Adherence to sports injury rehabilitation programmes

Many studies have shown that low adherence is a common problem in treatment programmes. Adherence to sports injury rehabilitation is dependent on the personality characteristics of athletes operating in conjunction with particular aspects of their rehabilitation settings and the quality of interactions developed between athletes and their therapists. Any attempt to view treatment adherence as a unitary construct is doomed to fail; a complex construct demands a multidimensional outlook. Taking into account the challenges that injured athletes face during their rehabilitation, strategies can be designed to promote adherence. Self-confidence is the key to enhanced rehabilitation adherence, and the strategies are organised within that framework. Competence strategies include education, treatment efficacy, tailoring, and relapse prevention training. Control strategies include dissociation, self-monitoring, decision-balance sheet, and pain deconditioning. Commitment strategies include shaping, contracting, threats, goal-setting, and social support. Because of the dearth of empirical data on the specific issue of adherence to sports injury rehabilitation programmes, it is necessary to extrapolate from various other areas of treatment adherence (e.g. cardiac rehabilitation). Treatment dropout does not seem to be inevitable, but is in fact preventable. The task for the sports medicine professional is to recognise and acknowledge the salient features of their clients and the rehabilitation demands on them and then to utilise various strategies to enhance the likelihood of treatment adherence.     

Cardiovascular Response to Exercise Training

Overstretching by forceful and excessive dorsiflexion of the hallux can cause strain injury to the muscles that flex the big toe. Five patients learned this the hard way.     

Mutations Linked to Exercise Intolerance

Abstract

Asthma is common in many types of athletes, but its prevalence appears to be particularly high in swimmers. Long-term and acute exposure to swimming pool disinfectants has been shown to increase asthma risk in swimmers through inducing oxidative stress, which results in inflammation of the pulmonary epithelium and subsequent airway remodeling. Individuals with specific genotypes are more likely to develop asthma when exposed to inhaled irritants. Therefore, it is important for physicians to be knowledgeable about the risks associated with asthma in swimmers, as well as the diagnostic techniques and practices to reduce asthma symptoms.     

Leveraging Emergency Department Encounters to Improve Cancer Screening Adherence

ObjectiveWe aimed to estimate the proportion of patients visiting the emergency department (ED) who were not up to date with cancer screening guidelines to assess the scope of need and potential impact of ED-based cancer screening interventions.MethodsAdult participants from the 2015 National Health Interview Survey were included. Among patients nonadherent to national breast, colorectal, or lung cancer screening guidelines, the proportion of patients reporting an ED visit within the last year was estimated, accounting for complex survey sampling design features. Multiple variable logistic regression analyses were then conducted to evaluate the association between sociodemographic characteristics and screening adherence.ResultsOf screening eligible respondents, 17.2% of women nonadherent to mammography screening, 16.9% of patients nonadherent to colorectal cancer screening, and 25.0% of patients nonadherent to lung cancer screening reported at least one ED visit in the preceding year. Patients visiting the ED with postsecondary school education were more likely to be up to date with mammography screening than those without advanced education (odds ratio [OR] 1.45; 95% confidence interval [CI]: 1.21-1.74; P = .01). Patients without insurance were less likely than those with insurance to report being up to date with both mammography screening (OR 0.31; 95% CI: 0.21-0.48; P = .01) and colorectal cancer screening (OR 0.56; 95% CI: 0.34-0.93; P = .03).DiscussionOpportunities to improve cancer screening adherence exist through ED-based preventative care interventions, which leverage multidisciplinary partnerships, including radiologists, to reach large volumes of patients who are not engaged in cancer screening.     

Adherence of radiopharmaceuticals and labeled cells to intravenous tubing

A survey of 67 nuclear medicine departments revealed no agreement on which radiolabeled agents could be injected through intravenous lines (IVs) and which required direct venipuncture. Labeled cells and several common radiopharmaceuticals were tested for adherence to intravenous tubing. Residual activity remaining in the tubing after an adequate flush was less than 1% of the injected dose in each case. Administration of radiolabeled agents through existing IVs is an acceptable alternative to direct venipuncture in many cases.     

Nutrition to Promote Recovery from Exercise

KEY POINTS ·Recovery from strenuous daily training or competition is improved when athletes consume a high-carbohydrate diet. The most important effect of such a diet is to maximize the stores of glycogen in the muscles. Roughly 10 g carbohydrate per kg body weight should be sufficient to replenish glycogen stores after a tough training session.     

Adherence to sport injury rehabilitation programmes: a conceptual review

It is widely acknowledged that the importance of sound theoretical guidance is essential to any academic discipline. A common recommendation within the adherence literature related to sport injury rehabilitation has been the need to establish clear theoretical frameworks to guide research and practice. As such, an increasing amount of literature has employed conceptual models that include protection motivation theory, health action process approach, cognitive appraisal models, and attribution theory. Therefore, the purpose of this review is to critically evaluate these contemporary theoretical approaches that have been utilised within the sport injury rehabilitation adherence literature. Alongside this, practical implications emerging from this research base are outlined and future recommendations are suggested that may be of benefit to sports medicine practitioners and researchers alike.     

Pregnancy: A Time to Exercise Judgment

What advice should physicians give their pregnant patients who want to exercise? Moderation seems to be the key to safety for both mother and fetus.     

Unsupervised SVM-based gridding for DNA microarray images

This paper presents a novel method for unsupervised DNA microarray gridding based on support vector machines (SVMs). Each spot is a small region on the microarray surface where chains of known DNA sequences are attached. The goal of microarray gridding is the separation of the spots into distinct cells. The positions of the spots on a DNA microarray image are first detected using image analysis operations and then a set of soft-margin linear SVM classifiers is used to estimate the optimal layout of the grid lines in the image. Each grid line is the separating line produced by one of the SVM classifiers, which maximizes the margin between two consecutive rows or columns of spots. The classifiers are trained using the spot locations as training vectors. The proposed method was evaluated on reference microarray images containing more than two million spots in total. The results illustrate its robustness in the presence of artifacts, noise and weakly expressed spots, as well as image rotation. The comparison to state of the art methods for microarray gridding reveals the superior performance of the proposed method. In 96.4% of the cases, the spots reside completely inside their respective grid cells.     

Adherence to Radiology Recommendations in a Clinical CT Lung Screening Program

BackgroundAssess patient adherence to radiologist recommendations in a clinical CT lung cancer screening program.MethodsPatients undergoing CT lung cancer screening between January 12, 2012, and June 12, 2013, were included in this institutional review board–approved retrospective review. Patients referred from outside our institution were excluded. All patients met National Comprehensive Cancer Network Guidelines Lung Cancer Screening high-risk criteria. Full-time program navigators used a CT lung screening program management system to schedule patient appointments, generate patient result notification letters detailing the radiologist follow-up recommendation, and track patient and referring physician notification of missed appointments at 30, 60, and 90 days. To be considered adherent, patients could be no more than 90 days past due for their next recommended examination as of September 12, 2014. Patients who died, were diagnosed with cancer, or otherwise became ineligible for screening were considered adherent. Adherence rates were assessed across multiple variables.ResultsDuring the study interval, 1,162 high-risk patients were screened, and 261 of 1,162 (22.5%) outside referrals were excluded. Of the remaining 901 patients, 503 (55.8%) were male, 414 (45.9%) were active smokers, 377 (41.8%) were aged 65 to 73, and >95% were white. Of the 901 patients, 772 (85.7%) were adherent. Most common reasons for nonadherence were patient refusal of follow-up exam (66.7%), inability to successfully contact the patient (20.9%), and inability to obtain the follow-up order from the referring provider (7.8%); 23 of 901 (2.6%) were discharged for other reasons.ConclusionsHigh rates of adherence to radiologist recommendations are achievable for in-network patients enrolled in a clinical CT lung screening program.     

Adherence to lipid-lowering drug therapy among members of the Canadian Forces

OBJECTIVE: This study was performed to quantify adherence rates to lipid-lowering drug therapy among members of the Canadian Forces (CF) and to identify factors associated with nonadherence. METHODS: Pharmacy claims were reviewed for all CF members who received a lipid-lowering drug between April 1 and June 1, 2003. Subjects were categorized as adherent if records indicated consumption of at least 80% of prescribed doses. Logistic regression was performed to assess the impact of patient and drug characteristics upon adherence. RESULTS: Overall adherence rate at 1 year was 38.5% among all users of lipid-lowering medications. Adherence did not vary among the different classes of lipid-lowering drugs. Duration of service was the only independent predictor of adherence. CONCLUSIONS: Despite a relative lack of treatment barriers and the presence of established treatment programs in the CF health care system, long-term adherence with lipid-lowering medications remains suboptimal in this population.     

Adherence to sport injury rehabilitation programs: an integrated psycho-social approach

The aim of the present study was to examine an adapted integrated psycho-social model to predict sport injury rehabilitation adherence. A longitudinal prospective design was used whereby 70 patients attending private physiotherapy clinics completed a battery of questionnaires both pre- and post-rehabilitation treatment based on the adapted framework. All participants were receiving treatment for tendonitis-related injuries. Adherence was monitored prospectively over the entire rehabilitation program using an observational measure of clinic adherence, a self-report measure of home-based adherence, in addition to monitoring attendance at rehabilitation sessions. In the initial phase of rehabilitation learning goal orientation, attitudes and perceived severity were found to predict rehabilitation intention. Intentions were also found to mediate the relationship between the aforementioned variables and clinic rehabilitation. Self-efficacy and self-motivation were predictors of clinic rehabilitation and attendance but not home rehabilitation. During the maintenance phase of rehabilitation coping ability and social support were predictors regarding all three measures of adherence. Implications for practitioners rehabilitating injured athletes are discussed.