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Krommes K, Thorborg K, Clausen MB, Rathleff MS, Olesen JL, Kallemose T, Hölmich P. Self-management including exercise, education and activity modification compared to usual care for adolescents with Osgood-Schlatter (the SOGOOD trial): protocol of a randomized controlled superiority trial. BMC Sports Sci Med Rehabil 2024; 16:89. [PMID: 38643184 PMCID: PMC11032598 DOI: 10.1186/s13102-024-00870-0] [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: 09/28/2023] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Osgood-Schlatter is the most frequent growth-related injury affecting about 10% of physically active adolescents. It can cause long-term pain and limitations in sports and physical activity, with potential sequela well into adulthood. The management of Osgood-Schlatter is very heterogeneous. Recent systematic reviews have found low level evidence for surgical intervention and injection therapies, and an absence of studies on conservative management. Recently, a novel self-management approach with exercise, education, and activity modification, demonstrated favorable outcomes for adolescents with patellofemoral pain and Osgood-Schlatter in prospective cohort studies. AIM The aim of this trial is to assess the effectiveness of the novel self-management approach compared to usual care in improving self-reported knee-related function in sport (measured using the KOOS-child 'Sport/play' subscale) after a 5-month period. METHODS This trial is a pragmatic, assessor-blinded, randomized controlled trial with a two-group parallel arm design, including participants aged 10-16 years diagnosed with Osgood-Schlatter. Participants will receive 3 months of treatment, consisting of either usual care or the self-management approach including exercise, education, and activity modification, followed by 2 months of self-management. Primary endpoint is the KOOS-child 'Sport/play' score at 5 months. This protocol details the planned methods and procedures. DISCUSSION The novel approach has already shown promise in previous cohort studies. This trial will potentially provide much-needed level 1 evidence for the effectiveness of the self-management approach, representing a crucial step towards addressing the long-term pain and limitations associated with Osgood-Schlatter. TRIAL REGISTRATION Clinicaltrials.gov: NCT05174182. Prospectively registered December 30th 2021. Date of first recruitment: January 3rd 2022. Target sample size: 130 participants.
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Affiliation(s)
- Kasper Krommes
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, DK-2650, Denmark.
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, DK-2650, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
| | - Mikkel Bek Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Sigurdsgade 26, DK-2200, Copenhagen N, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg. Fyrkildevej 7, DK-9220, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, DK-9220, Aalborg, Denmark
| | - Jens Lykkegaard Olesen
- Center for General Practice at Aalborg University, Aalborg. Fyrkildevej 7, DK-9220, Aalborg, Denmark
| | - Thomas Kallemose
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Sigurdsgade 26, DK-2200, Copenhagen N, Denmark
- Department of Clinical Research, Amager-Hvidovre, Copenhagen University Hospital, Kettegaard Alle 30, Hvidovre, DK-2610, Danmark
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, DK-2650, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
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Sprague AL, Couppé C, Pohlig RT, Snyder-Mackler L, Silbernagel KG. Pain-guided activity modification during treatment for patellar tendinopathy: a feasibility and pilot randomized clinical trial. Pilot Feasibility Stud 2021; 7:58. [PMID: 33632313 PMCID: PMC7905015 DOI: 10.1186/s40814-021-00792-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 08/18/2020] [Accepted: 02/08/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Activity modification is a key component of patellar tendinopathy treatment but there is a lack of evidence guiding activity modification prescription. Use of activity modification in treatment studies has varied widely and the impact of those recommendations has not been directly investigated or compared. The purpose of this study was to assess (1) the feasibility of using pain-guided activity modification during treatment for patellar tendinopathy and (2) if our outcome measures are responsive to changes in tendon health over the course of treatment. METHODS This was an unblinded, randomized two-arm pilot and feasibility study randomized clinical trial with parallel assignment, conducted in Newark, DE. Individuals between the ages of 16 and 40 years old with patellar tendinopathy were included. Participants were randomly assigned to a pain-guided activity (PGA) or pain-free activity (PFA) group using a spreadsheet-based randomization scheme. All participants received standardized treatment using a modified version of the heavy-slow resistance protocol 3×/week for 12 weeks. For the first 6 weeks, the PGA group used the Pain-Monitoring Model to guide activity outside of treatment and the PFA group was restricted from running, jumping, or activities that provoked their patellar tendon pain. Feasibility outcomes included recruitment, enrollment, randomization, compliance, and retention percentages. Clinical evaluations were conducted at baseline, 6, and 12 weeks to assess symptom severity, psychological factors, tendon morphology and mechanical properties, lower extremity function, and quadriceps muscle performance. RESULTS In a ~ 13-month period, 108 individuals were screened, 47/108 (43.5%) were eligible for participation, and 15/47 (32.0%) of those were enrolled (9 PGA, 6 PFA). The recruitment rate was 1.15 participants/month. The mean ± SD compliance with treatment was PGA: 86.1 ± 13.0% and PFA: 67.1 ± 30.7%. There was one missed evaluation session and two adverse events, which were not due to study interventions. Changes exceeding the smallest detectable change were observed for at least one outcome in each domain of tendon health. CONCLUSIONS Use of pain-guided activity modification during exercise therapy for patellar tendinopathy was found to be feasible, and the proposed outcome measures appropriate. Computer-based allocation concealment, blinding of evaluators, and greater recruitment of high-level athletes should be implemented in future trials. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03694730 . Registered 3rd of October, 2018.
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Affiliation(s)
- Andrew L Sprague
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
- Department of Biomechanics and Movement Science, University of Delaware, Newark, DE, USA.
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Christian Couppé
- Department of Orthopaedic Surgery M, Faculty of Health and Medical Sciences, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark
- IOC Research Center Copenhagen Center for Injury Prevention and Protection of Athlete Health, Bispebjerg Hospital, Copenhagen, Denmark
| | - Ryan T Pohlig
- Biostatistic Core Facility, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
- Department of Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
- Department of Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
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Tripp B, Vincent HK, Bruner M, Smith MS. Comparison of wet bulb globe temperature measured on-site vs estimated and the impact on activity modification in high school football. Int J Biometeorol 2020; 64:593-600. [PMID: 31863179 DOI: 10.1007/s00484-019-01847-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/01/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
Exertional heat stroke is one of the top three causes of death in young athletes, particularly high school football players. Despite evidence that these deaths are completely avoidable with appropriate prevention and treatment, deaths still occur at an alarming rate. Wet bulb globe temperature (WBGT) is the preferred method of both the National Athletic Trainers' Association and American College of Sports Medicine to measure heat intensity. Based on the WBGT, activity modification guidelines (AMG) dictate work-to-rest ratios, activity levels and duration, protective equipment worn, and length and frequency of hydration breaks. Due to the cost of handheld WBGT monitors, smartphone apps that estimate WBGT have been considered an alternative. However, it is unclear how WBGT values estimated by these smartphone apps compare to those measured on-site using handheld WBGT monitors. We compared WBGT values estimated by a commercial smartphone app to those taken on-site at the same time and place. Thirteen athletic trainers measured WBGT in the field during high school football practices over a three-month season in North Central Florida. A paired sample t-test indicated the smartphone app significantly overestimated WBGT (29.0°C ± 4.1°C) compared to on-site measures (26.4°C ± 3.2°C) ( r =0.580; t(943)=-23.38, p <0.0001). The smartphone app-estimated values were consistently greater than on-site measures, resulting in potentially unnecessary activity modifications and cancellations if the app was used in place of on-site handheld WBGT monitors. Despite being significantly cheaper than handheld WBGT monitors, at this time, smartphone apps are not ready for widespread use to guide activity modification decisions.
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Affiliation(s)
- Brady Tripp
- University of Florida, Gainesville, FL, USA.
| | - Heather K Vincent
- Department of Orthopaedics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Michelle Bruner
- University of Florida, Department of Orthopedics and Rehabilitation, Gainesville, FL, USA
| | - Michael Seth Smith
- University of Florida, Department of Orthopedics and Rehabilitation, Gainesville, FL, USA
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Hosokawa Y, Adams WM, Belval LN, Davis RJ, Huggins RA, Jardine JF, Katch RK, Stearns RL, Casa DJ. Exertional heat illness incidence and on-site medical team preparedness in warm weather. Int J Biometeorol 2018; 62:1147-1153. [PMID: 29594509 DOI: 10.1007/s00484-018-1517-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/11/2018] [Accepted: 02/14/2018] [Indexed: 06/08/2023]
Abstract
To investigate the influence of estimated wet bulb globe temperature (WBGT) and the International Institute of Race Medicine (IIRM) activity modification guidelines on the incidence of exertional heat stroke (EHS) and heat exhaustion (HEx) and the ability of an on-site medical team to treat those afflicted. Medical records of EHS and HEx patients over a 17-year period from the New Balance Falmouth Road Race were examined. Climatologic data from nearby weather stations were obtained to calculate WBGT with the Australian Bureau of Meteorology (WBGTA) and Liljegren (WBGTL) models. Incidence rate (IR) of EHS, HEx, and combined total of EHS and HEx (COM) were calculated, and linear regression analyses were performed to assess the relationship between IR and WBGTA or WBGTL. One-way ANOVA was performed to compare differences in EHS, HEx, and COM incidence to four alert levels in the IIRM guidelines. Incidence of EHS, HEx, and COM was 2.12, 0.98, and 3.10 cases per 1000 finishers. WBGTA explained 48, 4, and 46% of the variance in EHS, HEx, and COM IR; WBGTL explained 63, 13, and 69% of the variance in EHS, HEx, and COM IR. Main effect of WBGTA and WBGTL on the alert levels were observed in EHS and COM IR (p < 0.05). The cumulative number of EHS patients treated did not exceed the number of cold water immersion tubs available to treat them. EHS IR increased as WBGT and IIRM alert level increased, indicating the need for appropriate risk mitigation strategies and on-site medical treatment.
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Affiliation(s)
- Yuri Hosokawa
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA.
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA.
| | - William M Adams
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of North Carolina at Greensboro, 1408 Walker Avenue, 237 Coleman Building, Greensboro, NC, 27412, USA
| | - Luke N Belval
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
| | - Robert J Davis
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Falmouth Road Race, P.O. Box 732, Falmouth, MA, 02541-0732, USA
| | - Robert A Huggins
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
| | - John F Jardine
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Falmouth Road Race, P.O. Box 732, Falmouth, MA, 02541-0732, USA
| | - Rachel K Katch
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
| | - Rebecca L Stearns
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
| | - Douglas J Casa
- Korey Stringer Institute, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
- Department of Kinesiology, University of Connecticut, 2095 Hillside Road U-1110, Storrs, CT, 06269, USA
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Abstract
Osteochondritis dissecans is a potentially devastating cause of knee pain in adolescents and adults. Prognosis and treatment depends on the stability of the lesion and the age of the patient. Skeletally immature patients with stable lesions are amenable for nonoperative treatment. Nonoperative treatment is less predictable in skeletally mature patients and patients with unstable lesions. Lesion size, location, stability along with symptomatology should all be considered before initiating treatment. Modalities of nonoperative treatment can range from activity modification to complete immobilization. Close follow-up is recommended to monitor healing progression and symptom resolution.
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Affiliation(s)
- Justin S Yang
- Department of Orthopedics, Washington University, 660 South Euclid MS 8233, St Louis, MO, USA
| | - Ljiljana Bogunovic
- Department of Orthopedics, Washington University, 660 South Euclid MS 8233, St Louis, MO, USA
| | - Rick W Wright
- Department of Orthopedics, Washington University, 660 South Euclid MS 8233, St Louis, MO, USA.
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Vandamme AM, Michaux C, Mayard A, Housen I. Asparagine 42 of the conserved endo-inulinase INU2 motif WMNDPN from Aspergillus ficuum plays a role in activity specificity. FEBS Open Bio 2013; 3:467-72. [PMID: 24251113 PMCID: PMC3829992 DOI: 10.1016/j.fob.2013.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 08/19/2013] [Revised: 10/29/2013] [Accepted: 10/29/2013] [Indexed: 11/09/2022] Open
Abstract
Endo-inulinase INU2 from Aspergillus ficuum belongs to glycosidase hydrolase family 32 (GH32) that degrades inulin into fructo oligosaccharides consisting mainly of inulotriose and inulotetraose. The 3D structure of INU2 was recently obtained (Pouyez et al., 2012, Biochimie, 94, 2423–2430). An enlarged cavity compared to exo-inulinase formed by the conserved motif W-M(I)-N-D(E)-P-N-G, the so-called loop 1 and the loop 4, was identified. In the present study we have characterized the importance of 12 residues situated around the enlarged cavity. These residues were mutated by site-directed mutagenesis. Comparative activity analysis was done by plate, spectrophotometric and thin-layer chromatography assay. Most of the mutants were less active than the wild-type enzyme. Most interestingly, mutant N42G differed in the size distribution of the FOS synthesized. Endo-inulinase INU2 degrades inulin into fructo oligosaccharides. 12 residues around the catalytic pockets of INU2 enzyme were determined. These residues were mutated to either a G or A residue. The activity has been tested by plate, spectrophotometric and TLC assays. One mutation, N42G, which changes the specificity of activity, has been identified.
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Affiliation(s)
- Anne-Michèle Vandamme
- Unité de Recherche en Biologie des Microorganismes, Biology Department, University of Namur, Belgium
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