Background:
Field expedient screening tools that can identify individuals at an elevated risk for injury are needed to minimize time loss in American football players. Previous research has suggested ...that poor dynamic balance may be associated with an elevated risk for injury in athletes; however, this has yet to be examined in college football players.
Hypothesis:
To determine if dynamic balance deficits are associated with an elevated risk of injury in collegiate football players. It was hypothesized that football players with lower performance and increased asymmetry in dynamic balance would be at an elevated risk for sustaining a noncontact lower extremity injury.
Study Design:
Prospective cohort study.
Methods:
Fifty-nine collegiate American football players volunteered for this study. Demographic information, injury history, and dynamic balance testing performance were collected, and noncontact lower extremity injuries were recorded over the course of the season. Receiver operator characteristic curves were calculated based on performance on the Star Excursion Balance Test (SEBT), including composite score and asymmetry, to determine the population-specific risk cut-off point. Relative risk was then calculated based on these variables, as well as previous injury.
Results:
A cut-off point of 89.6% composite score on the SEBT optimized the sensitivity (100%) and specificity (71.7%). A college football player who scored below 89.6% was 3.5 times more likely to get injured.
Conclusion:
Poor performance on the SEBT may be related to an increased risk for sustaining a noncontact lower extremity injury over the course of a competitive American football season.
Clinical Relevance:
College football players should be screened preseason using the SEBT to identify those at an elevated risk for injury based upon dynamic balance performance to implement injury mitigation strategies to this specific subgroup of athletes.
Background Patient selection and outcomes for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) have changed over the past decade. However, there is limited ...information on outcomes for both revascularization strategies in the same population. The study evaluated temporal changes in risk profile, procedural characteristics, and clinical outcomes for PCI- and CABG-treated patients. Methods and Results We analyzed all PCI and isolated CABG between 2005 and 2017 in nonfederal hospitals in Washington State. Descriptive analysis was performed to evaluate temporal changes in risk profile and, risk-adjusted in-hospital mortality. Over the study period, 178 474 PCI and 36 592 CABG procedures were performed. PCI and CABG volume decreased by 2.9% and 22.6%, respectively. Compared with 2005-2009, patients receiving either form of revascularization between 2014 and 2017 had a higher prevalence of comorbidities including diabetes mellitus and hypertension and dialysis. Presentation with ST-segment-elevation myocardial infarction (17% versus 20%) and cardiogenic shock (2.4% versus 3.4%) increased for patients with PCI compared with CABG. Conversely, clinical acuity decreased for patients receiving CABG over the study period. From 2005 to 2017, mean National Cardiovascular Data Registry CathPCI mortality score increased for patients treated with PCI (20.1 versus 22.4,
<0.0001) and decreased for patients treated with CABG (18.8 versus 17.8,
<0.0001). Adjusted observed/expected in-hospital mortality ratio increased for PCI (0.98 versus 1.19,
<0.0001) but decreased for CABG (1.21 versus 0.74,
<0.0001) over the study period. Conclusions Clinical acuity increased for patients treated with PCI rather than CABG. This resulted in an increase in adjusted observed/expected mortality ratio for patients undergoing PCI and a decrease for CABG. These shifts may reflect an increased use of PCI instead of CABG for patients considered to be at high surgical risk.
Literature consistently identifies two key examination components when managing ankle/foot pathologies: 1) dorsiflexion range of motion (DFROM) and 2) single limb balance. Mobilizations with movement ...(MWM) and Instrument-Assisted Soft Tissue (IASTM) are two emerging manual therapy (MT) options in the management of ankle/foot conditions.
In this observational cohort study, 147 subjects were randomized in a block fashion as follows: 1) Control, 2) IASTM, 3) MWM, and 4) Combination of both MT interventions. Descriptive statistics of the sample were conducted with integrity checks followed by comparative analysis for mean change between the variables or DFROM and YBTLQ ™ performance.
ANOVA Welch's F indicated significant differences between the treatment conditions (Welch's F (3,75.669) = 4.533, p = .006). Games-Howell post hoc tests indicated significantly more change in DFROM in the IASTM (p = .043) and CKCMOB (p = .026) conditions when they were administered as single treatments, than in the Control Condition or when the treatments were combined. Dynamic balance, as measured by the YBT-LQ™, did not yield a significant response based on the intervention arm.
Specifically, IASTM or closed kinetic chain (CKC) MWM MT techniques used in isolation can be considered a cost-effective intervention that can be administered by a skilled MT practitioner in a “low risk-high reward” clinical scenario with potential biomechanical and neurophysiological benefits for improving CKCDFROM.
•CKCDFROM and YBT-LQ are two reliable and valid tests that can be administered during ankle/foot management.•CKCMWM and IASTM are two-cost-effective, non-invasive MT viable options aimed at improving CKCDFROM.•Compounding MT techniques such as CKCDFROM and IASTM at the ankle region in one session may minimize benefits of improving CKCDFROM.
The purpose of the cross-sectional observational cohort study was to quantify movement patterns and neuromuscular impairments in Olympic Female Field Hockey utilizing a standardized movement-centered ...assessment model.
A sample of convenience was obtained from the active roster of the 2016 USA Women's Olympic Field Hockey team. Inclusion and exclusion criteria were applied and resulted in nine participants. The study was conducted over 1 session in which each athlete was tested using the SFMA™, Y Balance Test Lower Quarter (YBT-LQ™) FMS™, and closed chain dorsiflexion range of motion (CKCDFROM). Injury risk assignment was generated based on an evidenced based algorithm. Descriptive statistics and frequency distributions were applied to the subjects.
Injury risk stratification was applied to the subjects with 44% being at moderate risk and 56% at slight risk. 100% of the athletes exhibited spinal extension deficits and 89% of the athletes displayed a dysfunctional single leg stance pattern. Regional impairments included the following observations: anterior hip mobility deficits (5/9 subjects) and rolling motor control dysfunction (7/9 subjects).
A battery of movement centered tests combined with an evidenced based algorithm can provide meaningful information informing future programming for the elite female athlete. Considering regional interdependence applications, impairments at the hip and thoracic spine, combined with poor quality of movement in extension could create undue stress in remote regions of the spine and lower quarter, thus contributing to injury risk for the spine and lower quarter.
•A battery of reliable and valid movement-centered tests may provide clinically valuable information regarding injury risk for musculoskeletal injury.•The identification of intrinsic modifiable risk factors may be useful to the sports medicine professional by informing preventative programming in the Olympic Field Hockey Athlete.•Within this elite olympic athlete population, neuromuscular impairments are prevalent and specific to the lumbopelvic hip complex, which may predispose this unique population to increased injury risk.
Background
Intrathoracic complications (ITC) requiring emergency surgical intervention occur during transcatheter aortic valve replacement (TAVR).
Objectives
Characterize the incidence, outcomes and ...predictors of ITC in a large cohort of transfemoral (TF) TAVR cases over a 5 year period.
Methods
Retrospective registry and chart review of all nonclinical trial TF‐TAVR patients from seven centers within one hospital system from 2012–2016. ITC were defined as cardiac perforation, new or worsening pericardial effusion/tamponade, annular rupture, thoracic aortic injury, aortic valve dislodgement, and coronary artery occlusion. Procedural and 30‐day outcomes and 1‐year mortality were compared between ITC and no ITC patients. Multivariable logistic regression was used to identify predictors of ITC.
Results
Over the study period, 1,581 patients had TF‐TAVR and 68 ITC occurred in 46 patients (2.9%). The most common ITCs were pericardial effusion/tamponade (59%), cardiac perforation (33%), and valve dislodgement (33%). ITC rate did not decline over time (rate (95% confidence interval) for 2012 = 0% (0–8.8%), 2013 = 1.3% (0–7.2%), 2014 = 4.4% (2.2–8.0%), 2015 = 3.5% (2.0–5.6%), and 2016 = 2.4% (1.5–3.8%)). ITC patients had worse 1‐year survival (ITC: 60.7% (45.1–73.1%), no ITC: 88.7% (87.0–90.3%); p < .001). The majority of ITC patient deaths occurred within the first 30 days. Multivariable models to predict ITC were not successful.
Conclusions
ITC did not decline over time in our cohort. Predictors of ITC could not be identified. While these events are rare, they are associated with worse procedural outcomes and mortality. Heart teams should continue to be prepared for emergency intervention.
•Movement centered examination strategies for foot and ankle pathology can enhance clinical reasoning within the interprofessional team.•Dorsiflexion range of motion can impact movement patterns ...throughout the lower extremity kinetic chain.•Professionals managing foot and ankle pathology may consider regional interdependence applications of dorsiflexion range of motion limitations and the implications of movement dysfunction within the squat pattern.
An association between limited ankle closed kinetic chain dorsiflexion range of motion (CKCDFROM) and movement dysfunction in the lower quarter is often implied, limited research exists linking CKCDFROM and gross movement patterns, such as the squatting. The purpose of this study is to investigate the association between CKCDFROM and movement patterns in collegiate athletes, as measured by the functional movement screen (FMS).
A quasi-experimental observational analytical cohort study with 147 athletes from five Division III collegiate men’s and women’s athletic teams were included in the study. CKCDFROM was assessed utilizing the lunge test. Movement patterns, specifically the deep squat (DS) and inline lunge (ILL) were assessed utilizing the FMS qualitative criteria. Descriptive statistical analysis examined the association between CKCDFROM limitations and a dysfunctional deep squat or ILL.
Seventy-nine (53.7%) and 30 (20.4%) participants scored a “1” on their FMS deep squat test and ILL, respectively. Participants who scored a “1” on the deep squat and ILL were 3.75 times as likely (3.75 odds ratio; 95% CI 1.57–9.14; p = 0.002) and 1.53 times as likely (1.53 odds ratio; 95% CI 0.65–3.60; p = 0.392), respectively, to have at least one ankle CKCDFROM limitation. The deep squat (DS) was statistically significant, but the ILL did not rise to the level of significance.
Physical therapists should consider regional interdependence implications of movement dysfunction stemming from impairments within the kinetic chain.
A dysfunctional lower extremity movement pattern might be associated with a lack of CKCDFROM. Clinicians will likely benefit from assessing CKCDFROM in those exhibiting dysfunctional squatting and/or lunging.
The risk of musculoskeletal injury is multifactorial (Bahr 2005). Injury risk is a composite of intrinsic and extrinsic risk factors that can be modifiable or non-modifiable. Ballet dancers have ...unique risk factors, due to the nature of their art and sport. The purpose of this literature review is to identify intrinsic modifiable risk factors for injury in ballet dancers. The secondary purpose is to investigate potential screening tools which can be used to identify these risk factors.
The authors performed a review of the literature in October 2017 within the databases of MEDLINE Complete, SPORTDiscus, and PubMed Central following a list of inclusion and exclusion criteria.
A review of the available literature identified seven intrinsic modifiable factors specifically for ballet dancers and seven appropriate screening tools.
The literature identified the most common intrinsic modifiable risk factors associated with ballet dancers to be: hypermobility, fatigue, overuse, neuromuscular dysfunction, degree of turnout, weakness of core and lower extremity musculature, and lower extremity range of motion (ROM) discrepancies.
Sports medicine professionals who manage these performing artists can use this literature review to help develop injury prevention programs and enhance return to sport decision.
•Intrinsic risk factors for injury are classified as modifiable and non-modifiable.•The literature identified seven intrinsic modifiable risk factors in ballet dancers.•The literature identified a battery of effective tests to screen for injury risk.•The sports medicine professional can use this information to enhance clinical decision making.
Abstract Athletic participation growth has resulted in increased exposures and neuromusculoskeletal (NMSK) non-contact injuries. Based on current evidence, the primary objective of this literature ...review is to create a preliminary evidence-based NMSK exercise guideline, addressing these intrinsic modifiable risk factors. Systematic searches were conducted September 2014 prior to data extraction utilizing CINAHL Plus (1995 to September 2014), MEDLINE (1995 to September 2014), and Academic Search Premier (1995 to September 2014). A priori defined inclusion criteria were applied and included the following: (i) full text, (ii) published in English, (iii) peer-reviewed articles addressing injury risk of non-contact lower extremity injury, (iv) identified specific exercises aimed at reducing injury risk of non-contact lower extremity injury, were the key data extraction points of interest. 3163 potential articles were identified from the initial search, 3120 excluded with reason based on the exclusion criteria. Exclusion criteria was applied in the form of an eight item list summarized in table 2, 43 articles remained after search criteria were applied. Novel to the current body of knowledge, this review identified nine intrinsic modifiable risk factors of the NMSK system that were used as a foundation to create the exercise guideline consisting of 30 exercise techniques.
Current guidelines recommend a target international normalized ratio (INR) range of 2.5 to 3.5 in patients with a mechanical mitral prosthesis. The Prospective Randomized On-X Anticoagulation ...Clinical Trial (PROACT) Mitral randomized controlled noninferiority trial assessed safety and efficacy of warfarin at doses lower than currently recommended in patients with an On-X (Artivion, Inc) mechanical mitral valve.
After On-X mechanical mitral valve replacement, followed by at least 3 months of standard anticoagulation, 401 patients at 44 North American centers were randomized to low-dose warfarin (target INR, 2.0-2.5) or standard-dose warfarin (target INR, 2.5-3.5). All patients were prescribed aspirin, 81 mg daily, and encouraged to use home INR testing. The primary end point was the sum of the linearized rates of thromboembolism, valve thrombosis, and bleeding events. The design was based on an expected 7.3% event rate and 1.5% noninferiority margin.
Mean patient follow-up was 4.1 years. Mean INR was 2.47 and 2.92 (P <.001) in the low-dose and standard-dose warfarin groups, respectively. Primary end point rates were 11.9% per patient-year in the low-dose group and 12.0% per patient-year in the standard-dose group (difference, −0.07%; 95% CI, −3.40% to 3.26%). The CI >1.5%, thus noninferiority was not achieved. Rates (percentage per patient-year) of the individual components of the primary end point were 2.3% vs 2.5% for thromboembolism, 0.5% vs 0.5% for valve thrombosis, and 9.13% vs 9.04% for bleeding.
Compared with standard-dose warfarin, low-dose warfarin did not achieve noninferiority for the composite primary end point. (PROACT Clinicaltrials.gov number, NCT00291525).
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The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in hospital resource utilization and the need to defer nonurgent cardiac surgery procedures. The present study aims to ...report the regional variations of North American adult cardiac surgical case volume and case mix through the first wave of the COVID-19 pandemic.
A survey was sent to recruit participating adult cardiac surgery centers in North America. Data in regard to changes in institutional and regional cardiac surgical case volume and mix were analyzed.
Our study comprises 67 adult cardiac surgery institutions with diverse geographic distribution across North America, representing annualized case volumes of 60,452 in 2019. Nonurgent surgery was stopped during the month of March 2020 in the majority of centers (96%), resulting in a decline to 45% of baseline with significant regional variation. Hospitals with a high burden of hospitalized patients with COVID-19 demonstrated similar trends of decline in total volume as centers in low burden areas. As a proportion of total surgical volume, there was a relative increase of coronary artery bypass grafting surgery (high +7.2% vs low +4.2%, P = .550), extracorporeal membrane oxygenation (high +2.5% vs low 0.4%, P = .328), and heart transplantation (high +2.7% vs low 0.4%, P = .090), and decline in valvular cases (high –7.6% vs low –2.6%, P = .195).
The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix.
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