Objective: Effusion-synovitis is related to pain and progression in knee osteoarthritis (OA), but current gold standard ultrasound (US) measures are limited to semi-quantitative grading of joint ...distension or 1-dimensional thickness measures. A novel quantitative 2-dimensional image analysis methodology is applied to US images of effusion-synovitis; reliability and concurrent validity was assessed in patients with knee OA. Methods: Cross sectional analysis of US images collected from 51 patients with symptomatic knee OA were processed in ImageJ and segmented in 3DSlicer to produce a binary mask of the supra-patellar synovitis region of interest (ROI). Area measures (mm2) of total synovitis, effusion and hypertrophy components were exported. Intra-rater reliability and test-retest reliability (1–14 days washout) were estimated with intra-class correlation coefficients (ICCs). Concurrent validity was measured by Spearman correlations between quantitative measures and gold standard OMERACT and caliper measurements of synovitis. Results: Intra-rater reliability for hypertrophy area was estimated at 0.98, 0.99 for effusion area, and 0.99 for total synovitis area. The test-retest reliability for total synovitis area was 0.63 (SEM 87.8 mm2), 0.59 for hypertrophy area (SEM 21.0 mm2), and 0.64 for effusion area (SEM 73.8 mm2). Correlation between total synovitis area and OMERACT grade was 0.84, 0.81 between total synovitis area and effusion-synovitis calipers, and 0.81 between total effusion area and effusion calipers. Conclusion: This new research tool for image analysis demonstrated excellent intra-rater reliability, good concurrent validity, and moderate test-retest reliability. Quantitative 2D US measures of effusion-synovitis and its individual components may enhance the study and management of knee OA.
Highlights • Clinicians struggle to address parents who question evidence-based recommendations. • Trainees were randomized to view an underuse, overuse or equipoise scenario. • Vaccine hesitancy ...(vs. antibiotics overuse or ear tube surgery) was most difficult. • They felt a values conflict when parents questioned vaccines or asked for antibiotics. • They valued professionalism and respected the parent most in the equipoise scenario.
OBJECTIVE:To examine the association between “overscheduling” and sports-related overuse and acute injuries in young athletes and to identify other potential contributing factors to create a working ...definition for “overscheduling injury.”
DESIGN:Survey.
SETTING:Six university-based sports medicine clinics in North America.
PARTICIPANTS:Athletes aged 6 to 18 years (13.8 ± 2.6) and their parents and pediatric sports medicine-trained physicians.
INTERVENTIONS:Questionnaires developed from literature review and expert consensus to investigate overscheduling and sports-related injuries were completed over a 3-month period.
MAIN OUTCOME MEASURES:Physicianʼs clinical diagnosis and injury categorizationacute not fatigue related (AI), overuse not fatigue related (OI), acute fatigue related (AFI), or overuse fatigue related (OFI).
RESULTS:Overall, 360 questionnaires were completed (84% response rate). Overuse not fatigue-related injuries were encountered most often (44.7%), compared with AI (41.9%) and OFI (9.7%). Number of practices within 48 hours before injury was higher (1.7 ± 1.5) for athletes with OI versus those with AI (1.3 ± 1.4; P = 0.025). Athlete or parent perception of excessive play/training without adequate rest in the days before the injury was related to overuse (P = 0.016) and fatigue-related injuries (P = 0.010). Fatigue-related injuries were related to sleeping ≤6 hours the night before the injury (P = 0.028).
CONCLUSIONS:When scheduling youth sporting events, potential activity volume and intensity over any 48-hour period, recovery time between all training and competition bouts, and potential between-day sleep time (≥ 7 hours) should be considered to optimize safety. An overscheduling injury can be defined as an injury related to excessive planned physical activity without adequate time for rest and recovery, including between training sessions/competitions and consecutive days.
