bluuebunny/crossref_metadata_2025 huggingface dataset:
The Diagnostic Value of the Clarke Sign in Assessing Chondromalacia Patella
Authors: Doberstein Scott T. , Romeyn Richard L. , Reineke David M.
Published: December 2009

Context: Various techniques have been described for assessing conditions that cause pain at the patellofemoral (PF) joint. The Clarke sign is one such test, but the diagnostic value of this test in assessing chondromalacia patella is unknown.

Objective: To (1) investigate the diagnostic value of the Clarke sign in assessing the presence of chondromalacia patella using arthroscopic examination of the PF joint as the “gold standard,” and (2) provide a historical perspective of the Clarke sign as a clinical diagnostic test.

Design: Validation study.

Setting: All patients of one of the investigators who had knee pain or injuries unrelated to the patellofemoral joint and were scheduled for arthroscopic surgery were recruited for this study.

Patients or Other Participants: A total of 106 otherwise healthy individuals with no history of patellofemoral pain or dysfunction volunteered.

Main Outcome Measure(s): The Clarke sign was performed on the surgical knee by a single investigator in the clinic before surgery. A positive test was indicated by the presence of pain sufficient to prevent the patient from maintaining a quadriceps muscle contraction against manual resistance for longer than 2 seconds. The preoperative result was compared with visual evidence of chondromalacia patella during arthroscopy.

Results: Sensitivity was 0.39, specificity was 0.67, likelihood ratio for a positive test was 1.18, likelihood ratio for a negative test was 0.91, positive predictive value was 0.25, and negative predictive value was 0.80.

Conclusions: Diagnostic validity values for the use of the Clarke sign in assessing chondromalacia patella were unsatisfactory, supporting suggestions that it has poor diagnostic value as a clinical examination technique. Additionally, an extensive search of the available literature for the Clarke sign reveals multiple problems with the test, causing significant confusion for clinicians. Therefore, the use of the Clarke sign as a routine part of a knee examination is not beneficial, and its use should be discontinued.
Individual Moral Philosophies and Ethical Decision Making of Undergraduate Athletic Training Students and Educators
Authors: Caswell Shane V. , Gould Trenton E.
Published: December 2009

Context: Ethics research in athletic training is lacking. Teaching students technical skills is important, but teaching them how to reason and to behave in a manner that befits responsible health care professionals is equally important.

Objective: To expand ethics research in athletic training by (1) describing undergraduate athletic training students' and educators' individual moral philosophies and ethical decision-making abilities and (2) investigating the effects of sex and level of education on mean composite individual moral philosophies and ethical decision-making scores.

Design: Stratified, multistage, cluster-sample correlational study.

Setting: Mailed survey instruments were distributed in classroom settings at 30 institutions having Commission on Accreditation of Allied Health Education Programs (CAAHEP)–accredited athletic training programs.

Patients or Other Participants: Undergraduate students and educators (n = 598: 373 women, 225 men; mean age = 23.5 ± 6.3 years) from 25 CAAHEP-accredited athletic training programs.

Main Outcome Measure(s): We used the Ethics Position Questionnaire and the Dilemmas in Athletic Training Questionnaire to compute participants' mean composite individual moral philosophies (idealism and relativism) and ethical decision-making scores, respectively. Three separate 2 (sex: male, female) × 3 (education level: underclass, upper class, educator) between-subjects factorial analyses of variance using idealism, relativism, and ethical decision-making scores as dependent measures were performed.

Results: Respondents reported higher idealism scores (37.57 ± 4.91) than relativism scores (31.70 ± 4.80) (response rate = 83%). The mean ethical decision-making score for all respondents was 80.76 ± 7.88. No significant interactions were revealed. The main effect for sex illustrated that men reported significantly higher relativism scores (P = .0014, η2 = .015) than did women. The main effect for education level revealed significant differences between students' and educators' idealism (P = .0190, η2 = .013), relativism (P < .001, η2 = .050), and ethical decision-making scores (P < .001, η2 = .027). Tukey honestly significant difference post hoc analysis indicated that educators possessed lower idealism scores (36.90 ± 5.70) and relativism scores (29.92 ± 4.86) and higher ethical decision-making scores (82.98 ± 7.62) than did students.

Conclusions: Our findings do not support changes in athletic training ethics education practices to address sex-specific needs. However, when opportunities occur for students to reason using different ethical perspectives, educators should be aware of their students' and their own moral philosophies in order to optimally facilitate professional growth.
The Role of Shoe Design in Ankle Sprain Rates Among Collegiate Basketball Players
Authors: Curtis Claudia K. , Laudner Kevin G. , McLoda Todd A. , McCaw Steven T.
Published: December 2009

Context:

Much of the recent focus in shoe design and engineering has been on improving athletic performance. Currently, this improvement has been in the form of “cushioned column systems,” which are spring-like in design and located under the heel of the shoe in place of a conventional heel counter. Concerns have been raised about whether this design alteration has increased the incidence of ankle sprains.

Objective:

To examine the incidence of lateral ankle sprains in collegiate basketball players with regard to shoe design.

Design:

Prospective cohort study.

Setting:

Certified athletic trainers at 1014 National Collegiate Athletic Association (NCAA)-affiliated schools sponsoring basketball during the 2005–2006 regular season were notified of an online questionnaire. Athletic trainers at 22 of the 1014 schools participated.

Patients or Other Participants:

A total of 230 basketball players (141 males, 89 females; age  =  20.2 ± 1.5 years) from NCAA Division I–III basketball programs sustained lateral ankle sprains.

Main Outcome Measure(s):

Ankle sprain information and type of shoe worn (cushioned column or noncushioned column) were collected via online survey. The incidence of lateral ankle sprains and type of shoes worn were compared using a chi-square analysis.

Results:

No difference was noted in ankle sprain incidence between groups (χ2  =  2.44, P  =  .20, relative risk  =  1.47, 95% confidence interval [CI]  =  0.32, 6.86). The incidence of ankle sprains was 1.33 per 1000 exposures in the cushioned column group (95% CI  =  0.62, 3.51) and 1.96 per 1000 exposures in the noncushioned column group (95% CI  =  0.51, 4.22).

Conclusions:

No increased incidence of ankle sprains was associated with shoe design.
Lower Extremity Kinematics and Ground Reaction Forces After Prophylactic Lace-Up Ankle Bracing
Authors: DiStefano Lindsay J. , Padua Darin A. , Brown Cathleen N. , Guskiewicz Kevin M.
Published: December 2009

Context:

Long-term effects of ankle bracing on lower extremity kinematics and kinetics are unknown. Ankle motion restriction may negatively affect the body's ability to attenuate ground reaction forces (GRFs).

Objective:

To evaluate the immediate and long-term effects of ankle bracing on lower extremity kinematics and GRFs during a jump landing.

Design:

Experimental mixed model (2 [group] × 2 [brace] × 2 [time]) with repeated measures.

Setting:

Sports medicine research laboratory.

Patients or Other Participants:

A total of 37 healthy subjects were assigned randomly to either the intervention (n  =  11 men, 8 women; age  =  19.63 ± 0.72 years, height  =  176.05 ± 10.58 cm, mass  =  71.50 ± 13.15 kg) or control group (n  =  11 men, 7 women; age  =  19.94 ± 1.44 years, height  =  179.15 ± 8.81 cm, mass  =  74.10 ± 10.33 kg).

Intervention(s):

The intervention group wore braces on both ankles and the control group did not wear braces during all recreational activities for an 8-week period.

Main Outcome Measure(s):

Initial ground contact angles, maximum joint angles, time to reach maximum joint angles, and joint range of motion for sagittal-plane knee and ankle motion were measured during a jump-landing task. Peak vertical GRF and the time to reach peak vertical GRF were assessed also.

Results:

While participants were wearing the brace, ankle plantar flexion at initial ground contact (brace  =  35° ± 13°, no brace  =  38° ± 15°, P  =  .024), maximum dorsiflexion (brace  =  21° ± 7°, no brace  =  22° ± 6°, P  =  .04), dorsiflexion range of motion (brace  =  56° ± 14°, no brace  =  59° ± 16°, P  =  .001), and knee flexion range of motion (brace  =  79° ± 16°, no brace  =  82° ± 16°, P  =  .036) decreased, whereas knee flexion at initial ground contact increased (brace  =  12° ± 9°, no brace  =  9° ± 9°, P  =  .0001). Wearing the brace for 8 weeks did not affect any of the outcome measures, and the brace caused no changes in vertical GRFs (P > .05).

Conclusions:

Although ankle sagittal-plane motion was restricted with the brace, knee flexion upon landing increased and peak vertical GRF did not change. The type of lace-up brace used in this study appeared to restrict ankle motion without increasing knee extension or vertical GRFs and without changing kinematics or kinetics over time.
Knee and Ankle Position, Anterior Drawer Laxity, and Stiffness of the Ankle Complex
Authors: Kovaleski John E. , Norrell Phillip M. , Heitman Robert J. , Hollis J. Marcus , Pearsall Albert W.
Published: December 2009

Context:

Anterior drawer testing of the ankle is commonly used to diagnose lateral ligamentous instability. Our hypothesis was that changing knee and ankle positions would change the stability of the ankle complex during anterior drawer testing.

Objectives:

To assess the effects of knee and ankle position on anterior drawer laxity and stiffness of the ankle complex.

Design:

A repeated-measures design with knee and ankle position as independent variables.

Setting:

University research laboratory.

Patients or Other Participants:

Bilateral ankles of 10 female (age  =  19.8 ± 1.1 years) and 10 male (age  =  20.8 ± 1.2 years) collegiate athletes were tested.

Intervention(s):

Each ankle complex underwent loading using an ankle arthrometer under 4 test conditions consisting of 2 knee positions (90° and 0° of flexion) and 2 ankle positions (0° and 10° of plantar flexion [PF]).

Main Outcome Measure(s):

Recorded anterior laxity (mm) and stiffness (N/mm).

Results:

Anterior laxity of the ankle complex was maximal with the knee positioned at 90° of flexion and the ankle at 10° of PF when compared with the knee positioned at 0° of flexion and the ankle at 10° or 0° of PF (P < .001), whereas ankle complex stiffness was greatest with the knee positioned at 0° of flexion and the ankle at 0° of PF (P < .009).

Conclusions:

Anterior drawer testing of the ankle complex with the knee positioned at 90° of flexion and the ankle at 10° of PF produced the most laxity and the least stiffness. These findings indicate that anterior drawer testing with the knee at 90° of flexion and the ankle at 10° of PF may permit better isolation of the ankle capsuloligamentous structures.
Athletic Trainers' and Physical Therapists' Perceptions of the Effectiveness of Psychological Skills Within Sport Injury Rehabilitation Programs
Authors: Hamson-Utley J. Jordan , Martin Scott , Walters Jason
Published: December 2009

Context:

Psychological skills are alleged to augment sport-injury rehabilitation; however, implementation of mental imagery within rehabilitation programs is limited.

Objective:

To examine attitudes of athletic trainers (ATs) and physical therapists (PTs) on the effectiveness of mental imagery, goal setting, and positive self-talk to improve rehabilitation adherence and recovery speed of injured athletes.

Design:

The ATs and PTs were contacted via electronic or physical mailings to complete a single administration survey that measured their beliefs about the effectiveness of psychological skills for increasing adherence and recovery speed of injured athletes undergoing rehabilitation.

Setting:

Professional member databases of the National Athletic Trainers' Association and the American Physical Therapy Association.

Patients or Other Participants:

Of the 1000 ATs and 1000 PTs who were selected randomly, 309 ATs (age  =  34.18 ± 8.32 years, years in profession  =  10.67 ± 7.34) and 356 PTs (age  =  38.58 ± 7.51 years, years in profession  =  13.18 ± 6.17) responded.

Main Outcome Measure(s):

The Attitudes About Imagery (AAI) survey measures attitudes about psychological skills for enhancing adherence and recovery speed of injured athletes. The AAI includes demographic questions and 15 items on a 7-point Likert scale measuring attitudes about the effectiveness of mental imagery, self-talk, goal setting, and pain control on rehabilitation adherence and recovery speed of injured athletes. Test-retest reliability ranged from .60 to .84 and Cronbach αs ranged from .65 to .90. We calculated 1-way analyses of variance to determine whether differences existed in attitudes as a result of the professionals' education, training experience, and interest.

Results:

Mean differences were found on attitudes about effectiveness of psychological skills for those who reported formal training and those who reported interest in receiving formal training (P < .05). In addition, ATs held more positive attitudes than PTs on 9 of 15 AAI items (P < .05).

Conclusions:

Overall, ATs and PTs held positive attitudes on the effectiveness of psychological skills to augment the rehabilitation process. Clinical implications regarding the use of mental skills are discussed.
Concussion in Sports: Postconcussive Activity Levels, Symptoms, and Neurocognitive Performance
Authors: Majerske Cynthia W. , Mihalik Jason P. , Ren Dianxu , Collins Michael W. , Reddy Cara Camiolo , Lovell Mark R. , Wagner Amy K.
Published: December 2009

Context:

Evidence suggests that athletes engaging in high-intensity activities after concussion have more difficulties with cognitive recovery.

Objective:

To examine the role postinjury activity level plays in postconcussive symptoms and performance on neurocognitive tests in a population of student-athletes.

Design:

Retrospective cohort study with repeated measures of neurocognitive performance and symptom reporting.

Setting:

University-based sports concussion clinic.

Patients or Other Participants:

Ninety-five student-athletes (80 males, 15 females: age  =  15.88 ± 1.35 years) were retrospectively assigned to 1 of 5 groups based on a postinjury activity intensity scale.

Main Outcome Measure(s):

We employed a regression analysis for repeated measures to evaluate the relationship of activity intensity to symptoms and neurocognitive outcome up to 33 days after concussion. Postconcussion symptom scores and neurocognitive (verbal memory, visual memory, visual motor speed, and reaction time) scores served as the primary outcome measures.

Results:

Level of exertion was significantly related to all outcome variables (P < .02 for all comparisons). With multivariate analysis, activity intensity remained significant with respect to visual memory (P  =  .003) and reaction time (P < .001).

Conclusions:

Activity level after concussion affected symptoms and neurocognitive recovery. Athletes engaging in high levels of activity after concussion demonstrated worse neurocognitive performance. For these tasks, those engaging in moderate levels of activity demonstrated the best performance.
Questioning Skills Demonstrated by Approved Clinical Instructors During Clinical Field Experiences
Authors: Barnum Mary G.
Published: December 2009

Context:

The current trend in athletic training clinical education places greater emphasis on the quality of interactions occurring between Approved Clinical Instructors (ACIs) and athletic training students (ATSs). Among other attributes, the ability of ACIs to facilitate and direct quality clinical learning experiences may be influenced by the skill with which the ACI is able to use selected teaching strategies.

Objective:

To gain insight into ACIs' use of questioning as a specific teaching strategy during the clinical education experiences of undergraduate ATSs.

Design:

Qualitative case study design involving initial and stimulated-recall interviews, prolonged field observations, and audio recording of ACI-ATS interactions.

Setting:

The primary athletic training facility at one athletic training education program accredited by the Commission on Accreditation of Athletic Training Education.

Patients or Other Participants:

The 8 ACI participants included 3 full-time athletic training education program faculty members and 5 graduate-level assistants. The 24 ATS participants included 1 senior, 17 juniors, and 6 sophomores.

Data Collection and Analysis:

Transcribed data collected from 8 initial interviews, 23 field observations, 23 audio-recorded ACI-ATS interactions and 54 stimulated-recall interviews were analyzed through microscopic, open, and axial coding, as well as coding for process. The cognition level of questions posed by ACIs was analyzed according to Sellappah and colleagues' Question Classification Framework.

Results:

The ACI participants posed 712 questions during the 23 observation periods. Of the total questions, 70.37% were classified as low-level cognitive questions and 17.00% as high-level cognitive questions. The remaining 12.64% were classified as other.

Conclusions:

Although all ACIs used questioning during clinical instruction, 2 distinct questioning patterns were identified: strategic questioning and nonstrategic questioning. The way ACIs sequenced questions (their questioning pattern) appeared to be more important than the number of specific cognitive-level questions posed. Nonstrategic questioning appears to support knowledge and comprehension, whereas strategic questioning appears to support critical thinking.
Systematic Review of Postural Control and Lateral Ankle Instability, Part II: Is Balance Training Clinically Effective?
Authors: McKeon Patrick O. , Hertel Jay
Published: December 2009

Objective:

To answer the following clinical questions: (1) Can prophylactic balance and coordination training reduce the risk of sustaining a lateral ankle sprain? (2) Can balance and coordination training improve treatment outcomes associated with acute ankle sprains? (3) Can balance and coordination training improve treatment outcomes in patients with chronic ankle instability?

Data Sources:

PubMed and CINAHL entries from 1966 through October 2006 were searched using the terms ankle sprain, ankle instability, balance, chronic ankle instability, functional ankle instability, postural control, and postural sway.

Study Selection:

Only studies assessing the influence of balance training on the primary outcomes of risk of ankle sprain or instrumented postural control measures derived from testing on a stable force plate using the modified Romberg test were included. Studies had to provide results for calculation of relative risk reduction and numbers needed to treat for the injury prevention outcomes or effect sizes for the postural control measures.

Data Extraction:

We calculated the relative risk reduction and numbers needed to treat to assess the effect of balance training on the risk of incurring an ankle sprain. Effect sizes were estimated with the Cohen d for comparisons of postural control performance between trained and untrained groups.

Data Synthesis:

Prophylactic balance training substantially reduced the risk of sustaining ankle sprains, with a greater effect seen in those with a history of a previous sprain. Completing at least 6 weeks of balance training after an acute ankle sprain substantially reduced the risk of recurrent ankle sprains; however, consistent improvements in instrumented measures of postural control were not associated with training. Evidence is lacking to assess the reduction in the risk of recurrent sprains and inconclusive to demonstrate improved instrumented postural control measures in those with chronic ankle instability who complete balance training.

Conclusions:

Balance training can be used prophylactically or after an acute ankle sprain in an effort to reduce future ankle sprains, but current evidence is insufficient to assess this effect in patients with chronic ankle instability.
Managing Heteronormativity and Homonegativity in Athletic Training: In and Beyond the Classroom
Authors: Maurer-Starks Suanne S. , Clemons Heather L. , Whalen Shannon L.
Published: December 2009

Context:

As an allied health professional working in various settings, an athletic trainer (AT) is responsible for the health care of a highly diverse population. More often than not, this diversity is defined by the visible, such as race or sex. However, diversity encompasses many more variables than these observable factors and includes sexual orientation. Efforts have been made to educate ATs about issues related to sex and race; however, sexual orientation typically has not been addressed, although ATs have treated and will continue to treat lesbian, gay, and bisexual (LGB) patients.

Objective:

To introduce ATs (educators and practicing clinicians) to the concept of heteronormativity, its effect on society, and its influences on the manner in which they teach athletic training students and deliver health care to their patients.

Data Collection and Analysis:

We searched various databases, including MEDLINE, ERIC, SportDiscus, and CINAHL Information Systems using the terms bisexual, diversity, gay, heteronormativity, homophobia in sport, and lesbian. Pertinent articles were cross-referenced to gain additional information.

The literature revealed the historic implications of homonegativity for sport and its effects on those involved in sport culture, including ATs.

Conclusions:

Future dialogues should focus on innovative strategies for including LGB issues into athletic training curricula and for meeting the needs of students and professionals in addition to patients who identify as LGB.
Functional Performance Testing in Participants With Functional Ankle Instability and in a Healthy Control Group
Authors: Buchanan Amanda S. , Docherty Carrie L. , Schrader John
Published: December 2009

Context:

Functional ankle instability (FAI) affects a large part of the population. Inconsistent findings have been reported regarding the existence of functional performance deficits in individuals with FAI.

Objective:

To examine functional performance in participants with FAI compared with participants in a control group during 2 hopping tests.

Design:

Case-control study.

Settings:

Athletic training research laboratory.

Patients or Other Participants:

There were 40 college-aged individuals who participated in our study: 20 with FAI and 20 without FAI. We defined FAI as history of an ankle sprain and residual episodes of “giving way.”

Intervention(s):

Participants completed 2 functional performance tests (FPTs): the single-limb hopping and the single-limb hurdle tests.

Main Outcome Measure(s):

Time to complete each test was recorded. Following each FPT, participants were asked if their ankles felt unstable during the test.

Results:

We found no difference between participants in the FAI and control groups for the hopping or hurdle tests (P > .05). When asked if their ankles felt unstable during the FPTs, approximately half of the participants in the FAI group and none of the participants in the control group reported a feeling of instability. Subsequently, a secondary analysis of variance was calculated with participants grouped into 3 categories: control participants, FAI participants reporting instability symptoms during FPT (FAI-S), and FAI participants not reporting instability symptoms during FPT (FAI-NS). Results revealed a difference among the 3 groups for the single-limb hopping test (P < .01). Post hoc analysis revealed a difference between the FAI-S participants and both the control and the FAI-NS participants. No difference was identified for the single-limb hurdle test (P  =  .41).

Conclusions:

The FAI-S participants had performance deficits during the single-limb hopping test. Therefore, clinicians could use this simple hopping test as an additional method to determine the presence of FAI.
Prophylactic Ankle Braces and Star Excursion Balance Measures in Healthy Volunteers
Authors: Hardy Lisa , Huxel Kellie , Brucker Jody , Nesser Thomas
Published: December 2009

Context:

The effects of prophylactic ankle braces on lower extremity functional performance in healthy participants have not been studied extensively.

Objective:

To determine if prophylactic ankle braces affected multidirectional reach distances during a test of dynamic balance.

Design:

Crossover.

Setting:

Laboratory.

Patients or Other Participants:

Thirty-six healthy, physically active volunteers (18 men, 18 women; age  =  23.6 ± 2.7 years, height  =  173.8 ± 9.3 cm, mass  =  74.4 ± 12.7 kg, reach-leg length  =  91.9 ± 5.1 cm).

Intervention(s):

Volunteers performed balance testing in 3 conditions: unbraced, while wearing a semirigid ankle brace, and while wearing a lace-up ankle brace.

Main Outcome Measure(s):

We used the Star Excursion Balance Test, calculating the mean of 3 attempts in 8 directions (anterior, anterior-medial, medial, posterior-medial, posterior, posterior-lateral, lateral, and anterior-lateral), normalized by the participant's reach-leg length. Data were collected after 6 practice attempts for each of the conditions according to a balanced Latin square.

Results:

Bracing condition had no effect (P > .05) on any of the Star Excursion Balance Test directional measures. The largest mean difference due to bracing was 2.5% between the lace-up brace condition and the control in the posterior reach direction. This indicates that the actual reach differences due to bracing were less than 5.08 cm (2 inches) in length.

Conclusions:

Clinicians can be confident that the prophylactic use of ankle braces does not disrupt lower extremity dynamic balance during a reaching task in healthy participants.
The Acute Effects of Sleeper Stretches on Shoulder Range of Motion
Authors: Laudner Kevin G. , Sipes Robert C. , Wilson James T.
Published: December 2009

Context:

The deceleration phase of the throwing motion creates large distraction forces at the shoulder, which may result in posterior shoulder tightness and ensuing alterations in shoulder range of motion (ROM) and may result in an increased risk of shoulder injury. Researchers have hypothesized that various stretching options increase this motion, but few data on the effectiveness of treating such tightness are available.

Objective:

To evaluate the acute effects of “sleeper stretches” on shoulder ROM.

Design:

Descriptive with repeated measures.

Setting:

Biomechanics laboratory and 2 separate collegiate athletic training facilities.

Patients or Other Participants:

Thirty-three National Collegiate Athletic Association Division I baseball players (15 pitchers, 18 position players; age  =  19.8 ± 1.3 years, height  =  184.7 ± 6.4 cm, mass  =  84.8 ± 7.7 kg) and 33 physically active male college students (age  =  20.1 ± 0.6 years, height  =  179.6 ± 6.6 cm, mass  =  83.4 ± 11.3 kg) who reported no recent participation (within 5 years) in overhead athletic activities.

Intervention(s):

Range-of-motion measurements of the dominant shoulder were assessed before and after completion of 3 sets of 30-second passive sleeper stretches among the baseball players. The ROM measurements in the nonthrower group were taken using identical methods as those in the baseball group, but this group did not perform any stretch or movement between measurements.

Main Outcome Measure(s):

Internal and external glenohumeral rotation ROM and posterior shoulder motion (glenohumeral horizontal adduction).

Results:

In the baseball group, posterior shoulder tightness, internal rotation ROM, and external rotation ROM were −3.5° ± 7.7°, 43.8° ± 9.5°, and 118.6° ± 10.9°, respectively, before the stretches and were −1.2° ± 8.8°, 46.9° ± 9.8°, and 119.2° ± 11.0°, respectively, after the stretches. These data revealed increases in posterior shoulder motion (P  =  .01, effect size  =  0.30) and in internal shoulder rotation (P  =  .003, effect size  =  0.32) after application of the stretches. No other differences were observed in the baseball group, and no differences were noted in the nonthrower group.

Conclusions:

Based on our results, the sleeper stretches produced a statistically significant acute increase in posterior shoulder flexibility. However, this change in motion may not be clinically significant.
The Interrelationships Among Sex Hormone Concentrations, Motoneuron Excitability, and Anterior Tibial Displacement in Women and Men
Authors: Hoffman Mark , Harter Rod A. , Hayes Bradley T. , Wojtys Edward M. , Murtaugh Paul
Published: December 2009

Context:

Sex hormone fluctuations have been implicated as a contributing factor to the high rates of noncontact injury to the anterior cruciate ligament in females.

Objective:

To determine the strength of the relationships among variables of sex hormone concentrations, motoneuron excitability, and anterior tibial displacement (ATD) in women and men and to determine if these relationships differ between the sexes.

Design:

Cohort study.

Setting:

Sports medicine laboratory.

Patients or Other Participants:

Twenty-eight regularly menstruating women (age  =  22.4 ± 3.4 years) and 15 men (age  =  22.3 ± 3.7 years) participated in the study.

Intervention(s):

Fluctuations in sex hormones were determined for the participants. Female participants were tested every other day of their menstrual cycles, whereas male participants were tested every fourth day during the 28-day period.

Main Outcome Measure(s):

We measured Hoffmann reflexes (maximum Hoffmann reflex [Hmax] to maximum M-wave [Mmax] ratio in the soleus), ATD under a 134-N load, and saliva concentrations of estrogen and progesterone. The independent variable was sex. Pearson product moment correlation coefficients were calculated for each participant by pairing measurements made on the same day. Two-tailed independent-samples t tests were used to determine the difference between the male and female correlations for each variable.

Results:

Over the course of the study, the relationships between Hmax∶Mmax and estrogen, Hmax∶Mmax and progesterone, ATD and estrogen, and ATD and progesterone were not different between the sexes. However, the relationship between ATD and progesterone was different between the sexes (P  =  .036).

Conclusions:

The observed correlations did not support our hypothesis that the relationships between sex hormone levels and reflex activity or between sex hormone levels and ATD would be different for women compared with men. If sex hormone concentrations significantly contribute to anterior cruciate ligament ruptures because of changes in laxity or in motoneuron excitability, their mechanism of action is likely multifactorial and complex.
Summary Statement: Appropriate Medical Care for the Secondary School-Aged Athlete
Authors: Almquist Jon , Valovich McLeod Tamara C. , Cavanna Angela , Jenkinson Dave , Lincoln Andrew E. , Loud Keith , Peterson Bart C. , Portwood Craig , Reynolds John , Woods Thomas S.
Published: December 2009

Objective:

To present the recommendations made by the Appropriate Medical Care for Secondary School-Aged Athletes Task Force and to summarize the subsequent monograph developed around 11 consensus points.

Data Sources:

The MEDLINE, CINAHL, and SportDiscus databases were searched for relevant literature regarding secondary school-aged athletes; health care administration; preparticipation physical examination; facilities; athletic equipment; emergency action planning; environmental conditions; recognition, evaluation, and treatment of injuries; rehabilitation and reconditioning; psychosocial consultation; nutrition; and prevention strategies.

Conclusions and Recommendations:

Organizations that sponsor athletic programs for secondary school-aged athletes should establish an athletic health care team to ensure that appropriate medical care is provided to all participants. The 11 consensus points provide a framework—one that is supported by the medical literature and case law—for the development of an athletic health care team and for assigning responsibilities to the team, administrators, and staff members of institutions sponsoring secondary school and club-level athletic programs.
Using Disablement Models and Clinical Outcomes Assessment to Enable Evidence-Based Athletic Training Practice, Part I: Disablement Models
Authors: Snyder Alison R. , Parsons John T. , Valovich McLeod Tamara C. , Curtis Bay R. , Michener Lori A. , Sauers Eric L.
Published: December 2009

Objective:

To present and discuss disablement models and the benefits of using these models as a framework to assess clinical outcomes in athletic training.

Background:

Conceptual schemes that form the basic architecture for clinical practice, scholarly activities, and health care policy, disablement models have been in use by health care professions since the 1960s. Disablement models are also the foundation for clinical outcomes assessment. Clinical outcomes assessment serves as the measurement tool for patient-oriented evidence and is a necessary component for evidence-based practice.

Description:

Disablement models provide benefits to health professions through organization of clinical practice and research activities; creation of a common language among health care professionals; facilitation of the delivery of patient-centered, whole-person health care; and justification of interventions based on a comprehensive assessment of the effect of illness or injury on a person's overall health-related quality of life. Currently, the predominant conceptual frameworks of disability in health care are those of the National Center for Medical Rehabilitation Research and the World Health Organization. Disablement models need to be understood, used, and studied by certified athletic trainers to promote patient-centered care and clinical outcomes assessment for the development of evidence-based practice in athletic training.

Clinical and Research Advantages:

For clinicians and researchers to determine effective athletic training treatments, prevention programs, and practices, they must understand what is important to patients by collecting patient-oriented evidence. Patient-oriented evidence is the most essential form of outcomes evidence and necessitates an appreciation of all dimensions of health, as outlined by disablement models. The use of disablement models will allow the athletic training profession to communicate, measure, and prioritize the health care needs of patients, which will facilitate organized efforts aimed at assessing the quality of athletic training services and practices and ultimately promote successful evidence-based athletic training practice.
Using Disablement Models and Clinical Outcomes Assessment to Enable Evidence-Based Athletic Training Practice, Part II: Clinical Outcomes Assessment
Authors: Valovich McLeod Tamara C. , Snyder Alison R. , Parsons John T. , Curtis Bay R. , Michener Lori A. , Sauers Eric L.
Published: December 2009

Objective:

To provide an overview of clinical outcomes assessment, discuss the classification of outcomes measures, present considerations for choosing outcomes scales, identify the importance of assessing clinical outcomes, and describe the critical link between the utilization of disablement models and clinical outcomes assessment.

Background:

Clinical outcomes are the end result of health care services. Clinical outcomes assessment is based on the conceptual framework of disablement models and serves as the measurement method for the collection of patient-oriented evidence, a concept central to evidence-based practice.

Description:

Clinical outcomes management refers to the use of outcomes measures in the course of routine clinical care and provides athletic trainers with a mechanism to assess treatment progress and to measure the end results of the services they provide. Outcomes measures can be classified as either clinician based or patient based. Clinician-based measures, such as range of motion and strength, are taken directly by clinicians. Patient-based measures solicit a patient's perception as to health status in the form of questionnaires and survey scales. Clinician-based measures may assist with patient evaluation, but patient-based measures should always be included in clinical assessment to identify what is important to the patient.

Clinical and Research Advantages:

Evidence-based athletic training practice depends on clinical outcomes research to provide the foundation of patient-oriented evidence. The widespread use of clinical outcomes assessment, based on the disablement model framework, will be necessary for athletic trainers to demonstrate the effectiveness of therapies and interventions, the provision of patient-centered care, and the development of evidence-based practice guidelines.
Reliability Limits Of The Modified Thomas Test For Assessing Rectus Femoris Muscle Flexibility About The Knee Joint
Authors: Peeler Jason D. , Anderson Judy E.
Published: December 2009

Context:

The modified Thomas test is commonly used in the clinical setting to assess flexibility about the thigh region.

Objective:

To evaluate the clinical reliability of the modified Thomas test for evaluating the flexibility of the rectus femoris muscle about the knee joint.

Design:

Descriptive laboratory study using a test-retest design.

Setting:

Institution-based clinical orthopaedic setting.

Patients Or Other Participants:

Fifty-seven individuals between the ages of 18 and 45 years with no history of trauma participated. Of those, 54 completed the study.

Intervention(s):

Three Board-certified athletic therapists with an average of 12.67 years of sport medicine expertise assessed rectus femoris flexibility using pass/fail and goniometer scoring systems. A retest session was completed 7 to 10 days later.

Main Outcome Measure(s):

Parametric and nonparametric tests were used to compare participants' test-retest results.

Results:

Chance-corrected κ values (intrarater x¯  =  0.40, 95% confidence interval [CI]  =  0.30, 0.54; interrater x¯  =  0.33, 95% CI  =  0.23, 0.41) indicated generally poor levels of reliability for pass/fail scoring. Intraclass correlation coefficient (ICC) values (intrarater x¯  =  0.67, 95% CI  =  0.55, 0.76; interrater x¯  =  0.50, 95% CI  =  0.40, 0.60) indicated fair to moderate levels of reliability for goniometer data. Measurement error values (standard error of measurement  =  7°, method error  =  6°, and coefficient of variation  =  13%) and Bland-Altman plots (with 95% limits of agreement) further demonstrated the degree of intrarater variance for each examiner when conducting the test.

Conclusions:

These results call into question the statistical reliability of the modified Thomas test and provide clinicians with important information regarding its reliability limits when used to clinically assess flexibility of the rectus femoris muscle about the knee joint in a physically active population. More research is needed to ascertain the variables that may confound the statistical reliability of this orthopaedic technique.
A Biomechanical Investigation of A Single-Limb Squat: Implications for Lower Extremity Rehabilitation Exercise
Authors: Richards Jim , Thewlis Dominic , Selfe James , Cunningham Andrew , Hayes Colin
Published: December 2009

Context:

Single-limb squats on a decline angle have been suggested as a rehabilitative intervention to target the knee extensors. Investigators, however, have presented very little empirical research in which they have documented the biomechanics of these exercises or have determined the optimum angle of decline used.

Objective:

To determine the involvement of the gastrocnemius and rectus femoris muscles and the external ankle and knee joint moments at 60° of knee flexion while performing a single-limb squat at different decline angles.

Design:

Participants acted as their own controls in a repeated-measures design.

Patients or Other Participants:

We recruited 10 participants who had no pain, injury, or neurologic disorder.

Intervention(s):

Participants performed single-limb squats at different decline angles.

Main Outcome Measure(s):

Angle-specific knee and ankle moments were calculated at 60° of knee flexion. Angle-specific electromyography (EMG) activity was calculated at 60° of knee flexion. Integrated EMG also was calculated to determine the level of muscle activity over the entire squat.

Results:

An increase was seen in the knee moments (P < .05) and integrated EMG in the rectus femoris (P < .001) as the decline angle increased. A decrease was seen in the ankle moments as the decline angle increased (P  =  .001), but EMG activity in the gastrocnemius increased between 16° and 24° (P  =  .018).

Conclusions:

As the decline angle increased, the knee extensor moment and EMG activity increased. As the decline angle increased, the ankle plantar-flexor moments decreased; however, an increase in the EMG activity was seen with the 24° decline angle compared with the 16° decline angle. This indicates that decline squats at an angle greater than 16° may not reduce passive calf tension, as was suggested previously, and may provide no mechanical advantage for the knee.
Explosive Strength Imbalances in Professional Basketball Players
Authors: Schiltz Marc , Lehance Cédric , Maquet Didier , Bury Thierry , Crielaard Jean-Michel , Croisier Jean-Louis
Published: December 2009

Context:

Despite the high rate of lower limb injuries in basketball players, studies of the dominant-limb effect in elite athletes often neglect injury history.

Objective:

To determine lower limb explosive-strength asymmetries in professional basketball players compared with junior basketball players and control participants.

Design:

Cohort study.

Setting:

Academic medical institution.

Patients or Other Participants:

15 professional basketball players, 10 junior basketball players, and 20 healthy men.

Main Outcome Measure(s):

We performed an isokinetic examination to evaluate the knee extensor (Ext) and flexor (Fl) concentric peak torque at 60°·s−1 and 240°·s−1 and (Fl only) eccentric peak torque at 30°·s−1 and 120°·s−1. Functional evaluation included countermovement jump, countermovement jump with arms, 10-m sprint, single-leg drop jump, and single-leg, 10-second continuous jumping. Variables were compared among groups using analysis of variance or a generalized linear mixed model for bilateral variables.

Results:

The 2 groups of basketball players demonstrated better isokinetic and functional performances than the control group did. No differences in functional or relative isokinetic variables were noted between professional and junior basketball players. Professional players with a history of knee injury failed to reach normal knee extensor strength at 60°·s−1. Knee Ext (60°·s−1) and Fl (eccentric 120°·s−1) torque values as well as 10-second continuous jumping scores were higher in those professional players without a history of knee injury than those with such a history. Compared with the group without a history of knee injury, the group with a history of knee injury maintained leg asymmetry ratios greater than 10% for almost all isokinetic variables and more than 15% for unilateral functional variables.

Conclusions:

The relative isokinetic and functional performances of professional basketball players were similar to those of junior players, with no dominant-side effect. A history of knee injury in the professional athlete, however, was reflected in bilateral isokinetic and functional asymmetries and should be considered in future studies of explosive strength.
Application of Generalizability Theory in Estimating the Reliability of Ankle-Complex Laxity Measurement
Authors: Heitman Robert J. , Kovaleski John E. , Pugh Steven F.
Published: December 2009

Context:

Generalizability theory is an appropriate method for determining the reliability of measurements obtained across more than a single facet. In the clinical and research settings, ankle-complex laxity assessment may be performed using different examiners and multiple trials.

Objective:

To determine the reliability of ankle-complex laxity measurements across different examiners and multiple trials using generalizability theory.

Design:

Correlational study.

Setting:

Laboratory.

Patients or Other Participants:

Forty male university students without a history of ankle injury.

Main Outcome Measure(s):

Measures of right ankle-complex anteroposterior and inversion-eversion laxity were obtained by 2 examiners. Each examiner performed 2 anteroposterior trials, followed by 2 inversion-eversion trials for each ankle at 0° of ankle flexion. Using generalizability theory, we performed G study and D study analyses.

Results:

More measurement error was found for facets associated with examiner than with trial for both anteroposterior and inversion-eversion laxity. Inversion-eversion measurement was more reliable than anteroposterior laxity measurement. Although 1 examiner and 1 trial had acceptable reliability (G coefficient ≥ .848), increasing the number of examiners increased reliability to a greater extent than did increasing the number of trials.

Conclusions:

Within the range of examiner and trial facets studied, any combination of examiners or trials (or both) above 1 can change ankle laxity measurement reliability from acceptable (1 examiner, 1 trial) to highly reliable (3 examiners, 3 trials). Individuals may respond to examiners and their procedural nuances differently; thus, standardized procedures are important.