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Åkesson KS, Hansson EE, Pawlikowska T, Sundén A, Stigmar K, Ageberg E. Factors associated with empowerment after participating in a supported osteoarthritis self-management program: An explorative study. Osteoarthritis and Cartilage Open 2024; 6:100464. [PMID: 38584596 PMCID: PMC10998234 DOI: 10.1016/j.ocarto.2024.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
Objective To explore factors associated with change in empowerment in patients that have participated in a 3-month Supported Osteoarthritis Self-Management Program (SOASP). Further, to evaluate empowerment in the longer term. Design An explorative analysis including patients from a cohort study conducted in primary healthcare in Sweden was performed. Univariable linear regression models were performed to assess associations between demographics and patient-reported outcome measures (explanatory factors), respectively, and change in empowerment from baseline to 3-month follow-up (outcome variable). Long-term follow-up of empowerment was at 9 months. Results Self-reported increase in enablement at the 3-month follow-up was associated with a greater improvement in empowerment (B = 0.041, 95% CI (0.011, 0.07), p = 0.008). Living alone was associated with less improvement in empowerment (B = -0.278, 95% CI (-0.469, -0.086), p = 0.005) compared to living together. Physical exercise >120 min per week at baseline was associated with less improvement in empowerment (B = -0.293, 95% CI (-0.583, -0.004), p = 0.047) compared to reporting no exercise at baseline. No other associations were observed (p > 0.05). Empowerment improved from baseline to the 3-month follow-up (mean 0.20 (SD 0.5), p < 0.001) but there was no change from baseline to the 9-month follow-up (mean 0.02 (SD 0.6), p = 0.641). Conclusions Self-reported increased enablement may lead to greater improvement in empowerment after SOASP. Greater efforts may be needed to support those that live alone, are physically active, and to sustain empowerment in the longer term after SOASP. More research is needed on empowerment to provide personalized support for patients with OA after SOASP.
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Affiliation(s)
| | - Eva Ekvall Hansson
- Department of Health Sciences, Health Science Centre, Box 157, SE-221 00, Lund, Sweden
| | - Teresa Pawlikowska
- Health Professions Education Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Sundén
- Department of Health Sciences, Health Science Centre, Box 157, SE-221 00, Lund, Sweden
| | - Kjerstin Stigmar
- Department of Health Sciences, Health Science Centre, Box 157, SE-221 00, Lund, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Health Science Centre, Box 157, SE-221 00, Lund, Sweden
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2
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Sturesson V, Marforio P, Reuter A, Johansson K, Ageberg E. Youth handball concussion prevention strategies: a workshop-based study with experts and end users. BMJ Open Sport Exerc Med 2024; 10:e001877. [PMID: 38495959 PMCID: PMC10941137 DOI: 10.1136/bmjsem-2023-001877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Sport-related concussion (SRC) is a serious injury in youth team sports, including handball. While research on the prevention of SRC has made progress over the past 5 years, prevention strategies are lacking in handball. The aim was to explore and develop strategies focusing on information, rules and training that may prevent concussion in youth handball by incorporating knowledge from experts and end users. Using a participatory methodology, experts (physiotherapy, biomechanics: n=3) and end users (players, coaches, referees, coach educators: n=7) contributed their experience and knowledge in a 2-hour online workshop. Participants were given three videos illustrating typical high-risk concussion scenarios from handball games and a youth player's accompanying fictional written scenario. In group discussions inspired by the brainwriting method, participants were asked to provide ideas for possible SRC prevention strategies related to information, rules and/or training. Data were collected on a digital whiteboard and analysed using reflexive thematic analysis. Three themes were derived: (1) 'Coaches' responsibility: raise awareness of the risk of injury and act to promote safe environments'; (2) 'Players' responsibility: safe defence and attack'; and (3) 'Improvement of personal skills'. Experts and end users found information about high-risk situations and SRC symptoms, stricter rules and safe playing strategy training for goalkeepers, attacking and defending players, respectively, may effectively reduce SRC in handball. Information and stricter rules could be delivered through education and dissemination activities, whereas safe playing strategies should be trained at regular handball practice.
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Affiliation(s)
| | - Peter Marforio
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Arlind Reuter
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Kajsa Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
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3
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Ageberg E, Bunke S, Linnéll J, Moesch K. Co-creating holistic injury prevention training for youth handball: Development of an intervention targeting end-users at the individual, team, and organizational levels. BMC Sports Sci Med Rehabil 2024; 16:10. [PMID: 38191495 PMCID: PMC10773026 DOI: 10.1186/s13102-023-00800-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Interventions that are co-created with end-users, and that are informed by behavior change or implementation theories, support implementation in real world settings. However, injury prevention programs for youth athletes have typically been developed by experts with no, or insufficiently described, end-user involvement and without guidance by theories. The aim of the current study was to describe the development of a holistic injury prevention intervention for youth handball targeting end-users at different levels, through using knowledge from end-users and researchers/experts and applying relevant behavior change and implementation theories. METHODS Knowledge from researchers/experts (sports medicine, sport psychology, handball, physical therapy, strength and conditioning (n = 14)) and end-users (coaches, players, club administrators, n = 16), and applying relevant implementation (Consolidated Framework for Implementation Research, CFIR), behavior change (Health Action Process Approach, HAPA) and motivational (Self-Determination Theory, SDT) theories, were used to co-design the intervention. Early end-users (coaches (n = 6), players (n = 3) and a club administrator (n = 1)) were interviewed for initial feedback. RESULTS The intervention consisted of end-user-targeted information and training that was made available in a specifically developed interactive mobile application with modules for players, coaches, club administrators, and caregivers. Information for all end-users included benefits and principles of physical and psychological injury prevention training, load-management, motivation, and communication. Information about implementation was developed for club administrators specifically. For coaches, training to do with their teams included handball-specific injury prevention exercises (legs, shoulders, core) combined with psychological aspects (motivation, task focus, body awareness) to integrate within warm-up and handball skills training. Training for players included handball-specific multi-joint strength, power, and explosive exercises (legs, shoulders, core) and sport psychology exercises (self-awareness, relaxation, being in the present moment, prevent and handle stress). To support self-management, adoption, and motivation, programs were provided, and players and coaches could change, add, progress the difficulty of exercises, and build their own programs. Initial feedback from early end-users was generally positive. CONCLUSIONS Utilizing an approach where researchers/experts and end-users co-created injury prevention training specifically for youth handball, an intervention was generated that included information and holistic training targeting end-users at the individual (players, caregivers), team (coaches), and organizational (club administrators) levels.
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Affiliation(s)
- Eva Ageberg
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 117, Lund, SE-221 00, Sweden.
| | - Sofia Bunke
- Department of Psychology, Lund University, Lund, Sweden
| | - Jennie Linnéll
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 117, Lund, SE-221 00, Sweden
- Swedish Handball Federation, Stockholm, Sweden
| | - Karin Moesch
- Department of Psychology, Lund University, Lund, Sweden
- Department of Sports Sciences, Malmö University, Malmö, Sweden
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4
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Cronström A, Häger CK, Thorborg K, Ageberg E. Factors Associated With Sports Function and Psychological Readiness to Return to Sports at 12 Months After Anterior Cruciate Ligament Reconstruction: A Cross-sectional Study. Am J Sports Med 2023; 51:3112-3120. [PMID: 37681565 PMCID: PMC10543957 DOI: 10.1177/03635465231192983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/05/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Sports function and psychological readiness to return to sports (RTS) are important outcomes when evaluating rehabilitation after anterior cruciate ligament reconstruction (ACLR). It is, however, unclear which specific factors contribute most to these outcomes. PURPOSE To determine associations between demographic characteristics, objective measurements of physical function, patient-reported outcome measure scores, sports-related function assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS) Sport and Recreation subscale, and psychological readiness to RTS assessed with the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale at 1 year after ACLR. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS At a mean of 12.5 ± 2.0 months after ACLR, 143 participants (50.3% female), with a mean age of 25.0 ± 5.7 years, were assessed for demographic characteristics, physical factors (hop performance, muscle strength, ankle and hip range of motion), and psychological factors (KOOS Pain and Symptoms subscales, Perceived Stress Scale, fear of reinjury) as well as the KOOS Sport and Recreation subscale and ACL-RSI scale. Backward linear regression models were used to evaluate factors associated with sports function and psychological readiness to RTS. RESULTS Lower isokinetic knee extension peak torque (limb symmetry index) (B = 18.38 [95% CI, 3.01-33.75]), lower preinjury activity level (B = 2.00 [95% CI, 0.87-3.14]), greater knee pain (B = 0.90 [95% CI, 0.70-1.10]), shorter time between injury and reconstruction (B = 0.16 [95% CI, 0.05-0.26]), and greater fear of reinjury (B = 0.11 [95% CI, 0.01-0.20]) were associated with a worse KOOS Sport and Recreation subscore (R2 = 0.683). A shorter hop distance (B = 0.15 [95% CI, 0.00-0.29]) was associated with a lower ACL-RSI score (R2 = 0.245). CONCLUSION A combination of knee muscle strength, activity level, knee pain, timing of surgery, and fear of reinjury accounted for approximately 70% of the variation in sports function at 1 year after ACLR. In contrast, there was only 1 weak association between physical function and psychological readiness to RTS at this time point. Thus, factors associated with current sports function are much better known than features related to psychological readiness to RTS.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Charlotte K. Häger
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Kristian Thorborg
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
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5
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Cederström N, Ageberg E, Granér S. Lived experiences of physical therapists treating traumatic knee injury using integrated psychological training (MOTIFS): a qualitative interview study. Physiother Theory Pract 2023:1-15. [PMID: 36779818 DOI: 10.1080/09593985.2023.2176729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND The novel Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) training model, which began development in 2018, integrates psychological training into physical rehabilitation in knee-injured people. OBJECTIVE This qualitative interview study aims to understand, interpret, and describe how physical therapists perceive using the MOTIFS Model. METHODS One-on-one semi-structured interviews were conducted with six physical therapists familiar with the MOTIFS model and eight with experience with care-as-usual training only, analyzed using Interpretive Phenomenological Analysis. RESULTS Two major themes were generated in the MOTIFS group: 1) "MOTIFS increases psychological focus during rehabilitation training"; and 2) "Care-as-Usual training is mainly physical, and lacks the necessary psychological focus." Physical therapists perceived structured methods of addressing psychological factors, such as using imagery to influence patients' motivation, fear, and preparation for return to activity. Three major themes were generated in the Care-as-Usual group: 1) "Rehabilitation is mainly to restore physical function"; 2) "Rehabilitation training includes a biopsychosocial interaction"; and 3) "Psychological factors are important to address, but strategies are lacking." CONCLUSION Physical therapists perceive MOTIFS as a method of consciously shifting perspective toward an increased focus on psychological factors in knee-injury rehabilitation. Results indicate that a training model with integrated psychological strategies to create more holistic rehabilitation may be beneficial.
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Affiliation(s)
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Simon Granér
- Department of Psychology, Lund University, Lund, Sweden
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6
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Estberger A, Kemp JL, Thorborg K, Pålsson A, Ageberg E. Are Exercise Therapy Protocols For The Treatment of Hip-Related Pain Adequately Described? A Systematic Review of Intervention Descriptions. Int J Sports Phys Ther 2023; 18:38-54. [PMID: 36793572 PMCID: PMC9897011 DOI: 10.26603/001c.68069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background Hip-related pain is an umbrella term encompassing pain from non-arthritic hip joint pathologies, such as femoroacetabular impingement syndrome, hip dysplasia, and labral tears. Exercise therapy is commonly recommended for these conditions, but the reporting completeness of these interventions is currently unclear. Purpose The aim of this systematic review was to assess the reporting completeness of exercise therapy protocols for people with hip-related pain. Study design Systematic review according to PRISMA guidelines. Materials and Methods A systematic search was conducted, searching the MEDLINE, CINAHL, and Cochrane databases. The search results were independently screened by two researchers. Inclusion criteria were studies using exercise therapy in people with non-arthritic hip-related pain. Two independent researchers used the Cochrane risk of bias tool version 2 to analyze risk of bias, and the Consensus on Exercise Reporting Template (CERT) checklist and score (1-19) to synthesize reporting completeness. Results Fifty-two studies used exercise therapy for hip-related pain, but only 23 were included in the synthesis as 29 studies had no description of the intervention. CERT scores ranged from 1 to 17 (median 12, IQR 5-15). The most well-described items were tailoring (87%), and the least well-described items were motivation strategies (9%) and starting level (13%). Studies used exercise therapy alone (n=13), or in combination with hip arthroscopy (n=10). Conclusion Only 23 of 52 eligible studies reported sufficient details to be included in the CERT synthesis. The median CERT score was 12 (IQR 5-15), with no study reaching the maximum score of 19. Lack of reporting makes it difficult to replicate interventions in future research, and to draw conclusions on efficacy and dose-response to exercise therapy for hip-related pain. Level of evidence Level 1, systematic review.
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Affiliation(s)
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport La Trobe University
| | - Kristian Thorborg
- Department of Health Sciences Lund University, Lund, Sweden
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Departement of Orthopedic Surgery, Amager-Hvidovre Hospital, Institute for Clinical Medicine Copenhagen University, Copenhagen, Denmark
| | - Anders Pålsson
- Department of Health Sciences Lund University, Lund, Sweden
| | - Eva Ageberg
- Department of Health Sciences Lund University, Lund, Sweden
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7
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Cederström N, Ageberg E, Granér S. Lived experiences of patients undergoing treatment for traumatic knee injury using integrated psychological training (MOTIFS) in the context of care-as-usual training: a phenomenological interview study. BMJ Open Sport Exerc Med 2022; 8:e001409. [DOI: 10.1136/bmjsem-2022-001409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/23/2022] Open
Abstract
The objective was to increase understanding of how knee-injured people make sense of using the Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) training intervention. This model integrates structured psychological skills training into existing care-as-usual (CaU) rehabilitation protocols. To better understand patients’ lived experiences of MOTIFS, it was necessary to understand those of CaU training. Interviews were conducted with five people undergoing knee-injury rehabilitation according to the MOTIFS model, as well as seven receiving treatment according to CaU. Interpretive phenomenological analysis was used to explore patients’ lived experiences. Results indicate that patients in the MOTIFS group perceive individualised meaning and sport relevance in their rehabilitation training. Imagery is perceived to be a concrete strategy that can be difficult, but encourages a biopsychosocial interaction to improve confidence, motivation, enjoyment and sport-relevant context, thereby aiding in physically and psychologically preparing patients for return to activity. CaU training is discussed in terms of physical factors, though patients identify psychological factors as important, perceiving a lack of focus on this, resulting in inadequate psychological readiness to return to activity. In conclusion, the MOTIFS model is perceived as focusing more on psychological factors in rehabilitation, helping to develop coping strategies and physically and psychologically prepare for return to activity. Patients in the CaU group perceive rehabilitation training as restoring strength and function, but lack structured psychological strategies to aid in return to activity preparation. This study is part of the MOTIFS randomised controlled trial (clinicaltrials.gov registration:NCT03473821).
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8
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Ageberg E, Brodin EM, Linnéll J, Moesch K, Donaldson A, Adébo E, Benjaminse A, Ekengren J, Granér S, Johnson U, Lucander K, Myklebust G, Møller M, Tranaeus U, Bunke S. Cocreating injury prevention training for youth team handball: bridging theory and practice. BMJ Open Sport Exerc Med 2022; 8:e001263. [PMID: 35505981 PMCID: PMC8984048 DOI: 10.1136/bmjsem-2021-001263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/12/2022] Open
Abstract
Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants’ contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.
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Affiliation(s)
- Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Eva M Brodin
- Department of Educational Sciences, Lund University, Lund, Sweden.,Centre for Higher and Adult Education (CHAE), Stellenbosch University, Stellenbosch, South Africa
| | - Jennie Linnéll
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Karin Moesch
- Department of Psychology, Lund University, Lund, Sweden
| | - Alex Donaldson
- Centre for Sport and Social Impact (CSSI), La Trobe University, Melbourne, Victoria, Australia
| | - Emme Adébo
- Regional Handball Federation in South Sweden, Lund, Sweden
| | - Anne Benjaminse
- Center for Human Movement Sciences, University of Groningen, Groningen, The Netherlands.,School of Sport Studies, Hanze University Groningen School of Social Studies, Groningen, The Netherlands
| | - Johan Ekengren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Simon Granér
- Department of Psychology, Lund University, Lund, Sweden
| | - Urban Johnson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | | | - Grethe Myklebust
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
| | - Merete Møller
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ulrika Tranaeus
- Department of physiology, nutrition and biomechanics, The Swedish School of Sport and Health Sciences, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Bunke
- Department of Psychology, Lund University, Lund, Sweden
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9
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Moesch K, Bunke S, Linnéll J, Brodin EM, Donaldson A, Ageberg E. "Yeah, I Mean, You're Going to Handball, so You Want to Use Balls as Much as Possible at Training": End-Users' Perspectives of Injury Prevention Training for Youth Handball Players. Int J Environ Res Public Health 2022; 19:ijerph19063402. [PMID: 35329089 PMCID: PMC8949033 DOI: 10.3390/ijerph19063402] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023]
Abstract
Young handball players experience high injury rates. Specific injury prevention programs reduce injury rates but are not well implemented into youth players’ training. The ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ project addresses this challenge. The aim of this study was to investigate how youth handball coaches and players experienced the recently developed I-PROTECT GO pilot program, by focusing on barriers and facilitators. Three focus group interviews were conducted with coaches and players, and their answers were analyzed using a general inductive approach. The participants appreciated the program and found it useful for their context. The participants’ statements about facilitators and barriers centered around the categories of resources, exercises, program design, and learning. Facilitators that emerged were motivating exercises (e.g., handball-specific), a helpful set-up (e.g., variation), having a clear purpose of exercises, the possibility to fulfil basic psychological needs while training, receiving instructions and feedback, and having role models. Barriers that emerged were limited space and material, difficulties with exercises, an unhelpful set-up (e.g., too repetitive), and undisciplined training. It is important to address perceived barriers and facilitators among coaches and players when developing injury prevention training programs to enhance the uptake of such training.
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Affiliation(s)
- Karin Moesch
- Department of Psychology, Lund University, 22100 Lund, Sweden;
- Correspondence:
| | - Sofia Bunke
- Department of Psychology, Lund University, 22100 Lund, Sweden;
| | - Jennie Linnéll
- Department of Health Sciences, Lund University, 22100 Lund, Sweden; (J.L.); (E.A.)
| | - Eva M. Brodin
- Department of Educational Sciences, Lund University, 22100 Lund, Sweden;
- Centre for Higher and Adult Education (CHAE), Department of Curriculum Studies, Faculty of Education, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Alex Donaldson
- Centre for Sport and Social Impact (CSSI), La Trobe University, Bundoora, VIC 3086, Australia;
| | - Eva Ageberg
- Department of Health Sciences, Lund University, 22100 Lund, Sweden; (J.L.); (E.A.)
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10
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Cederström N, Granér S, Ageberg E. Addressing Psychological Factors in Sports Injury Rehabilitation - What is a Physical Therapist to do? Int J Sports Phys Ther 2022; 17:114-116. [PMID: 35136679 PMCID: PMC8805091 DOI: 10.26603/001c.31667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/01/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Simon Granér
- Department of Psychology, Lund University, Lund, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Pålsson A, Kostogiannis I, Ageberg E. Physical impairments in longstanding hip and groin pain: Cross-sectional comparison of patients with hip-related pain or non-hip-related groin pain and healthy controls. Phys Ther Sport 2021; 52:224-233. [PMID: 34628337 DOI: 10.1016/j.ptsp.2021.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare physical impairments between patients with hip-related pain and those with non-hip-related groin pain, and to compare both patient groups with healthy controls. DESIGN Cross-sectional. PARTICIPANTS Eighty-one hip and groin pain patients were consecutively included and categorized into having hip-related pain or non-hip-related groin pain. Twenty-eight healthy controls were recruited. SETTINGS Tertiary care. MAIN OUTCOME MEASURES All participants performed physical impairment testing including hip ROM, muscle function, and functional tasks. An analysis of covariates was used for analysis between patients groups and controls. RESULTS Patients with hip-related pain showed reduced hip ROM in internal rotation compared to patients with non-hip-related groin pain and controls (p ≤ 0.026, d -0.65; -0.97). No differences in muscle function or performance in functional tasks were observed between patients with hip-related pain and those with non-hip-related groin pain (p ≥ 0.136, d 0.00; 0.68). Both patient groups had worse muscle function and worse performance in functional tasks compared to controls (p ≤ 0.048, d -0.67; -1.83). CONCLUSIONS Both patients with and without hip-related pain had worse muscle function and worse performance in functional tasks compared to matched controls but no differences were observed between the patient groups. Only patients with hip-related pain had reduced ROM in internal rotation.
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Affiliation(s)
- Anders Pålsson
- Department of Health Sciences, Lund University, Lund, Sweden.
| | | | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden.
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Eskilsson A, Ageberg E, Ericson H, Marklund N, Anderberg L. Decompression of the greater occipital nerve improves outcome in patients with chronic headache and neck pain - a retrospective cohort study. Acta Neurochir (Wien) 2021; 163:2425-2433. [PMID: 34195861 PMCID: PMC8357752 DOI: 10.1007/s00701-021-04913-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Compression of the greater occipital nerve (GON) may contribute to chronic headache, neck pain, and migraine in a subset of patients. We aimed to evaluate whether GON decompression could reduce pain and improve quality of life in patients with occipital neuralgia and chronic headache and neck pain. METHODS In this retrospective cohort study, selected patients with neck pain and headache referred to a single neurosurgical center were analyzed. Patients (n = 22) with suspected GON neuralgia based on nerve block or clinical criteria were included. All patients presented with occipital pain spreading frontally and to the neck in various degree. Surgical decompression was performed under local anesthesia. Follow-up was made by an assessor not involved in the treatment of the patients, by telephone 2-5 years after the surgical procedure and an interview protocol was used to collect information. The data from the follow-up protocols were then analyzed and reported. RESULTS When analyzing the follow-up protocols, decreased headache/migraine was reported in 77% and neck pain was reduced in 55% of the patients. CONCLUSIONS Decompression of GON(s) may reduce neck pain and headache in selected patients with persistent headache, neck pain, and clinical signs of GON neuralgia. Based on the limitations of the present retrospective study, the results should be considered with caution.
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Affiliation(s)
- Anja Eskilsson
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, 221 85, Lund, Sweden.
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Hans Ericson
- Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, 221 85 Lund, Sweden ,Skane University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden
| | - Leif Anderberg
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, 221 85 Lund, Sweden
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17
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Estberger A, Pålsson A, Kostogiannis I, Ageberg E. Less hip range of motion is associated with a greater alpha angle in people with longstanding hip and groin pain. Knee Surg Sports Traumatol Arthrosc 2021; 29:4091-4099. [PMID: 34510222 PMCID: PMC8595235 DOI: 10.1007/s00167-021-06733-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE A higher alpha angle has been proposed to correlate with lower hip range of motion, but the association in people with longstanding hip and groin pain is currently unclear. The aims were to: (1) assess the association between range of motion and alpha angle in patients with longstanding hip and groin pain; (2) examine if a cut-off value in range of motion variables could identify patients with an alpha angle above or below 60°. METHODS Seventy-two participants were consecutively recruited from an orthopaedic department after referral for hip- and groin-related pain. Passive hip range of motion was measured in flexion, internal rotation with 90° hip flexion, internal rotation in neutral hip position, external rotation with 90° hip flexion, and abduction. The alpha angle was calculated from a frog-leg lateral radiograph. Linear regression examined the association between range of motion and alpha angle, and an ROC-curve analysis was performed to identify the sensitivity and specificity of range of motion cut-offs. RESULTS Lower range of motion in internal rotation in flexion, external rotation, and abduction were associated with higher alpha angle. Internal rotation of 27° or less displayed good sensitivity (81%) and specificity (85%) to detect an alpha angle above 60°, while a cut-off of 41° in external rotation and 27° in abduction showed a sensitivity of 72% and specificity of 50% and 60%, respectively. CONCLUSION Less internal rotation in flexion, external rotation, and abduction are associated with a greater alpha angle in a cohort of people with longstanding hip and groin pain. A cut-off of 27° in internal rotation has good sensitivity and specificity to identify people with an alpha angle above or below 60° and have the potential to be used in the clinical setting to identify patients that require further imaging, or that are unlikely to have cam morphology. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Anders Pålsson
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Lund University, Lund, Sweden
| | - Ioannis Kostogiannis
- grid.4514.40000 0001 0930 2361Department of Orthopaedics, Clinical Sciences, Lund University, Lund, Sweden
| | - Eva Ageberg
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Lund University, Lund, Sweden
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18
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Cederström N, Granér S, Nilsson G, Ageberg E. Effect of motor imagery on enjoyment in knee-injury prevention and rehabilitation training: A randomized crossover study. J Sci Med Sport 2020; 24:258-263. [PMID: 32958377 DOI: 10.1016/j.jsams.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/14/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The novel MOTor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) model takes a uniquely holistic approach by integrating mental and physical aspects into current training programs. The aim of this trial was to evaluate enjoyment of MOTIFS training as compared to Care-as-Usual (CaU) knee injury and/or rehabilitation training. The primary hypothesis was that enjoyment would be greater following MOTIFS training than CaU training. DESIGN Block-randomized 2×2 cross-over trial. METHODS Thirty athletes (18-31years, 50% women) currently or previously active in team ball sports, with no pain or injury preventing jump and/or directional changes. MOTIFS training integrates sport-specific experiences and equipment into physical exercises to increase individualized realism and meaning. The CaU condition included solely physical exercise. The main outcome was the Physical Activity Enjoyment Scale (PACES). Secondary outcomes included Self-Assessment Manikin (SAM; subscales Valence, Arousal, Dominance), Perceived exertion, pulse, duration, and movement quality. RESULTS PACES scores were better following MOTIFS training than CaU (point estimate 24.67; 95% CI: 19.0; 30.3). Between-groups differences in SAM Valence (median 2, quartiles 1;3), Arousal (median 1, quartiles 0;2.25), and Dominance (median 0.5, quartiles 0;2), and RPE (median 1, quartiles -0.3;2), training duration (mean 5.34, 95% CI: -0.17; -0.73), and pulse (median 7.50, quartiles 0.25;16.75) were higher following MOTIFS training than CaU training. CONCLUSIONS Results suggest that the MOTIFS model, which integrates simultaneous physical and psychological interventions, is a clinically plausible method of influencing enjoyment and other psychological outcomes. Further studies may explore effects of the MOTIFS principles on injury prevention and rehabilitation training.
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Affiliation(s)
| | - Simon Granér
- Department of Psychology, Lund University, Sweden
| | | | - Eva Ageberg
- Department of Health Sciences, Lund University, Sweden
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19
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Reiman MP, Agricola R, Kemp JL, Heerey JJ, Weir A, van Klij P, Kassarjian A, Mosler AB, Ageberg E, Hölmich P, Warholm KM, Griffin D, Mayes S, Khan KM, Crossley KM, Bizzini M, Bloom N, Casartelli NC, Diamond LE, Di Stasi S, Drew M, Friedman DJ, Freke M, Glyn-Jones S, Gojanovic B, Harris-Hayes M, Hunt MA, Impellizzeri FM, Ishøi L, Jones DM, King MG, Lawrenson PR, Leunig M, Lewis CL, Mathieu N, Moksnes H, Risberg MA, Scholes MJ, Semciw AI, Serner A, Thorborg K, Virgile A, Wörner T, Dijkstra HP. Infographic. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2020; 55:115-117. [PMID: 32868314 PMCID: PMC7788225 DOI: 10.1136/bjsports-2020-102219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Michael P Reiman
- Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joanne L Kemp
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua J Heerey
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Weir
- Department of Orthopaedic Surgery, Erasmus MC Center for Groin Injuries, Erasmus University Medical Centre, Rotterdam, Netherlands.,Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Pim van Klij
- Department of Orthopaedic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Ara Kassarjian
- Elite Sports Imaging, SL, Madrid, Spain.,Musculoskeletal Radiology, Corades, LLC, Brookline, Massachusetts, USA
| | - Andrea B Mosler
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Eva Ageberg
- Health Sciences, Lund University, Lund, Sweden
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Amager-Hvidovre Hospital, Hvidovre, Copenhagen, Denmark
| | | | - Damian Griffin
- Warwick Orthopaedics, University of Warwick, Coventry, Warwick, UK.,Orthopaedics Warwick Medical School, University of Warwick, Coventry, Warwick, UK
| | - Sue Mayes
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kay M Crossley
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Mario Bizzini
- Research, Schulthess Clinic Human Performance Lab, Zurich, ZH, Switzerland
| | - Nancy Bloom
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Laura E Diamond
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Stephanie Di Stasi
- Division of Physical Therapy, The Ohio State University, Columbus, Ohio, USA
| | - Michael Drew
- Department of Physiotherapy, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia.,Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Daniel J Friedman
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Matthew Freke
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Sion Glyn-Jones
- Department of Orthopaedic Surgery, University of Oxford, Institute of Musculoskeletal Sciences, Oxford, UK
| | - Boris Gojanovic
- Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland.,Sports Medicine, University Hospital of Lausanne, Lausanne, VD, Switzerland
| | - Marcie Harris-Hayes
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Michael A Hunt
- Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lasse Ishøi
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen (SORC-C), Hvidovre, Denmark
| | - Denise M Jones
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services, and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Peter R Lawrenson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Leunig
- Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
| | - Cara L Lewis
- Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Nicolas Mathieu
- Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Leukerbad, Valais, Switzerland
| | - Håvard Moksnes
- Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway
| | - May Arna Risberg
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Mark J Scholes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Adam I Semciw
- Latrobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Andreas Serner
- Research & Scientific Support, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Amager-Hvidovre Hospital, Hvidovre, Copenhagen, Denmark
| | - Adam Virgile
- College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | | | - H Paul Dijkstra
- Sports Medicine, ASPETAR Orthopedic and Sports Medicine Hospital, Doha, Qatar.,Department for Continuing Education, University of Oxford, Oxford, UK
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20
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Cronström A, Creaby MW, Ageberg E. Do knee abduction kinematics and kinetics predict future anterior cruciate ligament injury risk? A systematic review and meta-analysis of prospective studies. BMC Musculoskelet Disord 2020; 21:563. [PMID: 32819327 PMCID: PMC7441716 DOI: 10.1186/s12891-020-03552-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/31/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To systematically review the association between knee abduction kinematics and kinetics during weight-bearing activities at baseline and the risk of future anterior cruciate ligament (ACL) injury. METHODS Systematic review and meta-analysis according to PRISMA guidelines. A search in the databases MEDLINE (PubMed), CINAHL, EMBASE and Scopus was performed. Inclusion criteria were prospective studies including people of any age, assessing baseline knee abduction kinematics and/or kinetics during any weight-bearing activity for the lower extremity in individuals sustaining a future ACL injury and in those who did not. RESULTS Nine articles were included in this review. Neither 3D knee abduction angle at initial contact (Mean diff: -1.68, 95%CI: - 4.49 to 1.14, ACL injury n = 66, controls n = 1369), peak 3D knee abduction angle (Mean diff: -2.17, 95%CI: - 7.22 to 2.89, ACL injury n = 25, controls n = 563), 2D peak knee abduction angle (Mean diff: -3.25, 95%CI: - 9.86 to 3.36, ACL injury n = 8, controls n = 302), 2D medial knee displacement (cm; Mean diff:: -0.19, 95%CI: - 0,96 to 0.38, ACL injury n = 72, controls n = 967) or peak knee abduction moment (Mean diff:-10.61, 95%CI: - 26.73 to 5.50, ACL injury n = 54, controls n = 1330) predicted future ACL injury. CONCLUSION Contrary to clinical opinion, our findings indicate that knee abduction kinematics and kinetics during weight-bearing activities may not be risk factors for future ACL injury. Knee abduction of greater magnitude than that observed in the included studies as well as factors other than knee abduction angle or moment, as possible screening measures for knee injury risk should be evaluated in future studies.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden. .,Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Australia
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
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21
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Nae J, Creaby MW, Ageberg E. Extended Version of a Test Battery for Visual Assessment of Postural Orientation Errors: Face Validity, Internal Consistency, and Reliability. Phys Ther 2020; 100:1542-1556. [PMID: 32402078 PMCID: PMC7462053 DOI: 10.1093/ptj/pzaa092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Undesirable postural orientation may be a risk factor for a second anterior cruciate ligament (ACL) injury. The purpose of this study was to evaluate face validity, internal consistency, and interrater reliability of an extended version of a previous test battery for visual assessment of postural orientation errors (POEs) in patients during the late phase of rehabilitation following ACL reconstruction (ACLR) (ie, when they have initiated jumping exercises). METHODS This study used a cross-sectional design. Fifty-three patients (45% women) in the late phase of ACLR rehabilitation performed 5 functional tasks of varying difficulty. POEs of the lower extremity and trunk were visually assessed from video and scored on a scale from 0 (good) to 2 (poor). RESULTS The side-hop and 2 new POEs (femur medial to shank, femoral valgus) were added to the test battery after expert focus group discussions. Internal consistency was calculated for all tasks (α = .712-.823). Interrater reliability showed fair to substantial agreement for femur medial to shank and femoral valgus during all tasks (K = 0.31-0.815) and almost perfect agreement for side-hop (intraclass correlation coefficient = 0.88). CONCLUSIONS The good internal consistency and reliability after adding side-hop, femur medial to shank, and femoral valgus suggests that this test battery is a suitable tool to quantify postural orientation throughout ACLR rehabilitation. IMPACT This test battery for visual assessment of POEs was evaluated in a heterogeneous group of patients in different phases of ACLR battery and can be used in clinical practice to measure POEs in patients with ACLR, including in the late phase of rehabilitation to return to sport. This study encourages research on more demanding tasks and additional POEs to cover the entire rehabilitation period after ACL injury or reconstruction.
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Affiliation(s)
- Jenny Nae
- Address all correspondence to Mrs Nae at:
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Australia
| | - Eva Ageberg
- Department of Health Sciences, Lund University
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22
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Impellizzeri FM, Jones DM, Griffin D, Harris-Hayes M, Thorborg K, Crossley KM, Reiman MP, Scholes MJ, Ageberg E, Agricola R, Bizzini M, Bloom N, Casartelli NC, Diamond LE, Dijkstra HP, Di Stasi S, Drew M, Friedman DJ, Freke M, Gojanovic B, Heerey JJ, Hölmich P, Hunt MA, Ishøi L, Kassarjian A, King M, Lawrenson PR, Leunig M, Lewis CL, Warholm KM, Mayes S, Moksnes H, Mosler AB, Risberg MA, Semciw A, Serner A, van Klij P, Wörner T, Kemp J. Patient-reported outcome measures for hip-related pain: a review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2020; 54:848-857. [DOI: 10.1136/bjsports-2019-101456] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 12/11/2022]
Abstract
Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5) voting and consensus. Out of 102 articles retrieved, 6 systematic reviews were selected and assessed for quality according to AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Two showed moderate quality. We then updated the most recent review. The updated literature search resulted in 10 additional studies that were included in the qualitative synthesis. The recommendations based on evidence summary and PROMs limitations were presented at the consensus meeting. The group makes the following recommendations: (1) the Hip and Groin Outcome Score (HAGOS) and the International Hip Outcome Tool (iHOT) instruments (long and reduced versions) are the most appropriate PROMs to use in young and middle-aged active adults with hip-related pain; (2) more research is needed into the utility of the HAGOS and the iHOT instruments in a non-surgical treatment context; and (3) generic quality of life measures such as the EuroQoL-5 Dimension Questionnaire and the Short Form Health Survey-36 may add value for researchers and clinicians in this field. We conclude that as none of the instruments shows acceptable quality across various psychometric properties, more methods studies are needed to further evaluate the validity of these PROMS—the HAGOS and iHOT—as well as the other (currently not recommended) PROMS.
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23
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Ageberg E, Bunke S, Nilsen P, Donaldson A. Planning injury prevention training for youth handball players: application of the generalisable six-step intervention development process. Inj Prev 2020; 26:164-169. [PMID: 32019772 PMCID: PMC7146925 DOI: 10.1136/injuryprev-2019-043468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 11/21/2022]
Abstract
Background Youth handball players are vulnerable to injuries. Because there is no available injury prevention training specifically developed for youth handball players targeting both upper and lower limbs or incorporating psychological aspects of injury, we undertook the ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ project. We used an ecological participatory design incorporating the perspectives of multiple stakeholders (health beneficiaries, programme deliverers and policy makers). The aim of this paper was to describe the process of developing the I-PROTECT model, featuring injury prevention training and an accompanying implementation strategy. Design We used the generalisable six-step intervention development process, outlined to guide researchers when developing implementable, evidence-based sports injury prevention interventions, to develop the I-PROTECT model. The six-step process involves establishing a research–stakeholder collaborative partnership to (1) identify and synthesise research evidence and clinical experience; (2) consult with relevant experts; (3) engage end users to ensure their needs, capacity and values are considered; (4) test the feasibility and acceptability of the intervention; (5) evaluate the intervention against theory; and (6) obtain feedback from early implementers. Two community handball clubs in southern Sweden, offering organised training for youth male and female players, and the district handball federation, participate in the intervention development. Drafts of the I-PROTECT model will be developed and revised with key stakeholder advice and input throughout all six steps. Conclusion The I-PROTECT model described will be an end user-driven intervention, including evidence-based, theory-informed and context-specific injury prevention training for youth handball, and an associated implementation strategy.
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Affiliation(s)
- Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Sofia Bunke
- Department of Psychology, Lund University, Lund, Sweden
| | - Per Nilsen
- Department of Community Medicine, Division of Health and Medical Sciences, Linköping University, Linkoping, Sweden
| | - Alex Donaldson
- Centre for Sport and Social Impact, La Trobe University, Melbourne, Victoria, Australia
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24
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Reiman MP, Agricola R, Kemp JL, Heerey JJ, Weir A, van Klij P, Kassarjian A, Mosler AB, Ageberg E, Hölmich P, Warholm KM, Griffin D, Mayes S, Khan KM, Crossley KM, Bizzini M, Bloom N, Casartelli NC, Diamond LE, Di Stasi S, Drew M, Friedman DJ, Freke M, Gojanovic B, Glyn-Jones S, Harris-Hayes M, Hunt MA, Impellizzeri FM, Ishøi L, Jones DM, King MG, Lawrenson PR, Leunig M, Lewis CL, Mathieu N, Moksnes H, Risberg MA, Scholes MJ, Semciw AI, Serner A, Thorborg K, Wörner T, Dijkstra HP. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2020; 54:631-641. [PMID: 31959678 DOI: 10.1136/bjsports-2019-101453] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2020] [Indexed: 12/31/2022]
Abstract
There is no agreement on how to classify, define or diagnose hip-related pain-a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion-adduction-internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head-neck radiographs are the initial diagnostic imaging of choice-advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.
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Affiliation(s)
- Michael P Reiman
- Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus, MC, University Medical Center, Rotterdam, Netherlands
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Weir
- Orthopaedics, Erasmus MC Center for Groin Injuries, Rotterdam, The Netherlands.,Sports Groin Pain Centre, Aspetar Hospital, Doha, Qatar
| | - Pim van Klij
- Department of Orthopaedic Surgery, Erasmus, MC, University Medical Center, Rotterdam, Netherlands
| | - Ara Kassarjian
- Elite Sports Imaging SL, Madrid, Spain.,Musculoskeletal Radiology, Corades, LLC, Brookline, MA, United States
| | - Andrea Britt Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Eva Ageberg
- Sport Sciences, Deparment of Health Sciences, Lund University, Lund, Sweden
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | | | - Damian Griffin
- Orthopaedics - Medical School, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Sue Mayes
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Karim M Khan
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Mario Bizzini
- Research, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Nancy Bloom
- Physical Therapy, Washington University, St. Louis, Missouri, USA
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland Griffith University, Schoold of Allied Health Sciences, Griffith, Queensland, Australia
| | - Stephanie Di Stasi
- School of Health and Rehabilitation Sciences, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael Drew
- Athlete Availability, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia.,Research into Sport and Exercise, University of Canberra, Canberra, Bruce, Australian Capital Territory, Australia
| | | | - Matthew Freke
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Boris Gojanovic
- Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland.,Sports Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sion Glyn-Jones
- Department of Orthopaedic Surgery, University of Oxford, Institute of Musculoskeletal Sciences, Oxford, United Kingdom
| | | | - Michael A Hunt
- Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Peter R Lawrenson
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Leunig
- Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
| | - Cara L Lewis
- Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Nicolas Mathieu
- Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Loeche-les-Bains, Valais, Switzerland
| | | | - May-Arna Risberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Mark James Scholes
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Andreas Serner
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Tobias Wörner
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Hendrik Paulus Dijkstra
- Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
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25
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Mosler AB, Kemp J, King M, Lawrenson PR, Semciw A, Freke M, Jones DM, Casartelli NC, Wörner T, Ishøi L, Ageberg E, Diamond LE, Hunt MA, Di Stasi S, Reiman MP, Drew M, Friedman D, Thorborg K, Leunig M, Bizzini M, Khan KM, Crossley KM, Agricola R, Bloom N, Dijkstra HP, Griffin D, Gojanovic B, Harris-Hayes M, Heerey JJ, Hölmich P, Impellizzeri FM, Kassarjian A, Warholm KM, Mayes S, Moksnes H, Risberg MA, Scholes MJ, Serner A, van Klij P, Lewis CL. Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: recommendations from the first International Hip-related Pain Research Network (IHiPRN) meeting, Zurich, 2018. Br J Sports Med 2019; 54:702-710. [DOI: 10.1136/bjsports-2019-101457] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 01/12/2023]
Abstract
Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport/performance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupation) be quantified, and sport-specific activities should be assessed prior to return to sport. The IHiPRN participants were uncertain regarding recommendations for range of motion assessment. Research recommendations were that the measurement properties of range of motion, strength and functional performance tests be investigated, reported and improved in both clinical and research settings. Reporting of movement-related parameters (biomechanics and muscle function) should be standardised and the relationship among movement-related parameters, symptoms, function, quality of life, and intra-articular and imaging findings should be investigated. Quantification of return to physical activity (including sport and occupational demands) is required in future research, and the return to sport continuum should be used. Future research is required to determine the best criteria for rehabilitation progression and return to physical activity following hip-related pain management.
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26
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Kemp JL, Risberg MA, Mosler A, Harris-Hayes M, Serner A, Moksnes H, Bloom N, Crossley KM, Gojanovic B, Hunt MA, Ishøi L, Mathieu N, Mayes S, Scholes MJ, Gimpel M, Friedman D, Ageberg E, Agricola R, Casartelli NC, Diamond LE, Dijkstra HP, Di Stasi S, Drew M, Freke M, Griffin D, Heerey J, Hölmich P, Impellizzeri FM, Jones DM, Kassarjian A, Khan KM, King MG, Lawrenson PR, Leunig M, Lewis CL, Warholm KM, Reiman MP, Semciw A, Thorborg K, van Klij P, Wörner T, Bizzini M. Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2019; 54:504-511. [PMID: 31732651 DOI: 10.1136/bjsports-2019-101458] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 11/04/2022]
Abstract
The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.
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Affiliation(s)
- Joanne L Kemp
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - May Arna Risberg
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Andrea Mosler
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Marcie Harris-Hayes
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA.,Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Nancy Bloom
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA.,Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Kay M Crossley
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Boris Gojanovic
- Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland.,SportAdo consultation, University Hospital of Lausanne (CHUV) Multidisciplinary Unit of Adolescent Health, Lausanne, Switzerland
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Nicolas Mathieu
- Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Leukerbad, Valais, Switzerland
| | - Sue Mayes
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,The Australian Ballet, Southbank, Victoria, Australia
| | - Mark J Scholes
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Mo Gimpel
- Performance Science, Southampton Football Club, Southampton, Hampshire, UK
| | - Daniel Friedman
- Monash School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Rintje Agricola
- Department of Orthopaedic Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE, Menzies Health Institute Queensland Griffith University, School of Allied Health Sciences, Gold Coast, Queensland, Australia
| | - H Paul Dijkstra
- Department for Continuing Education, University of Oxford, Oxford, Oxfordshire, UK.,Aspetar Sports Medicine Hospital, Doha, Qatar
| | - Stephanie Di Stasi
- Division of Physical Therapy, The Ohio State Univesity, Columbus, Ohio, USA
| | - Michael Drew
- University of Canberra Research into Sport and Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Matthew Freke
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Damian Griffin
- Warwick Orthopaedics, University of Warwick, Coventry, Warwick, UK
| | - Joshua Heerey
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Denise M Jones
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Ara Kassarjian
- Musculoskeletal Radiology, Corades, LLC, Brookline, Massachusetts, USA.,Musculoskeletal Radiology, Elite Sports Imaging, SL, Madrid, Spain
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew G King
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Peter R Lawrenson
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Leunig
- Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
| | - Cara L Lewis
- Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
| | | | - Michael P Reiman
- Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Adam Semciw
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Pim van Klij
- Department of Orthopaedic Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tobias Wörner
- Department of Health Sciences, Lunds University, Lund, Sweden
| | - Mario Bizzini
- Schulthess Clinic Human Performance Lab, Zurich, Switzerland
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27
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Pålsson A, Kostogiannis I, Lindvall H, Ageberg E. Hip-related groin pain, patient characteristics and patient-reported outcomes in patients referred to tertiary care due to longstanding hip and groin pain: a cross-sectional study. BMC Musculoskelet Disord 2019; 20:432. [PMID: 31521142 PMCID: PMC6745069 DOI: 10.1186/s12891-019-2794-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 08/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to advances in hip arthroscopy, the number of surgical procedures has increased dramatically. The diagnostic challenge in patients with longstanding hip and groin pain, as well as the increasing number of hip arthroscopies, may lead to a higher number of patients referred to tertiary care for consideration for surgery. Therefore, the aims were: 1) to describe the prevalence of hip-related groin pain in patients referred to tertiary care due to longstanding hip and groin pain; and 2) to compare patient characteristics and patient-reported outcomes for patients categorized as having hip-related groin pain and those with non-hip-related groin pain. METHODS Eighty-one patients referred to the Department of Orthopedics at Skåne University Hospital for longstanding hip and groin pain were consecutively included and categorized into hip-related groin pain or non-hip-related groin pain using diagnostic criteria based on current best evidence (clinical examination, radiological examination and intra-articular block injection). Patient characteristics (gender (%), age (years), BMI (kg/m2)), results from the Hip Sports Activity Scale (HSAS), the SF-36, the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain distribution (pain manikin) were collected. Parametric and non-parametric statistics were used as appropriate for between-group analysis. RESULTS Thirty-three (47%) patients, (30% women, 70% men, p < 0.01), were categorized as having hip-related groin pain. The hip-related groin pain group had a higher activity level during adolescence (p = 0.013), and a higher pre-injury activity level (p = 0.034), compared to the non-hip-related groin pain group. No differences (mean difference (95% CI)) between hip-related groin pain and non-hip-related groin pain were observed for age (0 (- 4; 4)), BMI (- 1.75 (- 3.61; 0.12)), any HAGOS subscales (p ≥ 0.318), any SF-36 subscales (p ≥ 0.142) or pain distribution (p ≥ 0.201). CONCLUSIONS Only half of the patients referred to tertiary care for long-standing hip and groin pain, who were predominantly men with a high activity level, had hip-related groin pain. Self-reported pain localization and distribution did not differ between patients with hip-related groin pain and those with non-hip-related groin pain, and both patient groups had poor perceived general health, and hip-related symptoms and function.
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Affiliation(s)
- Anders Pålsson
- Department of Health Sciences, Lund University, PO Box 157, 22100, Lund, Sweden.
| | - Ioannis Kostogiannis
- Department of Health Sciences, Lund University, PO Box 157, 22100, Lund, Sweden.,Department of Orthopaedics, Clinical Sciences, Lund University, Malmö, Sweden
| | - Håkan Lindvall
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Malmö, Sweden.,Department of Imaging and Functional Medicine, Skåne University Hospital Malmö, Malmö, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Lund University, PO Box 157, 22100, Lund, Sweden
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Cronström A, Ageberg E, Franettovich Smith MM, Blackmore T, Nae J, Creaby MW. Factors affecting knee abduction during weight-bearing activities in individuals with anterior cruciate ligament reconstruction. Phys Ther Sport 2019; 38:8-15. [PMID: 31005032 DOI: 10.1016/j.ptsp.2019.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate if muscle strength and muscle activation patterns are associated with increased knee abduction during two functional tasks, commonly used in rehabilitation for individuals with anterior cruciate ligament reconstruction (ACLR). DESIGN Cross-sectional study. SETTING Laboratory. PARTICIPANTS 24 women and 29 men approximately 7 months after ACLR. MAIN OUTCOME MEASURES Isometric peak torque of the trunk and lower extremity muscles were determined during maximal voluntary contractions. Trunk and lower extremity average muscle activation amplitude and peak knee abduction were evaluated during the single-leg squat (SLS) and the single-leg hop for distance (SLHD) for the injured side. Separate backward regressions were performed for men and women. RESULTS In women, lower knee flexion and extension strength were associated with greater peak knee abduction during the SLS (B = 4.63-18.26, p ≤ 0.036); lower knee flexion strength and iliocostalis activation on the non-injured side were associated with greater peak knee abduction during the SLHD (B = 0.60-20.48, p ≤ 0.043). No associations between muscle function and peak knee abduction were found in men. CONCLUSIONS Muscle function may contribute differently to knee abduction in men and women after ACLR. This should be considered when designing rehabilitation programs to reduce knee abduction in these patients.
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Affiliation(s)
- A Cronström
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - E Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - M M Franettovich Smith
- School of Health and Rehabilitation Science, University of Queensland, Brisbane, Australia
| | - T Blackmore
- School of Exercise Science, Australian Catholic University, Brisbane, Australia; Department of Sport and Exercise Science, University of Portsmouth, Hampshire, UK
| | - J Nae
- Department of Health Sciences, Lund University, Lund, Sweden
| | - M W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Australia
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Ageberg E, Bunke S, Lucander K, Nilsen P, Donaldson A. Facilitators to support the implementation of injury prevention training in youth handball: A concept mapping approach. Scand J Med Sci Sports 2018; 29:275-285. [PMID: 30339309 PMCID: PMC7380009 DOI: 10.1111/sms.13323] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 10/12/2018] [Indexed: 12/11/2022]
Abstract
There is a need for research to identify effective implementation strategies for injury prevention training within real-world community sports. The aim of this ecological participatory study was to identify facilitators, among stakeholders at multiple levels, that could help injury prevention training become part of regular training routines in youth team handball. Concept mapping, a mixed-method approach for qualitative data collection and quantitative data analysis, was used. Stakeholders (n = 196) of two community team handball clubs (29% players, 13% coaches, 38% caregivers, 11% club, district and national handball administrators, 9% unknown) participated in a brainstorming process. After the research team synthesized the 235 generated statements, 50 stakeholders (34% players, 22% coaches, 24% caregivers, 20% administrators) sorted 89 unique facilitator statements into clusters and rated them for importance and feasibility. Multidimensional scaling and hierarchical cluster analysis yielded five clusters (stress value 0.231): "Understanding and applying knowledge," "Education, knowledge, and consistency," "Set-up and exercises," "Inspiration, motivation, and routines," and "Club policy and expert collaboration." The cluster "Understanding and applying knowledge" had the highest mean importance (3.17 out of 4) and feasibility (2.93) ratings. The 32 statements rated as both highly important and feasible (Go-zone) indicate action is required at the individual (end-users) and organizational (policymakers) levels to implement injury prevention training. Results suggest that developing evidence-based context-specific injury prevention training, incorporating physiological, biomechanical and psychological components, and an associated context-specific implementation plan in partnership with all stakeholders should be a high priority to facilitate the implementation of injury prevention training in youth team handball.
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Affiliation(s)
- Eva Ageberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Sofia Bunke
- Department of Psychology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Karolina Lucander
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Per Nilsen
- Department of Community Medicine, Division of Health and Medical Sciences, Linköping University, Linköping, Sweden
| | - Alex Donaldson
- Centre for Sport and Social Impact (CSSI), La Trobe University, Melbourne, Victoria, Australia.,Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia
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Ageberg E, Cronström A. Agreement between test procedures for the single-leg hop for distance and the single-leg mini squat as measures of lower extremity function. BMC Sports Sci Med Rehabil 2018; 10:15. [PMID: 30167308 PMCID: PMC6103854 DOI: 10.1186/s13102-018-0104-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/15/2018] [Indexed: 12/31/2022]
Abstract
Background Different test procedures are often used within performance-based measures, causing uncertainty as to whether results can be compared between studies. Thus, the aim of this study was to assess agreement between different test procedures for the single-leg hop for distance (SLHD) and the single-leg mini squat (SLMS), respectively, two commonly used tasks for assessing deficiency in lower extremity muscle function. Methods Twenty-three participants (20–42 years) with lower extremity injury performed the SLHD with arms free and with arms behind back, and the Limb Symmetry Index (LSI; injured leg divided by uninjured and multiplied by 100) was calculated. Another group of 28 participants (mean 18–38 years) performed five SLMSs at a pre-defined speed and maximum number of SLMSs during 30 seconds, and were visually observed and scored as either having a knee-over-foot or a knee-medial-to-foot position (KMFP). Results No systematic difference between test procedures for the LSI of the SLHD was noted (p=0.736), Cohen’s kappa = 0.42. The Bland & Altman plot showed wide limits of agreement between test procedures, with particularly poor agreement for participants with abnormal LSI (<90%). Ten participants were scored as having a KMFP during five SLMSs at a predefined speed, while five had a KMFP during maximum number of SLMSs during 30 seconds (p=0.063, Cohen’s kappa = 0.56). Conclusions The moderate agreement between the two test procedures for the SLHD and the SLMS, respectively, indicate that results from these different test procedures should not be compared across studies. SLHD with arms behind back, and five SLMSs at a pre-defined speed, respectively, were the most sensitive procedures to detect individuals with poor functional performance.
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Affiliation(s)
- Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Anna Cronström
- Department of Health Sciences, Lund University, Lund, Sweden
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31
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Cronström A, Creaby MW, Nae J, Ageberg E. Modifiable Factors Associated with Knee Abduction During Weight-Bearing Activities: A Systematic Review and Meta-Analysis. Sports Med 2018; 46:1647-1662. [PMID: 27048463 DOI: 10.1007/s40279-016-0519-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Increased knee abduction angle during activity is suggested to be a risk factor for sustaining an anterior cruciate ligament (ACL) injury or developing patellofemoral pain syndrome (PFPS). Knowledge of the modifiable mechanisms that are associated with increased knee abduction will aid in the appropriate design of preventive and rehabilitative strategies for these injuries. OBJECTIVE Our objective was to systematically review modifiable mechanisms contributing to increased knee abduction in healthy people and in individuals with an ACL injury or PFPS. METHODS We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the databases MEDLINE, CINAHL, and Embase until September 2015. Inclusion criteria were studies in healthy individuals and/or those with ACL injury or PFPS reporting (1) muscle strength, muscle activation, proprioception, and/or range of motion (ROM) and (2) knee abduction angle assessed with either motion analysis or visual observation during weight-bearing activity. RESULTS In total, 33 articles were included. Reduced trunk strength, reduced gluteus maximus amplitude, decreased ankle ROM, and increased hip external rotation ROM were moderately associated with increased knee abduction angle (r -0.34 or higher, standardized difference in means (SDM) greater than -0.39, p < 0.05, articles n = 3, total sample size n = 101-114) in healthy individuals. Decreased strength of hip abductors, external rotators, and extensors and knee flexors were at most weakly associated with increased knee abduction angle (r ≤ 0.21, p = 0.013-0.426, articles n = 2-9, total sample size n = 80-311). Too few articles included patients with knee injury to be included in any meta-analysis. CONCLUSION The associations identified in this review indicate that investigation of strengthening of the trunk muscles, and improvement of gluteus maximus activation and ankle ROM to change knee kinematics is merited. Studies on modifiable factors associated with increased knee abduction angle in people with knee injury are needed.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, QLD, Australia
| | - Jenny Nae
- Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden
| | - Eva Ageberg
- Department of Health Sciences, Lund University, PO Box 157, 221 00, Lund, Sweden
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Abstract
Background: The Activity Rating Scale (ARS) for disorders of the knee evaluates the level of activity by the frequency of participation in 4 separate activities with high demands on knee function, with a score ranging from 0 (none) to 16 (pivoting activities 4 times/wk). Purpose: To translate and cross-culturally adapt the ARS into Swedish and to assess measurement properties of the Swedish version of the ARS. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The COSMIN guidelines were followed. Participants (N = 100 [55 women]; mean age, 27 years) who were undergoing rehabilitation for a knee injury completed the ARS twice for test-retest reliability. The Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale (TAS), and modernized Saltin-Grimby Physical Activity Level Scale (SGPALS) were administered at baseline to validate the ARS. Construct validity and responsiveness of the ARS were evaluated by testing predefined hypotheses regarding correlations between the ARS, KOOS, TAS, and SGPALS. The Cronbach alpha, intraclass correlation coefficients, absolute reliability, standard error of measurement, smallest detectable change, and Spearman rank-order correlation coefficients were calculated. Results: The ARS showed good internal consistency (α ≈ 0.96), good test-retest reliability (intraclass correlation coefficient >0.9), and no systematic bias between measurements. The standard error of measurement was less than 2 points, and the smallest detectable change was less than 1 point at the group level and less than 5 points at the individual level. More than 75% of the hypotheses were confirmed, indicating good construct validity and good responsiveness of the ARS. Conclusion: The Swedish version of the ARS is valid, reliable, and responsive for evaluating the level of activity based on the frequency of participation in high-demand knee sports activities in young adults with a knee injury.
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Affiliation(s)
| | - Ewa M Roos
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
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Creaby MW, Le Rossignol S, Conway ZJ, Ageberg E, Sweeney M, Franettovich Smith MM. Frontal plane kinematics predict three-dimensional hip adduction during running. Phys Ther Sport 2017; 27:1-6. [DOI: 10.1016/j.ptsp.2017.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/18/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
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Turkiewicz A, Timpka S, Thorlund JB, Ageberg E, Englund M. Knee extensor strength and body weight in adolescent men and the risk of knee osteoarthritis by middle age. Ann Rheum Dis 2017; 76:1657-1661. [PMID: 28487313 DOI: 10.1136/annrheumdis-2016-210888] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/10/2017] [Accepted: 04/22/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the extent to which knee extensor strength and weight in adolescence are associated with knee osteoarthritis (OA) by middle age. METHODS We studied a cohort of 40 121 men who at age 18 years in 1969/1970 underwent mandatory conscription in Sweden. We retrieved data on isometric knee extensor strength, weight, height, smoking, alcohol consumption, parental education and adult occupation from Swedish registries. We identified participants diagnosed with knee OA or knee injury from 1987 to 2010 through the National Patient Register. We estimated the HR of knee OA using multivariable-adjusted Cox proportional regression model. To assess the influence of adult knee injury and occupation, we performed a formal mediation analysis. RESULTS The mean (SD) knee extensor strength was 234 (47) Nm, the mean (SD) weight was 66 (9.3) kg. During 24 years (median) of follow-up starting at the age of 35 years, 2049 persons were diagnosed with knee OA. The adjusted HR (95% CI) of incident knee OA was 1.12 (1.06 to 1.18) for each SD of knee extensor strength and 1.18 (1.15 to 1.21) per 5 kg of body weight. Fifteen per cent of the increase in OA risk due to higher knee extensor strength could be attributed to knee injury and adult occupation. CONCLUSION Higher knee extensor strength in adolescent men was associated with increased risk of knee OA by middle age, challenging the current tenet of low muscle strength being a risk factor for OA. We confirmed higher weight to be a strong risk factor for knee OA.
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Affiliation(s)
- Aleksandra Turkiewicz
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Faculty of Medicine, Lund University, Lund, Sweden
| | - Simon Timpka
- Genetic and Molecular Epidemiology Unit, Lund University Diabetes Center, Lund University, Malmö, Sweden.,Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Faculty of Medicine, Lund University, Lund, Sweden.,Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
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Nae J, Creaby MW, Cronström A, Ageberg E. Measurement properties of visual rating of postural orientation errors of the lower extremity - A systematic review and meta-analysis. Phys Ther Sport 2017. [PMID: 28647205 DOI: 10.1016/j.ptsp.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To systematically review measurement properties of visual assessment and rating of Postural Orientation Errors (POEs) in participants with or without lower extremity musculoskeletal disorders. METHODS A systematic review according to the PRISMA guidelines was conducted. The search was performed in Medline (Pubmed), CINAHL and EMBASE (OVID) databases until August 2016. Studies reporting measurement properties for visual rating of postural orientation during the performance of weight-bearing functional tasks were included. No limits were placed on participant age, sex or whether they had a musculoskeletal disorder affecting the lower extremity. RESULTS Twenty-eight articles were included, 5 of which included populations with a musculoskeletal disorder. Visual rating of the knee-medial-to-foot position (KMFP) was reliable within and between raters, and meta-analyses showed that this POE was valid against 2D and 3D kinematics in asymptomatic populations. Other segment-specific POEs showed either poor to moderate reliability or there were too few studies to permit synthesis. Intra-rater reliability was at least moderate for POEs within a task whereas inter-rater reliability was at most moderate. CONCLUSIONS Visual rating of KMFP appears to be valid and reliable in asymptomatic adult populations. Measurement properties remain to be determined for POEs other than KMPF.
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Affiliation(s)
- Jenny Nae
- Department of Health Sciences, Lund University, PO Box 157, SE-221 00 Lund, Sweden.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Queensland 4014, Australia.
| | - Anna Cronström
- Department of Health Sciences, Lund University, PO Box 157, SE-221 00 Lund, Sweden.
| | - Eva Ageberg
- Department of Health Sciences, Lund University, PO Box 157, SE-221 00 Lund, Sweden.
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Ryman Augustsson S, Ageberg E. Weaker lower extremity muscle strength predicts traumatic knee injury in youth female but not male athletes. BMJ Open Sport Exerc Med 2017; 3:e000222. [PMID: 29259807 PMCID: PMC5731228 DOI: 10.1136/bmjsem-2017-000222] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/23/2022] Open
Abstract
Background The role of lower extremity (LE) muscle strength for predicting traumatic knee injury in youth athletes is largely unknown. Aims The aim was to investigate the influence of LE muscle strength on traumatic knee injury in youth female and male athletes. Methods 225 athletes (40% females) from sport senior high schools in Sweden were included in this case-control study. The athletes recorded any traumatic knee injury that had occurred during their high-school period in a web-based injury form. A one repetition maximum (1RM) barbell squat test was used to measure LE muscle strength. The 1RM was dichotomised to analyse 'weak' versus 'strong' athletes according to the median (weakmedian vs strongmedian). Results 63 traumatic knee injuries, including 18 ACL injuries, were registered. The majority of injured female athletes were in the weak group compared with the strong group (p=0.0001). The odds of sustaining a traumatic knee injury and an ACL injury was 9.5 times higher and 7 times higher, respectively, in the weakmedian group compared with the strongmedian group in females (p ≤0.011). A relative 1RM squat ≤1.05 kg (105% of bodyweight) was established as the best cut-off value to distinguish high versus low risk of injury in female athletes. No strength-injury relationships were observed for the male athletes (p ≥0.348). Conclusions Weaker LE muscle strength predicted traumatic knee injury in youth female athletes, but not in males. This suggests that LE muscle strength should be included in injury screening in youth female athletes.
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Affiliation(s)
| | - Eva Ageberg
- Department of Health Sciences, Musculoskeletal Function, Lund University, Lund, Sweden
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Cronström A, Roos EM, Ageberg E. Association between sensory function and hop performance and self-reported outcomes in patients with anterior cruciate ligament injury. Open Access J Sports Med 2017; 8:1-8. [PMID: 28176927 PMCID: PMC5261846 DOI: 10.2147/oajsm.s120058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In patients with anterior cruciate ligament (ACL) deficiency (ACLD) or reconstruction (ACLR), sensory deficits are commonly assessed as knee kinesthesia using time-consuming laboratory equipment. Portable equipment such as that used for evaluation of vibration sense would be preferable. In contrast to kinesthesia, vibration sense is not well studied in these patients. Objectives 1) To study the association between kinesthesia and vibration sense to investigate if one sensory measurement can replace the other; and 2) to determine the clinical relevance by investigating associations between the sensory measurements and functional performance and patient-reported outcomes in patients with ACLD or ACLR. Methods Twenty patients with ACLD and 33 patients with ACLR were assessed with knee kinesthesia, vibration sense, the one-leg hop test for distance, as well as the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Scale. Results There were no significant correlations between kinesthesia and vibration sense (r= −0.267, p>0.269) or between the sensory measures and hop performance (r= −0.351, p>0.199). In patients with ACLD, worse knee kinesthesia was associated with worse scores on KOOS subscales pain (r= −0.464, p=0.046) and activities of daily living (r= −0.491, p=0.033), and worse vibration sense was associated with worse scores on KOOS subscale quality of life (r= −0.469, p=0.037) and worse knee confidence (item Q3 from subscale quality of life) (rs=0.436, p=0.054). In patients with ACLR, worse vibration sense was associated with worse scores on KOOS subscales pain (r= −0.402, p=0.020) and activities of daily living (r= −0.385, p=0.027). Conclusion Kinesthesia and vibration sense cannot be used interchangeably as measures of sensory function in patients with ACLD or ACLR. Both sensory measurements were weakly related to hop performance. Adequate sensory function appears to have importance for perceived function in patients with ACLD or ACLR and may therefore be a factor that needs to be addressed in rehabilitation programs for these patients.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
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Ageberg E, Bunke S, Andersson K, Nilsen P, Donaldson A. A CONCEPT MAPPING APPROACH TO IDENTIFY PERCEIVED FACILITATORS TO ENHANCE THE IMPLEMENTATION OF INJURY PREVENTION TRAINING IN YOUTH TEAM HANDBALL: THE I-PROTECT PROJECT. Br J Sports Med 2017. [DOI: 10.1136/bjsports-2016-097372.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Flosadottir V, Roos EM, Ageberg E. Muscle function is associated with future patient-reported outcomes in young adults with ACL injury. BMJ Open Sport Exerc Med 2016; 2:e000154. [PMID: 27900196 PMCID: PMC5125420 DOI: 10.1136/bmjsem-2016-000154] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 11/29/2022] Open
Abstract
Background/aim Consequences of an anterior cruciate ligament (ACL) injury include worse patient-reported outcomes (PROs) and a decrease in activity level. Muscle function can be improved by targeted exercise. Our aims were to investigate cross-sectional and longitudinal associations among lower extremity muscle function and PROs after ACL injury. Methods Fifty-four participants (15 women, mean 30 years) with ACL injury or reconstruction, from the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial (ISRCTN84752559), were assessed with hop performance, muscle power and postural orientation 3 years (SD 0.85) after ACL injury. PROs at 3 and 5 years after injury included Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Function in sport and recreation (KOOS Sport/rec) and Knee-related Quality of life (KOOS QoL), KOOS item Q3 (KOOS Q3), Tegner Activity Scale and Activity Rating Scale (ARS). Partial Spearman's rank-order correlation was used to analyse correlations between muscle function and PROs, controlling for gender and treatment. Results Numerous cross-sectional correlations were observed between muscle function and PROs (rsp≈0.3–0.5, p≤0.045). Worse hop performance and worse postural orientation were associated with worse KOOS scores 2 years later (rsp≥0.280, p≤0.045). Worse muscle power was associated with lower future ARS scores (rsp=0.281, p=0.044). Conclusions The moderate associations suggest that improving muscle function during rehabilitation could improve present and future PROs.
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Affiliation(s)
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports and Clinical Biomechanics, University of Southern Denmark , Odense , Denmark
| | - Eva Ageberg
- Department of Health Sciences , Lund University , Lund , Sweden
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Ageberg E. Commentary on: "Scientific evidence is just the starting point: A generalizable process for developing sports injury prevention interventions" by Alex Donaldson et al. J Sport Health Sci 2016; 5:322-323. [PMID: 30356497 PMCID: PMC6188578 DOI: 10.1016/j.jshs.2016.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 06/08/2023]
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Cronström A, Creaby MW, Nae J, Ageberg E. Gender differences in knee abduction during weight-bearing activities: A systematic review and meta-analysis. Gait Posture 2016; 49:315-328. [PMID: 27479217 DOI: 10.1016/j.gaitpost.2016.07.107] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased knee abduction during weight-bearing activities is suggested to be a contributing factor for the high knee injury risk reported in women. However, studies investigating gender difference in knee abduction are inconclusive. OBJECTIVE To systematically review gender-differences in knee abduction during weight-bearing activities in individuals with or without knee injury. METHODS A systematic review and meta-analysis were conducted according to the PRISMA guidelines. A search in the databases Medline, CINAHL and EMBASE was performed until September 2015. Inclusion criteria were studies that reported (1) gender differences, (2) healthy individuals and/or those with anterior cruciate ligament (ACL) deficiency or reconstruction or patellofemoral pain PFP, and (3) knee abduction assessed with either motion analysis or visual observation during weight-bearing activity. RESULTS Fifty-eight articles met the inclusion criteria. Women with PFP had greater peak knee abduction compared to men (Std diff in mean; -1.34, 95%CI; -1.83 to -0.84). In healthy individuals, women performed weight-bearing tasks with greater knee abduction throughout the movement (initial contact, peak abduction, excursion) (Std diff in mean; -0.68 to -0.79, 95%CI; -1.04 to -0.37). In subgroup analyses by task, differences in knee abduction between genders were present for most tasks, including running, jump landings and cutting movements. There were too few studies in individuals with ACL injury to perform meta-analysis. CONCLUSION The gender difference in knee abduction during weight-bearing activities should be considered in training programs aimed at preventing or treating knee injury.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Australia.
| | - Jenny Nae
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden.
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Nae JÄ, Nilsson G, Creaby MW, Crossley K, Ageberg E. Measurement Properties Of Postural Orientation Errors During Functional Tasks In Patients With Acl Injury. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000486218.10519.cd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Flosadottir V, Roos EM, Ageberg E. Muscle Function at 3 Years Following ACL Injury Affects 5 Year Patient-Reported Outcomes. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000485905.23199.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Exercise is recommended as first-line treatment of degenerative knee disease. Our hypothesis is that neuromuscular exercise is feasible and at least as effective as traditionally used strength or aerobic training but aims to target more closely the sensorimotor deficiencies and functional instability associated with the degenerative knee disease than traditionally used training methods.
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Affiliation(s)
- Eva Ageberg
- 1Department of Health Sciences, Lund University, Lund, Sweden; and 2Institute of Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Cronström A, Ageberg E. Association between sensory function and medio-lateral knee position during functional tasks in patients with anterior cruciate ligament injury. BMC Musculoskelet Disord 2014; 15:430. [PMID: 25494866 PMCID: PMC4301659 DOI: 10.1186/1471-2474-15-430] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with anterior cruciate ligament (ACL) injury often exhibit reduced movement quality during functional tasks in the form of a knee-medial-to-foot position (KMFP). This movement pattern is suggested to be more common in women than in men, but the possible contributing sensorimotor factors for this altered knee position are poorly studied in these patients. The aim of this study was to evaluate the association between sensory function and medio-lateral knee position during functional tasks in men and women with ACL injury. METHODS Fifty-one patients (23 women) aged 18-40 years with ACL injury were included in this cross-sectional study. Measures of sensory function were assessed by the threshold to detection of passive motion (TDPM) for knee kinesthesia and by the vibration perception threshold (VPT) for vibration sense. Movement quality was assessed by visual observation of the position of the knee relative to the foot during the following four functional tasks with different degrees of difficulty: the single-limb mini-squat, stair descending, the forward lunge, and the drop-jump. Spearman's rank correlation coefficient was used to determine the relationship between the sensory measures and the medio-lateral knee position during the functional tasks. Differences in TDPM and/or VPT between subjects with good and poor movement quality were evaluated using the independent t-test. Separate gender analyses were performed. RESULTS Worse TDPM was associated with a KMFP during the drop jump in men. Worse VPT at the toe and ankle was associated with a KMFP during stair descending and the forward lunge in women, but no associations were found in men. CONCLUSION Worse kinesthesia, measured by TDPM, might be associated with KMFP during the drop jump in men with ACL injury while worse vibration sense, measured by the VPT, at the foot and ankle might be related to KMFP in women. Further studies are needed to confirm these results.
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Affiliation(s)
- Anna Cronström
- Department of Health Sciences, Lund University, PO Box 157, Lund, SE-221 00 Sweden.
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Bennell KL, Kyriakides M, Metcalf B, Egerton T, Wrigley TV, Hodges PW, Hunt MA, Roos EM, Forbes A, Ageberg E, Hinman RS. Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: a randomized controlled trial. Arthritis Rheumatol 2014; 66:950-9. [PMID: 24757146 DOI: 10.1002/art.38317] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 12/10/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To compare the effects of neuromuscular exercise (NEXA) and quadriceps strengthening (QS) on the knee adduction moment (an indicator of mediolateral distribution of knee load), pain, and physical function in patients with medial knee joint osteoarthritis (OA) and varus malalignment. METHODS One hundred patients with medial knee pain, mostly moderate-to-severe radiographic medial knee OA, and varus malalignment were randomly allocated to one of two 12-week exercise programs. Each program involved 14 individually supervised exercise sessions with a physiotherapist plus a home exercise component. Primary outcomes were peak external knee adduction moment (3-dimensional gait analysis), pain (visual analog scale), and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index). RESULTS Eighty-two patients (38 [76%] of 50 in the NEXA group and 44 [88%] of 50 in the QS group) completed the trial. There was no significant between-group difference in the change in the peak knee adduction moment (mean difference 0.13 Nm/[body weight × height]% [95% confidence interval (95% CI) -0.08, 0.33]), pain (mean difference 2.4 mm [95% CI -6.0, 10.8]), or physical function (mean difference -0.8 units [95% CI -4.0, 2.4]). Neither group showed a change in knee moments following exercise, whereas both groups showed similar significant reductions in pain and improvement in physical function. CONCLUSION Although comparable improvements in clinical outcomes were observed with both neuromuscular and quadriceps strengthening exercise in patients with moderate varus malalignment and mostly moderate-to-severe medial knee OA, these forms of exercise did not affect the knee adduction moment, a key predictor of structural disease progression.
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Affiliation(s)
- Kim L Bennell
- University of Melbourne, Melbourne, Victoria, Australia
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Roos EM, Ageberg E. [Exercise is a cornerstone in the treatment]. Lakartidningen 2014; 111:943-947. [PMID: 24946499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Kosek E, Roos EM, Ageberg E, Nilsdotter A. Increased pain sensitivity but normal function of exercise induced analgesia in hip and knee osteoarthritis--treatment effects of neuromuscular exercise and total joint replacement. Osteoarthritis Cartilage 2013; 21:1299-307. [PMID: 23973144 DOI: 10.1016/j.joca.2013.06.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 06/05/2013] [Accepted: 06/17/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess exercise induced analgesia (EIA) and pain sensitivity in hip and knee osteoarthritis (OA) and to study the effects of neuromuscular exercise and surgery on these parameters. DESIGN The dataset consisted of knee (n = 66) and hip (n = 47) OA patients assigned for total joint replacement at Lund University Hospital undergoing pre-operative neuromuscular exercise and 43 matched controls. Sensitivity to pressure pain was assessed by pressure algometry at 10 sites. Subjects were then instructed to perform a standardized static knee extension. Pressure pain thresholds (PPTs) were assessed at the contracting quadriceps muscle (Q) and at the resting deltoid muscle (D) before and during contraction. The relative increase in PPTs during contraction was taken as a measure of localized (Q) or generalized (D) EIA. Patients were assessed at baseline, following on average 12 weeks of neuromuscular exercise and 3 months following surgery. RESULTS We found a normal function of EIA in OA patients at baseline. Previous studies have reported beneficial effects of physical exercise on pain modulation in healthy subjects. However, no treatment effects on EIA were seen in OA patients despite the increase in muscle strength following neuromuscular exercise and reduced pain following surgery. Compared to controls, OA patients had increased pain sensitivity and no beneficial effects on pain sensitivity were seen following treatment. CONCLUSIONS To our knowledge, this is the first study of EIA in OA patients. Despite increased pain sensitivity, OA patients had a normal function of EIA.
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Affiliation(s)
- E Kosek
- Osher Center for Integrative Medicine and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
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Ageberg E, Nilsdotter A, Kosek E, Roos EM. Effects of neuromuscular training (NEMEX-TJR) on patient-reported outcomes and physical function in severe primary hip or knee osteoarthritis: a controlled before-and-after study. BMC Musculoskelet Disord 2013; 14:232. [PMID: 23924144 PMCID: PMC3750589 DOI: 10.1186/1471-2474-14-232] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 08/06/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The benefits of exercise in mild and moderate knee or hip osteoarthritis (OA) are apparent, but the evidence in severe OA is less clear. We recently reported that neuromuscular training was well tolerated and feasible in patients with severe primary hip or knee OA. The aims of this controlled before-and-after study were to compare baseline status to an age-matched population-based reference group and to examine the effects of neuromuscular training on patient-reported outcomes and physical function in patients with severe primary OA of the hip or knee. METHODS 87 patients (60-77 years) with severe primary OA of the hip (n = 38, 55% women) or knee (n = 49, 59% women) awaiting total joint replacement (TJR) had supervised, neuromuscular training (NEMEX-TJR) in groups with individualized level and progression of training. A reference group (n = 43, 53% women) was included for comparison with patients' data. Assessments included self-reported outcomes (HOOS/KOOS) and measures of physical function (chair stands, number of knee bends/30 sec, knee extensor strength, 20-meter walk test) at baseline and at follow-up before TJR. Analysis of covariance (ANCOVA) was used for comparing patients and references and elucidating influence of demographic factors on change. The paired t-test was used for comparisons within groups. RESULTS At baseline, patients reported worse scores than the references in all HOOS/KOOS subscales (hip 27-47%, knee 14-52%, of reference scores, respectively) and had functional limitations (hip 72-85%, knee 42-85%, of references scores, respectively). NEMEX-TJR (mean 12 weeks (SD 5.6) of training) improved self-reported outcomes (hip 9-29%, knee 7-20%) and physical function (hip 3-18%, knee 5-19%) (p < 0.005). Between 42% and 62% of hip OA patients, and 39% and 61% of knee OA patients, displayed a clinically meaningful improvement (≥15%) in HOOS/KOOS subscales by training. The improvement in HOOS/KOOS subscale ADL was greater for patients with knee OA than hip OA, while the improvement in subscale Sport/Rec was greater for patients with hip OA than knee OA. CONCLUSIONS Both self-reported outcomes and physical function were clearly worse compared with the reference group. Neuromuscular training with an individualized approach and gradual progression showed promise for improving patient-reported outcomes and physical function even in older patients with severe primary OA of the hip or knee.
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