bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship Between Wearing Incorrectly Sized Shoes and Foot Dimensions, Foot Pain, and Diabetes
Authors: de Castro Alessandra Paiva , Rebelatto José Rubens , Aurichio Thaís Rabiatti 
Published: August 2016

Context:Wearing inappropriate shoes can cause biomechanical imbalance, foot problems, and pain and induce falls.Objective:To verify the prevalence of wearing incorrectly sized shoes and the relationship between incorrectly sized shoes and foot dimensions, pain, and diabetes among older adults.Design:A cross-sectional study.Participants:399 older adults (227 women and 172 men) age 60 to 90 y.Main Outcome Measures:The participants were asked about the presence of diabetes, pain in the lower limbs and back, and pain when wearing shoes. Foot evaluations comprised the variables of width, perimeter, height, length, first metatarsophalangeal angle, the Arch Index, and the Foot Posture Index. The data analysis was performed using a 2-sample t test and chi-square test.Results:The percentage of the participants wearing shoe sizes bigger than their foot length was 48.5% for the women and 69.2% for the men. Only 1 man was wearing a shoe size smaller than his foot length. The older adults wearing the incorrect shoe size presented larger values for foot width, perimeter, and height than those wearing the correct size, but there were no significant differences between the groups with respect to the Arch Index and the Foot Posture Index. Incorrectly sized shoes were associated with ankle pain in women but not with diabetes. Men were more likely to wear incorrectly fitting shoes. The use of correctly sized shoes was associated with back pain in women.Conclusions:The use of incorrectly sized shoes was highly prevalent in the population studied and was associated with larger values for foot width, perimeter, and height and with ankle pain.
Effects of Saddle Height, Pedaling Cadence, and Workload on Joint Kinetics and Kinematics During Cycling
Authors: Bini Rodrigo R. , Tamborindeguy Aline C. , Mota Carlos B. 
Published: August 2016

Context:It is not clear how noncyclists control joint power and kinematics in different mechanical setups (saddle height, workload, and pedaling cadence). Joint mechanical work contribution and kinematics analysis could improve our comprehension of the coordinative pattern of noncyclists and provide evidence for bicycle setup to prevent injury.Objective:To compare joint mechanical work distribution and kinematics at different saddle heights, workloads, and pedaling cadences.Design:Quantitative experimental research based on repeated measures.Setting:Research laboratory.patients:9 healthy male participants 22 to 36 years old without competitive cycling experience.Intervention:Cycling on an ergometer in the following setups: 3 saddle heights (reference, 100% of trochanteric height; high, + 3 cm; and low, − 3 cm), 2 pedaling cadences (40 and 70 rpm), and 3 workloads (0, 5, and 10 N of braking force).Main Outcome Measures:Joint kinematics, joint mechanical work, and mechanical work contribution of the joints.Results:There was an increased contribution of the ankle joint (P = .04) to the total mechanical work with increasing saddle height (from low to high) and pedaling cadence (from 40 to 70 rpm, P < .01). Knee work contribution increased when saddle height was changed from high to low (P < .01). Ankle-, knee-, and hip-joint kinematics were affected by saddle height changes (P < .01).Conclusions:At the high saddle position it could be inferred that the ankle joint compensated for the reduced knee-joint work contribution, which was probably effective for minimizing soft-tissue damage in the knee joint (eg, anterior cruciate ligament and patellofemoral cartilage). The increase in ankle work contribution and changes in joint kinematics associated with changes in pedaling cadence have been suggested to indicate poor pedaling-movement skill.
Progression of Secondary Injury After Musculoskeletal Trauma—A Window of Opportunity?
Authors: Merrick Mark A. , McBrier Nicole M. 
Published: August 2016

Context:Acute musculoskeletal-injury management largely focuses on inhibiting secondary injury, although the data describing secondary injury and the timeline for its progression are sparse.Objective:To describe the timeline and early progression of secondary injury in skeletal muscle over the first 5 h after blunt trauma.Design:A controlled laboratory study with 2 independent variables (injury status and postinjury time point) in a 2 × 21 factorial.Setting:University research laboratory.Subjects:168 male Sprague Dawley rats (250 to 275 g).Interventions:Uniform blunt-contusion injury was caused to the right triceps surae using a drop-weight method; the contralateral limb served as an uninjured control. Both triceps surae were excised and flash frozen at 21 intervals across 5 h postinjury (8 animals, each 15 min).Main Outcome Measures:Cytochrome-c oxidase activity via reduction of triphenyltetrazolium chloride (TTC) to triphenyl-formazan.Results:There was an interaction effect (P = .041) between and main effects for both injury status (P < .0005) and postinjury time point (P = .038). In the first 30 min after injury, uninjured tissues did not differ from injured tissues, and both displayed TTC reduction rates in the vicinity of 7.1 ± 0.94 μg · mg−1 · h−1. Statistical differences between uninjured and injured tissues became evident starting at 30 min. TTC reduction for uninjured tissues did not change, but injured tissues declined in a roughly linear fashion across the entire 5-h period to 4.8 ± 1.04 μg · mg−1 · h−1.Conclusions:Cytochrome-c oxidase activity, an indicator of oxidative phosphorylation and mitochondrial viability, is diminished by events that follow muscle trauma. Loss of this enzymatic activity becomes statistically evident at 30 min postinjury and continues linearly for at least 5 h. This suggests that secondary injury is a slowly developing problem of more than 5 h duration. A window of opportunity for intervention may lie somewhere within the first 30 min after injury.
Responsiveness of the Numeric Pain Rating Scale in Patients With Shoulder Pain and the Effect of Surgical Status
Authors: Michener Lori A. , Snyder Alison R. , Leggin Brian G. 
Published: August 2016

Context:The Numeric Pain Rating Scale (NPRS) is commonly used to assess pain. Change in the NPRS across time can be interpreted with responsiveness indices.Objective:To determine the minimal clinically important difference (MCID) of the NPRS.Design:Single-group repeated measures.Setting:Outpatient rehabilitation clinics.Patients:Patients with shoulder pain (N = 136).Main Outcome Measures:At the initial evaluation patients completed the Penn Shoulder Score (PSS), which includes pain, satisfaction, and function sections. Pain was measured using an 11-point NPRS for 3 conditions of pain: at rest, with normal daily activities, and with strenuous activities. The NPRS average was calculated by averaging the NPRS scores for 3 conditions of pain. The final PSS was completed after 3–4 wk of rehabilitation. To determine the MCID for the NPRS average, the minimal detectible change of 8.6 points for the PSS function scale (0–60 points) was used as an external criterion anchor to classify patients as meaningfully improved (≥8.6 point change) or not improved (<8.6-point change). The MCID for the NPRS average was also determined for subgroups of surgical and nonsurgical patients. Cohen’s effect sizes were calculated as a measure of group responsiveness for the NPRS average.Results:Using a receiver-operating-characteristic analysis, the MCID for the average NPRS for all patients was 2.17, and it was 2.17 for both the surgical and nonsurgical subgroup: area-under-the-curve range .74–.76 (95%CI: .55–.95). The effect size for all patients was 1.84, and it was 1.51 and 1.94 for the surgical and nonsurgical groups, respectively.Conclusions:The NPRS average of 3 pain questions demonstrated responsiveness with an MCID of 2.17 in patients with shoulder pain receiving rehabilitation for 3–4 wk. The effect sizes indicated a large effect. However, responsiveness values are not static. Further research is indicated to assess responsiveness of the NPRS average in different types of patients with shoulder pain.
Clinical Assessment of Upper Extremity Injury Outcomes
Authors: Thigpen Charles , Shanley Ellen 
Published: August 2016

Patient Scenario:The patient presented is a high school baseball pitcher who was unable to throw because of shoulder pain. He subsequently failed nonoperative management but was able to return to pitching after surgery and successful rehabilitation.Clinical Outcomes Assessment:The Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PENN) were selected as clinical outcome assessment tools to quantify the patient’s perceived ability to perform common daily tasks and sport tasks and current symptoms such as pain and patient satisfaction.Clinical Decision Making:The DASH and PENN provide important information that can be used to target specific interventions, set appropriate patient goals, assess between-sessions changes in patient status, and quantify patients’ functional loss.Clinical Bottom Line:Best clinical practice involves the use of clinical outcome assessment tools to garner an objective measure of the impact of a patient’s disease process on functional expectations. This process should facilitate a patient-centered approach by clinicians while they select the optimal intervention strategies and establish prognostic timelines.
Clinical Assessment of Low-Back-Pain Treatment Outcomes in Athletes
Authors: Vela Luzita I. , Haladay Douglas E. , Denegar Craig 
Published: August 2016

Patient Scenario:A 21-year-old male rodeo athlete complains of acute low back pain (LBP) after a bareback event. The athlete wishes to compete in a rodeo event in 4 d.Clinical Outcomes Assessment:Given the questionable validity and reliability of traditional clinical examination techniques for LBP, a treatment subgroup classification system combined with clinical outcomes assessment provides greater insight into suitable clinical interventions and patient response to treatment. Four LBP treatment subgroups based on the patient’s clinical presentation and symptoms have been established: manipulation, stabilization, specific exercise, and traction. Manipulation subgroup research has produced a valid clinical prediction rule (CPR). The Visual Analog Scale, Numeric Rating Scale (NRS), Oswestry Low Back Pain Disability Index (ODI), Roland Morris Disability Questionnaire, Short Form 36 (SF-36), and Global Rating of Change Scale are valid, reliable, and responsive outcomes instruments with established values for minimum clinically important difference (MCID). These instruments document important changes in disablement and health-related quality of life in patients with low back injury, as well as demonstrate treatment outcomes.Clinical Decision Making:On examination the athlete presents with moderate pain and disability as measured by the NRS, ODI, and SF-36 and meets all 5 criteria for the manipulation subgroup, indicating a high likelihood of success with manipulative therapy when following the guidelines presented in the CPR. Expected outcomes values, based on MCID values, were met after 1 treatment. Preferred outcomes, based on physical activity requirements for sport, were met on day 4.Clinical Bottom Line:LBP generators are difficult to establish using traditional clinical examination techniques. The combined use of clinical criteria, using an LBP subgroup system, and baseline outcomes measures should guide treatment. Benchmarks should be guided by established MCID values for each instrument.
Clinical Assessment of Ankle Injury Outcomes: Case Scenario Using the Foot and Ankle Ability Measure
Authors: Cosby Nicole L. , Hertel Jay 
Published: August 2016

Patient Scenario:A 20-y-old male Division 1 college basketball player sustained a grade 2 inversion ankle sprain during preseason that is preventing him from practicing and competing.Clinical Outcomes Assessment:The Foot and Ankle Ability Measure (FAAM) was administered to the injured athlete as an evaluative tool to provide the clinician with valuable subjective information on the patient’s self-reported function. The FAAM consists of 2 subscales: the activities of daily living (ADL) subscale and the sports subscale. Together the 2 subscales contain 29 questions (21 questions on the ADL and 8 on the sports subscale), which assess self-reported function and disability in the foot and ankle.Clinical Decision Making:The addition of the self-reported functional measures provides the clinician with more quantitative data to make clinical decisions than is possible with typical clinical exams. Self-reported functional assessments should not replace thorough clinical examination or sound clinical judgment; instead they should be an adjunct to them.Clinical Bottom Line:In addition to our objective assessment tools, the FAAM provides clinicians with a tool that can be used to assess function and disability through our patients’ self-reported responses. When used for evaluative purposes the FAAM can measure an individual’s changes in function and disability over time.
Validation of the Short Form-36 Health Survey Supported With Isokinetic Strength Testing After Sport Knee Injury
Authors: Marn-Vukadinovic Dusa , Jamnik Helena 
Published: August 2016

Context:Valid patient-based outcome instruments are necessary for comprehensive patient care that focuses on all aspects of health, from impairments to participation restrictions.Objective:To validate the Slovenian translation of Medical Outcome Survey (MOS) Short Form Health Survey (SF-36) and to assess relations among various knee measurements, activity tested with Oxford Knee Score (OKS) and health-related quality of life as estimated with SF-36 domains.Design:Descriptive validation study.Setting:Isokinetic laboratory in outpatient rehabilitation unit.Participants:101 subjects after unilateral sport knee injury.Interventions:All subjects completed the SF-36 and OKS, and isokinetic knee-muscle strength output at 60°/s was determined in 78 participants. Within a 3-d period, 43 subjects completed the SF-36 and OKS questionnaires again.Main Outcome Measures:Reliability testing included internal consistency and test–retest reliability. Correlations between SF-36 subscales and OKS were calculated to assess construct validity, and correlation between SF-36 subscales and muscle strength was calculated to assess concurrent validity.Results:Chronbach α was above .78 for all SF-36 subscales. ICCs ranged from .80 to .93. The correlation between OKS and the physical-functioning subscale, showing convergent construct validity, was higher (r = .83, P < .01) than between OKS and mental health (r = .50, P < .01), showing divergent construct validity. Knee-extensor weakness negatively correlated with physical-functioning (r = −.59, P < .01) and social-functioning (r = −.43, P < .01) subscales.Conclusions:The Slovenian translation of the SF-36 is a reliable and valuable tool. The relationships between knee-muscle strength and activity and between knee-muscle strength and SF-36 subscales in patients after sport knee injury were established.
The Effects of Anthropometric Scaling Parameters on Normalized Muscle Strength in Uninjured Baseball Pitchers
Authors: Hurd Wendy J. , Morrey Bernard F. , Kaufman Kenton R. 
Published: August 2016

Context:Muscle force must be normalized for between-subjects comparisons of strength to be valid. The most effective method for normalizing muscle strength has not, however, been systematically evaluated.Objective:To evaluate the effects of normalizing muscle strength using a spectrum of anthropometric parameters.Design:Cross-sectional.Setting:Laboratory.Participants:50 uninjured high-school-age baseball pitchers.Interventions:Shoulder-rotation strength was tested at 0° and 90° abduction with a handheld dynamometer. Muscle force was normalized to parameters including subject height, weight, height × weight, body-mass index (BMI), forearm length, and forearm length × height.Outcome Measures:Statistical analysis included evaluating the coefficient of variation, skewness, and kurtosis of the nonnormalized and normalized muscle force. The most effective normalization method was determined based on the scaling factor that yielded the lowest variability for the data set and promoted the most normal distribution of the data set.Results:Using body weight to scale muscle force was the most effective anthropometric parameter for normalizing strength values based on the group of statistical measures of variability. BMI, height × weight, and forearm length × weight as scaling factors also yielded less variable values for muscle strength compared with nonnormalized strength, but less consistently than body weight. Height and forearm length were least effective in reducing the variability of the data set relative to nonnormalized muscle force.Conclusion:This study provides objective support for scaling muscle strength to subject body weight. This approach to normalizing muscle strength uses methods readily accessible to clinicians and researchers and may facilitate the identification of differences in strength between individuals with diverse physical characteristics.
Measurement of Ankle Dorsiflexion: A Comparison of Active and Passive Techniques in Multiple Positions
Authors: Krause David A. , Cloud Beth A. , Forster Lindsey A. , Schrank Jennifer A. , Hollman John H. 
Published: August 2016

Context:Limited ankle DF (DF) range of motion (ROM) resulting from restricted gastrocnemius and soleus mobility is associated with a variety of lower extremity pathologies. Several techniques are used clinically to measure ankle DF.Objectives:To evaluate the reliability and minimal detectable change of DF ROM measurement, determine whether there is a difference in measured DF between techniques, and quantify the electromyographic (EMG) activity of the soleus and tibialis anterior muscles associated with the techniques.Design:Repeated measures.Setting:Controlled laboratory setting.Participants:39 healthy subjects, age 22–33.Main Outcome Measures:DF measurements using 5 different techniques including active and passive DF with the knee extended and flexed to 90° and a modified lunge. EMG activity of the soleus and anterior tibialis muscles.Results:Intrarater reliability values (ICC3,1) ranged from .68 to .89. Interrater reliability (ICC2,1) ranged from .55 to .82. ICCs were the greatest with the modified lunge. The minimal detectable change (MDC95) ranged from 6° to 8° among the different techniques. A significant difference in DF ROM was found between all methods. Measurements taken with active DF were greater than the same measures taken passively. The lunge position resulted in greater DF ROM than both active and passive techniques. EMG activity of the soleus was greater with active DF and the lunge than with passive DF.Conclusions:The modified lunge, which demonstrated excellent intrarater and interrater reliability, may best represent maximal DF. Active end-range DF was significantly greater than passive end-range DF when measured at either 0° or 90° knee flexion. Greater active DF was not explained by inhibition of the soleus. Finally, using the modified lunge, a difference between 2 measurements over time of 6° or more suggests that a meaningful change has occurred.
Fatigue’s Effect on Eversion Force Sense in Individuals With and Without Functional Ankle Instability
Authors: Wright Cynthia J. , Arnold Brent L. 
Published: August 2016

Context:Force sense (FS), the proprioceptive ability to detect muscle-force generation, has been shown to be impaired in individuals with functional ankle instability (FAI). Fatigue can also impair FS in healthy individuals, but it is unknown how fatigue affects FS in individuals with FAI.Objective:To assess the effect of fatigue on ankle-eversion force-sense error in individuals with and without FAI. Design: Case control with repeated measures.Setting:Sports medicine research laboratory.Participants:32 individuals with FAI and 32 individuals with no ankle sprains or instability in their lifetime. FAI subjects had a history of ≥1 lateral ankle sprain and giving-way ≥1 episode per month.Interventions:Three eversion FS trials were captured per load (10% and 30% of maximal voluntary isometric contraction) using a load cell before and after a concentric eversion fatigue protocol.Main Outcome Measures:Trial error was the difference between the target and reproduction forces. Constant error (CE), absolute error (AE), and variable error (VE) were calculated from 3 trial errors. A Group × Fatigue × Load repeated-measures ANOVA was performed for each error.Results:There were no significant 3-way interactions or 2-way interactions involving group (all P > .05). CE and AE had a significant 2-way interaction between load and fatigue (CE: F1,62 = 8.704, P = .004; AE: F1,62 = 4.024, P = .049), and VE had a significant main effect for fatigue (F1,62 = 5.130, P = .027), all of which indicated increased FS error with fatigue at 10% load. However, at 30% load only VE increased with fatigue. The FAI group had greater error as measured by AE (F1,62 = 4.571, P = .036) but not CE or VE (P > .05).Conclusions:Greater AE indicates that FAI individuals are less accurate in their force production. Fatigue impaired force sense in all subjects equally. These deficits provide evidence of impaired proprioception with fatigue and in individuals with FAI.
Effect of Limiting Ankle-Dorsiflexion Range of Motion on Lower Extremity Kinematics and Muscle-Activation Patterns During a Squat
Authors: Macrum Elisabeth , Bell David Robert , Boling Michelle , Lewek Michael , Padua Darin 
Published: August 2016

Context:Limitations in gastrocnemius/soleus flexibility that restrict ankle dorsiflexion during dynamic tasks have been reported in individuals with patellofemoral pain (PFP) and are theorized to play a role in its development.Objective:To determine the effect of restricted ankle-dorsiflexion range of motion (ROM) on lower extremity kinematics and muscle activity (EMG) during a squat. The authors hypothesized that restricted ankle-dorsiflexion ROM would alter knee kinematics and lower extremity EMG during a squat.Design:Cross-sectional.Participants:30 healthy, recreationally active individuals without a history of lower extremity injury.Interventions:Each participant performed 7 trials of a double-leg squat under 2 conditions: a nowedge condition (NW) with the foot flat on the floor and a wedge condition (W) with a 12° forefoot angle to simulate reduced plantar-flexor flexibility.Main Outcome Measures:3-dimensional hip and knee kinematics, medial knee displacement (MKD), and ankle-dorsiflexion angle. EMG of vastus medialis oblique (VMO), vastus lateralis (VL), lateral gastrocnemius (LG), and soleus (SOL). One-way repeated-measures ANOVAs were performed to determine differences between the W and NW conditions.Results:Compared with the NW condition, the wedge produced decreased peak knee flexion (P < .001, effect size [ES] = 0.81) and knee-flexion excursion (P < .001, ES = 0.82) while producing increased peak ankle dorsiflexion (P = .006, ES = 0.31), ankle-dorsiflexion excursion (P < .001, ES = 0.31), peak knee-valgus angle (P = .02, ES = 0.21), and MKD (P < .001, ES = 2.92). During the W condition, VL (P = 0.002, ES = 0.33) and VMO (P = .049, ES = 0.20) activity decreased while soleus activity increased (P = .03, ES = 0.64) compared with the NW condition. No changes were seen in hip kinematics (P > .05).Conclusions:Altering ankle-dorsiflexion starting position during a double-leg squat resulted in increased knee valgus and MKD, as well as decreased quadriceps activation and increased soleus activation. These changes are similar to those seen in people with PFP.