bluuebunny/crossref_metadata_2025_split huggingface dataset:
Positive Parenting Program to Promote Child Development Among Children 1 to 3 Years Old: A Quasi-Experimental Research
Authors: Viet Truong Hoang , Nanthamongkolchai Sutham , Munsawaengsub Chokchai , Pitikultang Supachai 
Published: May 2022

Introduction: Child development receives lack of concern and the role of parents in promoting child development is not frequently mentioned in Vietnam. This study aimed to examine the effectiveness of Positive Parenting Program to Promote Child Development on maternal knowledge and practice and development of children aged 1 to 3 years. Methods: This is a quasi-experimental study conducted in Nha Trang city, Vietnam. There are a total of 60 mothers whose children were identified as suspected developmental delayed participated in the study. There were 30 mothers who attended the program as experimental group and 30 mothers who joined the study as comparison group. Ages and Stages Questionnaires, Third Edition (ASQ-3) were applied to assess the child development. Descriptive analysis and paired and independent-samples t-test were applied to examine the research objectives. Results: The findings suggested that after the program implementation, the maternal knowledge of child development and child development of the experimental group were significantly higher than pre-program and the improvements of these variables were better than the comparison group ( P < .05) while the maternal practice to promote child development was significantly better only within the experimental group. Conclusions: The program was effective in improving several maternal outcomes and child development. The study recommends applying the Positive Parenting Program to Promote Child Development to enhance mother’s knowledge of child development and child development.
Understanding Who Uses Whole Health Services: A Program Evaluation
Authors: Mitzel Luke D. , Possemato Kyle , Smith Allyson R. , Seifert Cheryl A. , Ramon Abigail E. , Grewal Harminder 
Published: May 2022

Background The Veterans Health Administration is rolling out a Whole Health system of care as part of an enhanced focus on proactive, person-centered healthcare. Objective Our program evaluation seeks to characterize what Veterans use Whole Health services, for what diagnoses they are seeking Whole Health services, and to examine “high utilizers” of Whole Health services. Methods Data were collected on 174 Veterans using Whole Health services from December 2018 through March 2020 and consisted of chart review and self-report data. Results Women were more likely than men Veterans to use individual only Whole Health services. High utilizers (the top 30% of the sample in Whole Health services used) were more likely to attend groups than the remainder of the sample. Conclusion Future work should examine the community-building aspects of Whole Health and ways to create group programming tailored to women Veterans.
Psychological Readiness to Return to Sport at 6 Months is Higher After Bridge-Enhanced ACL Repair than Autograft ACL Reconstruction
Authors: Sanborn Ryan M. , Badger Gary J. ,   *The BEAR Trial Team, Yen Yi-Meng , Murray Martha M. , Christino Melissa A. ,   *The BEAR Trial Team: Benedikt Proffen, Sant Nicholas , Barnett Samuel , Fleming Braden C. , Kramer Dennis E. , Micheli Lyle J. 
Published: May 2022

Background: Prior clinical studies have shown that psychological factors have a significant effect on an athlete’s readiness to return to sport following ACL reconstruction (ACLR). Hypothesis/Purpose: We hypothesized that patients who underwent Bridge-Enhanced ACL Repair (BEAR) would have higher levels of psychological readiness for return to sport compared to ACLR, and baseline characteristics and 6-month outcomes would predict psychological readiness at 6 months following an ACL surgical procedure. Methods: 100 patients (median age 17 years; median pre-operative Marx Activity Score 16) with complete mid-substance ACL injuries were randomized to either the BEAR procedure (n=65) or autograft ACLR (n=35) and underwent surgery within 45 days of injury. Objective, functional, and patient-reported outcomes, including the ACL-Return to Sport after Injury (ACL-RSI) scale, were assessed at 6 months, 12 months, and 24 months. Results: Patients who underwent the BEAR procedure had significantly higher ACL-RSI scores at 6 months compared to those that underwent an ACLR (71.1 vs 58.2, p=.008), and scores were similar at 12 months and 24 months. Baseline factors independently predictive of higher ACL-RSI scores at 6 months were having a BEAR procedure and participating in Level 1 sports prior to injury, which explained 15% of the variability in ACL-RSI scores. Regression analysis of baseline and 6-month outcomes as predictors indicated that the IKDC score at 6 months explained 45% of the 6-month ACL-RSI variance. Subsequent analysis, with IKDC excluded from the model, indicated that decreased pain, increased hamstring and quadriceps strength in the surgical limb, and decreased side-to-side difference in AP knee laxity were significant predictors of a higher ACL-RSI score at 6 months, explaining 34% of the variability in ACL-RSI scores. Higher ACL-RSI scores at 6 months were associated with earlier clearance to return to sports. Conclusion: Patients who underwent the BEAR procedure had higher ACL-RSI scores at 6 months after surgery. Better ACL-RSI scores at 6 months were related most strongly to higher IKDC scores at 6 months. Lower pain levels, better muscle recovery, and less knee laxity at 6-months post-surgery were also associated with improved ACL-RSI scores at that time point.
Biomarkers of Knee Joint Healing in Adolescents Following Anterior Cruciate Ligament Reconstruction: A Systematic Review
Authors: Ek Orloff Lisa E. , Del Bel Michael J. , Romanchuk Nicholas J. , Carsen Sasha , Imbeault Pascal , Benoit Daniel L. 
Published: May 2022

Background: Anterior cruciate ligament (ACL) injuries are increasing in prevalence by 2.3% annually in adolescents and have been linked to an increased risk for early-onset knee osteoarthritis (OA). Current ACL rehabilitation guidelines do not directly account for the physiological healing process of the knee joint. Instead, the sole focus is on a patients’ perceived function and their ability to meet functional benchmarks in the lower extremities. The physiological healing process could provide prognostic insight for clinicians and physiotherapists when rehabilitating ACL-injured patients. Hypotheses/Purpose: The purpose of this systematic review was to identify existing literature to determine i) the most prevalent biomarkers for reflecting knee joint healing in patients after ACL reconstruction (ACLR), and ii) the quantity of these studies which include adolescents. Methods: Following PRISMA guidelines, Medline, Embase, SCOPUS and Web of Science databases were searched up until September 2020. Studies were included if they (1) included participants who had sustained a primary ACL injury and undergone a subsequent ACLR, and (2) measured at least one biomarker of knee joint healing at more than one time point. An NIH quality assessment tool was used to assess study quality. The following data were extracted: participant age; biological sample(s); biomarker(s) analyzed. Results: Seven studies met inclusion criteria for this systematic review (Table 1). Interleukin-6 (IL-6) and C-terminal crosslinking telopeptide of type II collagen (CTX-II) were the most prevalent biomarkers used in the literature (3/7 studies). These biomarkers reflected knee joint healing through consistent elevation and/or gradual decrease following ACLR. Six studies evaluated adult populations (age range; Table 1). One study (average age 19.6±4.5) evaluated the effect of age on biomarker levels of knee joint healing and showed a negative correlation between age and CTX-II concentrations (r=-.769, p < 0.001). Conclusions: This systematic review identified (i) seven studies which evaluated healing using biomarkers following ACLR, (ii) IL-6 and CTX-II were most commonly used, and (iii) there is little research evaluating the physiological healing of the knee joint in any cohorts, in particular adolescent patients following ACLR. Adolescents are unique from adults due to growth and sex hormone variation. Therefore, what little biomarker research completed in adults cannot simply be extrapolated to adolescents. In addition to existing biomechanical rehabilitation tasks, we propose that rehabilitation and return to activity assessment following ACLR in adolescents could be informed by the healing status of the knee, improving outcomes and reducing their risk of early-onset knee OA. [Table: see text]
Relationship Between Ankle Dorsiflexion Mobility and Functional Return to Sport Test Performance in Athletes Who Have Undergone ACL Reconstruction
Authors: Dabis Jessica B. , Ulman Sophia , Cooper Savannah , Kemper W. Craig , Zimmerhanzel David , Wilson Philip L. , Ellis Henry B. 
Published: May 2022

Background: Limited ankle dorsiflexion (DF) range has been associated with knee injuries and altered biomechanics during functional squatting and landing tasks. Prior studies correlating weight-bearing DF with altered landing mechanics have primarily used advanced motion capture technology, with limited research using clinically validated scoring tools. Hypothesis/Purpose: To assess the relationship between decreased DF and functional testing performance in youth athletes who have undergone anterior cruciate ligament reconstruction (ACLR). Methods: A retrospective review of standardized data was conducted on patients who had undergone ACLR at a pediatric sports medicine practice that had completed functional testing between December 2017 and November 2020. Patients with testing completed at a minimum of five months post-operatively, and who planned to return-to-sport (RTS) were included. Functional testing included validated protocols for the Y-Balance Test (YBT) and the Landing Error Scoring System (LESS), as well as a modified Single-Leg Squat Endurance Test (SLSET) utilizing the VAIL sports test scoring criteria. DF was measured in a weight-bearing lunge position off the front foot. Subjects were categorized into a pass or fail group based on their YBT and LESS scores (YBT≥94%, LESS≤4), and t-tests were performed to identify significant differences in DF between groups ( α=0.05). Lastly, Pearson correlations were performed to identify potential relationships between DF and SLSET total score as well as normalized anterior reach collected as a component of the YBT ( α=0.05). Results: 303 patients (148 (48.8%) males, 15.94±2.15 years, 7.46±2.11 months post-operative) were included for analysis. Significant correlations were identified between DF and YBT composite score ( p <0.001) and LESS total score ( p <0.001; Table 1). Additionally, positive relationships were found between DF and both SLSET total score ( p <0.001, r = 0.296) and anterior reach ( p <0.001; r =0.400). Average values for DF, YBT, and LESS can be found in Table 2. Conclusion: In this pediatric ACLR population, decreased ankle dorsiflexion is associated with high risk movement patterns during functional testing. This study adds to the literature by identifying clinically applicable DF thresholds associated with passing scores on the YBT and LESS functional tests. Clinical interventions aimed at improving ankle dorsiflexion to >36° may be an important component of ACL rehabilitation. [Table: see text][Table: see text]
Monitoring Recovery After Pediatric ACL Reconstruction Utilizing Promis
Authors: Block Andrew M. , Ganapathy Aravinda , Nepple Jeffrey J. 
Published: May 2022

Introduction: Anterior Cruciate Ligament Reconstruction (ACL-R) is increasingly common procedure performed in pediatric and adolescents. Patient-Reported Outcomes Measurements Information System (PROMIS) computer adaptive testing (CAT) has demonstrated to be a valid and reliable means to assess PROs in the pediatric population. Currently, all studies looking at the performance of PROMIS in the ACL-R population have utilized adult cohorts. Purpose: To characterize the recovery after pediatric ACL-R utilizing PROMIS including (1) changes in PROMIS domains during 1-year postoperative period and (2) to investigate if PROMIS scores can identify patients with early signs of arthrofibrosis at 6 weeks postoperatively and deficits in return to play testing at 6 months. Methods: Pediatric patients that underwent ACL-R were prospectively assessed with PROMIS at each clinical visit. PROMIS CAT domains included Mobility and Pain Interference. Inclusion criteria included patients <18 years old who underwent ACL-R with both pre-operative and >6 month PROMIS scores. Time points were as followed: baseline, 1 week, 1 month, 3 months, 6 months, and 1 year. Time points were compared utilizing a mixed-linear regression model. Significance was set at p<0.05. Early signs of arthrofibrosis were identified at 6 weeks postoperatively and defined as flexion less than 90° and lack of full extension greater than 5° regarding best values at physical therapy visits and/or office physical exam. Return to play was assessed via hop testing at 6 months postoperatively with deficits defined as greater than 10% compared to contralateral. Results: The study included 62 ACL-R with a mean age of 14.6±1.9 years. Patients demonstrated significant increases in Mobility and Pain Interference compared to pre-operative values by 3 months postoperatively and continued to significantly improve through 6 months (Figure 1 and 2). Significant improvements from 6 months to 1 year were not seen in either domain (all p>0.05). At 6 weeks postoperatively, 24% of patients had signs of early arthrofibrosis (none ultimately requiring surgical intervention). Significant differences in PROMIS Mobility (29.1 v. 35.1, p=0.001) were present between patients with and without early arthrofibrosis, while differences in Pain Interference were not significant (53.0 vs. 49.4, p=0.15). Patients with deficits on hop testing at return to play had lower PROMIS mobility (48.2 vs. 54.4, p=0.04) and higher PROMIS pain interference (38.9 vs. 33.8, p=0.02) than without deficits. Conclusions: PROMIS domains are easily obtained and demonstrate utility in monitoring pediatric patients after ACL-R including early signs of arthrofibrosis and deficits at return to play testing. [Figure: see text][Figure: see text]
A Return to Sport Test Battery does not Predict Second Injury After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes
Authors: Butler Lauren , Martinez Alexa , Gupta Apeksha , Hayden Kristin 
Published: May 2022

Background: There is mixed evidence on the effectiveness of return to sport test (RTST) batteries and their ability to predict second Anterior Cruciate Ligament (ACL) injury. The majority of tests in the literature include objective measures of strength, hop test distance, knee range of motion and laxity, and measures of psychological readiness to return. Few RTST batteries include movement quality assessments. Purpose: To determine the effectiveness of a RTST test battery, including qualitative movement assessments, to predict second ACL injury in adolescent athletes after primary Anterior Cruciate Ligament Reconstruction (ACLR). Methods: A retrospective chart review of 77 adolescent athletes who underwent primary ACLR between 2014 and 2018 (55 males, age at surgery 16 + 2 years, BMI 25 ± 5) was conducted. All athletes completed a RTST battery consisting of psychological assessment with the Tampa Scale of Kinesiophobia (TSK-11), lateral step down test (LSDT), Tuck jump assessment (TJA), single leg hop testing (SLHT) including the single, triple, and triple crossover hop for distance, and an evaluation of cutting performance. The LSDT, SLHT’s and cutting task were evaluated using a qualitative movement assessment checklist, which awarded a point for each movement fault identified. Athletes passed the RTST if they scored <19 on the TSK-11, <2 on the LSDT, <3 on all SLHT’s with a Limb Symmetry index > 95%, < 5 on the TJA and, < 2 on the cutting assessment. All variables were analyzed descriptively. For continuous variables, median and interquartile ranges (IQR) were reported and Wilcoxon rank sum test was used to assess the differences. For categorical variables, frequency and proportion were reported and chi-square or Fisher’s exact test was used to assess differences between “no second ACL injury” and “second ACL injury” groups. Results: Overall, 14.2% of athletes (N=11) suffered a second ACL injury (81.8% males). Median Tegner score in both groups was 7 (IQR: 7-9). Median time to RTS clearance was significantly different between the no second ACL injury and second ACL injury groups (10 [IQR: 8-12] vs 8[IQR:8-9] months; p=0.017). A total of 66.2% of athletes (N= 51) passed the RTST. Of those who suffered a second ACL injury, 63.6% passed the RTS. There was no statistically significant difference between those who passed the RTST and those that did not on the occurrence of second ACL injury. Conclusion: A RTST battery including qualitative movement assessments does not predict second ACL injury in adolescent athletes after ACLR.
Differences in the Course of Rehabilitation and Outcomes for Publicly Insured Pediatric Patients After Anterior Cruciate Ligament Reconstruction
Authors: Greenberg Elliot , Butler Lauren , Giampetruzzi Nicholas , Link Meredith , Prati Victor , Weaver Adam , Saper Michael 
Published: May 2022

Background: Previous research has demonstrated individuals with public insurance may encounter delays accessing care and experience different orthopedic management for musculoskeletal injuries. Rehabilitation after anterior cruciate ligament reconstruction (ACLR) is critical to optimize outcomes. The effect of insurance status on rehabilitation practice and patient outcomes among youth athletes has not been explored. Purpose: To examine the effect of insurance type (public vs private) on physical therapy (PT) visit utilization and outcomes within pediatric and adolescent patients after ACLR. Methods: This was a sub-analysis of a larger retrospective dataset of patients who underwent primary ACLR between 2013 and 2019 at 5 institutions. All patients followed a structured rehabilitation protocol as directed by the treating institution and completed a battery of return to sport (RTS) tests which included single-legged hop testing. PT visit frequency was assessed both overall and by time period (first 6 weeks, week 7-month 3, 3-6 months, and 6+ months). PT visits were recorded up until the time of last recorded hop test within 12 months post-surgery. The average number of visits attended per week during the observed time was calculated for each patient. The effect of insurance status on PT management was analyzed using T-tests. The effect of insurance status on the odds of passing hop tests was assessed using multivariable logistic regression with a random effect of site. Adjusted models controlled for time to test in months. An alpha level of p<0.05 was used to determine significance. Results: 281 (15.7 ± 1.9 years, 58% male) patients were included in this analysis. The groups were demographically similar, with 45.5% classified as having public insurance. (Table 2) Patients with public insurance experienced a longer delay from surgery to the time of hop test (8.3±2.2 vs 7.7±1.5 months, p=0.009) and had a lower number of PT visits per week (0.92±0.37 vs 1.04±0.38, p=0.005). Publicly insured subjects attended fewer PT visits from week 7-3 months (1.06±0.50 vs 1.26±0.52, p=0.001) and 3-6 months (0.88±0.45 vs 0.99±0.45, p=0.04). Insurance status had a statistically significant effect (p=0.01) on the odds of passing the single leg hop test (OR, 2.72; 95% CI, 1.27-5.81) and was nearly significant (p=0.06) for all hop tests (OR, 1.74; 95% CI, 0.98-3.07). Conclusion: Publicly insured youth athletes average a lower number of weekly PT visits, experienced a longer delay from surgery to hop test and were 2.7 times less likely to pass the single leg hop test. [Table: see text][Table: see text]
Using Machine Learning to Identify the Optimal Limb Symmetry Index Cut-Off Threshold in Paediatric Patients with ACL Injury
Authors: Romanchuk Nicholas J. , Bel Michael J. Del , Girard Celine I. , Flaxman Teresa , Carsen Sasha , Benoit Daniel L. 
Published: May 2022

Background: The risk for a subsequent ACL injury following a primary paediatric ACL reconstruction is extremely high, with 17-30% of paediatric patients sustaining a second ACL injury within two years. It is possible that this risk is associated with a lack of evidence for identifying return-to-activity (RTA) measures to guide postoperative decision-making. Limb symmetry indices (LSI) derived from functional and strength tasks are commonly used, however LSIs used by paediatric orthopaedic surgeons can range from 75-95%, with no objective evidence to support these values. Purpose: To create knowledge that could be used to inform RTA and to determine if a machine learning approach could objectively identify LSI thresholds from functional tasks that classify paediatric individuals as injured or healthy. Methods: Forty-two patients (30 females) who had suffered an ACL injury (ACLi) and 69 matched uninjured controls (36 females; CON) performed isometric knee extension and flexion, and single-leg hopping tasks. LSIs were calculated as injured/uninjured limb for ACLi and non-dominant/dominant limb for CON. LSIs with significant between-group (ACLi vs CON) differences (independent t-tests), were used in a machine learning algorithm. A classification tree (CT) was used to classify ACLi and CON participants using LSI percentages. Ten-fold cross-validation was used to determine optimal tree complexity. LSIs were then converted from percentage to categorical ‘pass/fail’ grades according to cut-off thresholds ranging from 70-100%. CTs were then fit to the converted categorical data at each cut-off threshold and the model accuracies were compared. Results: Anterior, lateral, triple, and timed 6m hop tasks, and knee extension strength LSIs were used in the machine learning algorithm. The CT using the raw LSI percentages correctly classified 85.9% of participants. When data were converted from percentage to categorical ‘pass/fail’ grades, a plateau in classification accuracy occurred between LSIs cut-off thresholds of ˜83-90%. The most accurate LSI cut-off threshold was 89%, which correctly classified 84.4% of participants. Conclusion: Based on our preliminary analysis, the 90% LSI cut-off is an appropriate threshold for separating the hopping and strength performance of ACLi and CON paediatric participants. It is nevertheless important to recognize that this threshold can identify those with ACL injury, and not those who are ready for return to activity. A 90% LSI is therefore only a minimum criterion to reach as part of an RTA evaluation, and not a threshold that identifies when an individual is ready to return.