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MacGregor AJ, Crouch DJ, Zouris JM, Dougherty AL, Dye JL, Fraser JJ. Sex Differences in Postinjury Health Profiles Among U.S. Military Personnel Following Deployment-Related Concussion. J Womens Health (Larchmt) 2024; 33:515-521. [PMID: 38497537 DOI: 10.1089/jwh.2023.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background: Women in the U.S. military are now authorized to serve in direct combat occupations. This may increase their risk of combat injuries, such as concussion, in future conflicts. Knowledge of sex differences in health profiles after concussion is paramount for military medical planning efforts. The purpose of this study was to assess sex-related differences in health profiles among U.S. military personnel following deployment-related concussion. Materials and Methods: We conducted a retrospective study of service members who sustained a concussion during combat deployment between 2004 and 2013. Postinjury diagnoses were abstracted from outpatient encounters in electronic health records for 24 months after concussion. We used hierarchical clustering to identify clusters, termed "health profiles," and logistic regression to determine whether sex predicted membership in the health profiles. Results: The study sample included 346 women and 4536 men with deployment-related concussion. Five postinjury health profiles were identified and classified as no morbidity, back pain, tinnitus/memory loss, posttraumatic stress disorder/postconcussion syndrome, and multimorbidity. Women relative to men had higher odds of membership in the back pain (odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.05-1.67) and multimorbidity profiles (OR = 1.44; 95% CI = 1.03-2.00) and lower odds than men in the tinnitus/memory loss profile (OR = 0.62; 95% CI = 0.42-0.91). Conclusions: Postinjury health profiles among U.S. service members differ by sex following deployment-related concussion, particularly with a higher burden of multimorbidity among women than men, which may require interdisciplinary care. Women also had higher odds of membership in the back pain profile and lower odds in the tinnitus/memory loss profile than men. To prepare for future military operations where women may have greater exposure to combat, continued research elucidating health-related sex differences after deployment-related concussion is imperative.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Daniel J Crouch
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - James M Zouris
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Judy L Dye
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - John J Fraser
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, California, USA
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Paradise SL, Beer JR, Cruz CA, Fechner KM, MacGregor AJ, Fraser JJ. Prescribed footwear and orthoses are not prophylactic in preventing lower extremity injuries in military tactical athletes: a systematic review with meta-analysis. BMJ Mil Health 2024; 170:64-71. [PMID: 34785586 DOI: 10.1136/bmjmilitary-2021-001955] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/02/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Military members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The purpose of this systematic review with meta-analysis was to assess if prescribed prophylactic footwear or foot orthoses reduced the risk of lower extremity injury in military tactical athletes. METHODS MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Defense Technical Information Center databases were searched for randomised controlled trials published at any time that compared foot orthoses or prescribed footwear (to include shock-absorbing insoles and socks) with a placebo intervention or a no-treatment control. Methodological quality was assessed and the number of injuries, population at risk and duration of the study epoch were extracted and relative risk (RR) calculated. An omnibus meta-analysis was performed assessing all prescribed footwear and orthoses intervention studies, with subgroup analyses conducted on studies with similar interventions (ie, basketball athletic shoes, athletic shoes (prescribed by foot type), foot orthoses, shock-absorbing insoles, socks, tropical combat boots). RESULTS Of 1673 studies identified, 22 were included. Three of eight studies that employed orthoses demonstrated significantly reduced overuse injuries compared with no-treatment controls (RR range: 0.34-0.68); one study showed neoprene insoles significantly decreased overuse injuries (RR: 0.75). There were no other significant effects in the individual studies and no protective effects observed in the omnibus meta-analysis or in the component subanalyses. CONCLUSIONS Prescribed footwear and orthoses do not appear to have a prophylactic effect on lower quarter musculoskeletal injuries in military members and cannot be recommended at this time.
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Affiliation(s)
- Scott L Paradise
- Department of Orthopaedics, United States Navy Medicine Readiness and Training Command Guam, Agana, GU, USA
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
| | - J R Beer
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- Sports Medicine and Rehabilitation Therapy Clinic, United States Navy Medicine Readiness and Training Unit Parris Island, Parris Island, SC, USA
| | - C A Cruz
- Medical Home Port Clinic, United States Navy Medicine Readiness and Training Command Lemoore, Lemoore, CA, USA
| | - K M Fechner
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
| | - A J MacGregor
- Directorate for Operational Readiness & Health, Naval Health Research Center, San Diego, CA, USA
- Axiom Resource Management, Inc, San Diego, CA, USA
| | - J J Fraser
- Directorate for Operational Readiness & Health, Naval Health Research Center, San Diego, CA, USA
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Bullock GS, Dartt CE, Ricker EA, Fallowfield JL, Arden N, Clifton D, Danelson K, Fraser JJ, Gomez C, Greenlee TA, Gregory A, Gribbin T, Losciale J, Molloy JM, Nicholson KF, Polich JG, Räisänen A, Shah K, Smuda M, Teyhen DS, Allard RJ, Collins GS, de la Motte SJ, Rhon DI. Barriers and facilitators to implementation of musculoskeletal injury mitigation programmes for military service members around the world: a scoping review. Inj Prev 2023; 29:461-473. [PMID: 37620010 DOI: 10.1136/ip-2023-044905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Musculoskeletal injury (MSK-I) mitigation and prevention programmes (MSK-IMPPs) have been developed and implemented across militaries worldwide. Although programme efficacy is often reported, development and implementation details are often overlooked, limiting their scalability, sustainability and effectiveness. This scoping review aimed to identify the following in military populations: (1) barriers and facilitators to implementing and scaling MSK-IMPPs; (2) gaps in MSK-IMPP research and (3) future research priorities. METHODS A scoping review assessed literature from inception to April 2022 that included studies on MSK-IMPP implementation and/or effectiveness in military populations. Barriers and facilitators to implementing these programmes were identified. RESULTS From 132 articles, most were primary research studies (90; 68.2%); the remainder were review papers (42; 31.8%). Among primary studies, 3 (3.3%) investigated only women, 62 (69%) only men and 25 (27.8%) both. Barriers included limited resources, lack of stakeholder engagement, competing military priorities and equipment-related factors. Facilitators included strong stakeholder engagement, targeted programme design, involvement/proximity of MSK-I experts, providing MSK-I mitigation education, low burden on resources and emphasising end-user acceptability. Research gaps included variability in reported MSK-I outcomes and no consensus on relevant surveillance metrics and definitions. CONCLUSION Despite a robust body of literature, there is a dearth of information about programme implementation; specifically, barriers or facilitators to success. Additionally, variability in outcomes and lack of consensus on MSK-I definitions may affect the development, implementation evaluation and comparison of MSK-IMPPs. There is a need for international consensus on definitions and optimal data reporting elements when conducting injury risk mitigation research in the military.
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Affiliation(s)
- Garrett S Bullock
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Centre for Sport, Exercise, and Osteoarthritis, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Carolyn E Dartt
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Emily A Ricker
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Joanne L Fallowfield
- Environmental Medicine and Sciences Division, Institute of Naval Medicine, Gosport, UK
| | - Nigel Arden
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
- University of Southampton MRC Lifecourse Epidemiology Centre, Southampton, UK
| | - Daniel Clifton
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Kerry Danelson
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - John J Fraser
- Directorate for Operational Readiness & Health, Naval Health Research Center, San Diego, California, USA
| | - Christina Gomez
- College of Health Sciences, Western University of Health Sciences, Pomona, California, USA
| | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Alexandria Gregory
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Timothy Gribbin
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Justin Losciale
- Department of Rehabilitation, The University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Joseph M Molloy
- Office of the Army Surgeon General, Falls Church, Virginia, USA
| | - Kristen F Nicholson
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Julia-Grace Polich
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anu Räisänen
- Department of Physical Therapy Education, Oregon, College of Health Sciences, Western University of Health Sciences, Lebanon, Oregon, USA
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Karishma Shah
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
| | - Michael Smuda
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Deydre S Teyhen
- Army Medical Specialist Corps Chief, Office of the Army Surgeon General, Falls Church, Virginia, USA
| | - Rhonda J Allard
- Learning Resource Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Sarah J de la Motte
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, Bethesda, Maryland, USA
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Aguero AD, Irrgang JJ, MacGregor AJ, Rothenberger SD, Hart JM, Fraser JJ. Sex, military occupation and rank are associated with risk of anterior cruciate ligament injury in tactical-athletes. BMJ Mil Health 2023; 169:535-541. [PMID: 35165197 PMCID: PMC10715491 DOI: 10.1136/bmjmilitary-2021-002059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/16/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) injury is common within the US military and represents a significant loss to readiness. Since recent changes to operational tempo, there has not been an analysis of ACL injury risk. The aim of this retrospective cohort study was to evaluate military occupation, sex, rank and branch of service on ACL injury risk in the US military from 2006 to 2018. METHODS The Defense Medical Epidemiology Database was queried for the number of US tactical athletes with International Classification of Diseases diagnosis codes 717.83 (old disruption of ACL), 844.2 (sprain of knee cruciate ligament), M23.61 (other spontaneous disruption of ACL) and S83.51 (sprain of ACL of knee) on their initial encounter. Relative risk and χ2 statistics were calculated to assess sex and military occupation effects on ACL injury. A multivariable negative binomial regression model evaluated changes in ACL injury incidence with respect to sex, branch of service and rank. RESULTS The study period displayed a significant decrease in the ACL injury rate at 0.18 cases per 1000 person-years or relative decrease of 4.08% each year (p<0.001) after averaging over the main and interactive effects of sex, rank and branch of service. The interaction effect of time with sex indicated a steeper decline in the incidence in men as compared with women. The risk of ACL injury by sex was modified by rank. The incidence among military personnel varied by occupation. CONCLUSION Despite the decline among tactical athletes over time, rates of ACL injury remain much higher than the general US population. Sex, rank, branch of service and military occupation were found to be risk factors for ACL injury. It is critical for policy makers to understand the salient risk factors for ACL injury to guide proactive measures to prevent injury.
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Affiliation(s)
- Aubrey D Aguero
- Physical Therapy Department, School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Naval Medical Leader & Professional Development Command, US Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA
| | - J J Irrgang
- Physical Therapy Department, School of Health & Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - A J MacGregor
- Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, California, USA
| | - S D Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - J M Hart
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - J J Fraser
- Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, California, USA
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5
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Webber BJ, Deuster PA, Fraser JJ, Nindl BC, Phillips EM, Piercy KL, Stiegmann RA, Bornstein DB. Research agenda for physical activity promotion to enhance health and performance in the military community. BMJ Mil Health 2023:e002565. [PMID: 37949478 DOI: 10.1136/military-2023-002565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Bryant J Webber
- Air Force Institute of Technology, Wright-Patterson AFB, Ohio, USA
| | - P A Deuster
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - J J Fraser
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, California, USA
| | - B C Nindl
- Department of Sports Medicine and Nutrition, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - E M Phillips
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Physical Medicine & Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - K L Piercy
- Office of Disease Prevention and Health Promotion, Rockville, Maryland, USA
| | - R A Stiegmann
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
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Fraser JJ, Ryans CP, MacGregor AJ, Janney CF. Macrotraumatic Fractures of the Multisegmented Ankle-Foot Complex in Military Tactical Athletes: A Cohort Study. J Am Podiatr Med Assoc 2023; 113:22-114. [PMID: 38175726 DOI: 10.7547/22-114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Ankle-foot injuries are common in military personnel and substantially degrade function and force readiness. The purpose of this retrospective cohort study was to assess the incidence and contributing factors of traumatic ankle-foot fractures in the US military. METHODS A population-based study of all service members in the US military was performed assessing the factors of sex, occupation, service branch, rank, and year on segmental tibia-fibula, rearfoot, and forefoot fracture incidence between 2006 and 2015. The Defense Medical Epidemiology Database was queried for the number of individuals with fractures of the tibia-fibula, rearfoot, and forefoot using International Classification of Diseases, Ninth Revision, Clinical Modification on the initial medical encounter. Unadjusted relative risk (RR) calculations were performed assessing sex and occupation. A negative binomial regression assessed the adjusted factors of sex, branch, rank, and year. RESULTS During this study, 95,540 enlisted service members (8.4 per 1,000 person-years) and 13,318 military officers (5.8 per 1,000 person-years) were diagnosed with ankle-foot fractures. In the adjusted analysis, sex was found to only be a significant factor in forefoot fractures (RR, 1.54), with female service members having a significantly higher risk. There were no significant sex-related differences observed in tibia-fibula or rearfoot fractures. US Navy and Air Force personnel had significantly lower risk of tibia-fibula fractures (RR range, 0.76-0.84) compared with the US Army. Forefoot fracture risk was significantly higher in the US Marine Corps (RR, 1.47) compared with the US Army. Officers had consistently lower risk for fractures in each segment (RR range, 0.68-0.77) compared with enlisted personnel. Enlisted engineers, aviation, and artillery/gunnery compared to infantry, and ground/naval gunfire officers had the greatest relative risk compared all other officer fields (RR range, 1.11-3.67). CONCLUSIONS Sex, occupation, branch, and rank were salient factors for macrotraumatic ankle-foot fractures. These findings can be used to inform and increase precision in medical planning and in the targeted development of preventive interventions.
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Affiliation(s)
- John J Fraser
- *Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, CA
| | | | - Andrew J MacGregor
- ‡Epidemiology and Information Management Support Department, Naval Health Research Center, San Diego, CA
| | - Cory F Janney
- §Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA
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O'Reilly M, Hu YWE, Gruber J, Jones DM, Daniel A, Marra J, Fraser JJ. Consistency and applicability of return to function guidelines in tactical-athletes with exertional heat illness. A systematic review. PHYSICIAN SPORTSMED 2023; 51:482-491. [PMID: 36239088 DOI: 10.1080/00913847.2022.2135973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/10/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the consistency of return to sport and occupation recommendations following EHI provided in published clinical practice guidelines, consensus statements, position statements, and practice alerts. The agreement between medical policies governing the return to duty following EHI between the branches of the United States Armed Forces and published recommendations was assessed. METHODS Ovid MEDLINE, Web of Science, and CINAHL databases were searched for clinical practice guidelines and position statements published at any time that guided return to activity in individuals with EHI. Methodological quality was assessed, and the specific recommendations for clinical management were extracted. Consistency of recommendations was evaluated. Agreement between published guidelines and the policies governing return to activity in military tactical athletes with heat injury were also evaluated. RESULTS Guidelines developed by two civilian sports medicine societies in the United States detailing recommendations for return to function following EHI were identified. There was consistency between guidelines regarding recommendations that addressed abstinence from activity; medical follow-up; graded resumption of activity; and return to function. Pertaining military policy, contemporary regulations published in recent years reflected the recommendations provided in the professional guidelines. The greatest incongruence was noted in older military policies. CONCLUSIONS This systematic review highlights the need for consistent recommendations across all branches of the military and medical specialties pertaining to returning servicemembers to duty after EHI .
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Affiliation(s)
- Matthew O'Reilly
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- United States Navy Medicine Readiness and Training Unit, Naval Medical Center San Diego, San Diego, CA, USA
| | - Yao-Wen Eliot Hu
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
| | - Jonathan Gruber
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- United States Navy Medicine Readiness and Training Unit, Naval Medical Center Camp Lejeune, Jacksonville, NC, USA
| | - Douglas M Jones
- Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, CA, USA
| | - Arthur Daniel
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
| | - Janelle Marra
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- 17th Combat Logistics Regiment, 1st Marine Logistics Group, Camp Pendleton, CA, USA
| | - John J Fraser
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, CA, USA
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8
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Sullivan CK, Janney CF, Fraser JJ. Burden and risk factors for Achilles tendinopathy in the military population from 2006 to 2015. A retrospective cohort study. J Athl Train 2023:495949. [PMID: 37734728 DOI: 10.4085/1062-6050-0182.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
CONTEXT Ankle-foot injuries are ubiquitous in the US military, with Achilles tendinopathy (AT) a common condition that affects function and health-related quality of life. OBJECTIVE To evaluate the burden and associated factors of AT. DESIGN Descriptive Epidemiology Study. SETTING The Defense Medical Epidemiological Database was utilized to identify relevant healthcare encounters. PATIENTS OR OTHER PARTICIPANTS All active duty and reserve military members who served between 2006 to 2015 (officers: n= 2 149 887; enlisted: n= 9 503 995). MAIN OUTCOME MEASURES Multi-year prevalence of AT care episodes were calculated and compared by year, service branch, and military rank. Unadjusted and adjusted assessment of injury burden were calculated. RESULTS Officers incurred 37,939 episodes at a prevalence of 17.65 per 1000 servicemembers (male officers: 18.20 per 1000 servicemembers; female officers: 14.80 per 1000 servicemembers). Among enlisted personnel, there were 116,122 episodes of AT that occurred in 12.22 per 1000 servicemembers (male enlisted: 12.07 per 1000 servicemembers; female enlisted: 13.22 per 1000 servicemembers). All officer specialties had significantly higher burden of AT episodes compared to the ground and naval gunfire officers (prevalence ratio [PR]: 1.04-1.43), except for aviation that demonstrated a significantly lower burden (PR: 0.65). Among enlisted occupations, maritime/naval specialties had lower burden of AT compared to infantry (PR: 0.82) and all other specialties, except for aviation, had significantly higher burden (PR: 1.07-1.71). There were multiple associated factors identified, to include sex, age, rank, military occupation, and service branch. CONCLUSION AT was ubiquitous in the US military, with a progressive increase in prevalence during the study epoch. There were multiple associated factors identified, to include sex, age, rank, military occupation, and service branch. These findings highlight both the need for prophylactic interventions and identification of the populations with the greatest need.
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Affiliation(s)
- Christopher K Sullivan
- Department of Orthopedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Cory F Janney
- Department of Orthopedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - John J Fraser
- Operational Readiness & Health Directorate, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521, USA
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MacGregor AJ, D'Souza EW, Dougherty AL, Fraser JJ. Research Letter: Prevalence of Spine Injuries Among US Military Personnel With Combat-Related Concussion. J Head Trauma Rehabil 2023; 38:410-415. [PMID: 36730823 DOI: 10.1097/htr.0000000000000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the prevalence of spine injuries among US service members with combat-related concussion. DESIGN AND PARTICIPANTS A retrospective review of medical records for US service members injured during combat operations in Iraq and Afghanistan between 2002 and 2020. The study sample included 27 897 service members categorized into 3 groups: concussion with loss of consciousness (LOC, n = 4631), concussion non-LOC ( n = 5533), and non-concussion ( n = 17 333). MAIN MEASURES Spine injuries were identified by International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM ) codes and classified by body region and nature of injury using the Barell injury diagnosis matrix. Differences in prevalence of spine injuries by concussion group were evaluated using χ 2 tests. RESULTS Spine injuries were most prevalent among service members with concussion LOC (31.1%), followed by concussion non-LOC (18.3%), and non-concussion (10.0%, P < .001). Sprains and strains were the most prevalent spine injury category, with injuries to the cervical, thoracic, and lumbar regions significantly more prevalent in the concussion groups ( P values < .001), particularly individuals with LOC compared with non-concussion. CONCLUSION The US military personnel with combat-related concussion, especially individuals with LOC, may also have spine injuries. Routine assessment for spine injury is recommended during concussion screening because this may impact clinical management and rehabilitation.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department (Dr MacGregor, Mr D'Souza, and Ms Dougherty) and Operational Readiness and Health Directorate (Dr Fraser), Naval Health Research Center, San Diego, California; and Leidos, Inc, San Diego, California (Mr D'Souza and Ms Dougherty)
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Hoch MC, Hertel J, Gribble PA, Heebner NR, Hoch JM, Kosik KB, Long D, Sessoms PH, Silder A, Torp DM, Thompson KL, Fraser JJ. Correction: Effects of foot intensive rehabilitation (FIRE) on clinical outcomes for patients with chronic ankle instability: a randomized controlled trial protocol. BMC Sports Sci Med Rehabil 2023; 15:70. [PMID: 37143146 PMCID: PMC10157992 DOI: 10.1186/s13102-023-00679-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA.
| | - Jay Hertel
- Sports Medicine and Chair, Department of Kinesiology, University of Virginia, 550 Brandon Avenue, Charlottesville, VA, 22904-4407, USA
| | - Phillip A Gribble
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Johanna M Hoch
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Kyle B Kosik
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Doug Long
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 South Limestone, Lexington, KY, 40536-0200, USA
| | - Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Amy Silder
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Danielle M Torp
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Katherine L Thompson
- Dr. Bing Zhang Department of Statistics, University of Kentucky, 725 Rose Street, Lexington, KY, 40536, USA
| | - John J Fraser
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106- 3521, USA
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Hoch MC, Hertel J, Gribble PA, Heebner NR, Hoch JM, Kosik KB, Long D, Sessoms PH, Silder A, Torp DM, Thompson KL, Fraser JJ. Effects of foot intensive rehabilitation (FIRE) on clinical outcomes for patients with chronic ankle instability: a randomized controlled trial protocol. BMC Sports Sci Med Rehabil 2023; 15:54. [PMID: 37032355 PMCID: PMC10084629 DOI: 10.1186/s13102-023-00667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Lateral ankle sprains account for a large proportion of musculoskeletal injuries among civilians and military service members, with up to 40% of patients developing chronic ankle instability (CAI). Although foot function is compromised in patients with CAI, these impairments are not routinely addressed by current standard of care (SOC) rehabilitation protocols, potentially limiting their effectiveness. The purpose of this randomized controlled trial is to determine if a Foot Intensive REhabilitation (FIRE) protocol is more effective compared to SOC rehabilitation for patients with CAI. METHODS This study will use a three-site, single-blind, randomized controlled trial design with data collected over four data collection points (baseline and post-intervention with 6-, 12-, and 24-month follow-ups) to assess variables related to recurrent injury, sensorimotor function, and self-reported function. A total of 150 CAI patients (50 per site) will be randomly assigned to one of two rehabilitation groups (FIRE or SOC). Rehabilitation will consist of a 6-week intervention composed of supervised and home exercises. Patients assigned to SOC will complete exercises focused on ankle strengthening, balance training, and range of motion, while patients assigned to FIRE will complete a modified SOC program along with additional exercises focused on intrinsic foot muscle activation, dynamic foot stability, and plantar cutaneous stimulation. DISCUSSION The overall goal of this trial is to compare the effectiveness of a FIRE program versus a SOC program on near- and long-term functional outcomes in patients with CAI. We hypothesize the FIRE program will reduce the occurrence of future ankle sprains and ankle giving way episodes while creating clinically relevant improvements in sensorimotor function and self-reported disability beyond the SOC program alone. This study will also provide longitudinal outcome findings for both FIRE and SOC for up to two years. Enhancing the current SOC for CAI will improve the ability of rehabilitation to reduce subsequent ankle injuries, diminish CAI-related impairments, and improve patient-oriented measures of health, which are critical for the immediate and long-term health of civilians and service members with this condition. Trial Registration Clinicaltrials.gov Registry: NCT #NCT04493645 (7/29/20).
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Grants
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
- W81XWH-20-2-0035 U.S. Army Medical Research and Development Command, Peer Reviewed Orthopaedic Research Program
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Affiliation(s)
- Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA.
| | - Jay Hertel
- Sports Medicine and Chair, Department of Kinesiology, University of Virginia, 550 Brandon Avenue, Charlottesville, VA, 22904-4407, USA
| | - Phillip A Gribble
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Johanna M Hoch
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Kyle B Kosik
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Doug Long
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 South Limestone, Lexington, KY, 40536-0200, USA
| | - Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Amy Silder
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
| | - Danielle M Torp
- Sports Medicine Research Institute, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Katherine L Thompson
- Dr. Bing Zhang Department of Statistics, University of Kentucky, 725 Rose Street, Lexington, KY, 40536, USA
| | - John J Fraser
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA
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MacGregor AJ, Casachahua JD, Walton SR, Harbertson J, Jurick SM, Dougherty AL, McCabe CT, Watrous JR, Fraser JJ. Deployment-related concussion and long-term health-related quality of life among US military personnel. Qual Life Res 2023:10.1007/s11136-023-03367-4. [PMID: 36897531 DOI: 10.1007/s11136-023-03367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To examine the relationship between deployment-related concussion and long-term health-related quality of life (HRQoL) among injured US military personnel. METHODS The study sample included 810 service members with deployment-related injuries between 2008 and 2012 who responded to a web-based longitudinal health survey. Participants were categorized into three injury groups: concussion with loss of consciousness (LOC; n = 247), concussion without LOC (n = 317), or no concussion (n = 246). HRQoL was measured using the 36-Item Short Form Health Survey physical and mental component summary (PCS and MCS) scores. Current post-traumatic stress disorder (PTSD) and depression symptoms were examined. Multivariable linear regression models assessed the effects of concussion on PCS and MCS scores, while controlling for covariates. RESULTS A lower PCS score was observed in participants with concussion with LOC (B = - 2.65, p = 0.003) compared with those with no history of concussion. Symptoms of PTSD (PCS: B = - 4.84, p < 0.001; MCS: B = - 10.53, p < 0.001) and depression (PCS: B = - 2.85, p < 0.001; MCS: B = - 10.24, p < 0.001) were the strongest statistically significant predictors of lower HRQoL. CONCLUSION Concussion with LOC was significantly associated with lower HRQoL in the physical domain. These findings affirm that concussion management should integrate physical and psychological care to improve long-term HRQoL and warrant a more detailed examination of causal and mediating mechanisms. Future research should continue to incorporate patient-reported outcomes and long-term follow-up of military service members to further define the lifelong impact of deployment-related concussion.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
| | - John D Casachahua
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Samuel R Walton
- Virginia Commonwealth University School of Medicine, Department of Physical Medicine and Rehabilitation, Richmond, VA, USA
| | - Judith Harbertson
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Sarah M Jurick
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Cameron T McCabe
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - Jessica R Watrous
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc, San Diego, CA, USA
| | - John J Fraser
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, USA
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13
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Foster KS, Greenlee TA, Fraser JJ, Young JL, Rhon DI. The Influence of Therapeutic Exercise after Ankle Sprain on the Incidence of Subsequent Knee, Hip, and Lumbar Spine Injury. Med Sci Sports Exerc 2023; 55:177-185. [PMID: 36084225 DOI: 10.1249/mss.0000000000003035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE This study aimed to investigate the burden of knee, hip, and lumbar spine disorders occurring in the year after an ankle sprain and the influence therapeutic exercise (TE) has on this burden. METHODS A total of 33,361 individuals diagnosed with ankle sprain in the Military Health System between 2010 and 2011 were followed for 1 yr. The prevalence of knee, hip, and lumbar care-seeking injuries sustained after sprain was identified. Relationships between demographic groups, ankle sprain type, and use of TE with rate of proximal injuries were evaluated using Cox proportional hazard models to determine hazard rate effect modification by attribute. The observed effect of TE for ankle sprain on rate of injury to proximal joints was evaluated using Kaplan-Meier survival analyses. RESULTS Of the total cohort, 20.5% ( n = 6848) of patients sustained a proximal injury. Specifically, 10.1% of the cohort sustained a knee ( n = 3356), 2.9% a hip ( n = 973), and 10.3% a lumbar injury ( n = 3452). Less than half of the cohort received TE after initial sprain. Patients that did were less likely to have subsequent knee (HR = 0.87, 95% confidence interval [CI] = 0.80-0.94), hip (HR = 0.68, 95% CI = 0.58-0.79), or lumbar (HR = 0.82, 95% CI = 0.76-0.89) injuries. CONCLUSIONS One in five individuals that sought care for an ankle sprain experienced a proximal joint injury in the following year. TE for the management of the initial ankle sprain reduced the likelihood of proximal injury diagnosis and should be considered in treatment plans for return to work and sport protocols after ankle sprains.
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Affiliation(s)
- Kaitlyn S Foster
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX
| | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX
| | - John J Fraser
- Directorate for Operational Readiness and Health, Naval Health Research Center, San Diego, CA
| | - Jodi L Young
- Doctor of Science Program in Physical Therapy, Bellin College, Green Bay, WI
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14
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Fraser JJ, MacGregor AJ, Fechner KM, Galarneau MR. Factors Associated With Neuromusculoskeletal Injury and Disability in Navy and Marine Corps Personnel. Mil Med 2022; 188:usac386. [PMID: 36515160 DOI: 10.1093/milmed/usac386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/26/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Neuromusculoskeletal injuries (NMSKI) are very common in the military, which contribute to short- and long-term disability. MATERIALS AND METHODS Population-level NMSKI, limited duty (LIMDU), and long-term disability episode counts in the U.S. Navy (USN) and U.S. Marine Corps (USMC) from December 2016 to August 2021 were extracted from the Musculoskeletal Naval Epidemiological Surveillance Tool. The incidence of NMSKI, LIMDU, and long-term disability was calculated. A hurdle negative binomial regression evaluated the association of body region, sex, age, rank, age by rank, and service branch on NMSKI, LIMDU, and long-term disability incidence. RESULTS From December 2016 to August 2021, there were 2,004,196 NMSKI episodes (USN: 3,285/1,000 Sailors; USMC: 4,418/1,000 Marines), 16,791 LIMDU episodes (USN: 32/1,000 Sailors; USMC: 29/1,000 Marines), and 2,783 long-term disability episodes (USN: 5/1,000 Sailors; USMC: 5/1,000 Marines). There was a large-magnitude protective effect on NMSKI during the pandemic (relative risk, USN: 0.70; USMC: 0.75). Low back and ankle-foot were the most common, primarily affecting female personnel, aged 25-44 years, senior enlisted, in the USMC. Shoulder, arm, pelvis-hip, and knee conditions had the greatest rates of disability, with female sex, enlisted ranks, aged 18-24 years, and service in the USMC having the most salient risk factors. CONCLUSION Body region, sex, age, rank, and branch were the salient factors for NMSKI. The significant protective effect during the pandemic was likely a function of reduced physical exposure and limited access to nonurgent care. Geographically accessible specialized care, aligned with communities with the greatest risk, is needed for timely NMSKI prevention, assessment, and treatment.
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Affiliation(s)
- John J Fraser
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA 92106-3521, USA
| | - Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106-3521, USA
| | - Kenneth M Fechner
- Physical Therapy Department/Sports Medicine and Reconditioning Team, Naval Health Clinic Hawaii, Joint Base Pearl Harbor, HI 96860, USA
| | - Michael R Galarneau
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA 92106-3521, USA
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15
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Fraser JJ, Pommier R, MacGregor AJ, Silder A, Sander TC. Does policy that provides choice in athletic footwear affect musculoskeletal injury risk in US Coast Guard recruits? BMJ Mil Health 2022:e002211. [PMID: 36175029 DOI: 10.1136/military-2022-002211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/09/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Musculoskeletal injuries (MSKIs) are ubiquitous during initial entry military training, with overuse injuries the most common. A common injury mechanism is running, an activity that is integral to US Coast Guard (USCG) training and a requirement for graduation. The purpose of this study was to assess the effects of a policy that allowed for athletic footwear choice on risk of lower quarter MSKI in USCG recruits. METHODS A retrospective cohort study was performed that included 1230 recruits (1040 men, 190 women) who trained under a policy that allowed self-selection of athletic footwear and 2951 recruits (2329 men, 622 women) who trained under a policy that mandated use of prescribed uniform athletic shoes and served as controls. Demographic data and physical performance were derived from administrative records. Injury data were abstracted from a medical tracking database. Unadjusted risk calculations and multivariable logistic regression assessing the effects of group, age, sex, height, body mass and 2.4 km run times on MSKI were performed. RESULTS Ankle-foot, leg, knee and lumbopelvic-hip complex injuries were ubiquitous in both groups (experimental: 13.13 per 1000 person-weeks; control: 11.69 per 1000 person-weeks). Group was not a significant factor for any of the injuries assessed in either the unadjusted or adjusted analysis, despite widespread reports of pain (58.6%), perceived injury attribution (15.7%), perceived deleterious effect on performance (25.3%), general dissatisfaction (46.3%) and intended discontinuance of use following graduation (87.7%). CONCLUSION MSKI continues to be a major source of morbidity in the recruit training population. The policy that allowed USCG recruits to self-select athletic footwear did not decrease or increase the risk of MSKI. While regulations pertaining to footwear choice did not influence injury outcomes, there was general dissatisfaction with the prescribed uniform athletic footwear conveyed by the recruits and widespread reports of discomfort, perceived deleterious effects from wear and intended discontinued use following training completion.
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Affiliation(s)
- John J Fraser
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, California, USA
- Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - R Pommier
- Samuel J Call Health Services Center, US Coast Guard Training Center, Cape May, New Jersey, USA
| | - A J MacGregor
- Medical Modelling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - A Silder
- Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - T C Sander
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
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16
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Lin YA, Mhaskar Y, Silder A, Sessoms PH, Fraser JJ, Loh KJ. Muscle Engagement Monitoring Using Self-Adhesive Elastic Nanocomposite Fabrics. Sensors (Basel) 2022; 22:6768. [PMID: 36146120 PMCID: PMC9503620 DOI: 10.3390/s22186768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Insight into, and measurements of, muscle contraction during movement may help improve the assessment of muscle function, quantification of athletic performance, and understanding of muscle behavior, prior to and during rehabilitation following neuromusculoskeletal injury. A self-adhesive, elastic fabric, nanocomposite, skin-strain sensor was developed and validated for human movement monitoring. We hypothesized that skin-strain measurements from these wearables would reveal different degrees of muscle engagement during functional movements. To test this hypothesis, the strain sensing properties of the elastic fabric sensors, especially their linearity, stability, repeatability, and sensitivity, were first verified using load frame tests. Human subject tests conducted in parallel with optical motion capture confirmed that they can reliably measure tensile and compressive skin-strains across the calf and tibialis anterior. Then, a pilot study was conducted to assess the correlation of skin-strain measurements with surface electromyography (sEMG) signals. Subjects did biceps curls with different weights, and the responses of the elastic fabric sensors worn over the biceps brachii and flexor carpi radialis (i.e., forearm) were well-correlated with sEMG muscle engagement measures. These nanocomposite fabric sensors were validated for monitoring muscle engagement during functional activities and did not suffer from the motion artifacts typically observed when using sEMGs in free-living community settings.
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Affiliation(s)
- Yun-An Lin
- Department of Structural Engineering, University of California San Diego, La Jolla, CA 92093, USA
- Active, Responsive, Multifunctional, and Ordered-materials Research (ARMOR) Laboratory, University of California San Diego, La Jolla, CA 92093, USA
| | - Yash Mhaskar
- Active, Responsive, Multifunctional, and Ordered-materials Research (ARMOR) Laboratory, University of California San Diego, La Jolla, CA 92093, USA
- Department of Mechanical & Aerospace Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Amy Silder
- Leidos, Inc., San Diego, CA 92106, USA
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Pinata H. Sessoms
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - John J. Fraser
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Kenneth J. Loh
- Department of Structural Engineering, University of California San Diego, La Jolla, CA 92093, USA
- Active, Responsive, Multifunctional, and Ordered-materials Research (ARMOR) Laboratory, University of California San Diego, La Jolla, CA 92093, USA
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18
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Butler CR, Scott WC, Hintz CN, Mata JD, Bryant JF, Tchandja JN, Hando BR, Fraser JJ. Heat Stroke Burden And Validity Of Wearable-derived Core Temperature Estimation During Elite Military Training. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000881908.66626.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fraser JJ, Myers EE, MacGregor AJ, Hertel J. Burden And Rehabilitation Care Of Chronic Ankle Instability In Military Tactical Athletes. A Retrospective Population Study. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000883096.26600.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Livesey ACS, Hu YWE, Boldt BF, Sturgill SB, Serafine MS, Fraser JJ. Battlefield Acupuncture for Palliation of Periprocedural and Postprocedural Pain during Platelet-Rich Plasma Injections. Curr Sports Med Rep 2022; 21:265-266. [PMID: 35946844 DOI: 10.1249/jsr.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Audrey C S Livesey
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Camp Pendleton, CA
| | | | - Brandon F Boldt
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Camp Pendleton, CA
| | - Sarah B Sturgill
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Camp Pendleton, CA
| | - Matthew S Serafine
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Camp Pendleton, CA
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21
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Fraser JJ, Saliba SA, Hart JM, Park JS, Hertel J. Corrigendum to "Effects of midfoot joint mobilization on ankle-foot morphology and function following acute ankle sprain. A crossover clinical trial" [Musculoskel. Sci. Pract. 46 (2020) 102130]. Musculoskelet Sci Pract 2022; 59:102477. [PMID: 34838510 DOI: 10.1016/j.msksp.2021.102477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- John J Fraser
- Department of Kinesiology, University of Virginia, 550 Brandon Ave Room 340C, Charlottesville, VA, 22904-4407, USA; Warfighter Performance Department, Naval Health Research Center, USA.
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, 550 Brandon Ave Room 340C, Charlottesville, VA, 22904-4407, USA
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, 550 Brandon Ave Room 340C, Charlottesville, VA, 22904-4407, USA
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, 550 Brandon Ave Room 340C, Charlottesville, VA, 22904-4407, USA
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22
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Russell Esposito E, Farrokhi S, Shuman BR, Sessoms PH, Szymanek E, Hoppes CW, Bechard L, King D, Fraser JJ. Uneven treadmill training for rehabilitation of lateral ankle sprains and chronic ankle instability: a pragmatic randomized controlled trial (Preprint). JMIR Res Protoc 2022; 11:e38442. [PMID: 35731551 PMCID: PMC9260521 DOI: 10.2196/38442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 12/26/2022] Open
Abstract
Background Lateral ankle sprains (LASs) are common injuries among military service members. Approximately 40% of individuals with an LAS progress to develop chronic ankle instability (CAI), a condition that results in substantial mechanical and neurophysiological impairment and activity limitation. Since proprioceptive and balance training improve functional outcomes and prevent secondary injury following LAS, they are recommended in clinical practice. Uneven treadmills are an innovative modality that challenge the sensorimotor system while performing an ecologically valid task simulating environments frequently encountered by service members with LAS and CAI. Objective The aim of this study is to evaluate whether the inclusion of uneven treadmill training in standard rehabilitation can improve clinical, functional, biomechanical, and patient-reported outcomes compared with the standard of care alone in service members with LAS and CAI. The prophylactic effects of treatment on secondary injury and identification of any contributing or mediating factors that influence outcomes following treatment will also be evaluated. We hypothesize that service members receiving uneven treadmill training will demonstrate greater improvements in clinical and instrumented measures of impairment, patient-reported function, and lower risk of injury recurrence than the control group immediately post and 18 months following treatment. Methods A multisite, parallel randomized clinical trial will be performed among service members aged 18-49 years being treated for LAS and CAI in military treatment facilities in the United States. Participants randomly assigned and allocated to receive the experimental intervention will be provided up to 12 sessions of training on an uneven terrain treadmill over a 6-week treatment course to supplement standard rehabilitation care. Treatment intensity of the rehabilitation exercises and treadmill training will be progressed on the basis of patient-perceived intensity and treatment responses. Outcome measures will include patient-reported outcomes, functional assessments, performance measures, and biomechanical measures. Investigators collecting outcome measures will be blinded to treatment allocation. Reinjury rates and patient-reported outcomes of function will be tracked over 18 months following treatment. Results The project was funded in September 2020. Patient recruitment began in November 2021, with 3 participants enrolled as of February 2022. Dissemination of the main study findings is anticipated in 2024. Conclusions This study will assess the impact of an innovative uneven-terrain treadmill on treatment outcomes in the rehabilitation of service members with LAS and CAI. The results of this study will be used to inform rehabilitation practices and to potentially improve functional outcomes and secondary prevention in this patient population. Trial Registration ClinicalTrials.gov NCT04999904; https://clinicaltrials.gov/ct2/show/NCT04999904?term=NCT04999904 International Registered Report Identifier (IRRID) DERR1-10.2196/38442
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Affiliation(s)
- Elizabeth Russell Esposito
- Department of Defense -Veterans Affairs Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
- Center for Limb Loss and Mobility, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, United States
| | - Shawn Farrokhi
- Department of Defense -Veterans Affairs Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, United States
- Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, United States
| | - Benjamin R Shuman
- Center for Limb Loss and Mobility, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
- Henry M Jackson Foundation, Bethesda, MD, United States
| | - Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, United States
| | - Eliza Szymanek
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA, United States
- Doctoral Program in Physical Therapy, Army-Baylor University, U.S. Army Medical Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
| | - Carrie W Hoppes
- Doctoral Program in Physical Therapy, Army-Baylor University, U.S. Army Medical Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
- San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, United States
| | - Laura Bechard
- Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, United States
- Henry M Jackson Foundation, Bethesda, MD, United States
| | - David King
- Henry M Jackson Foundation, Bethesda, MD, United States
| | - John J Fraser
- Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, United States
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, United States
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, United States
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MacGregor AJ, Fogleman SA, Dougherty AL, Ryans CP, Janney CF, Fraser JJ. Sex Differences in the Incidence and Risk of Ankle-Foot Complex Stress Fractures Among U.S. Military Personnel. J Womens Health (Larchmt) 2021; 31:586-592. [PMID: 34846948 DOI: 10.1089/jwh.2021.0292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: The objective of this study was to evaluate sex differences in the incidence and risk of ankle-foot complex (AFC) stress fractures among U.S. military personnel, which could assist in developing management strategies as females assume a greater role in U.S. military operations. Materials and Methods: The Defense Medical Epidemiology Database was used to identify all diagnosed AFC stress fractures in military personnel from 2006 to 2015. Cumulative incidence of AFC stress fractures was calculated and compared by year, service branch, and military rank. Sex differences in the risk of AFC stress fractures by occupation were examined, and integrated (i.e., male and female) occupations were compared with nonintegrated (i.e., male only) occupations. Results: A total of 43,990 AFC stress fractures were identified. The overall incidence rate was 2.76 per 1,000 person-years (p-y) for males and 5.78 per 1,000 p-y for females. Females consistently had higher incidence of AFC stress fractures across all subgroups, particularly among enlisted personnel. Female enlisted service members had the highest risk of AFC stress fractures in aviation (relative risk [RR] = 5.74; 95% confidence interval [CI]: 4.80-6.87) and artillery/gunnery (RR = 5.15; 95% CI: 4.62-5.75) occupations. Females in integrated occupations had significantly higher rates of AFC stress fractures than males in both integrated and nonintegrated occupations (i.e., special forces, infantry, and mechanized/armor). Conclusions: Females in the U.S. military have a higher risk of AFC stress fractures than males. As integration of females into previously sex-restricted occupations continues, focused prevention efforts may be needed to reduce injury burden and maximize medical readiness.
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Affiliation(s)
- Andrew J MacGregor
- Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA.,Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA.,Axiom Resource Management, Inc., San Diego, California, USA
| | - Sarah A Fogleman
- Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA.,Department of Orthopedic Surgery, Naval Medical Center San Diego, California, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA.,Leidos, Inc., San Diego, California, USA
| | - Camille P Ryans
- Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA.,Department of Orthopedic Surgery, Naval Hospital Jacksonville, Jacksonville, Florida, USA
| | - Cory F Janney
- Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA.,Department of Orthopedic Surgery, Naval Medical Center San Diego, California, USA
| | - John J Fraser
- Foot and Ankle Subcommittee, Neuromusculoskeletal Clinical Community Advisory Board, U.S. Navy Bureau of Medicine and Surgery, Falls Church, Virginia, USA.,Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, California, USA
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24
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Rhon DI, Greenlee TA, Cook CE, Westrick RB, Umlauf JA, Fraser JJ. Fractures and Chronic Recurrence are Commonly Associated with Ankle Sprains: a 5-year Population-level Cohort of Patients Seen in the U.S. Military Health System. Int J Sports Phys Ther 2021; 16:1313-1322. [PMID: 34631252 PMCID: PMC8486414 DOI: 10.26603/001c.27912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/05/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Whereas ankle-foot injuries are ubiquitous and affect ~16% of military service-members, granularity of information pertaining to ankle sprain subgroups and associated variables is lacking. The purpose of this study was to characterize and contextualize the burden of ankle sprain injuries in the U.S. Military Health System. METHODS This was a retrospective cohort study of beneficiaries seeking care for ankle sprains, utilizing data from the Military Health System Data Repository from 2009 to 2013. Diagnosis and procedural codes were used to identify and categorize ankle sprains as isolated lateral, isolated medial, concomitant medial/lateral, unspecified, or concomitant ankle sprain with a malleolar or fibular fracture. Patient characteristics, frequency of recurrence, operative cases, and injury-related healthcare costs were analyzed. RESULTS Of 30,910 patients included, 68.4% were diagnosed with unspecified ankle sprains, 22.8% with concomitant fractures, (6.9%) with isolated lateral sprains, (1.7%) with isolated medial sprains and 0.3% with combined medial/lateral sprains. Pertaining to recurrence, 44.2% had at least one recurrence. Sprains with fractures were ~2-4 times more likely to have surgery within one year following injury (36.2% with fractures; 9.7% with unspecified sprains) and had the highest ankle-related downstream costs. CONCLUSION Fractures were a common comorbidity of ankle sprain (one in five injuries), and operative care occurred in 16.4% of cases. Recurrence in this cohort approximates the 40% previously reported in individuals with first-time ankle sprain who progress to chronic ankle instability. Future epidemiological studies should consider reporting on subcategories of ankle sprain injuries to provide a more granular assessment of the distribution of severity. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Daniel I Rhon
- Military Performance Division, United States Army Research Institute of Environmental Medicine; Department of Rehabilitation Medicine, Brooke Army Medical Center
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25
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Fraser JJ, VanDehy J, Bodell DM, Gottshall KR, Sessoms PH. Head and Body Dyskinesia During Gait in Tactical Athletes With Vestibular Deficit Following Concussion. Front Sports Act Living 2021; 3:703982. [PMID: 34447930 PMCID: PMC8384176 DOI: 10.3389/fspor.2021.703982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Vestibular deficit is common following concussion and may affect gait. The purpose of this study was to investigate differences in head and pelvic center of mass (COM) movement during gait in military tactical athletes with and without concussion-related central vestibular impairment. Material and Methods: 24 patients with post-concussion vestibular impairment (20 males, 4 females; age: 31.7 ± 7.9 years; BMI: 27.3 ± 3.3) and 24 matched controls (20 males, 4 females; age: 31.8 ± 6.4 years; BMI: 27.2 ± 2.6) were included in the analyses. Three-dimensional head and pelvic displacement and velocities were collected at a 1.0 m/s standardized treadmill walking speed and assessed using Statistical Parametric Mapping t-tests. Maximum differences (dmax) between groups were reported for all significant kinematic findings. Results: The Vestibular group demonstrated significantly diminished anteroposterior head excursions (dmax = 2.3 cm, p = 0.02) and slower anteroposterior (dmax = 0.37 m/s, p = 0.01), mediolateral (dmax = 0.47 m/s, p = 0.02) and vertical (dmax = 0.26 m/s, p < 0.001) velocities during terminal stance into pre-swing phases compared to the Control group. Vertical pelvic excursion was significantly increased in midstance (dmax = 2.4 cm, p = 0.03) and mediolaterally during pre- to initial-swing phases (dmax = 7.5 cm, p < 0.001) in the Vestibular group. In addition, pelvic velocities of the Vestibular group were higher mediolaterally during midstance (dmax = 0.19 m/s, p = 0.02) and vertically during post-initial contact (dmax = 0.14 m/s, p < 0.001) and pre-swing (dmax = 0.16 m/s, p < 0.001) compared to the Control group. Significance: The Vestibular group demonstrated a more constrained head movement strategy during gait compared with Controls, a finding that is likely attributed to a neurological impairment of visual-vestibular-somatosensory integration.
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Affiliation(s)
- John J Fraser
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, United States
| | - Jacob VanDehy
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, United States.,Leidos, Inc., San Diego, CA, United States
| | - Dawn M Bodell
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, United States.,Leidos, Inc., San Diego, CA, United States
| | - Kim R Gottshall
- Leidos, Inc., San Diego, CA, United States.,Florida Ear and Balance Center, Kissimmee, FL, United States
| | - Pinata H Sessoms
- Warfighter Performance Department, Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, United States
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Abstract
CONTEXT Anterior knee pain (AKP) is ubiquitous in early-career military members and exacerbated during functional tasks required during military duties. Therefore, it is important to understand risk of this condition in male and female tactical athletes in diverse military occupations. OBJECTIVE To assess sex and occupation on AKP risk in military members. DESIGN Descriptive Epidemiology Study. SETTING United States Armed Forces. Patients All military members diagnosed with anterior or retro-patellar pain, patellar instability, knee tendinopathy on their initial encounter from 2006 to 2015. OUTCOME MEASURES The Defense Medical Epidemiology Database was queried for the number of individuals with AKP. Relative risk (RR) and chi-square statistics were calculated in the assessment of sex and occupational category. Regressions were calculated to determine association between service branch, sex, and AKP across time. RESULTS From 2006-2015, a total of 151,263 enlisted and 14,335 officer services members were diagnosed with AKP. Enlisted females had an incidence rate of 16.7 per 1000 person-years compared to the enlisted male service members with an incidence rate of 12.7 per 1000 person-years (RR: 1.32, 95%CI: 1.30-1.34, p<0.001) across all AKP diagnoses. Female officers had an incidence rate of 10.7 per 1,000 person-years compared to male officers at an incidence rate of 5.3 per 1000 person-years (RR: 2.01, 95%CI: 1.94-2.09). Differences in risk were also noted across military occupation for both enlisted and officer service members (p<.05). CONCLUSION Sex and military occupation were salient factors for AKP risk. Evaluation of training requirements and developing interventions programs across military occupation could serve as a focus for future research aiming to mitigate associated risk factors of AKP.
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Affiliation(s)
- Neal R Glaviano
- 1Department of Kinesiology, University of Connecticut, Storrs, CT. . Twitter: @NealGlaviano
| | - Michelle C Boling
- 2Brooks College of Health, University of North Florida, Jacksonville, FL. . Twitter: @mcboling23
| | - John J Fraser
- 1Department of Kinesiology, University of Connecticut, Storrs, CT. . Twitter: @NealGlaviano
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Fraser JJ, Hertel J. The quarter-ellipsoid foot: A clinically applicable 3-dimensional composite measure of foot deformation during weight bearing. Foot (Edinb) 2021; 46:101717. [PMID: 33509711 DOI: 10.1016/j.foot.2020.101717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/14/2020] [Accepted: 07/03/2020] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Descriptive Laboratory OBJECTIVES: To assess change in foot morphology across loading using innovative, clinically accessible 3-dimesional composite measurements of surface area (SA), volume (V), and SA:V ratio in recreationally-active young adults. METHODS The feet of 53 female [mean age:20.7 ± 3.8 years, BMI:23.9 ± 4.2 kg m-2, foot posture index (FPI):3.8 ± 3.7] and 31 male participants (mean age:20.8 ± 2.4 years, BMI:23.7 ± 2.5 kg m-2, FPI:3.8 ± 4.1) were evaluated. FPI was assessed and foot length, width, and dorsal arch height were measured in sitting and bipedal standing and used to calculate the SA and V of a quarter-ellipsoid. ΔSA characterized foot widening and lengthening and ΔV characterized arch deformation during loading. The SA:V represented changes in both foot size and shape. Linear regression was performed to assess the effects of component foot change measures during loading on the composite measurements. The composite measures were compared to the established measures of ΔArch Height Index (ΔAHI), Arch Flexibility, Foot Mobility Magnitude (FMM), and FPI. RESULTS Foot width and dorsal arch height change measures were significant predictors (p < 0.001) for the ΔV and SA:V composite measures, explaining 90-91% of the variance. Significant fair to good associations (p < .05) were found between the novel and established composite measures: ΔSA: Arch flexibility (r=-0.27); SA:V: ΔAHI (r=-0.57), Arch Flexibility (r=-0.75), FMM (r=-0.30), FPI (r = 0.42). CONCLUSION Quarter-ellipsoid measures calculated from morphologic measurements may have clinical utility in quantifying 3-dimensional foot changes during loading and may be useful when assessing need and response to clinical interventions.
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Affiliation(s)
- John J Fraser
- Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA 22904-4407, USA; Warfighter Performance Department, Naval Health Research Center, San Diego, CA.
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA 22904-4407, USA.
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28
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MacGregor AJ, Zouris JM, Watrous JR, McCabe CT, Dougherty AL, Galarneau MR, Fraser JJ. Multimorbidity and quality of life after blast-related injury among US military personnel: a cluster analysis of retrospective data. BMC Public Health 2020; 20:578. [PMID: 32345277 PMCID: PMC7189580 DOI: 10.1186/s12889-020-08696-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/13/2020] [Indexed: 11/25/2022] Open
Abstract
Background Blast injury emerged as a primary source of morbidity among US military personnel during the recent conflicts in Iraq and Afghanistan, and led to an array of adverse health outcomes. Multimorbidity, or the presence of two or more medical conditions in an individual, can complicate treatment strategies. To date, there is minimal research on the impact of multimorbidity on long-term patient-reported outcomes. We aimed to define multimorbidity patterns in a population of blast-injured military personnel, and to examine these patterns in relation to long-term quality of life (QOL). Methods A total of 1972 US military personnel who sustained a blast-related injury during military operations in Iraq and Afghanistan were identified from clinical records. Electronic health databases were used to identify medical diagnoses within the first year postinjury, and QOL was measured with a web-based assessment. Hierarchical cluster analysis methods using Ward’s minimum variance were employed to identify clusters with related medical diagnosis categories. Duncan’s multiple range test was used to group clusters into domains by QOL. Results Five distinct clusters were identified and grouped into three QOL domains. The lowest QOL domain contained one cluster with a clinical triad reflecting musculoskeletal pain, concussion, and mental health morbidity. The middle QOL domain had two clusters, one with concussion/anxiety predominating and the other with polytrauma. The highest QOL domain had two clusters with little multimorbidity aside from musculoskeletal pain. Conclusions The present study described blast-related injury profiles with varying QOL levels that may indicate the need for integrated health services. Implications exist for current multidisciplinary care of wounded active duty and veteran service members, and future research should determine whether multimorbidity denotes distinct post-blast injury syndromes.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
| | - James M Zouris
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
| | - Jessica R Watrous
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc., 140 Sylvester Road, San Diego, CA, 92106, USA
| | - Cameron T McCabe
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc., 140 Sylvester Road, San Diego, CA, 92106, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, Inc., 140 Sylvester Road, San Diego, CA, 92106, USA
| | - Michael R Galarneau
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
| | - John J Fraser
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
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Taylor MK, Hernández LM, Sessoms PH, Kawamura C, Fraser JJ. Trauma Exposure and Functional Movement Characteristics of Male Tactical Athletes. J Athl Train 2020; 55:384-389. [PMID: 32058798 DOI: 10.4085/1062-6050-111-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Tactical athletes commonly experience high levels of physical stress, which may increase their risk of musculoskeletal injury. It is critical to understand psychological predictors of functional movement (FM), which may help prevent musculoskeletal injury in this population. OBJECTIVE To determine the associations of combat and trauma exposure with FM characteristics of male tactical athletes. Secondary objectives were to explore confounding influences of age and physical injury history as well as the mediating role of bodily pain. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Eighty-two healthy, male, active-duty US Navy Explosive Ordnance Disposal personnel (age = 34.0 ± 6.7 years). MAIN OUTCOME MEASURE(S) Participants completed measures of combat exposure, trauma exposure, physical injury history, and bodily pain. We assessed FM characteristics (ie, Functional Movement Screen [FMS], Y-Balance Test), from which we derived a composite functional status (CFS) measure. Hypotheses were tested using correlational and multiple regression (causal-steps) models. RESULTS In unadjusted models, trauma exposure was inversely associated with the FMS (P = .005) and CFS (P = .009) scores. In adjusted models, these relationships were robust to the confounding influences of age and physical injury history. Trauma exposure and bodily pain were substantive, independent predictors of FMS and CFS in causal-steps models (all P values < .05), implying additive rather than mediated effects (R2adj = 0.18-0.20). Combat exposure did not predict FM characteristics. CONCLUSIONS To our knowledge, this is the first evidence of the influence of trauma exposure on the FM characteristics of male tactical athletes, independent of age, physical injury, and bodily pain. This program of research may help to advance the prevention and treatment of musculoskeletal injuries in the tactical environment.
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Affiliation(s)
- Marcus K Taylor
- Biobehavioral Sciences Lab, Naval Health Research Center, San Diego, CA.,Warfighter Performance Department, Naval Health Research Center, San Diego, CA
| | - Lisa M Hernández
- Biobehavioral Sciences Lab, Naval Health Research Center, San Diego, CA.,Leidos, Inc, San Diego, CA
| | - Pinata H Sessoms
- Physical and Cognitive Research Laboratory, Naval Health Research Center, San Diego, CA.,Warfighter Performance Department, Naval Health Research Center, San Diego, CA
| | | | - John J Fraser
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA
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Lempke LB, Fraser JJ, Erdman NK, Barone NA, Saliba S, Resch JE. The Effects of Cranial Cryotherapy on Hemodynamics and Cognition in Healthy Adults. Transl J ACSM 2020. [DOI: 10.1249/tjx.0000000000000124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Koldenhoven RM, Fraser JJ, Saliba SA, Hertel J. Ultrasonography of Gluteal and Fibularis Muscles During Exercises in Individuals With a History of Lateral Ankle Sprain. J Athl Train 2019; 54:1287-1295. [PMID: 31584853 DOI: 10.4085/1062-6050-406-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT Individuals with a history of lateral ankle sprains (LASs) have ankle and hip neuromuscular changes compared with those who do not have a history of LAS. OBJECTIVE To compare gluteus maximus (GMax), gluteus medius (GMed), and fibularis longus and brevis muscle activation using ultrasound imaging during tabletop exercises and lateral resistance-band walking in individuals with or without a history of LAS or chronic ankle instability (CAI). DESIGN Cross-sectional study. PATIENTS OR OTHER PARTICIPANTS Sixty-seven young adults (27 males, 40 females). Groups were healthy = 16, coper = 17, LAS = 15, CAI = 19. The number of previous sprains was 0 ± 0 in the healthy group, 1.1 ± 0.3 in the coper group, 2.9 ± 2.4 in the LAS group, and 5.3 ± 5.9 in the CAI group. MAIN OUTCOME MEASURE(S) Ultrasound imaging measures of fibularis cross-sectional area (CSA) were collected during nonresisted and resisted ankle eversion. Gluteal muscle thicknesses were imaged during nonresisted and resisted side-lying abduction and during lateral resistance-band walking exercises (lower leg and forefoot band placement). Separate 4 × 2 repeated-measures analyses of variance and post hoc Fisher least significant difference tests were used to assess activation across groups and resistance conditions. RESULTS All groups demonstrated 3.2% to 4.1% increased fibularis CSA during resisted eversion compared with nonresisted. During side-lying abduction, the LAS and CAI groups displayed increased GMax thickness (6.4% and 7.2%, respectively), and all but the CAI group (-0.4%) increased GMed thickness (5.3%-11.8%) with added resistance in hip abduction. During band walking, the healthy and LAS groups showed increased GMax thickness (4.8% and 8.1%, respectively), and all groups had increased GMed thickness (3.0%-5.8%) in forefoot position compared with the lower leg position. Although the values were not different, copers exhibited the greatest amount of GMed thickness during band-walking activities (copers = 23%-26%, healthy = 17%-23%, LAS = 11%-15%, CAI = 15%-19%). CONCLUSIONS All groups had increased fibularis CSA with resisted eversion. In side-lying hip abduction, individuals with CAI had greater GMax thickness than GMed thickness. Ultrasound imaging of fibularis CSA and gluteal muscle thickness may be clinically useful in assessing and treating patients with LAS or CAI.
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Affiliation(s)
| | - John J Fraser
- Department of Kinesiology, University of Virginia, Charlottesville.,Warfighter Performance Department, Naval Health Research Center, San Diego, CA
| | - Susan A Saliba
- Department of Kinesiology, University of Virginia, Charlottesville
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville
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Fraser JJ, Hart JM, Saliba SF, Park JS, Tumperi M, Hertel J. Multisegmented ankle-foot kinematics during gait initiation in ankle sprains and chronic ankle instability. Clin Biomech (Bristol, Avon) 2019; 68:80-88. [PMID: 31174142 DOI: 10.1016/j.clinbiomech.2019.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/09/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with lateral ankle sprain and chronic ankle instability have impaired postural control and altered motor strategies during walking. However, little is known regarding foot mechanics during gait. The purpose of this study was to compare three-dimensional multisegmented ankle-foot kinematics during stance phase following gait-initiation in acute lateral ankle sprain (Ankle-sprain), chronic ankle instability (Chronic-instability), Coper, and Control groups. METHODS 80 recreationally-active individuals (Control: n = 22, Coper: n = 21, Ankle-sprain: n = 17, Chronic-instability: n = 20) participated. Three-dimensional kinematics of the hallux, medial forefoot, lateral forefoot, medial midfoot, lateral midfoot, and rearfoot on shank were collected during the stance phase following gait initiation using an electromagnetic motion capture system. The average joint excursions of 10 steps were normalized to 101 points and analyzed using Statistical Parametric Mapping ANOVA and post hoc t-tests comparing Coper, Ankle-sprain, or Chronic-instability versus Control groups. Secondary analysis was performed comparing Chronic-instability versus Coper groups. FINDINGS The Ankle-sprain group had up to 4.1° more rearfoot inversion during midstance (mean difference: 3.1°) from 42 to 49% of stance phase compared to healthy controls. The Chronic-instability group had up to 5.3° more rearfoot inversion (mean difference: 3.6°) from 34% to 91% of stance phase compared to controls. There were no further statistical differences found between Chronic-instability and Copers, other planes, or segments of the ankle-foot complex. INTERPRETATION Ankle-sprain and Chronic-instability groups demonstrated more rearfoot inversion compared to controls with no differences in midfoot or forefoot mechanics. Clinicians and researchers should include interventions that control inversion and increase eversion following lateral ankle sprain.
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Affiliation(s)
- John J Fraser
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA; Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA.
| | - Joseph M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA; Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Susan F Saliba
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Marshall Tumperi
- Department of Mechanical & Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA; Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
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Coffin S, Taylor MK, Hernández LM, Sessoms P, Kawamura C, Fraser JJ. Trauma Exposure Predicts Functional Movement Characteristics of Male Tactical Athletes. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563338.72837.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Weller RS, Jones DM, Wilson KM, Ordille AJ, Hirsch DA, Fraser JJ, Viboch TB, Wolf AJ, Costantini VM, Clifford H, Heaney JH, Laird MD. U.S. Navy Physical Readiness Test Modality Pilot Study. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563337.95708.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
A healthy 19-year-old male college student (height = 177.8 cm, mass = 64.3 kg, body mass index = 20.3 kg/m2, Foot Posture Index = -1) participating in a study sustained a grade 2 inversion lateral ankle sprain 3 days after completing patient-reported outcome measures. A treatment protocol including therapeutic exercises and midfoot mobilizations was provided. Patient-reported outcomes assessing physical health, mental health, and foot-ankle function were completed 3 days preinjury and 1, 3, and 12 weeks postinjury. Substantial postinjury changes in function, physical health, and kinesiophobia reflected functional limitations that improved with treatment and time. This level 3 exploration case report provides a rare opportunity to highlight preinjury-to-postinjury changes in patient-reported physical and psychological measures caused by a lateral ankle sprain.
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Affiliation(s)
- John J Fraser
- Department of Kinesiology, University of Virginia, Charlottesville.,Warfighter Performance Department, Naval Health Research Center, San Diego, CA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville
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Fraser JJ, Corbett R, Donner C, Hertel J. Does manual therapy improve pain and function in patients with plantar fasciitis? A systematic review. J Man Manip Ther 2018; 26:55-65. [PMID: 29686479 PMCID: PMC5901427 DOI: 10.1080/10669817.2017.1322736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To assess if manual therapy (MT) in the treatment of plantar fasciitis (PF) patients improves pain and function more effectively than other interventions. METHODS A systematic review of all randomized control trials (RCTs) investigating the effects of MT in the treatment of human patients with PF, plantar fasciosis, and heel pain published in English on PubMed, CINAHL, Cochrane, and Web of Science databases was conducted. Research quality was appraised utilizing the PEDro scale. Cohen's d effect sizes (ES) and associated 95% confidence intervals (CI) were calculated between treatment groups. RESULTS Seven RCTs were selected that employed MT as a primary independent variable and pain and function as dependent variables. Inclusion of MT in treatment yielded greater improvement in function (6 of 7 studies, CI that did not cross zero in 14 of 25 variables, ES = 0.5-21.5) and algometry (3 of 3 studies, CI that did not cross zero in 9 of 10 variables, ES = 0.7-3.0) from 4 weeks to 6 months when compared to interventions such as stretching, strengthening, or modalities. Though pain improved with the inclusion of MT, ES calculations favored MT in only 2 of 6 studies (3 of 13 variables) and was otherwise equivalent in effectiveness to comparison interventions. DISCUSSION MT is clearly associated with improved function and may be associated with pain reduction in PF patients. It is recommended that clinicians consider use of both joint and soft tissue mobilization techniques in conjunction with stretching and strengthening when treating patients with PF. LEVEL OF EVIDENCE Treatment, level 1a.
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Affiliation(s)
- John J. Fraser
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
- US Navy Medicine Professional Development Center, Bethesda, MD, USA
| | - Revay Corbett
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
| | - Chris Donner
- Athletics Program, Lindsey Wilson College, Columbia, KY, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
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Koldenhoven RM, Feger MA, Fraser JJ, Hertel J. Variability in center of pressure position and muscle activation during walking with chronic ankle instability. J Electromyogr Kinesiol 2017; 38:155-161. [PMID: 29294449 DOI: 10.1016/j.jelekin.2017.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/15/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022] Open
Abstract
Chronic ankle instability (CAI) patients exhibit altered gait mechanics. The objective was to identify differences in stride-to-stride variability in the position of the center of pressure (COP) and muscle activity during walking between individuals with and without CAI. Participants (17 CAI;17 Healthy) walked on a treadmill at 1.3 m/s while surface electromyography (sEMG) of the fibularis longus (FL) and plantar pressure were recorded. The medial-lateral COP position was averaged for each 10% interval of stance and group standard deviations (SD), coefficient of variation (COV), and range for the COP position were compared between groups via independent t-tests. Ensemble curves for sEMG amplitude SD were graphed for the entire stride cycle to determine significant differences. The CAI group had increased COP position variability (SD (CAI = 0.79 ± 0.47 mm, Control = 0.48 ± 0.17 mm), COV (CAI = 1.47 ± 0.87 mm, Control = 0.93 ± 0.33 mm), range (CAI = 2.97 ± 2.07 mm, Control = 1.72 ± 0.33 mm, P < .05 for all analyses)) during the first 10% of stance. The CAI group had lower FL sEMG amplitude variability from 1 to 10% (mean difference = 0.014 ± 0.006), 32-38% (mean difference = 0.013 ± 0.004) and 56-100% (mean difference = 0.026 ± 0.01) of the gait cycle. Increased COP variability at initial contact may increase risk of lateral ankle sprains in CAI patients. Decreased sEMG amplitude variability may indicate a constrained sensorimotor system contributing to an inability to adapt to changing environmental demands.
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Affiliation(s)
- Rachel M Koldenhoven
- Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA, USA.
| | - Mark A Feger
- Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA, USA
| | - John J Fraser
- Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA, USA
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Fraser JJ, Feger MA, Hertel J. MIDFOOT AND FOREFOOT INVOLVEMENT IN LATERAL ANKLE SPRAINS AND CHRONIC ANKLE INSTABILITY. PART 1: ANATOMY AND BIOMECHANICS. Int J Sports Phys Ther 2016; 11:992-1005. [PMID: 27904801 PMCID: PMC5095951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
UNLABELLED The modern human foot is the culmination of more than five million years of evolution. The ankle-foot complex absorbs forces during loading, accommodates uneven surfaces, and acts as a lever for efficient propulsion. The ankle-foot complex has six independent functional segments that should be understood for proper assessment and treatment of foot and ankle injuries: the shank, rearfoot, midfoot, lateral forefoot, and the medial forefoot. The compliance of the individual segments of the foot is dependent on velocity, task, and active and passive coupling mechanisms within each of the foot segments. It is also important to understand the passive, active, and neural subsystems that are functionally intertwined to provide structure and control to the multisegmented foot. The purpose of the first part of this clinical commentary and current concepts review was to examine foot and ankle anatomy, detail the roles of the intrinsic and extrinsic foot and ankle musculature from a multisegmented foot perspective, and discuss the biomechanics of the ankle-foot complex during function. The interplay of segmental joint mobility, afferent and efferent sensorimotor function, and movement and stabilization provided by the extrinsic and intrinsic musculature is required to coordinate and execute the complex kinematic movements in the ankle-foot complex during propulsion. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Mark A Feger
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
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Fraser JJ, Feger MA, Hertel J. CLINICAL COMMENTARY ON MIDFOOT AND FOREFOOT INVOLVEMENT IN LATERAL ANKLE SPRAINS AND CHRONIC ANKLE INSTABILITY. PART 2: CLINICAL CONSIDERATIONS. Int J Sports Phys Ther 2016; 11:1191-1203. [PMID: 27999731 PMCID: PMC5159641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Lateral ankle sprains (LAS) and chronic ankle instability (CAI) are common musculoskeletal injuries that are a result of inversion injury during sport. The midfoot and forefoot is frequently injured during a LAS, is often overlooked during clinical examination, and maybe contributory to the development of CAI. The purpose of part two of this clinical commentary and current concept review is to increase clinician's awareness of the contribution of midfoot and forefoot impairment to functional limitation and disability of individuals who experience LAS and CAI and to facilitate future research in this area. The importance of multisegmented foot and ankle assessment from a clinical and research perspective is stressed. Select physical assessment and manual therapeutic techniques are presented to assist the clinician in examination and treatment of the ankle-foot complex in patients with LAS and CAI.
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Affiliation(s)
| | - Mark A Feger
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jay Hertel
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA
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Shenoi RP, Levine N, Jones JL, Frost MH, Koerner CE, Fraser JJ. Spatial analysis of paediatric swimming pool submersions by housing type. Inj Prev 2015; 21:245-53. [PMID: 25575965 DOI: 10.1136/injuryprev-2014-041397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/08/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Drowning is a major cause of unintentional childhood death. The relationship between childhood swimming pool submersions, neighbourhood sociodemographics, housing type and swimming pool location was examined in Harris County, Texas. STUDY DESIGN AND SETTING Childhood pool submersion incidents were examined for spatial clustering using the Nearest Neighbor Hierarchical Cluster (Nnh) algorithm. To relate submersions to predictive factors, an Markov Chain Monte Carlo (MCMC) Poisson-Lognormal-Conditional Autoregressive (CAR) spatial regression model was tested at the census tract level. RESULTS There were 260 submersions; 49 were fatal. Forty-two per cent occurred at single-family residences and 36% at multifamily residential buildings. The risk of a submersion was 2.7 times higher for a child at a multifamily than a single-family residence and 28 times more likely in a multifamily swimming pool than a single family pool. However, multifamily submersions were clustered because of the concentration of such buildings with pools. Spatial clustering did not occur in single-family residences. At the tract level, submersions in single-family and multifamily residences were best predicted by the number of pools by housing type and the number of children aged 0-17 by housing type. CONCLUSIONS Paediatric swimming pool submersions in multifamily buildings are spatially clustered. The likelihood of submersions is higher for children who live in multifamily buildings with pools than those who live in single-family homes with pools.
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Affiliation(s)
- Rohit P Shenoi
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Texas, USA
| | | | - Jennifer L Jones
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Texas, USA
| | - Mary H Frost
- Trauma Services, Texas Children's Hospital, Texas, USA
| | - Christine E Koerner
- Department of Emergency Medicine, University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Texas USA
| | - John J Fraser
- Department of Emergency Medicine, University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Texas USA Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Texas, USA
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Abstract
Normal pressure hydrocephalus (NPH) is one of the few reversible causes of dementia in older adults and accounts for approximately 6% of all dementias. The cardinal sign of NPH is a hypokinetic gait disorder in which the older adult's feet look as though they are glued to the floor. The gait also has been described as magnetic. People with NPH also may have mild dementia and bladder and bowel incontinence. A 78-year-old man exhibited symptoms of NPH for at least 4 years before being diagnosed. A neurological assessment of the patient revealed gait, posture, and balance abnormalities; mild dementia; and urinary urgency, frequency, nocturia, and incontinence at least once a day. His risk factors for NPH included diabetes and hypertension. A computed tomography (CT) scan revealed dilated lateral ventricles in the brain. A lumbar puncture was used to remove 50 ml of cerebrospinal fluid, which resulted in a transient improvement in his gait for approximately 18 hours. A ventriculoperitoneal shunt was then inserted in the patient, and during a 1-year period his symptoms gradually improved. He recovered without any complications and was eventually able to resume his usual activities. When the gait associated with NPH is observed in an older adult, he or she should be referred to a neurologist or multidisciplinary team for a comprehensive evaluation. If an individual receives treatment for NPH, he or she may have an improved quality of life and the opportunity to reduce functional limitations and disability. Families may also experience positive outcomes, such as having a loved one who is cognitively improved and requires less care.
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Abstract
An estimated 11 to 17.5 million children are being raised by a substance-abusing parent or guardian. The importance of this statistic is undeniable, particularly when a patient is brought to a pediatric office by a parent or guardian exhibiting symptoms of judgment impairment. Although the physician-patient relationship exists between the pediatrician and the minor patient, other obligations (some perceived and some real) should be considered as well. In managing encounters with impaired parents who may become disruptive or dangerous, pediatricians should be aware of their responsibilities before acting. In addition to fulfilling the duty involved with an established physician-patient relationship, the pediatrician should take reasonable care to safeguard patient confidentiality; protect the safety of the patient and other patients, visitors, and employees; and comply with reporting mandates. This clinical report identifies and discusses the legal and ethical concepts related to these circumstances. The report offers implementation suggestions when establishing anticipatory office procedures and training programs for staff on what to do (and not do) in such situations to maximize the patient's well-being and safety and minimize the liability of the pediatrician.
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Abstract
The purpose of this technical report is to provide pediatricians with an understanding of past crises within the professional liability insurance industry, the difficulties of the tort system, and alternative strategies for resolving malpractice disputes that have been applied to medical malpractice actions. Through this report, pediatricians will gain a technical understanding of common alternative dispute resolution (ADR) strategies. The report explains the distinctions between various ADR methods in terms of process and outcome, risks and benefits, appropriateness to the nature of the dispute, and long-term ramifications. By knowing these concepts, pediatricians faced with malpractice claims will be better-equipped to participate in the decision-making with legal counsel on whether to settle, litigate, or explore ADR options.
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Swanson JT, Cox EO, France FL, Teets Grimm KC, Herbert JW, Hodgson ES, Lieberthal AS, Yasuda K, Davis T, Chessin RD, Sayers R, Eugenio EE, Berger JE, Buckley JM, Craft WH, Deitschel CH, Evans G, Fraser JJ, Myers H, Combs L, Heland K. American Academy of Pediatrics. Committee on Practice and Ambulatory Medicine and Committee on Medical Liability. Pediatric physician profiling. Pediatrics 1999; 104:970-2. [PMID: 10506244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Employers, insurers, and other purchasers of health care services collect data to profile the practice habits of pediatricians and other physicians. This policy statement delineates a series of recommendations that should be adopted by health care purchasers to guide the development and implementation of physician profiling systems.
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Abstract
BACKGROUND A comprehensive surveillance system for occupational injuries to adolescents does not exist in Texas, as in most states. Therefore, the magnitude, severity, nature, and source of injuries to working adolescents have not been well described in Texas. METHODS The investigators used three data sources to investigate work-related injuries and deaths in Texas: (1) Texas Workers' Compensation Commission (TWCC) claims data from 1991 through April 1996; (2) 1993 TWCC/Bureau of Labor Statistics (BLS) Annual Survey of Occupational Injuries and Illnesses; and (3) work-related fatalities identified from Texas death certificates from 1990-1995. RESULTS There were 9,027 injuries reported to the TWCC for adolescents 14-17 years of age during slightly more than 5 years. Injuries for which indemnity payments were made (more than 7 days out of work) occurred among 21.7% of the adolescents. Based on BLS data in 1993, of 992 non-fatal injuries involving days away from work, 35% were caused by contact with objects, 27% by bodily reaction, and 24% by falls. Two-thirds of these injuries occurred while working in eating and drinking places and grocery stores. Three-quarters of the 30 deaths from 1990-1995 were accounted for equally by motor vehicle and homicide. CONCLUSIONS In conclusion, a substantial number of adolescents are injured or killed in the workplace each year in Texas. Although improved population-based surveillance is needed, sufficient knowledge exists to begin prevention efforts now.
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Affiliation(s)
- S P Cooper
- University of Texas-Houston School of Public Health, USA.
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Walton PJ, Fraser JJ, Wilhelm GW. Gastrointestinal decontamination in the emergency department. Indian J Pediatr 1997; 64:451-5. [PMID: 10771873 DOI: 10.1007/bf02737747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pediatric poisoning is a problem commonly encountered in the emergency department. After stabilization of airway, breathing, and circulation, one of the goals of treatment is decontamination in order to limit poison absorption and the resulting systemic toxicity. Decontamination modalities include gastric emptying (ipecac and gastric lavage), inhibiting absorption (activated charcoal), and catharsis (sorbital, magnesium citrate, and whole bowel irrigation). Each modality is discussed. Choice of modality by the practitioner must be individualized to each patient's situation.
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Affiliation(s)
- P J Walton
- Department of Emergency Medicine, University of Texas-Houston Medical School, USA
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Fraser JJ. Medical malpractice arbitration: a primer for Texas physicians. Tex Med 1997; 93:76-80. [PMID: 9210844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The medical malpractice crises and ensuing tort reform efforts, including methods of alternative dispute resolution (ADR), are generally reviewed. Arbitration in the context of medical malpractice is examined from the perspective of other states' experiences. Michigan has one of the nation's oldest medical malpractice arbitration programs, but it suffers from underutilization. California's experience derives from the use of arbitration in the managed care setting. While Texas has statutory provisions for medical malpractice arbitration, in light of public policy favoring ADR, the statute could be perceived as antipublic policy, resulting in underuse. The National Practitioner Data Bank also serves to discourage physician participation. Policy options are offered to address these concerns.
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Affiliation(s)
- J J Fraser
- Department of Emergency Medicine, University of Texas-Houston Medical School, Houston 77030, USA
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Abstract
PURPOSE To describe the incidence and impact of nonfatal injuries in a national sample of adolescents. METHODS Data were obtained from the 1988 Child Health Supplement of the National Health Interview Survey (NHIS). The NHIS is a continuous multistage probability sample of the civilian noninstitutionalized population of the United States. Adolescents 10-17 years old (N = 7,470) of the total number of 17,110 children under 18 years of age in the survey were studied. Incidence rates (I) were calculated for accidents, injuries, and poisonings (AIPs) requiring medical attention in the previous 12 months and recalled by the adult household interviewee. Information on sociodemographic factors and impairment were reported. Sample weights were used to derive population estimates. RESULTS In 1988, 4,505,000 adolescents 10-17 years old were estimated to have experienced AIPs in the previous 12 months (I = 16.1/100), resulting in 3.2 mean number days of bed rest, 4.1 mean number of days absent from school, and 20% with limited activity due to AIPs. AIPs were most frequent in older adolescents 14-17 years of age (I = 18.2/100), males (I = 20.3/100), whites (19.5/100), and Midwest U.S. residents (I = 18.1/100). The most frequent AIPs were cuts (I = 59.6/1000), sprains (I = 51.3/1,000), and broken bones (I = 43.1/1,000). AIPs most limiting to adolescents' activity were broken bones (62.6%), head injuries (58.3%), and sprains (55.7%). CONCLUSIONS Although injury is the leading cause of death in adolescence, it also plays an important role in adolescent morbidity. Further national studies with better documentation of nonfatal injuries are needed to eliminate potential recall bias associated with an interview survey.
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Affiliation(s)
- J J Fraser
- Department of Emergency Medicine, School of Public Health, University of Texas-Houston Health Science Center, Houston, USA
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Fraser JJ. Immunization status of chronically ill children. Tex Med 1990; 86:76-9. [PMID: 2247848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The immunization status of 103 chronically ill children attending five specialty clinics, and 52 otherwise healthy children attending an acute care clinic, was determined using a questionnaire self-administered by parents. The immunization rate in specialty clinics was 72%, compared with 85% in the acute care clinic (P = 0.118). Only the neurology clinic rate (55%) differed significantly from the control (P = 0.014). In patients age 48 months or older, there was a significant association between clinics and overall compliance (P = 0.003). Older specialty clinic patients (79%) tended to be more compliant compared to their younger counterparts (60%) (P = 0.057). No significant association was noted between immunization compliance and source of primary care services or intensity of use of services. Greater efforts are needed to identify underimmunized chronically ill children and to provide the means to bring them into compliance.
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Vorse HB, Smith EI, Luckstead EF, Fraser JJ. Hepatic hemangiomatosis of infancy. Am J Dis Child 1983; 137:672-3. [PMID: 6858982 DOI: 10.1001/archpedi.1983.02140330056015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A 2-month-old female infant with congestive heart failure secondary to hepatic hemangiomatosis was treated with prednisone for five weeks without clinical improvement. She then underwent acute cardiac decompensation and required assisted ventilation. The hepatic artery was ligated to decrease the blood supply to the hemangiomata. Although the engorged liver softened dramatically, she continued to require mechanical ventilation for cardiac failure. Ten days postoperatively, she underwent digitalization with significant improvement in cardiac function, and she was then weaned from the respirator. Although, at 2 1/2 years of age, her liver has remained somewhat enlarged, her cardiovascular function has been normal. Our experience indicates that hepatic hemangiomatosis can be successfully treated via hepatic artery ligation and that cardiotonic measures might sometimes be required for recovery from coexisting congestive heart failure.
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