Between-seasons test-retest reliability of clinically measured reaction time in National Collegiate Athletic Association Division I athletes

Context:

Reaction time is typically impaired after concussion. A clinical test of reaction time (RT_clin) that does not require a computer to administer may be a valuable tool to assist in concussion diagnosis and management.

Objective:

To determine the test-retest reliability of RT_clin measured over successive seasons in competitive collegiate athletes and to compare these results with a computerized measure of reaction time (RT_comp).

Design:

Case series with repeated measures.

Setting:

Preparticipation physical examinations for the football, women''s soccer, and wrestling teams at a single university.

Patients or Other Participants:

102 National Collegiate Athletic Association Division I athletes.

Interventions :

The RT_clin was measured using a measuring stick embedded in a weighted rubber disk that was released and caught as quickly as possible. The RT_comp was measured using the simple reaction time component of CogState Sport.

Main Outcome Measure(s):

Data were collected at 2 time points, 1 season apart, during preparticipation physical examinations. Outcomes were mean simple RT_clin and RT_comp.

Results:

The intraclass correlation coefficient estimates from season 1 to season 2 were 0.645 for RT_clin (n = 102, entire sample) and 0.512 for RT_comp (n = 62 athletes who had 2 consecutive valid baseline CogState Sport test sessions).

Conclusions:

The test-retest reliability of RT_clin over consecutive seasons compared favorably with that of a concurrently tested computerized measure of reaction time and with literature-based estimates of computerized reaction time measures. This finding supports the potential use of RT_clin as part of a multifaceted concussion assessment battery. Further prospective study is warranted.     

Anatomical and mechanical relationship between the proximal attachment of adductor longus and the distal rectus sheath

The objectives of this study were to investigate the anatomical relationship between the proximal adductor longus (AL) and rectus abdominis muscles and to determine whether unilateral loading of AL results in strain transmission across the anterior pubic symphysis to the contralateral distal rectus sheath. Bilateral dissections were conducted on 10 embalmed cadavers. Strain transfer across the pubic symphysis was examined on seven of these cadavers. An AL contraction was simulated by applying a controlled load in the direction of its proximal tendinous fibers, and the resultant strain in the contralateral distal rectus sheath was measured using a foil‐type surface mounted microstrain gage. Adductor longus attached to the antero‐inferior aspect of the pubis. In 18 of the 20 limbs, the proximal attachment of AL was tendinous on its superficial surface and muscular on its deep surface. The proximal AL tendon was found in most instances to have secondary communications with structures such as the contralateral distal rectus sheath, pubic symphysis anterior capsule, ilio‐inguinal ligament, and contralateral proximal AL tendon. Despite these consistent anatomical observations, strain measured in the contralateral distal rectus sheath upon unilateral loading of the proximal AL varied considerably between cadavers. Measured strain had an average ± 1SD of 0.23 ± 0.43%. The proximal attachment of AL contributes to an anatomical pathway across the anterior pubic symphysis that is likely required to withstand the transmission of large forces during multidirectional athletic activities. This anatomical relationship may be a relevant factor in explaining the apparent vulnerability of the AL and rectus abdominis attachments to injury. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

Prevalence of invalid computerized baseline neurocognitive test results in high school and collegiate athletes

Context:

Limited data are available regarding the prevalence and nature of invalid computerized baseline neurocognitive test data.

Objective:

To identify the prevalence of invalid baselines on the desktop and online versions of ImPACT and to document the utility of correcting for left-right (L-R) confusion on the desktop version of ImPACT.

Design:

Cross-sectional study of independent samples of high school (HS) and collegiate athletes who completed the desktop or online versions of ImPACT.

Participants or Other Participants:

A total of 3769 HS (desktop  =  1617, online  =  2152) and 2130 collegiate (desktop  =  742, online  =  1388) athletes completed preseason baseline assessments.

Main Outcome Measure(s):

Prevalence of 5 ImPACT validity indicators, with correction for L-R confusion (reversing left and right mouse-click responses) on the desktop version, by test version and group. Chi-square analyses were conducted for sex and attentional or learning disorders.

Results:

At least 1 invalid indicator was present on 11.9% (desktop) versus 6.3% (online) of the HS baselines and 10.2% (desktop) versus 4.1% (online) of collegiate baselines; correcting for L-R confusion (desktop) decreased this overall prevalence to 8.4% (HS) and 7.5% (collegiate). Online Impulse Control scores alone yielded 0.4% (HS) and 0.9% (collegiate) invalid baselines, compared with 9.0% (HS) and 5.4% (collegiate) on the desktop version; correcting for L-R confusion (desktop) decreased the prevalence of invalid Impulse Control scores to 5.4% (HS) and 2.6% (collegiate). Male athletes and HS athletes with attention deficit or learning disorders who took the online version were more likely to have at least 1 invalid indicator. Utility of additional invalidity indicators is reported.

Conclusions:

The online ImPACT version appeared to yield fewer invalid baseline results than did the desktop version. Identification of L-R confusion reduces the prevalence of invalid baselines (desktop only) and the potency of Impulse Control as a validity indicator. We advise test administrators to be vigilant in identifying invalid baseline results as part of routine concussion management and prevention programs.     

Clavicular fracture in a collegiate football player: a case report of rapid return to play

Objective:

To present the case of surgical treatment and rehabilitation of a midshaft clavicular fracture in a National Collegiate Athletic Association Division I football athlete.

Background:

While attempting to catch a pass during practice, the athlete jumped up and then landed on the tip of his shoulder. On-the-field evaluation was inconclusive, with a sideline evaluation diagnosis of clavicular fracture. Postinjury radiographs revealed a midshaft clavicular fracture.

Differential Diagnosis:

Spiral oblique midshaft clavicular fracture.

Treatment:

The sports medicine staff discussed surgical and nonsurgical options. A surgical procedure of internal fixation with an 8-hole plate was performed.

Uniqueness:

Surgical treatment for clavicular fractures is becoming increasingly common. This is the first report of an advanced rehabilitation protocol for surgical repair. We suggest that new rehabilitation protocols for clavicular repairs be investigated now that surgical treatment is being pursued more frequently.

Conclusions:

More aggressive treatment procedures and rehabilitation protocols for clavicular fractures have evolved in recent years. With these medical advancements, athletes are able to return to play much more quickly without compromising their health and safety.     

Review of prophylactic knee bracing in athletes: Does it work?

Review of the literature, primarily articles published in the last few years, revealed that the subject of prophylactic (protective) knee bracing in athletes is highly complex and controversial. Published results of studies on knee bracing strongly suggest that it is ineffective in preventing ligamentous knee injuries, that it is time-consuming and often expensive, and most dramatically that it may contribute to a higher incidence of injury than when no external support is applied to healthy knees. Possible reasons for this include placing undue stress on the MCL (preloading), especially in varus knees, twisting or slipping of the brace during use, and changing directions of force as the knee moves during impact. Functional and rehabilitative knee braces, on the other hand, seem to have almost universal approval when combined with physical therapy and conditioning designed to prevent recurrence of knee injuries. The authors conclude that a need exists for effective prophylactic knee bracing and believe that, with continuing research, improved design, and rigorous testing, achieving this goal is possible.     

The uncertainty (validity and reliability) of three electrothermometers in therapeutic modality research

Context: Data from electrothermometers are used to determine therapeutic modality usage, but the value of experimental results is only as good as the data collected.Objective: To determine the reliability and validity of 3 electrothermometers from 2 manufacturers.Design: A 3 × 4 × 17 factorial with repeated measures on 2 factors. Independent variables were trial (1, 2, 3), thermometer (mercury thermometer, Iso-Thermex calibrated from −50°C to 50°C, Iso-Thermex calibrated from −20°C to 80°C, and Datalogger), and time (17).Setting: Human Performance Research Center.Intervention(s): Eighteen thermocouples were inserted through the wall of a foamed polystyrene cooler, and 6 were connected to each of the 3 electrothermometers. The cooler was positioned on a stir plate and filled with room-temperature water (18.4°C). A mercury thermometer was immersed into the water bath. Measurements of the water bath were taken every 10 seconds for three 3-minute trials.Main Outcome Measure(s): The temperature variability of 3 electrothermometers was taken from a calibrated mercury thermometer.Results: The Iso-Thermex electrothermometers did not differ statistically from each other in uncertainty (validity error ± reliability error = 0.06°C ± 0.03°C ± 0.03°C ± 0.02°C, P < .05), but both differed from the Datalogger (0.64°C ± 0.20°C, P < .05). The Datalogger temperature was consistently higher than the mercury thermometer temperature.Conclusions: The Iso-Thermex electrothermometers were more stable than the Datalogger, and values were within the published uncertainty (±0.1°C) when used with PT-6 thermocouples. The Datalogger we used had an uncertainty of measurement greater than that indicated in the user''s manual (∼±0.52°C). Uncertainty of ±0.84°C can significantly influence the interpretation of results when intramuscular temperature changes are usually less than 5°C.     

Validity and reliability of a novel instrumented one-legged hop test in patients with knee injuries

Background

Conventional one-legged hop tests simply evaluate the total hop distance, thus neglecting important temporal and spatial parameters related to the strategy of execution, such as foot contact time.

Validity and reliability of limits-of-stability testing: a comparison of 2 postural stability evaluation devices

Context:

A lack of published comparisons between measures from commercially available computerized posturography devices and the outcome measures used to define the limits of stability (LOS) makes meaningful interpretation of dynamic postural stability measures difficult.

Objectives:

To compare postural stability measures between and within devices to establish concurrent and construct validity and to determine test-retest reliability for LOS measures generated by the NeuroCom Smart Balance Master and the Biodex Balance System.

Design:

Cross-sectional study.

Setting:

Controlled research laboratory.

Patients or Other Participants:

A total of 23 healthy participants with no vestibular or visual disabilities or lower limb impairments.

Intervention(s):

The LOS were assessed during 2 laboratory test sessions 1 week apart.

Main Outcome Measure(s):

Three NeuroCom LOS variables (directional control, endpoint excursion, and movement velocity) and 2 Biodex LOS variables (directional control, test duration).

Results:

Test-retest reliability ranged from high to low across the 5 LOS measures (intraclass correlation coefficient [2,k] = 0.82 to 0.48). Pearson correlations revealed 4 significant relationships (P < .05) between and within the 2 computerized posturography devices (r = 0.42 to −0.65).

Conclusions:

Based on the wide range of intraclass correlation values we observed for the NeuroCom measures, clinicians and researchers alike should establish the reliability of LOS testing for their own clinics and laboratories. The low to moderate reliability outcomes observed for the Biodex measures were not of sufficient magnitude for us to recommend using the LOS measures from this system as the gold standard. The moderate Pearson interclass correlations we observed suggest that the Biodex and NeuroCom postural stability systems provided unique information. In this study of healthy participants, the concurrent and construct validity of the Biodex and NeuroCom LOS tests were not definitively established. We recommend that this study be repeated with a clinical population to further explore the matter.     

Validity and reliability of the Horiba C-122 compact sodium analyzer in sweat samples of athletes

Accurate sodium replacement during prolonged exercise is possible when sweat rate and sweat sodium content are directly measured. Few athletes have access to sweat sodium content measurement, as the equipment needed to perform such analyzes is costly, laboratory-based or requires technical skills. Using 70 sweat samples collected in 24 athletes from 3 anatomical sites, this study determined the reliability [single-trial and inter-day (7 samples over 3?days)] and validity (instrument error) of a pocket-sized, easy-to-use and low cost sodium analyzer (Horiba C-122, Kyoto, Japan) against reference values of an ion chromatograph, the 883 Basic IC plus (Metrohm AG, Herisau, Switzerland). The Horiba C-122 showed high single-trial reliability with an intraclass correlation coefficient (ICC) of 0.997, a typical error of measurement (EM) of 1.77?mmol/L and a coefficient of variation (CV) of 3.73%. As expected, the reliability of the 883 Basic IC plus was superior to that of the Horiba C-122 (ICC: 0.999; typical EM: 0.70?mmol/L; CV: 1.52%). The Horiba’s C-122 inter-day reliability was high (ICC: 1.00; typical EM: 0.35?mmol/L). An ICC of 0.975 indicates there was a strong relationship between results provided by both analyzers. Compared with reference values, the Horiba C-122 demonstrated a mean bias of 1.71?mmol/L, a pure EM of 7.52?mmol/L and 68% limits of agreement ranging from ?5.81 to 9.23?mmol/L. We propose that the Horiba C-122 is sufficiently reliable to be used under field conditions where some degree of imprecision is acceptable, but not for research purposes where high accuracy is required.     

Effects of long-term training specificity on maximal strength and power of the upper and lower extremities in athletes from different sports

Maximal concentric one repetition maximum half-squat (1RM_HS), bench-press (1RM_BP), power-load curves during concentric actions with loads ranging from 30% to 100% of 1RM_HS and 1RM_BP were examined in 70 male subjects divided into five groups: weightlifters (WL, n=11), handball players (HP, n=19), amateur road cyclists (RC, n=18), middle-distance runners (MDR, n=10) and age-matched control subjects (C, n=12). The 1RM_HS values in WL, HP and RC were 50%, 29% and 28% greater, respectively, (P<0.001–0.01) than those recorded for MDR and C. The half-squat average power outputs at all loads examined (from 30% to 100%) in WL and HP (P<0.001 at 45% and 60% with HP) were higher (P<0.05–0.001) than those in MDR, RC and C. Average power output at the load of 30% of 1RM_HS in RC was higher (P<0.05) than that recorded in MDR and C. Maximal power output was produced at the load of 60% for HP, MDR and C, and at the load of 45% for WL and RC. The 1RM_BP in WL was larger (P<0.05) than those recorded in HP, RC, MDR and C. In the bench press, average muscle power outputs in WL and HP were higher (P<0.05–0.001) than those in MDR, RC and C, and were maximized at a load of 30% of 1RM for WL and HP, and at 45% for RC, MDR and C. In addition, the velocities that elicited the maximal power in the lower extremities were lower (≈0.75 m·s^–1) than those occurring in the upper extremities (≈1 m·s^–1). The data suggest that the magnitude of the sport-related differences in strength and/or muscle power output may be explained in part by differences in muscle cross-sectional area, fibre type distribution and in the muscle mechanics of the upper and lower limbs as well as by training background. Electronic Publication     

Scoring reliability of the multiple sleep latency test in a clinical population

STUDY OBJECTIVES: To determine intrarater and interrater scoring reliability of the multiple sleep latency test (MSLT) in a population of sleep clinic patients. DESIGN: N/A. SETTING: Urban sleep center. PATIENTS: 200 consecutive sleep center patients (diagnoses included: obstructive sleep apnea, narcolepsy, periodic-limb-movement, and individuals with no diagnosis). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: MSLTs were recorded and scored according to standard clinical procedures. One of four clinical polysomnographers and one of seven polysomnographic technologists scored each MSLT. All MSLTs were then rescored by the same polysomnographer. The intrarater reliability coefficient for mean MSLT score was .87 and interrater reliability was .90. Coefficients for the mean number of REM onsets during the MSLT were .81 for intrarater and .88 for interrater reliability. Intrarater and interrater agreement (kappa coefficients) for the presence of at least one REM onset during the MSLT was .78 and .86, respectively. For the presence of greater than one REM onset, a kappa of .78 was obtained for intrarater agreement and .91 for interrater agreement. CONCLUSIONS: The clinical MSLT displays excellent interrater and intrarater reliability estimates for both sleep latency and REM onset scores in a sleep-disordered population.