait retraining intervention in a telehealth format might improve feasibility. The purpose of this randomized clinical trial is to determine the effectiveness of a telehealth gait retraining intervention on pain, self-reported function, and biomechanical risk factors for injury in service members who present to a Military Health System physical therapy clinic with an overuse knee injury. METHODS This is a parallel, two-arm, single-blind randomized clinical trial. The two independent variables are intervention (2 levels: telehealth gait retraining intervention with standard of care or only standard of care) and time (3 levels: baseline, 10 weeks or post-intervention, 14 weeks). Participants between the ages of 18 to 60 years will be included if they report knee pain during and/or after running to be anywhere from a 3 to a 7 on the numerical pain rating scale and demonstrate a rearfoot strike pattern. The primary dependent variables are as follows: (1) pain (worst pain during and/or after running) and (2) foot strike pattern (conversion rate from rearfoot to non-rearfoot foot strike pattern during running). Secondary outcomes include patient self-reported function and running biomechanics. DISCUSSION The effectiveness of a telehealth gait retraining intervention to reduce pain and modify foot strike pattern is not known. The results of this study may help determine the effectiveness and feasibility of a telehealth gait retraining intervention to reduce pain, change foot strike, improve function, and improve running gait biomechanics. TRIAL REGISTRATION ClinicalTrials.gov, NCT04269473 . Registered 05 February 2020.
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Affiliation(s)
- Michael S Crowell
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, 900 Washington Road, West Point, NY, 10966, USA.
| | | | - Erin M Miller
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, 900 Washington Road, West Point, NY, 10966, USA
| | - Nicholas Reilly
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Kevin R Ford
- Department of Physical Therapy, High Point University, High Point, NC, USA
| | - Donald L Goss
- Department of Physical Therapy, High Point University, High Point, NC, USA
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Ekizos A, Santuz A. "Biofeedback-based return to sport": individualization through objective assessments. Front Physiol 2023; 14:1185556. [PMID: 37378078 PMCID: PMC10291093 DOI: 10.3389/fphys.2023.1185556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Elite athletes are regularly exposed to high and repetitive mechanical stresses and impacts, resulting in high injury rates. The consequences of injury can range from time lost from training and competition to chronic physical and psychological burden, with no guarantee that the athlete will return to preinjury levels of sport activity and performance. Prominent predictors include load management and previous injury, highlighting the importance of the postinjury period for effective return to sport (RTS). Currently, there is conflicting information on how to choose and assess the best reentry strategy. Treating RTS as a continuum, with controlled progression of training load and complexity, seems to provide benefits in this process. Furthermore, objectivity has been identified as a critical factor in improving the effectiveness of RTS. We propose that assessments derived from biomechanical measurements in functional settings can provide the objectivity needed for regular biofeedback cycles. These cycles should aim to identify weaknesses, customize the load, and inform on the status of RTS progress. This approach emphasizes individualization as the primary determinant of RTS and provides a solid foundation for achieving it.
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Affiliation(s)
| | - Alessandro Santuz
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
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Eckenrode BJ, Kietrys DM, Brown A, Parrott JS, Noehren B. Signs of Nervous System Sensitization in Female Runners with Chronic Patellofemoral Pain. Int J Sports Phys Ther 2023; 18:132-144. [PMID: 36793566 PMCID: PMC9897008 DOI: 10.26603/001c.57603] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background Patellofemoral pain (PFP) is a common overuse injury among runners, affecting females at a higher rate than males. PFP can often become chronic, with evidence suggesting it may be linked to both peripheral and central sensitization of the nervous system. Sensitization of the nervous system can be identified through quantitative sensory testing (QST). Hypothesis/Purpose The primary objective of this pilot study was to quantify and compare pain sensitivity as identified through QST measures, in active female runners with and without PFP. Study Design Cohort Study. Methods Twenty healthy female runners and 17 female runners with chronic PFP symptoms were enrolled. Subjects completed the Knee injury and Osteoarthritis Outcome Score for Patellofemoral Pain (KOOS-PF), University of Wisconsin Running Injury and Recovery Index (UWRI), and the Brief Pain Inventory (BPI). QST consisted of pressure pain threshold testing to three local and three distant sites to the knee, heat temporal summation, heat pain threshold, and conditioned pain modulation. Data was analyzed utilizing independent t-tests for comparison of between-group data, effect sizes for QST measures (Pearson's r), and Pearson's correlation coefficient between pressure pain threshold values at the knee and functional testing. Results The PFP group exhibited significantly lower scores on the KOOS-PF (p<0.001), BPI Pain Severity and Interference Scores (p<0.001), and UWRI (p<0.001). Primary hyperalgesia, identified through decreased pressure pain threshold at the knee, was detected in the PFP group at the central patella (p<0.001), lateral patellar retinaculum (p=0.003), and patellar tendon (p=0.006). Secondary hyperalgesia, a sign of central sensitization, was observed via differences in pressure pain threshold testing for the PFP group at the uninvolved knee (p=0.012 to p=0.042), involved extremity remote sites (p=0.001 to p=0.006), and uninvolved extremity remote sites (p=0.013 to p=0.021). Conclusion Compared to healthy controls, female runners with chronic PFP symptoms exhibit signs of both peripheral sensitization. Despite actively participating in running, nervous system sensitization may contribute to continued pain in these individuals. For female runners with chronic PFP, physical therapy management may need to include interventions which address signs of central and peripheral sensitization. Level of Evidence Level 3.
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Affiliation(s)
- Brian J Eckenrode
- Department of Physical Therapy Arcadia University
- Department of Rehabilitation and Movement Sciences Rutgers School of Health Professions
| | - David M Kietrys
- Department of Rehabilitation and Movement Sciences Rutgers School of Health Professions
| | - Allison Brown
- Department of Rehabilitation and Movement Sciences Rutgers School of Health Professions
| | - J Scott Parrott
- Department of Interdisciplinary Studies Rutgers School of Health Professions
| | - Brian Noehren
- Department of Physical Therapy University of Kentucky
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Madsen A, Sharififar S, Oberhaus J, Vincent KR, Vincent HK. Anxiety state impact on recovery of runners with lower extremity injuries. PLoS One 2022; 17:e0278444. [PMID: 36454920 PMCID: PMC9714898 DOI: 10.1371/journal.pone.0278444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
This prospective cohort study examined the impact of high anxiety levels on psychological state and gait performance during recovery in runners with lower body injuries. Recreational runners diagnosed with lower body injuries who had reduced running volume (N = 41) were stratified into groups using State Trait Anxiety Inventory (STAI) scores: high anxiety (H-Anx; STAI ≥40 points) and low anxiety (L-Anx; STAI <40 points). Runners were followed through rehabilitation to return-to-run using monthly surveys. Main outcome measures included kinesiophobia (Tampa Scale of Kinesiophobia, TSK-11), Positive and Negative Affect Schedule (PANAS; Positive and negative scores), Lower Extremity Function Scale (LEFS), running recovery (University of Wisconsin Running Injury and Recovery Index [UWRI]) and CDC Healthy Days modules for general health, days of anxiety/tension, disrupted sleep and work/usual activities. Running biomechanics were assessed at baseline and the final visit using 3D motion capture and a force-plated treadmill. The time to return-to-running for was 5.0±3.1 and 7.9±4.1 months for L-Anx and H-Anx, respectively and participants who withdrew (n = 15) did so at 7.7±6.2 months. L-Anx maintained low anxiety and H-Anx reduced anxiety from baseline to final visit (STAI = 31.5 to 28.4 points, 50.4 to 37.8 points, respectively), whereas the withdrawn runners remained clinically anxious at their final survey (41.5 to 40.3 points; p < .05). Group by time interactions were found for PANAS positive, LEFS UWRI, general health scores, and days feeling worry, tension and anxiety (all p < .05). Final running performance in L-Anx compared to H-Anx was most improved with cadence (8.6% vs 3.5%; p = .044), impact loading rate [-1.9% vs +8.9%] and lower body stiffness [+14.1% vs +3.2%; all p < .05). High anxiety may identify runners who will experience a longer recovery process, health-related functional disruptions, and less optimization of gait biomechanics during rehabilitation after a lower extremity injury.
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Affiliation(s)
- Aimee Madsen
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Sharareh Sharififar
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Jordan Oberhaus
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Kevin R. Vincent
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Heather K. Vincent
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, Florida, United States of America,* E-mail:
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DeJong Lempke AF, Stephens SL, Fish PN, Thompson XD, Hart JM, Hryvniak DJ, Rodu JS, Hertel J. Sensor-based gait training to reduce contact time for runners with exercise-related lower leg pain: a randomised controlled trial. BMJ Open Sport Exerc Med 2022; 8:e001293. [PMID: 36353183 PMCID: PMC9639130 DOI: 10.1136/bmjsem-2021-001293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To assess the effects of a 4-week randomised controlled trial comparing an outdoor gait-training programme to reduce contact time in conjunction with home exercises (contact time gait-training feedback with home exercises (FBHE)) to home exercises (HEs) alone for runners with exercise-related lower leg pain on sensor-derived biomechanics and patient-reported outcomes. Design Randomised controlled trial. Setting Laboratory and field-based study. Participants 20 runners with exercise-related lower leg pain were randomly allocated into FBHE (4 male (M), 6 female (F), 23±4 years, 22.0±4.3 kg/m2) or HE groups (3 M, 7 F, 25±5 years, 23.6±3.9 kg/m2). Interventions Both groups completed eight sessions of HEs over 4 weeks. The FBHE group received vibrotactile feedback through wearable sensors to reduce contact time during outdoor running. Primary and secondary outcome measures Patient-reported outcome measures (PROMs) and outdoor gait assessments were conducted for both groups at baseline and 4 weeks. PROMs were repeated at 6 weeks, and feedback retention was assessed at 6 weeks for the FBHE group. Repeated measures analyses of variance were used to assess the influence of group and timepoint on primary outcomes. Results The FBHE group reported increased function and recovery on PROMs beyond the HE group at 6 weeks (p<0.001). There was a significant group by time interaction for Global Rating of Change (p=0.004) and contact time (p=0.002); the FBHE group reported greater subjective improvement and reduced contact time at 4 and 6 weeks compared with the HE group and compared with baseline. The FBHE group had increased cadence (mean difference: 7 steps/min, p=0.01) at 4 weeks during outdoor running compared with baseline. Conclusion FBHE was more effective than HE alone for runners with exercise-related lower leg pain, manifested with improved PROMs, reduced contact time and increased cadence. Trial registration number NCT04270565.
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Affiliation(s)
| | | | - Pamela N Fish
- Kidney Center, Fresenius Medical Care, Knoxville, Tennessee, USA
| | | | - Joseph M Hart
- Orthopaedics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David J Hryvniak
- Physical Medicine & Rehabilitation, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Jordan S Rodu
- Statistics, University of Virginia, Charlottesville, Virginia, USA
| | - Jay Hertel
- Kinesiology, University of Virginia, Charlottesville, Virginia, USA
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Tenforde AS, Vogel KEL, Tam J, Silbernagel KG. Research protocol to evaluate the effectiveness of shockwave therapy, photobiomodulation and physical therapy in the management of non-insertional Achilles tendinopathy in runners: a randomised control trial with elective cross-over design. BMJ Open Sport Exerc Med 2022; 8:e001397. [PMID: 36187084 PMCID: PMC9516084 DOI: 10.1136/bmjsem-2022-001397] [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: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Achilles tendinopathy (AT) is a common overuse injury in runners. While the mainstay of treatment for AT is tendon loading exercises (physical therapy and exercise programme (EXER)), some patients have refractory symptoms. Extracorporeal shockwave therapy (ESWT) and photobiomodulation therapy (PBMT) have each been evaluated to facilitate tendon healing; the influence of combining treatments is unknown and limited studies have been completed in runners. This randomised control study, with an elective cross-over at 3 months, will evaluate the efficacy of three forms of treatment of non-insertional AT: (1) EXER (loading programme specific to Achilles tendon combined with physical therapy); (2) EXER and ESWT; (3) EXER, ESWT and PBMT. Sixty runners will be assigned using block randomisation into one of three treatment groups (n=20). After 3 months, each participant may elect a different treatment than previously assigned and will be followed for an additional 3 months. The EXER Achilles loading programme will be standardised using the Silbernagel at-home programme. The primary outcome of interest is treatment group responses using the Victorian Institute of Sports Assessment—Achilles (VISA-A) Score. Secondary outcomes include the Patient-Reported Outcomes Measurement Information System—29 questions, the University of Wisconsin Running Injury and Recovery Index, heel raise to fatigue test, hopping test and ultrasound measurements. We will also capture patient preference and satisfaction with treatment. We hypothesise that the cohorts assigned EXER+ESWT+PBMT and EXER+ESWT will see greater improvements in VISA-A than the EXER cohort, and the largest gains are anticipated in combining ESWT+PBMT. The elective cross-over phase will be an exploratory study and will inform us whether patient preference for treatment will impact the treatment response. Trial registration number NCT04725513.
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Affiliation(s)
- Adam S Tenforde
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | | | - Joshua Tam
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
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Bunster J, Martínez MJ, Mauri-Stecca MV, Leppe J, Nelson EO, Heiderscheit B, Besomi M. Cross-cultural adaptation and evaluation of the psychometric properties of the University of Wisconsin Running Injury and Recovery Index questionnaire in Spanish (UWRI-S). Phys Ther Sport 2022; 55:289-295. [DOI: 10.1016/j.ptsp.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
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Rahlf AL, Hoenig T, Stürznickel J, Cremans K, Fohrmann D, Sanchez-Alvarado A, Rolvien T, Hollander K. A machine learning approach to identify risk factors for running-related injuries: study protocol for a prospective longitudinal cohort trial. BMC Sports Sci Med Rehabil 2022; 14:75. [PMID: 35473813 PMCID: PMC9040327 DOI: 10.1186/s13102-022-00426-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Running is a very popular sport among both recreational and competitive athletes. However, participating in running is associated with a comparably high risk of sustaining an exercise-related injury. Due to the often multifactorial and individual reasons for running injuries, a shift in thinking is required to account for the dynamic process of the various risk factors. Therefore, a machine learning approach will be used to comprehensively analyze biomechanical, biological, and loading parameters in order to identify risk factors and to detect risk patterns in runners. METHODS The prospective longitudinal cohort study will include competitive adult athletes, running at least 20 km per week and being free of injuries three months before the start of the study. At baseline and the end of the study period, subjective questionnaires (demographics, injury history, sports participation, menstruation, medication, psychology), biomechanical measures (e.g., stride length, cadence, kinematics, kinetics, tibial shock, and tibial acceleration) and a medical examination (BMI, laboratory: blood count, creatinine, calcium, phosphate, parathyroid hormone, vitamin D, osteocalcin, bone-specific alkaline phosphatase, DPD cross-links) will be performed. During the study period (one season), continuous data collection will be performed for biomechanical parameters, injuries, internal and external load. Statistical analysis of the data is performed using machine learning (ML) methods. For this purpose, the correlation of the collected data to possible injuries is automatically learned by an ML model and from this, a ranking of the risk factors can be determined with the help of sensitivity analysis methods. DISCUSSION To achieve a comprehensive risk reduction of injuries in runners, a multifactorial and individual approach and analysis is necessary. Recently, the use of ML processes for the analysis of risk factors in sports was discussed and positive results have been published. This study will be the first prospective longitudinal cohort study in runners to investigate the association of biomechanical, bone health, and loading parameters as well as injuries via ML models. The results may help to predict the risk of sustaining an injury and give way for new analysis methods that may also be transferred to other sports. TRIAL REGISTRATION DRKS00026904 (German Clinical Trial Register DKRS), date of registration 18.10.2021.
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Affiliation(s)
- A L Rahlf
- Department of Sports Science, Institute of Health, Nutrition and Sports Science, Europa-Universität Flensburg, Campusallee 2, 24943, Flensburg, Germany.
| | - T Hoenig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - J Stürznickel
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Cremans
- Department of Mechanical Engineering, Institute of Modelling and High-Performance Computing, Niederrhein University of Applied Sciences, Reinarzstraße 49, 47805, Krefeld, Germany
| | - D Fohrmann
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Am Kaiserkai 1, 20457, Hamburg, Germany
| | - A Sanchez-Alvarado
- Department of Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, Turmweg 2, 20148, Hamburg, Germany
| | - T Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - K Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Am Kaiserkai 1, 20457, Hamburg, Germany
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Maschke B, Palmsten A, Nelson EO, Obermeier MC, Reams M, Heiderscheit B, Russell H, Chmielewski TL. Injury-related psychological distress and the association with perceived running ability in injured runners. Phys Ther Sport 2022; 54:36-43. [PMID: 34999561 PMCID: PMC8872088 DOI: 10.1016/j.ptsp.2021.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Examine injury-related psychological distress and association with perceived running ability in injured runners. DESIGN Prospective longitudinal study. PARTICIPANTS Forty-three patients with a running-related injury. MAIN OUTCOME MEASURES Data collection at initial physical therapy visit and 12-16 weeks later included Optimal Screening for Prediction of Referral and Outcome - Yellow Flag (OSPRO-YF) and Athlete Fear Avoidance Questionnaire (AFAQ) for injury-related psychological distress, and University of Wisconsin Running and Recovery Index (UWRI) for perceived running ability. OSPRO-YF composite score, total yellow flags, and yellow flags in each domain (negative mood, fear-avoidance, positive affect/coping) were calculated. RESULTS UWRI score and OSPRO-YF composite score and yellow flags significantly improved over time, while AFAQ score and yellow flags in OSPRO-YF negative mood domain did not. AFAQ scores were significantly correlated with UWRI score at baseline, follow-up and change over time, while OSPRO-YF composite score and yellow flags were not. Baseline OSPRO-YF composite score and AFAQ score were not correlated with follow-up UWRI score. CONCLUSIONS Injury-related psychological distress is elevated when injured runners start rehabilitation, and generally improves; however, negative mood and athletic fear-avoidance may persist. Higher athletic fear-avoidance is associated with lower perceived running ability at the same time point or interval.
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Affiliation(s)
- Benjamin Maschke
- TRIA Orthopedic Center, 8100 Northland Drive, Bloomington, MN 55431, United States.
| | - Allison Palmsten
- TRIA Orthopedic Center, 8100 Northland Drive, Bloomington, MN 55431, United States.
| | - Evan O. Nelson
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, 4190 Medical Sciences Center, 1300 University Avenue, Madison, WI 53706, United States
| | - Michael C. Obermeier
- TRIA Orthopedic Center, 8100 Northland Drive, Bloomington, MN 55431, Bloomington, MN, United States
| | - Megan Reams
- TRIA Orthopedic Center, 8100 Northland Drive, Bloomington, MN 55431, United States.
| | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 685 Highland Ave, MFCB 1636, Madison, WI 53705, United States.
| | - Hayley Russell
- Gustavus Adolphus College, 800 W College Ave, Saint Peter, MN 56082, United States.
| | - Terese L. Chmielewski
- TRIA Orthopedic Center, 8100 Northland Drive, Bloomington, MN 55431, Bloomington, MN, United States
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DeJong Lempke AF, Hart JM, Hryvniak DJ, Rodu JS, Hertel J. Running-Related Injuries Captured Using Wearable Technology during a Cross-Country Season: A Preliminary Study. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2022. [DOI: 10.1249/tjx.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Running-related injury: How long does it take? Feasibility, preliminary evaluation, and German translation of the University of Wisconsin running and recovery index. Phys Ther Sport 2021; 52:204-208. [PMID: 34607122 DOI: 10.1016/j.ptsp.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The University of Wisconsin Running Injury and Recovery Index (UWRI) was developed as an evaluative patient-reported outcome measure of perceived running ability and recovery after running-related injuries. To date, the questionnaire was not translated into German language and studies on its clinical feasibility and validity are sparse. DESIGN Prospective cohort study. SETTING Outpatient sports medicine clinic. PARTICIPANTS The UWRI questionnaire was translated to German language using a state-of-the art back-translation method including three translators and two back-translators. Clinical feasibility and validation were assessed in 14 injured runners. MAIN OUTCOME MEASURES UWRI total score, running volume. RESULTS The translation process was completed without major discrepancies. Feasibility and preliminary evaluation were demonstrated in a cohort of 14 injured runners. The UWRI total score significantly improved throughout 12 weeks of recovering from running-related injuries (p < 0.001). Relative running volume significantly correlated with UWRI score (p < 0.001). CONCLUSION The University of Wisconsin Running Injury and Recovery Index was successfully translated into the German language. Its usage may hold promise for better rehabilitation surveillance following running-related injuries.
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15
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Construct Validity and Responsiveness of the University of Wisconsin Running Injury and Recovery Index. J Orthop Sports Phys Ther 2020; 50:702-710. [PMID: 33115339 DOI: 10.2519/jospt.2020.9698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The University of Wisconsin Running Injury and Recovery Index (UWRI) is the first running-specific patient-reported outcome measure (PROM). The UWRI evaluates the key elements runners use to self-assess running ability during recovery. This study evaluated the construct-related validity and responsiveness of the UWRI as an evaluative PROM of running ability following running-related injury (RRI). DESIGN Prospective longitudinal study. METHODS Runners seeking care from a physical therapist for an RRI (n = 396) completed PROMs at baseline and 12 weeks later. Change in UWRI score was validated against the global rating of change (GROC), Veterans RAND 12-Item Health Survey (VR-12) change, and change in body region- specific PROMs. Responsiveness was evaluated using anchor-based and distribution-based techniques. RESULTS Change in UWRI score (mean ± SD, 7.7 ± 8.9 points) was correlated with the GROC (r = 0.67), as well as with changes in the VR-12 Physical Component Summary (PCS) (r = 0.54) and Mental Component Summary (MCS) (r = 0.31). Change in UWRI score was correlated with changes in the Foot and Ankle Ability Measure sports subscale (r = 0.75), the 12-item International Hip Outcome Tool (r = 0.75), and the Anterior Knee Pain Scale (r = 0.48), but not with the Oswestry Disability Index Version 2.0 (r = 0.05). Change in UWRI score was significantly different in runners reporting significant improvement (12.2 ± 5.9 points), slight improvement (7.1 ± 6.6 points), no change (0.0 ± 9.1 points), and worsening (-14.6 ± 7.4 points) on the GROC anchor-based responsiveness assessment. The UWRI minimal important change and minimal clinically important difference were 5 and 8 points, respectively. CONCLUSION The UWRI is a valid clinical tool for evaluating running ability following RRI; it demonstrated longitudinal validity (GROC), convergent validity (PCS and body region- specific PROMs), divergent validity (MCS), and responsiveness to changes in patient-perceived running ability. J Orthop Sports Phys Ther 2020;50(12):702-710. Epub 28 Oct 2020. doi:10.2519/jospt.2020.9698.
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