Return to sport and beyond following intramuscular tendon hamstring injury: A case report of an English Premier League football player

BackgroundHamstring strain injuries are the most common type of injury in elite football and are associated with a high risk of reinjury, particularly those involving the intramuscular tendon (IMT). Limited information is available regarding the rehabilitation and return to sport (RTS) processes following such injuries. This case study describes the clinical presentation of an elite football player following IMT hamstring injury, their on- and off-pitch rehabilitation alongside performance monitoring throughout RTS and beyond.Case scenarioAn elite football player suffered a grade 2c hamstring injury during an English Premier League (EPL) match. The player underwent early post-injury management, alongside progressive off-pitch physical preparation. The ‘control-chaos continuum’ was used as a framework for on-pitch rehabilitation to prepare the player for a return to full team training and competition. Objective and subjective markers of the player's response to progressive on- and off-pitch loading were monitored throughout RTS and beyond.OutcomesThe player returned to on-pitch rehabilitation after 11 days, to full team training having achieved weekly pre-injury chronic running load outputs after 35 days and played in the EPL 40 days post-injury. The player did not suffer reinjury for the rest of the EPL season.ConclusionAn understanding the unique structural and mechanical properties of the IMT, alongside expected RTS timeframes are important to inform rehabilitation and decision-making processes post-injury. Performance and frequent load-response monitoring throughout RTS and beyond, in conjunction with practitioner experience and effective communication are critical in facilitating effective RTS and reduce risk of reinjury following IMT injury.     

Photodynamic therapy during second surgery for recurrent gliomas improves survival

BackgroundGlioma accounts for most central nervous system tumors, and the degree of invasion and malignancy are higher in the recurrent glioma. Photodynamic therapy (PDT) is an effective strategy in glioma. This study aimed to explore the risk factors for re-recurrence after a second glioma surgery and the effects of PDT on re-recurrence.MethodsThis was a retrospective study in the Second Affiliated Hospital of Harbin Medical University in China, and 43 patients that received the secondary surgery for recurrent glioma were included. The Kaplan-Meier test and Cox proportional hazard method were used to analyze.ResultsThe total re-recurrence rate after the second surgery for recurrent glioma was 48.84%. When the age increased by 1, the risk of re-recurrence increased 1.065 times (95% CI 1.000–1.134, P = 0.049). High matrix metalloproteinase (MMP) 2 expression was associated with a significantly higher risk of re-recurrence than low MMP2 expression (HR = 25.550, 95% CI 3.190–204.650, P = 0.002). Pathological grades IV and III were associated with a significantly higher risk of re-recurrence than pathological grade II (HR = 17.121, 95% CI 2.345–124.986, P = 0.005; HR = 2863.470, 95% CI 100.697–81,427.197, P < 0.001). PDT decreased the risk of re-recurrence (HR = 25.550, 95% CI 3.190–204.650, P = 0.002) and increased survival time (HR = 3.611, 95% CI 1.012–12.888, P = 0.048).ConclusionThe age, MMP2 expression, and pathological grade are independent risk factors for re-recurrence after a second surgery for recurrent glioma. PDT during the second surgery decreased the risk of re-recurrence and increased survival time.     

Evaluation of six anti-SARS-CoV-2 antibody test kits and practical approaches to optimize the diagnostic performance

In an investigation of six anti-SARS-CoV-2 antibody kits with different target antigen and methodology, each kit showed comparable performance. As false-positive reactions occurred independently with different kits, specificity increased to 100% when pairs of kits were used. With three-kit combination, both sensitivity (99.1%) and specificity (100%) increased.     

Normative values and changes in range of motion,strength, and functional performance over 1 year in adolescent female football players: Data from 418 players in the Karolinska football Injury Cohort study

ObjectiveTo study normative values of range of motion (ROM), strength, and functional performance and investigate changes over 1 year in adolescent female football players.DesignCross-sectional.Participants418 adolescent female football players aged 12–17 years.Main outcome measuresThe physical characteristic assessments included (1) ROM assessment of the trunk, hips, and ankles; (2) strength measures (maximal isometric and eccentric strength for the trunk, hips, and knees, and strength endurance for the neck, back, trunk and calves), and (3) functional performance (the one-leg long box jump test and the square hop test).ResultsOlder players were stronger, but not when normalized to body weight. Only small differences in ROM regarding age were found. ROM increased over 1 year in most measurements with the largest change in hip external rotation, which increased by 6–7° (Cohen's d = 0.83–0.87). Hip (d = 0.28–1.07) and knee (d = 0.38–0.53) muscle strength and the square hop test (d = 0.71–0.99) improved over 1 year.ConclusionsNormative values for ROM and strength assessments of neck, back, trunk, hips, knees, calves and ankles are presented for adolescent female football players. Generally, fluctuations in ROM were small with little clinical meaning, whereas strength improved over 1 year.     

Research methods in performance validity testing studies: Criterion grouping approach impacts study outcomes

Objective: Performance validity test (PVT) research studies commonly utilize a known-groups design, but the criterion grouping approaches within the design vary greatly from one study to another. At the present time, it is unclear as to what degree different criterion grouping approaches might impact PVT classification accuracy statistics. Method: To analyze this, the authors used three different criterion grouping approaches to examine how classification accuracy statistics of a PVT (Word Choice Test; WCT) would differ. The three criterion grouping approaches included: (1) failure of 2+ PVTs versus failure of 0 PVTs, (2) failure of 2+ PVTs versus failure of 0–1 PVT, and (3) failure of a stand-alone PVT versus passing of a stand-alone PVT (Test of Memory Malingering). Results: When setting specificity at ≥.90, WCT cutoff scores ranged from 41 to 44 and associated sensitivity values ranged from .64 to .88, depending on the criterion grouping approach that was utilized. Conclusions: When using a stand-alone PVT to define criterion group status, classification accuracy rates of the WCT were higher than expected, likely due to strong correlations between the reference PVT and the WCT. This held true even when considering evidence that this grouping approach results in higher rates of criterion group misclassification. Conversely, when using criterion grouping approaches that utilized failure of 2+ PVTs, accuracy rates were more consistent with expectations. These findings demonstrate that criterion grouping approaches can impact PVT classification accuracy rates and resultant cutoff scores. Strengths, weaknesses, and practical implications of each of the criterion grouping approaches are discussed.     

Spill Over Effects of Inpatient Bed Capacity on Accident and Emergency Performance in England

The English National Health Service (NHS) has failed to meet the four-hour waiting time target to admit, transfer or discharge 95 per cent of patients attending Accident and Emergency Departments (A&E) since 2013. A growing number of patients requiring inpatient care are waiting on trolleys longer than four hours before admission to a hospital bed. This study examines the role of bed occupancy in the deterioration of A&E performance in the NHS. Longitudinal panel data methods are used to analyse hospital data (n = 72,129,886) for 143 Trusts from 1^st June 2016 to 31^st October 2019. The average bed occupancy rate across the study period was 93.2%. A 1% increase in bed occupancy was associated with a 9.5 percentage point decrease in the Trusts’ probabilitay of meeting the waiting target, and an approximately 6 patient increase in four hours to 12 -hs trolley waits per 1,000 admissions. These relationships became more pronounced with rising bed occupancy levels above a 90% threshold. Bed occupancy is associated with significant negative spill-over effects on A&E performance. We estimate a minimum investment in 3,861 additional inpatient beds across the NHS to improve A&E performance in England. Relevant lessons can be derived for health care systems that have observed similar trends in increasing bed occupancy and deteriorations in A&E performance, including Ireland, Canada and Israel.     

Examining the evolution and classification of player position using performance indicators in the National Rugby League during the 2015–2019 seasons

ObjectivesThis study aimed to: 1) examine recent seasonal changes in performance indicators for different National Rugby League (NRL) playing positions; and 2) determine the accuracy of performance indicators to classify and discriminate positional groups in the NRL.DesignRetrospective, longitudinal analysis of individual performance metrics.Methods48 performance indicators (e.g. passes, tackles) from all NRL games during the 2015–2019 seasons were collated for each player´s match-related performance. The following analyses were conducted with all data: (i) one-way ANOVA to identify seasonal changes in performance indicators; (ii) principal component analysis (PCA) to group performance indicators into factors; (iii) two-step cluster analysis to classify playing positions using the identified factors; and (iv) discriminant analysis to discriminate the identified playing positions.ResultsANOVA showed significant differences in performance indicators across seasons (F = 2.3–687.7; p = 0–0.05; partial η² = 0.00–0.075). PCA pooled all performance indicators and identified 14 factors that were included in the two-step cluster analysis (average silhouette = 0.5) that identified six positional groups: forwards, 26.7%, adjustables, 17.2%, interchange, 23.2%, backs, 20.9%, interchange forwards, 5.5% and utility backs, 6.5%. Lastly, discriminant analysis revealed five discriminant functions that differentiated playing positions.ConclusionsResults indicated that player’s performance demands across different playing positions did significantly change over recent seasons (2015–2019). Cluster analysis yielded a high-level of accuracy relative to playing position, identifying six clusters that best discriminated positional groups. Unsupervised analytical approaches may provide sports scientists and coaches with meaningful tools to evaluate player performance and future positional suitability in RL.