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Ryman Augustsson S, Gustafsson T, Ageberg E. Can tests of physical fitness predict traumatic knee injury in youth female athletes? A prospective cohort study. Phys Ther Sport 2024; 69:15-21. [PMID: 38991623 DOI: 10.1016/j.ptsp.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES To compile a battery of test including various aspects of physical fitness that could be used on the field and to assess whether any of these tests are associated with future traumatic knee injuries in youth female team sports athletes. DESIGN Prospective cohort. SETTING Sport setting. PARTICIPANTS Female athletes (n = 117, age 15-19 years), from Swedish sport high schools, active in soccer, handball, or floorball. MAIN OUTCOME MEASURES Differences in pre-injury tests values of 11 physical fitness tests in injured versus non-injured athletes, assessed as number of traumatic knee injuries over one season. RESULTS 28 athletes sustained 34 traumatic knee injuries. Athletes who sustained an injury had a shorter distance on the Yo-Yo IR1 test at baseline than those without an injury (mean difference -193 m, CI -293- -65 m). None of the other tests, assessed for muscular strength, endurance, power, flexibility and dynamic knee valgus, differed between injured and non-injured athletes. CONCLUSIONS Youth female athletes with lower intermittent endurance capacity, assessed with the Yo-Yo IR1, seemed to be at greater risk of traumatic knee injury. Neither hop performance, flexibility, dynamic knee valgus nor isolated strength tests at baseline could distinguish between injured and non-injured youth female athletes at follow-up.
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Affiliation(s)
- Sofia Ryman Augustsson
- Department of Sport Science, Faculty of Social Sciences, Linnaeus University, Kalmar, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
| | - Timmy Gustafsson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
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Mathieu-Kälin M, Müller M, Weber M, Caminada S, Häberli M, Baur H. Content validity, interpretability, and internal consistency of the "Quality First" assessment to evaluate movement quality in hop tests following ACL rehabilitation. A cross-sectional study. Front Sports Act Living 2023; 5:1180957. [PMID: 37398553 PMCID: PMC10313111 DOI: 10.3389/fspor.2023.1180957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/03/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Current approaches fail to adequately identify sport readiness after anterior cruciate ligament (ACL) rehabilitation. Altered landing biomechanics after ACL reconstruction are associated with increased risk of a noncontact ACL reinjury. There is a lack of objective factors to screen for deficient movement patterns. Therefore, the aim of this study was to investigate content validity, interpretability, and internal consistency for the newly developed "Quality First" assessment to evaluate movement quality during hop tests in patients after ACL rehabilitation. Method Participants in this cross-sectional study were recruited in collaboration with the Altius Swiss Sportmed Center in Rheinfelden, Switzerland. After a successful ACL reconstruction, the movement quality of 50 hop test batteries was evaluated between 6 and 24 months postoperatively with the "Quality First" assessment. Content validity was assessed from the perspective of professionals. To check the interpretability, classical test theory was employed. Cronbach's α was calculated to evaluate internal consistency. Results Content validity resulted in the inclusion of three different hop tests (single-leg hop for distance, vertical hop, and side hop). The "Quality First" assessment is enabled to evaluate movement quality in the sagittal, vertical, and the transversal plane. After the exclusion process, the "Quality First" assessment was free from floor and ceiling effects and obtained a sufficient Cronbach's α. The final version consists of 15 items, rated on a 4-point scale. Discussion By means of further validations, the "Quality First" assessment could offer a possibility to evaluate movement quality after ACL rehabilitation during hop tests.
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Affiliation(s)
- Moritz Mathieu-Kälin
- Department of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Mirjam Müller
- Department of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Melanie Weber
- Department of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | | | | | - Heiner Baur
- Department of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Nae JÄ, Cronström A. Association between sensorimotor function and visual assessment of postural orientation in patients with ACL injury. Phys Ther Sport 2022; 55:160-167. [DOI: 10.1016/j.ptsp.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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Cederström N, Granér S, Nilsson G, Dahan R, Ageberg E. Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) after traumatic knee injury: study protocol for an adaptive randomized controlled trial. Trials 2021; 22:729. [PMID: 34674738 PMCID: PMC8532360 DOI: 10.1186/s13063-021-05713-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 10/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background Treatment following traumatic knee injury includes neuromuscular training, with or without surgical reconstruction. The aim of rehabilitation is to restore muscle function and address psychological factors to allow a return to activity. Attention is often on rehabilitation of knee function, but deficiencies often persist. Specific interventions addressing psychological factors are sparing with varying degrees of success. We have developed a novel training program, MOTor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS), which integrates simultaneous psychological training into physical rehabilitation exercises. The MOTIFS model individualizes rehabilitation to increase central nervous system involvement by creating realistic and relevant mental images based on past experiences. We hypothesize that a 12-week MOTIFS training intervention will improve psychological readiness to return to activity and muscle function to a greater extent than current neuromuscular training (Care-as-Usual). Methods This pragmatic 1:1 single assessor-blinded adaptive cumulative cluster-randomized controlled trial will include 106 knee-injured people with a goal of returning to physical activity. Participants are randomized to either the MOTIFS or Care-as-Usual condition. Primary outcomes are the ACL Return to Sport after Injury Scale and change in injured leg hop performance in a side hop task from baseline to 12 weeks. Secondary outcomes include patient-reported outcomes and assessment of muscle function using a hop test battery and Postural Orientation Errors at 12-week follow-up. At 12-month follow-up, patient-reported outcomes are assessed. A sub-group (7-10 in each group) will be interviewed to gain insight into experiences of rehabilitation. Discussion Strengths of this trial include that it is a randomized and pragmatic trial examining commonly under-studied aspects of rehabilitation following a knee injury. The model uses the patient as a reference, creating simultaneous psychological and physical training exercises with easily adopted principles for clinical practice. Limitations include that blinding is limited due to study design, and shifting the clinical paradigm to a more holistic model is a challenge. If successful, the MOTIFS model has implications for a clinically useful, individualized, and patient-relevant method of improving rehabilitation outcomes by integrating psychological training into physical training. Trial registration ClinicalTrials.gov NCT03473821. Registered March 22, 2018, with ethical approval that has been granted (Dnr 2016/413, Dnr 2018/927). Trial status Trial Status: Protocol Version is 2020, Dec 10 – Version 1 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05713-8.
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Affiliation(s)
- Niklas Cederström
- Department of Health Sciences, Lund University, Margaretavägen 1B, 222 40, Lund, Sweden. .,Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden.
| | - Simon Granér
- Department of Psychology, Lund University, Allhelgona Kyrkogata 16a, 223 62, Lund, Sweden
| | - Gustav Nilsson
- Malmö Idrottsklinik, Kalendegatan 20, 211 35, Malmö, Sweden
| | - Rickard Dahan
- Kulan Idrottsskadecentrum, Eric Perssons väg 5, 217 62, Malmö, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Margaretavägen 1B, 222 40, Lund, Sweden
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Augustsson SR, Nae J, Karlsson M, Peterson T, Wollmer P, Ageberg E. Postural orientation, what to expect in youth athletes? A cohort study on data from the Malmö Youth Sport Study. BMC Sports Sci Med Rehabil 2021; 13:76. [PMID: 34301323 PMCID: PMC8306364 DOI: 10.1186/s13102-021-00307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Studies investigating postural orientation in uninjured youth athletes are scarce. Understanding how postural orientation during functional performance tests change with age in uninjured athletes has the potential to enhance awareness of changes in performance after injury and to set realistic goals for injured athletes. Thus, the aim of this study was to explore postural orientation during functional tasks at early adolescence, and changes in postural orientation from early to middle adolescence and relate this to sex, type of sport and right leg lean body mass (RLLBM). METHODS In this cohort study 144 (38% female) youth athletes (mean age 13.5 years, SD 0.3) were included at baseline and 86 of these at follow up 2 years later. Four functional performance tests were visually evaluated for Postural Orientation Errors (POEs) with an ordinal scale, ranging from 0 (good) to 2 (poor), yielding a maximum total POE score of 51, and RLLBM by dual energy X-ray absorptiometry. RESULTS Improvements were observed in the total POE score from baseline to follow-up, median difference - 10 and - 7 (p < 0.001) for female and male athletes, respectively. At follow-up, female athletes had lower total POE score (median 18) than males (median 24) (p = 0.01). There were no differences in POE scores between sports type (team, individual, aesthetic) (p = 0.20-0.98) and no relationship between total POE score and RLLBM (rs = 0.09, p = 0.42). CONCLUSIONS POEs appear to be quite common in young athletic population, but improvements are achieved over time. At mid-adolescence, female athletes seem to have less POEs than males. Neither sport type nor RLLBM seem to influence postural orientation.
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Affiliation(s)
- Sofia Ryman Augustsson
- Department of Sport Science, Faculty of Social Sciences, Linnaeus University, SE-391 82, Kalmar, Sweden. .,Department of Health Sciences, Lund University, Lund, Sweden.
| | - Jenny Nae
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Magnus Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Tomas Peterson
- Faculty of Education and Society, Department of Sport Sciences, Malmö University, Malmö, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
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Nae J, Creaby MW, Cronström A, Ageberg E. Sex differences in postural orientation errors and association with objective and patient-reported function in patients with ACL injury: an exploratory cross-sectional study. BMJ Open Sport Exerc Med 2021; 7:e001045. [PMID: 34079620 PMCID: PMC8137201 DOI: 10.1136/bmjsem-2021-001045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives There is limited research on sex differences in postural orientation (ie, alignment between body segments) in people with knee injury measured with a clinically applicable method. An understanding of the relationship between postural orientation and physical function may help guide decision making in rehabilitation. The aims were to evaluate (1) sex differences in visual assessment of Postural Orientation Errors (POEs) and (2) the association between POEs and objective and patient-reported physical function, in men and women with anterior cruciate ligament reconstruction (ACLR). Methods Twenty-four women and 29 men (mean 26.7 (SD 6.5) years) with ACLR were included. Six POEs (lower extremity and trunk) were scored from a video of five tasks with varying difficulty to compute POE scores (total and subscores). Objective physical function was evaluated with the single-leg hop for distance and side hop. Patient-reported physical function was evaluated using patient-reported outcome measures (PROMs). Results Women had significantly more POEs than men (median difference 5.5–25, p≤0.028). More POEs were associated with shorter hop distance and fewer side hops in women (rs= −0.425 to −0.518, p<0.038), but not in men (rs<0.301, p>0.05). No associations were found between POE scores and PROMs, in either sex (rs< –0.246, p>0.05). Conclusions Women with ACLR seem to have more POEs compared with men, indicating worse postural orientation. More POEs were associated with worse hop performance, suggesting that POE scores may be used as criteria for rehabilitation progression. The lack of associations between POE scores and PROMs indicate that these measures complement each other.
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Affiliation(s)
- Jenny Nae
- Health Sciences, Lund University, Lund, Sweden
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Queensland, Australia
| | - Anna Cronström
- Health Sciences, Lund University, Lund, Sweden.,Department of Community Medicine and Rehabilitation, Umeå Univerisity, Umeå, Sweden
| | - Eva Ageberg
- Health Sciences, Lund University, Lund, Sweden
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Roe C, Jacobs C, Hoch J, Johnson DL, Noehren B. Test Batteries After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2021; 14:205-215. [PMID: 33896240 DOI: 10.1177/19417381211009473] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT There is a lack of consensus regarding test batteries for return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). OBJECTIVE To report the RTS test batteries for individuals after ACLR and to examine alignment with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC). Finally, to examine how published RTS batteries prior to the AAOS AUC (2010-2015) compared with those after publication of the AUC (2016-2020). DATA SOURCE A systematic search of PubMed (2010-2020). STUDY SELECTION Studies were included if they were published from 2010 to 2020, patients underwent primary ACLR and were tested between 6 months and 2 years postoperatively and included a minimum of 2 assessments. Studies were excluded if patients were tested outside the designated time; had undergone a revision, contralateral, or multiligament injury; included healthy participants; were level 5 evidence or the study was a systematic review. A total of 1012 articles were reviewed and 63 met the criteria. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Information regarding the RTS batteries and patient demographics were extracted from the included articles. RESULTS A total of 63 studies met the inclusion and exclusion criteria (22 from 2010-2015 and 41 from 2016-2020). The most common RTS batteries included the hop test, quadriceps strength test, and patient-reported outcome measures. No study met all 7 AUC; the most common criteria met were functional skills (98.4%), followed by confidence (22.2%), then range of motion and knee stability (20.6%). CONCLUSION The test batteries in the current literature show high variability and a lack of essential components necessary for RTS. No study met the AUC guidelines, suggesting a disconnect between recommended guidelines and clinical practice. Test battery research has expanded over the past decade; however, standardized, clinically applicable batteries that encompass all criteria are needed.
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Affiliation(s)
- Chelsey Roe
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | - Cale Jacobs
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Johanna Hoch
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky
| | - Darren L Johnson
- Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
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Cronström A, Ageberg E, Häger CK. Does sensorimotor function predict graft rupture, contra-lateral injury or failure to return to sports after ACL reconstruction? A protocol for the STOP Graft Rupture study. BMJ Open 2021; 11:e042031. [PMID: 33419913 PMCID: PMC7798666 DOI: 10.1136/bmjopen-2020-042031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION People with anterior cruciate ligament (ACL) reconstruction (ACLR) are at high risk of sustaining a graft rupture and/or contra-lateral ACL injury. The main factors that may predispose individuals for subsequent ACL injuries are, however, not established. To reduce the risk of reinjuries, it is of particular interest to identify modifiable risk-factors, for instance, those related to sensorimotor control which are responsive to training. The aim of the current study protocol is to present the design of our prospective cohort study STOP Graft Rupture investigating sensorimotor function as predictors for graft rupture, contra-lateral ACL injury and/or failure to return to sport (RTS) within 3 years following ACLR. METHODS AND ANALYSIS We aim to recruit 200 individuals (15-35 years, ~50% women) with ACLR from Norrland University Hospital, Umeå and Lund University Hospital, Lund, Sweden. Participants will be assessed with a comprehensive test battery for sensorimotor muscle function, including hop performance, muscle strength, muscle activation, hip and ankle range of motion and postural orientation as well as patient-reported function 1 year after ACLR (baseline). For a subgroup of individuals (Umeå cohort), 3D kinematics and joint position sense will also be evaluated. At follow-up (≥3 years post-ACLR), the participants will be asked to answer questions related to new ACL injuries to either knee and about RTS. Separate logistic regression models, adjusting for possible confounders, will be used to evaluate the influence of the different sensorimotor predictors on the prospective outcomes (graft rupture, contra-lateral ACL injury, RTS). ETHICS AND DISSEMINATION This study was approved by the Swedish Ethical Review Board (Dnr 2016/319 and Dnr 2019-04037). The results will be published in international peer-reviewed scientific journals and presented at clinical and scientific congresses. TRIAL REGISTRATION NUMBER NCT04162613.
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Affiliation(s)
- Anna Cronström
- Department of Community Medicine and Rehabilitation, Umeå Universitet, Umeå, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Umeå Universitet, Umeå, Sweden
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