Risk Stratification for 4,837 Individuals with Knee Pain Who Receive Physical Therapy Treatment

Risk stratification is a modelling method that is designed to target interventions toward patients with specific needs. The objective of the present study was to identify predictive characteristics related to patients with knee impairments who had a high risk of a bad prognosis (exceptional non‐responders) as well as those who were at low risk of a bad prognosis (exceptional responders). A cohort of 4,837 patients with knee pain seen for physical therapy was retrospective analysed using univariate and multivariate multinomial regression analyses. Modelling was used to identify characteristics associated with those who were exceptional responders and those who were exceptional non‐responders. Exceptional non‐responders were significantly associated with older age, female gender, longer duration of symptoms, surgical history, lower functional status at baseline and a payer type. Exceptional responders were significantly associated with younger age, no previous surgical history, higher functional status at baseline and a payer type. Findings may be used for managing processes involving intensity of care service and in understanding probable prognoses for each patient. Future research should continue to examine variables predictive of treatment response in patients with knee pain. Copyright © 2016 John Wiley & Sons, Ltd.     

Does Shoe Insole Modification Prevent Stress Fractures? A Systematic Review

Stress fractures can be debilitating in athletes and military personnel. Insoles may lower stress fracture rates by improving biomechanics, lessening fatigue, and attenuating impact. The objective of this study was to systematically review the best evidence on the use of insoles as a method of stress fracture prevention in a high-risk population. Using MEDLINE, Cochrane, Current Controlled Trials, UK National Research Register, ScienceDirect, CINAHL, and EMBASE, a review of randomized (level I) and quasi-randomized (level II) controlled trials was performed using an insole as the intervention and stress fracture incidence as the primary outcome measure. Five trials were included, and a random effects model was used to generate a summary estimate and an overall odds ratio. One study found a significant reduction in overall stress fracture incidence using a semirigid insole, while four studies found no overall reduction in military personnel. However, when the data are pooled, orthotic use was beneficial. When stratified by site, there was a reduction in femoral and tibial stress fracture incidence. Shoe insoles may reduce the overall femoral and tibial stress fracture incidence during military training. It is unclear if the use of insoles would prevent stress fractures in athletes. Additional studies are necessary to determine the efficacy of insoles in an athletic population.     

The role of the helmet in the prevention of traumatic brain injuries

Today, traumatic brain injuries (TBIs) exceed 1 million cases per year. Tens of thousands of people die and hundreds of thousands of people are hospitalized. The health care costs exceed $50 billion. The Centers for Disease Control and Prevention estimate that people with mild TBIs who are not hospitalized add another $17 billion to the total dollars spent on care. These high frequencies and costs place a high priority on programs and procedures to minimize the number of injuries and to reduce the severity of those that occur. One of these programs focuses on the protective devices worn by the people that work and play in environments where there is an identified risk of TBI. Because these environments cover a wide variety of activities, the design and effectiveness of these protective devices must be specific to the nature of the activity and the person they are designed to protect.     

Using social cognitive theory to explain discretionary, “leisure-time” physical exercise among high school students

PURPOSE: To examine whether knowledge of high school students' actions of self-regulation, and perceptions of self-efficacy to overcome exercise barriers, social situation, and outcome expectation will predict non-school related moderate and vigorous physical exercise. METHODS: High school students enrolled in introductory Physical Education courses completed questionnaires that targeted selected Social Cognitive Theory variables. They also self-reported their typical "leisure-time" exercise participation using a standardized questionnaire. Bivariate correlation statistic and hierarchical regression were conducted on reports of moderate and vigorous exercise frequency. RESULTS: Each predictor variable was significantly associated with measures of moderate and vigorous exercise frequency. All predictor variables were significant in the final regression model used to explain vigorous exercise. After controlling for the effects of gender, the psychosocial variables explained 29% of variance in vigorous exercise frequency. Three of four predictor variables were significant in the final regression equation used to explain moderate exercise. The final regression equation accounted for 11% of variance in moderate exercise frequency. CONCLUSIONS: Professionals who attempt to increase the prevalence of physical exercise through educational methods should focus on the psychosocial variables utilized in this study.     

Effect of Acute Fatigue of the Hip Abductors on Control of Balance in Young and Older Women

Bellew JW, Panwitz BL, Peterson L, Brock MC, Olson KE, Staples WH. Effect of acute fatigue of the hip abductors on control of balance in young and older women.

Objective

To examine the effects of acute fatigue of the hip abductors on the control of balance in young and older women.

Design

Pretest-posttest.

Setting

University research laboratory.

Participants

Healthy young women (n=20; age, 23.0±1.5y; height, 166.52±4.5cm; mass, 65.33±10.5kg) and community-dwelling older women (n=20; age, 71.65±7.2y; height, 162.31±3.8cm; mass, 71.16±11.6kg) without a fall history.

Intervention

Measurements of control of single-limb balance before and after fatiguing the hip abductors of the dominant leg.

Main Outcome Measure

Performance on 3 clinical assessments of control of balance: the modified Functional Reach Test in the forward, left, and right directions; the Lower-Extremity Reach Test in forward and lateral directions; and the Single-Limb Stance Time Test (SLSTT).

Results

Although the younger subjects showed a significantly greater control of balance than the older women in most tests, control of balance after acute fatigue failed to show a significant decline in either age group. The only exception to this was the SLSTT in the younger women in whom a significant 26% decline was noted (P<.05).

Conclusions

Acute fatigue of the hip abductors did not result in a decreased control of balance in healthy young or older women without fall history. Despite considerable changes in movement strategies used to complete the postfatigue tests of balance, quantitative measures of balance did not decrease.     

Recognition and Management of Athletic Pubalgia

<正>Introduction Whether termed"sports hernias","hockey groin",or"athletic pubalgia",insidious onset and vague groin and hip maladies seem to be on the rise in the last few years,creating much confusion as to the best way to diagnosis and treat the multifaceted and complex conditions.Because of the vague nature of their clinical