bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

AbstractContext: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 &lt; .05) and integrated EMG in the rectus femoris (P &lt; .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

Abstract

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

AbstractContext: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.
Concentric and Eccentric Torque of the Hip Musculature in Individuals With and Without Patellofemoral Pain
Authors: Boling Michelle C. , Padua Darin A. , Alexander Creighton R. 
Published: December 2009

AbstractContext:Individuals suffering from patellofemoral pain have previously been reported to have decreased isometric strength of the hip musculature; however, no researchers have investigated concentric and eccentric torque of the hip musculature in individuals with patellofemoral pain.Objective:To compare concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain.Design:Case control.Setting:Research laboratory.Patients or Other Participants:Twenty participants with patellofemoral pain (age  =  26.8 ± 4.5 years, height  =  171.8 ± 8.4 cm, mass  =  72.4 ± 16.8 kg) and 20 control participants (age  =  25.6 ± 2.8 years, height  =  169.5 ± 8.9 cm, mass  =  70.0 ± 16.9 kg) were tested. Volunteers with patellofemoral pain met the following criteria: knee pain greater than or equal to 3 cm on a 10-cm visual analog scale, insidious onset of symptoms not related to trauma, pain with palpation of the patellar facets, and knee pain during 2 of the following activities: stair climbing, jumping or running, squatting, kneeling, or prolonged sitting. Control participants were excluded if they had a prior history of patellofemoral pain, knee surgery in the past 2 years, or current lower extremity injury that limited participation in physical activity.Intervention(s):Concentric and eccentric torque of the hip musculature was measured on an isokinetic dynamometer. All volunteers performed 5 repetitions of each strength test. Separate multivariate analyses of variance were performed to compare concentric and eccentric torque of the hip extensors, abductors, and external rotators between groups.Main Outcome Measure(s):Average and peak concentric and eccentric torque of the hip extensors, abductors, and external rotators. Torque measures were normalized to the participant's body weight multiplied by height.Results:The patellofemoral pain group was weaker than the control group for peak eccentric hip abduction torque (F1,38  =  6.630, P  =  .014), and average concentric (F1,38  =  4.156, P  =  .048) and eccentric (F1,38  =  4.963, P  =  .032) hip external rotation torque.Conclusions:The patellofemoral pain group displayed weakness in eccentric hip abduction and hip external rotation, which may allow for increased hip adduction and internal rotation during functional movements.
Unique Treatment Regimen for Effort Thrombosis in the Nondominant Extremity of an Overhead Athlete: A Case Report
Authors: Snead Dale , Marberry Kevin M. , Rowdon Greg 
Published: December 2009

Abstract

Objective:
To advise athletic trainers on the potential for effort thrombosis to occur in nonthrowing athletes and to underscore the importance of early recognition and treatment.

Background:
An 18-year-old offensive lineman presented with a 1-day history of diffuse shoulder pain with no specific history of injury; swelling and erythema involved the entire left upper extremity. He was immediately referred to the team physician, who suspected deep vein thrombosis and sent the athlete to an imaging center. Duplex ultrasound was obtained on the day of presentation, and he was admitted to the hospital that evening.

Differential Diagnosis:
Deep vein thrombosis, thoracic outlet syndrome, shoulder tendinitis.

Treatment:
Anticoagulation with heparin was administered at the hospital, and he was sent home the next day on subcutaneous enoxaparin sodium, followed by a 5-mg daily dose of oral warfarin sodium. Oral anticoagulants were continued for a total of 4 weeks. The athlete began upper body lifting and was released 5 weeks postinjury to gradually return to football without restrictions.

Uniqueness:
Effort thrombosis is typically seen in the dominant arm of athletes, and the current treatment protocol calls for thrombolysis or surgical intervention. This athlete, whose position required repeated elevation of his arms in forward flexion, sustained the injury in his nondominant arm, was treated with anticoagulation only, and had a full return to football. At 18-month follow-up, he had no recurrence of symptoms.

Conclusions:
Early recognition and treatment of athletes with effort thrombosis is paramount to a successful clinical outcome and prompt return to play.
Comparisons of Cubed Ice, Crushed Ice, and Wetted Ice on Intramuscular and Surface Temperature Changes
Authors: Dykstra Joseph H. , Hill Holly M. , Miller Michael G. , Cheatham Christopher C. , Michael Timothy J. , Baker Robert J. 
Published: December 2009

Abstract

Context:
Many researchers have investigated the effectiveness of different types of cold application, including cold whirlpools, ice packs, and chemical packs. However, few have investigated the effectiveness of different types of ice used in ice packs, even though ice is one of the most common forms of cold application.

Objective:
To evaluate and compare the cooling effectiveness of ice packs made with cubed, crushed, and wetted ice on intramuscular and skin surface temperatures.

Design:
Repeated-measures counterbalanced design.

Setting:
Human performance research laboratory.

Patients or Other Participants:
Twelve healthy participants (6 men, 6 women) with no history of musculoskeletal disease and no known preexisting inflammatory conditions or recent orthopaedic injuries to the lower extremities.

Intervention(s):
Ice packs made with cubed, crushed, or wetted ice were applied to a standardized area on the posterior aspect of the right gastrocnemius for 20 minutes. Each participant was given separate ice pack treatments, with at least 4 days between treatment sessions.

Main Outcome Measure(s):
Cutaneous and intramuscular (2 cm plus one-half skinfold measurement) temperatures of the right gastrocnemius were measured every 30 seconds during a 20-minute baseline period, a 20-minute treatment period, and a 120-minute recovery period.

Results:
Differences were observed among all treatments. Compared with the crushed-ice treatment, the cubed-ice and wetted-ice treatments produced lower surface and intramuscular temperatures. Wetted ice produced the greatest overall temperature change during treatment and recovery, and crushed ice produced the smallest change.

Conclusions:
As administered in our protocol, wetted ice was superior to cubed or crushed ice at reducing surface temperatures, whereas both cubed ice and wetted ice were superior to crushed ice at reducing intramuscular temperatures.
A Clinical Method for Identifying Scapular Dyskinesis, Part 1: Reliability
Authors: McClure Philip , Tate Angela R. , Kareha Stephen , Irwin Dominic , Zlupko Erica 
Published: December 2009

AbstractContext:Shoulder injuries are common in athletes involved in overhead sports, and scapular dyskinesis is believed to be one causative factor in these injuries. Many authors assert that abnormal scapular motion, so-called dyskinesis, is related to shoulder injury, but evidence from 3-dimensional measurement studies regarding this relationship is mixed. Reliable and valid clinical methods for detecting scapular dyskinesis are lacking.Objective:To determine the interrater reliability of a new test designed to detect abnormal scapular motion.Design:Correlation design using ratings from multiple pairs of testers.Setting:University athletic training facilities.Patients or Other Participants:A sample of 142 athletes (from National Collegiate Athletic Association Divisions I and III) participating in sports requiring intense overhead arm use.Intervention(s):Participants were videotaped from the posterior aspect while performing 5 repetitions of bilateral, weighted (1.4-kg [3-lb] or 2.3-kg [5-lb]) shoulder flexion and frontal-plane abduction. Videotapes from randomly chosen participants were subsequently viewed and independently rated for the presence of scapular dyskinesis by 6 raters (3 pairs), with each pair rating 30 different participants. Raters were trained to detect scapular dyskinesis using a self-instructional format with standardized operational definitions and videotaped examples of normal and abnormal motion.Main Outcome Measure(s):Scapular dyskinesis was defined as the presence of either winging or dysrhythmia. Right and left sides were rated independently as normal, subtle, or obvious dyskinesis. We calculated percentage of agreement and weighted kappa (κw) coefficients to determine reliability.Results:Percentage of agreement was between 75% and 82%, and κw ranged from 0.48 to 0.61.Conclusions:The test for scapular dyskinesis showed satisfactory reliability for clinical use in a sample of overhead athletes known to be at increased risk for shoulder symptoms.