A Randomized Controlled Trial of Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in Patients With Uncontrolled Type 2 Diabetes

OBJECTIVE

To test cognitive behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. We hypothesized that CBT-AD would improve adherence; depression; and, secondarily, hemoglobin A_1c (A1C).

RESEARCH DESIGN AND METHODS

Eighty-seven adults with unipolar depression and uncontrolled type 2 diabetes received enhanced treatment as usual (ETAU), including medication adherence, self-monitoring of blood glucose (SMBG), and lifestyle counseling; a provider letter documented psychiatric diagnoses. Those randomized to the intervention arm also received 9–11 sessions of CBT-AD.

RESULTS

Immediately after acute treatment (4 months), adjusting for baseline, CBT-AD had 20.7 percentage points greater oral medication adherence on electronic pill cap (95% CI −31.14 to −10.22, P = 0.000); 30.2 percentage points greater SMBG adherence through glucometer downloads (95% CI −42.95 to −17.37, P = 0.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI 2.33–10.56, P = 0.002); 0.74 points lower on the Clinical Global Impression (95% CI 0.16–1.32, P = 0.01); and 0.72 units lower A1C (95% CI 0.29–1.15, P = 0.001) relative to ETAU. Analyses of 4-, 8-, and 12-month follow-up time points indicated that CBT-AD maintained 24.3 percentage points higher medication adherence (95% CI −38.2 to −10.3, P = 0.001); 16.9 percentage points greater SMBG adherence (95% CI −33.3 to −0.5, P = 0.043); and 0.63 units lower A1C (95% CI 0.06–1.2, P = 0.03) after acute treatment ended. For depression, there was some evidence of continued improvement posttreatment, but no between-group differences.

CONCLUSIONS

CBT-AD is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes self-management and glycemic control in adults with type 2 diabetes and depression.     

Dietary Diabetes Risk Reduction Score,Race and Ethnicity,and Risk of Type 2 Diabetes in Women

OBJECTIVE

To evaluate racial and ethnic differences in the association between a dietary diabetes risk reduction score and incidence of type 2 diabetes in U.S. white and minority women.

RESEARCH DESIGN AND METHODS

We followed 156,030 non-Hispanic white (NHW), 2,026 Asian, 2,053 Hispanic, and 2,307 black women in the Nurses’ Health Study (NHS) (1980–2008) and NHS II (1991–2009). A time-updated dietary diabetes risk reduction score (range 8–32) was created by adding points corresponding with each quartile of intake of eight dietary factors (1 = highest risk; 4 = lowest risk). A higher score indicates a healthier overall diet.

RESULTS

We documented 10,922 incident type 2 diabetes cases in NHW, 157 in Asian, 193 in Hispanic, and 307 in black women. Multivariable-adjusted pooled hazard ratio across two cohorts for a 10th–90th percentile range difference in dietary diabetes risk reduction score was 0.49 (95% CI 0.46, 0.52) for NHW, 0.53 (0.31, 0.92) for Asian, 0.45 (0.29, 0.70) for Hispanic, 0.68 (0.47, 0.98) for black, and 0.58 (0.46, 0.74) for overall minority women (P for interaction between minority race/ethnicity and dietary score = 0.08). The absolute risk difference (cases per 1,000 person-years) for the same contrast in dietary score was −5.3 (−7.8, −2.7) for NHW, −7.2 (−22.9, 8.4) for Asian, −11.6 (−26.7, 3.5) for Hispanic, −6.8 (−19.5, 5.9) for black, and −8.0 (−15.6, −0.5) for overall minority women (P for interaction = 0.04).

CONCLUSIONS

A higher dietary diabetes risk reduction score was inversely associated with risk of type 2 diabetes in all racial and ethnic groups, but the absolute risk difference was greater in minority women.     

THE INFLUENCE OF HIP STRENGTH ON KNEE KINEMATICS DURING A SINGLE‐LEGGED MEDIAL DROP LANDING AMONG COMPETITIVE COLLEGIATE BASKETBALL PLAYERS

Background

A smaller knee flexion angle and larger knee valgus angle during weight‐bearing activities have been identified as risk factors for non‐contact anterior cruciate ligament (ACL) injuries. To prevent such injuries, attention has been focused on the role of hip strength in knee motion control. However, gender differences in the relationship between hip strength and knee kinematics during weight‐bearing activities in the frontal plane have not been evaluated.

Hypothesis/Purpose

The purpose of this study was to determine the influence of hip strength on knee kinematics in both genders during a single‐legged landing task in the frontal plane. The hypotheses were that 1) subjects with a greater hip strength would demonstrate larger knee flexion and smaller knee valgus and internal rotation angles and 2) no gender differences would exist during the single‐legged landing task.

Methods

Forty‐three Japanese collegiate basketball players (20 males, 23 females) participated in this study. Three‐dimensional motion analysis was used to evaluate knee kinematics during a single‐legged medial drop landing (SML). A hand‐held dynamometer was used to assess hip extensor (HEXT), abductor (HAB), and external rotator (in two positions: seated position [SHER] and prone [PHER]) isometric strength. Spearman rank correlation coefficients (ρ) were determined for correlations between hip strength and knee kinematics at initial contact (IC) and peak (PK) during SML (p < 0.05).

Results

Negative correlations were observed between the knee valgus angle at IC and HEXT (ρ = −0.48, p = 0.02), HAB (ρ = −0.46, p = 0.03) and PHER (ρ = −0.44, p = 0.04) strength in females. In addition, a significant positive correlation was observed between the knee flexion angle at PK and HEXT strength (ρ = 0.61, p = 0.004) in males.

Conclusions

Significant correlations between hip strength and knee kinematics during SML were observed in both genders. Hip strength may, therefore, play an important role in knee motion control during sports activities, suggesting that increased hip strength may help to prevent non‐contact ACL injuries in athletes of both genders. Moreover, gender‐specific programs may be needed to control abnormal knee motion, as the influence of hip strength on knee kinematics may differ based on gender.

Level of Evidence

3     

Acute Single-Stage Reconstruction of Multiligament Knee Injuries Using the Ligament Advanced Reinforcement System

Objective

The purpose of the study was to report our early outcome in the management of multiligament knee injuries with the ligament advanced reinforcement system (LARS).

Subjects and Methods

Between 2007 and 2010, 9 of 11 patients operated on for multiligament knee injuries were included in this study; 2 patients were excluded due to complicated neurovascular injuries, open knee dislocations and severe comorbidities. All patients were managed acutely (<3 weeks) by reconstructions of the cruciate and collateral ligaments with LARS ligament and were followed up for an average of 30 months (18–46 months).

Results

The mean Lysholm score of the 9 patients at final follow-up was around 90 (range 88–94) with an average Tegner activity score of 5.5. The postoperative function of 1 case of KD-11 and 2 cases of KD-111 was rated as ‘A,’ while the remaining cases were rated ‘B’. At final follow-up, minor osteoarthritic degeneration was detected in 1 case of KD-III and 2 cases of KD-IV. Superficial infection developed in 1 case, and no cases of knee synovitis and premature osteoarthritis were recorded.

Conclusion

A creditable outcome at mean of 30 months’ follow-up was obtained in acute single-stage reconstruction of uncomplicated multiligament knee injuries with LARS ligament.Key Words: Multiligament Injuries, Knee, Dislocation, Ligament advanced reinforcement system, Reconstruction, Cruciate and collateral ligaments     

Coccygeal Movement Test: An Objective,Non-Invasive Test for Localization of the Pelvic Floor Muscles in Healthy Women

Objective

To evaluate the use of palpation of the coccyx (the coccygeal movement test, CMT) as a possible objective screening tool for the assessment of adequate localization of the pelvic floor muscles (PFMs).

Subjects and Methods

Twenty-four healthy female volunteers, known to be able to locate their PFMs, were given instructions (allocated at random) to perform a ‘correct contraction’, ‘straining’ or ‘nothing’ when examined by six independent assessors using the CMT. The assessors were blinded to the instructions and to the test results recorded by other assessors. Data were available for 137 observations, and these were dichotomized into either ‘able to contract’ (‘correct contraction’) or ‘not able to contract’ (‘straining’ or ‘nothing’). This information was used to calculate the sensitivity, specificity and positive and negative predictive values for the CMT.

Results

The CMT correctly identified 56/58 observations when women did not perform the contraction of the PFMs compared to 61/79 observations when they did. Hence, the sensitivity and specificity were 97 and 77%, respectively.

Conclusion

This study showed that the CMT was a useful test to identify women who were able to localize their PFMs compared to those who were not, making it a potentially useful initial screening test in structured training programmes for the PFMs.Key Words: Pelvic floor, Incontinence, Coccygeal movement test, Pelvic floor muscle training     

Gap Analysis between Perceptions and Expectations of Medical-Surgical Patients in a Public Hospital in Saudi Arabia

Objectives

To investigate patients'' satisfaction with nursing care by measuring the gap between patients'' expectations of care and perceptions of the actual care provided and to identify the areas of nursing care that need improvement.

Subjects and Methods

A cross-sectional survey was conducted among patients who were admitted to the Departments of Medicine and Surgery at King Saud Medical City, Riyadh, Saudi Arabia. A modified Service Quality (SERVQUAL) instrument was adapted to collect information from a convenience sample of 432 patients from November 25, 2012, to February 3, 2013. The instrument comprised 22 pairs of questions assessing 5 dimensions of the nursing care provided to patients during hospitalizations. The mean patient expectations and perceptions as well as the gap score values for each dimension of nursing service were tested for differences between the mean scores of the sample at a level of significance of 0.05 using a t test.

Results

The gap score for all of the 5 dimensions of nursing services were: responsiveness, −1.71; reliability, −1.48; tangibles, −1.36; assurance, −1.26, and empathy, −0.96. Service quality across the dimensions of responsiveness and reliability was statistically significant (p < 0.05). This result indicated that patients were not satisfied with the nursing service quality in relation to all dimensions.

Conclusion

Our study showed negative gaps for the 5 nursing service quality dimensions evaluated. This could provide nurses with information about the aspects of nursing care that promote more positive patient outcomes and satisfaction.Key Words: Nursing care, Patient perception, Patient satisfaction, Patient expectation, Quality of nursing care     

LOWER LIMB ASYMMETRIES IN RHYTHMIC GYMNASTICS ATHLETES

Background

Different limb training demands and limb preference may determine anthropometric and muscle force inter-limb asymmetries in Rhythmic Gymnastics (RG) athletes.

Purpose

The purpose of this study was to evaluate the influence of lateral preference of the lower extremity on anthropometric, range of motion, and isokinetic torque measurements of RG athletes.

Study Design

Cross sectional study

Methods

Lower limb anthropometric measurements (girth, estimated anatomical cross-sectional area), hip, knee and ankle range of motion, flexor and extensor isokinetic torques (angular velocities = 60, 180, e 240 °·s⁻¹) and bilateral asymmetry index were evaluated in 11 international level Rhythmic Gymnastics athletes (17.9 ± 4.0 years of age; 9.1 ± 5,1 years of experience; 26.8 ± 6.0 weekly training hours).

Results

The preferred limb showed larger thigh girth and anatomical cross-sectional area, higher ankle dorsiflexor range of motion, higher hip flexor torque at 60 °·s⁻¹ and higher plantarflexor torque at 180 °·s⁻¹ compared to the non-preferred limb.

Conclusions

The observed differences seem to be strictly related to lateral preference and rhythmic gymnastics training.

Levels of Evidence

3     

Assessment of 25-Hydroxyvitamin D Levels in Patients with Resistant Hypertension

Objective

To investigate the possible correlation between serum 25-hydroxyvitamin D levels and resistant hypertension (RH).

Subjects and Methods

Patients who had undergone ambulatory blood pressure measurements (ABPM) during outpatient controls were enrolled. Fifty subjects with RH, 50 with controlled hypertension (CHT) and 50 normotensive subjects (NT) were included in the study. RH was defined as ‘suboptimal blood pressure control despite using 3 antihypertensive agents including a diuretic or need for 4 or more drugs to control blood pressure−. The 25-hydroxyvitamin D and parathormone levels were compared between the groups. Pearson''s correlation coefficient test was applied to assess the correlation between 25-hydroxyvitamin D levels and office blood pressure (BP) and ABPM. Logistic regression analysis was used to determine the independent correlates of RH.

Results

The 25-hydroxyvitamin D level was significantly lower in the RH group (17.02 ± 5.4 ng/ml) compared to the CHT (24.9 ± 4.8 ng/ml) and NT groups (28.0 ± 5.7 ng/ml, p < 0.001). In univariate correlation analysis, 25-hydroxyvitamin D levels had a significant negative correlation with office systolic BP (r = −0.329, p < 0.001), office diastolic BP (r = −0.395, p < 0.001), systolic ambulatory BP (r = −0.844, p = 0.004), and diastolic ambulatory BP (r = −0.567, p = 0.005). ROC analysis revealed that 25-hydroxyvitamin D levels <21.50 ng/ml predicted the presence of RH with a sensitivity of 78% and a specificity of 79% (AUC = 0.89, 95% CI 0.83-0.94). In the multivariate logistic regression analysis, 25-hydroxyvitamin D level was independently correlated with the presence of RH (β 0.660, 95% CI 0.572-0.760, p < 0.001).

Conclusion

There was an independent correlation between lower 25-hydroxyvitamin D levels and presence of RH.Key Words: Ambulatory blood pressure, Office blood pressure, Parathormone, Resistant hypertension, Vitamin D     

VALIDATION OF TWO CLINICAL MEASURES OF CORE STABILITY

Background

Emerging evidence suggests poor core stability is a risk factor for low back and lower extremity injuries in athletes. Recently the trunk stability test (TST) and unilateral hip bridge endurance test (UHBE) were developed to clinically assess core stability. Although these and other clinical tests of core stability exist, how well they assess core stability when compared to biomechanical measures of isolated core stability has not been thoroughly evaluated.

Purpose/Hypothesis

The purposes of this study were to 1) determine concurrent validity of two novel clinical core stability assessments (TST and UHBE), and 2) assess relationships between these assessments and the trunk endurance and Y-Balance tests. The authors’ hypothesized that the TST and UHBE would be highly correlated to the lab-based biomechanical measure of isolated core stability. Also, the TST and UHBE would be moderately correlated with each other, but not with the trunk extensor endurance and Y-Balance.

Study Design

Cross-Sectional design

Methods

Twenty healthy active individuals completed the TST (recorded number of errors), UHBE (s), trunk extensor endurance (s), Y-Balance (% leg length) test (YBT), and biomechanical test of core stability.

Results

Correlational analyses revealed a small, non-significant association between TST and biomechanical measures (r_s = 0.2 – 0.22), while a moderate, significant relationship existed between UHBE and biomechanical measures (r_s = −0.49 to −0.56, p < 0.05). There was little to no relationship between TST and UHBE (r = −0.07 to – 0.21), or TST and extensor endurance (r = −0.18 to −0.24). A moderate, significant association existed between TST and two reach directions of the YBT (r = −0.41 to −0.43, p < 0.05).

Conclusions

Study data support the utility of UHBE as a clinical measure of core stability. The poor relationship between the TST and biomechanical measures, combined with observation of most control faults occurring in the lower extremity (LE) suggest the TST may not be an appropriate clinical test of core stability.

Levels of Evidence

Level 3     

THE USE OF A STATIC MEASURE TO PREDICT FOOT POSTURE AT MIDSUPPORT DURING RUNNING

Background

The posture of the foot has been implicated as a factor in the development of running-related injuries. A static measure of foot posture, such as the longitudinal arch angle (LAA), that can be easily performed and is predictive of the posture of the foot at midsupport while running could provide valuable information to enhance the clinician''s overall evaluation of the runner.

Purpose

The purpose of this study was to determine if the LAA, assessed in relaxed standing, could predict the posture of the foot at midsupport while running on a treadmill.

Study Design

Cross-sectional Study

Methods

Forty experienced runners (mean age 26.6 years) voluntarily consented to participate. Inclusion criteria included running at least 18 miles per week, previous experience running on a treadmill, no history of lower extremity congenital or traumatic deformity, or acute injury three months prior to the start of the study. Each runner had markers placed on the medial malleolus, navicular tuberosity, and medial aspect 1^st metatarsal head of both feet. A high speed camera (240 Hz) was used to film both feet of each runner in standing and while running on a treadmill at their preferred speed. The LAA in standing and at mid-support while running was determined by angle formed by two lines drawn between the three markers with the navicular tuberosity serving as the apex. The LAA in midsupport was determined using the mean of the middle five running trials.

Results

The levels of intra-rater and inter-rater reliability for the dynamic LAA were excellent. The results of the t-tests indicated that mean values between the left and right foot were not significantly different for the standing or running LAA. The results of the t-tests between male and female runners were also not significantly different for standing or running LAA. The Pearson correlation between standing and running LAA for all 80 feet was r = 0.95 (r² = 0.90).

Conclusions

The standing LAA was found to be highly predictive of the running LAA at midsupport while running. Approximately 90% of the variance associated with foot posture at midsupport in running could be explained by the standing LAA.

Level of Evidence

4, Controlled laboratory study     

Effectiveness of trigger point dry needling for multiple body regions: a systematic review

Background

Trigger point dry needling (TDN) is commonly used to treat musculoskeletal pain related to myofascial trigger points (MTrPs). To date, no systematic review of high-quality randomised controlled trials (RCTs) investigating TDN to multiple body regions exists.

Purpose

The aim of this review is to determine the effectiveness of TDN based on high-quality RCTs for all body regions.

Methods

To ensure thorough reporting, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed as the methodological basis for this systematic review. PubMed, Physiotherapy Evidence Database (PEDro), Cinahl, Cochrane and reference lists were searched for the years 2000–2014 and the terms ‘TDN’, ‘dry needling NOT trigger point’, ‘functional dry needling’ and ‘intramuscular manual therapy’. Inclusion criteria: RCTs with PEDro scores 6–10 investigating TDN. Exclusion criteria: duplicates, non-human participants, non-English language, exclusive focus on acupuncture or medicinal injections. Three investigators searched databases, applied criteria, read and assigned PEDro scores to every RCT. Nineteen studies met the criteria. As compared to either baseline or control groups, significant differences were found for pain (14 studies), range of motion (ROM) (five studies) and at least one item on function and quality of life measures (six studies).

Limitations

This review was limited by inclusion criteria, timeframe, language and databases searched.

Conclusion

The majority of high-quality studies included in this review show measured benefit from TDN for MTrPs in multiple body areas, suggesting broad applicability of TDN treatment for multiple muscle groups. Further high-quality research is warranted to standardise TDN methods to determine clinical applicability.     

Atrial Electromechanical Delay Is Impaired in Patients with Psoriasis

Objective

In this study, we aimed to investigate atrial electromechanical delay (EMD) in patients with psoriasis.

Subjects and Methods

A total of 43 patients with psoriasis (26 mild-moderate, 17 severe) and 17 healthy control subjects were enrolled. Patients with psoriasis were divided into two groups: the mild-moderate group and the severe group according to their psoriasis area severity index (PASI) scores. Atrial EMD was measured from the lateral mitral annulus and called ‘PA lateral’, from the septal mitral annulus, called ‘PA septal’, and from the right ventricle tricuspid annulus, called ‘PA tricuspid’. Atrial EMD was defined as the time interval from the onset of atrial electrical activity (P wave on surface ECG) to the beginning of mechanical atrial contraction (late diastolic A wave). All three groups were compared with each other, and correlation analysis was performed to investigate the relationship between the PASI score and interatrial EMD.

Results

PA lateral was significantly higher in both the mild-moderate psoriasis group and the severe psoriasis group compared to controls (69 ± 12 and 78 ± 13 vs. 60 ± 6 ms; p = 0.001). Also, PA septal (63 ± 11 vs. 53 ± 6 ms; p = 0.005, post hoc analysis) and PA tricuspid (49 ± 7 vs. 41 ± 5 ms; p = 0.009, post hoc analysis) were significantly higher in the severe psoriasis group than in the control group. Correlation analysis revealed that the PASI score was well correlated with PA lateral (r = 0.520, p < 0.001), PA septum (r = 0.460, p = 0.002), interatrial EMD (r = 0.371, p = 0.014) and intra-atrial EMD (r = 0.393, p = 0.009).

Conclusion

Atrial EMD was prolonged in patients with psoriasis. The measurement of atrial EMD might be used to determine the risk of development of AF in patients with psoriasis.Key Words: Atrial fibrillation, Psoriasis, Atrial electromechanical delay     

Inter-study reproducibility of interleaved spiral phase velocity mapping of renal artery haemodynamics

Background

Qualitative and quantitative assessment of renal blood flow is valuable in the evaluation of patients with renal and renovascular diseases as well as in patients with heart failure. The temporal pattern of renal flow velocity through the cardiac cycle provides important information about renal haemodynamics. High temporal resolution interleaved spiral phase velocity mapping could potentially be used to study temporal patterns of flow and measure resistive and pulsatility indices which are measures of downstream resistance.

Methods

A retrospectively gated breath-hold spiral phase velocity mapping sequence (TR 19 ms) was developed at 3 Tesla. Phase velocity maps were acquired in the proximal right and left arteries of 10 healthy subjects in each of two separate scanning sessions. Each acquisition was analysed by two independent observers who calculated the resistive index (RI), the pulsatility index (PI), the mean flow velocity and the renal artery blood flow (RABF). Inter-study and inter-observer reproducibility of each variable was determined as the mean +/− standard deviation of the differences between paired values. The effect of background phase errors on each parameter was investigated.

Results

RI, PI, mean velocity and RABF per kidney were 0.71+/− 0.06, 1.47 +/− 0.29, 253.5 +/− 65.2 mm/s and 413 +/− 122 ml/min respectively. The inter-study reproducibilities were: RI −0.00 +/− 0.04 , PI −0.03 +/− 0.17, mean velocity −6.7 +/− 31.1 mm/s and RABF per kidney 17.9 +/− 44.8 ml/min. The effect of background phase errors was negligible (<2% for each parameter).

Conclusions

High temporal resolution breath-hold spiral phase velocity mapping allows reproducible assessment of renal pulsatility indices and RABF.     

Effect of Salsalate on Insulin Action,Secretion, and Clearance in Nondiabetic,Insulin-Resistant Individuals: A Randomized,Placebo-Controlled Study

OBJECTIVE

Salsalate treatment has been shown to improve glucose homeostasis, but the mechanism remains unclear. The aim of this study was to evaluate the effect of salsalate treatment on insulin action, secretion, and clearance rate in nondiabetic individuals with insulin resistance.

RESEARCH DESIGN AND METHODS

This was a randomized (2:1), single-blind, placebo-controlled study of salsalate (3.5 g daily for 4 weeks) in nondiabetic individuals with insulin resistance. All individuals had measurement of glucose tolerance (75-g oral glucose tolerance test), steady-state plasma glucose (SSPG; insulin suppression test), and insulin secretion and clearance rate (graded-glucose infusion test) before and after treatment.

RESULTS

Forty-one individuals were randomized to salsalate (n = 27) and placebo (n = 14). One individual from each group discontinued the study. Salsalate improved fasting (% mean change −7% [95% CI −10 to −14] vs. 1% [−3 to 5], P = 0.005) but not postprandial glucose concentration compared with placebo. Salsalate also lowered fasting triglyceride concentration (−25% [−34 to −15] vs. −6% [−26 to 14], P = 0.04). Salsalate had no effect on SSPG concentration or insulin secretion rate but significantly decreased insulin clearance rate compared with placebo (−23% [−30 to −16] vs. 3% [−10 to 15], P < 0.001). Salsalate was well tolerated, but four individuals needed a dose reduction due to symptoms.

CONCLUSIONS

Salsalate treatment in nondiabetic, insulin-resistant individuals improved fasting, but not postprandial, glucose and triglyceride concentration. These improvements were associated with a decrease in insulin clearance rate without change in insulin action or insulin secretion.     

KINEMATIC ANALYSIS OF KNEE VALGUS DURING DROP VERTICAL JUMP AND FORWARD STEP-UP IN YOUNG BASKETBALL PLAYERS

Purpose/Background

Lower limb asymmetry between dominant and nondominant limbs is often associated with injuries. However, there is a lack of evidence about frontal plane projection angle (FPPA) of the knee joint (knee valgus) during drop vertical jump (DVJ) and forward step-up tasks (FSUP) in young basketball players. Therefore, the purpose of this study was to assess the FPPA (i.e., dynamic knee valgus) via 2D video analysis during DVJ and FSUP tasks in the dominant and nondominant limbs of young male basketball players.

Methods

Twenty seven young male basketball players (age 14.5 ± 1.3 y, height 161.1 ± 4.1 cm, weight 64.2 ± 10.2 kg) participated in this study. The participants were asked to perform a bilateral DVJ and unilateral FSUP tasks. Kinematic analysis of FPPA was completed via a two-dimensional (2D) examination in order to evaluate the knee valgus alignment during the beginning of the concentric phase of each task. Knee valgus alignment was computed considering the angle between the line formed between the markers at the anterior superior iliac spine and middle of the tibiofemoral joint and the line formed from the markers on the middle of the tibiofemoral joint to the middle of the ankle mortise. Paired t-tests were used to evaluate differences in tasks. Standard error of measurement (SEM) was calculated to establish random error scores.

Results

There was no difference in knee valgus angle during the DVJ task between dominant (20.2 ± 4.4 º) and nondominant legs (20 ± 4.1 º; p = 0.067). However, a significant difference was noted during FSUP between the non-dominant limb (18.7 ± 3.4 º) when compared to the dominant (21.7 ± 3.5 º; p = 0.001) limb.

Conclusion

Two dimensional kinematic analysis of knee FPPA may help coaches and other professionals to detect asymmetries between dominant and nondominant limbs, and to develop training programs with the goal of reducing overall lower extremity injury risk.

Level of evidence

2b     

Peak Biomechanical Variables During Bilateral Drop Landings: Comparisons Between Sex (Female/Male) and Fatigue (Pre-Fatigue/Post-Fatigue)

Background

Although anterior cruciate ligament (ACL) sprains usually occur during the initial phase of the landing cycle (less than 40° knee flexion), the literature has focused on peak values of knee angles, vertical ground reaction force (VGRF), and muscle activity even though it is unclear what occurs during the initial phase of landing.

Objectives

The objectives of this study were to determine the effects of sex (male and female) and fatigue (prefatigue/post-fatigue) on knee flexion angles at the occurrence of peak values of biomechanical variables [knee valgus angle, VGRF, and normalized electromyographic amplitude (NEMG) of the quadriceps and hamstring muscles] during a bilateral drop landing task.

Methods

Knee valgus angle, VGRF, and NEMG of the quadricep and hamstring muscles were collected during bilateral drop landings for twenty-nine recreational athletes before and after a fatigue protocol.

Results

Peak values of knee valgus, VGRF, and NEMG of medial and lateral hamstring muscles occurred during the late phase of the landing cycle (>40° of knee flexion). Females in the post-fatigue condition exhibited peak VGRF at significantly less knee flexion than in the pre-fatigue condition. Males in the post-fatigue condition exhibited peak lateral hamstring muscles NEMG at significantly higher knee flexion than in the pre-fatigue condition.

Discussion and Conclusion

Peak values of biomechanical variables that have been previously linked to ACL injury did not occur during the initial phase of landing when ACL injuries occur. No biomechanical variables peaked during the initial phase of landing; therefore, peak values may not be an optimal indicator of the biomechanical factors leading to ACL injury during landing tasks.     

第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻

目的探讨第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻的疗效。方法以江苏省人民医院2010年1月至2017年8月收治的80例拇外翻患者为对象,共131足。其中中重度拇外翻68足,对此68足拇外翻患者均予以第一跖骨基底部楔形截骨联合改良Mcbride手术治疗,分析疗效。结果随访时间均为术后1年,拇外翻角、第一与二跖骨夹角、第一跖骨远端关节面角均小于术前,差异有统计学意义(P均<0. 01);并发症发生率为3. 33%(2/68)。术后1年VAS疼痛评分(1. 68±0. 12)分,较术前的(6. 65±0. 31)分降低(P <0. 01),AOFAS评分(89. 54±2. 36)分,较术前的(42. 38±3. 42)分升高(P <0. 01)。结论第一跖骨基底部楔形截骨联合改良Mcbride手术治疗中重度拇外翻,可改善患者症状,且并发症少,可有效缓解患者疼痛、促进足部功能康复。