Exercise combined with electrical stimulation for the treatment of chronic ankle instability - A randomized controlled trial

PURPOSE

To compare the short, medium, and long-term effects of balance exercises combined with either peroneal neuromuscular electrical stimulation (NMES) or peroneal transcutaneous electrical nerve stimulation (TENS) on dynamic postural control and patient reported outcome measures (PROMs) in patients with chronic ankle instability (CAI).

METHODS

Thirty-four participants with CAI were randomly assigned to a 12-session home based exercise program combined with NMES (Ex-NMES) or TENS (Ex- TENS). Baseline postural control was tested with the modified Star Excursion Balance Test (mSEBT) and time to stabilization (TTS) after a single-leg drop-jump. The self-reported function was measured using the Cumberland Ankle Instability Tool (CAIT), the Identification of Functional Ankle Instability (IdFAI), and the Sports subscale of the Foot and Ankle Ability Measure (FAAMSport).

RESULTS

Both groups showed significant improvements in all self-reported outcome measures at the 12-month follow-up. Subjects in the Ex-NMES group had significantly better IdFAI (-4.2 [95% CI -8.1, -0.2]) and FAAMSport (13.7 [95% CI 2.2, 25.2]) scores at 6- and 12-month follow-up, respectively, compared to the Ex-TENS group. Medium to large between-group effect sizes were observed in self-reported functional outcomes and the mSEBT.

CONCLUSION

The consistent trend of improvement in self-reported functional outcomes when training is combined with NMES compared with training with TENS may indicate a potential benefit that should be further investigated as a treatment for patients with CAI.

A matter of choice: Should students self-select exercise for their nonspecific chronic low back pain? A controlled study

OBJECTIVES

To explore the effect of autonomy to choose exercise-therapy (ET) for nonspecific chronic low back pain (NSCLBP) on treatment adherence and clinical outcomes.

PARTICIPANTS

Forty-six students were recruited from Ariel University.

METHODS

Every two gender-and-age-matched students were allocated to either self-selected exercise group (SSE) or pre-determined exercise group (PDE). Subjects completed 4-weeks exercise and filled a training-log. Oswestry disability-index (ODI) and numerical pain-rating scores (NPRS) were measured, as well as exercise quality-performance.

RESULTS

ODI and NPRS improved in both groups, with no between-group differences. Exercise quality-performance was also similar between groups. A trend for better exercise-adherence was found in the SSE-group (75.3% vs 65.0% adherence, p = 0.08, effect size d = 0.59). Meaningful NPRS improvement was demonstrated in 54.5% of SSE-group participants compared with 33.3% in the PDE-group.

CONCLUSIONS

Autonomy may serve as a factor to enhance treatment adherence and clinical outcomes of ET for NSCLBP among students.

Peroneal muscle response to single-leg drop-jump and unexpected leg-drop in young and middle-aged adults before and after one session of neuromuscular training

BACKGROUND

Changes in neuromuscular ability in middle age (MA) may lead to deterioration of postural control. The aim of this study was to investigate the anticipatory response of the peroneus longus muscle (PL) to landing after a single-leg drop-jump (SLDJ), and its postural response after an unexpected leg-drop in MA and young adults. A second aim was to investigate the influence of neuromuscular training on PL postural responses in both age groups.

METHODS

Twenty-six healthy MA (55.3 ± 4 years) and 26 healthy young adults (26.3 ± 3.6 years) participated in the study. Assessments were performed before (T0) and after (T1) PL EMG biofeedback (BF) neuromuscular training. Subjects performed SLDJ, and PL EMG activity in preparation for landing (% of flight time) was calculated. To measure PL time to activation onset and time to peak activation in response to an unexpected leg-drop, subjects stood on a customized trapdoor device that produced a sudden 30° ankle inversion.

RESULTS

Before training, the MA group showed significantly shorter PL activity in preparation for landing compared to the young adults (25.0% vs. 30.0%, p = 0.016), while after training there was no difference between the groups (28.0% vs. 29.0%, p = 0.387). There were no differences between groups in peroneal activity after the unexpected leg-drop before and after training.

CONCLUSIONS

Our results suggest that automatic anticipatory peroneal postural responses are decreased at MA, whereas reflexive postural responses appear to be intact in this age group. A short PL EMG-BF neuromuscular training may have an immediate positive effect on PL muscle activity at MA. This should encourage the development of specific interventions to ensure better postural control in this group.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05006547.

Functional tests as predictors of ankle instability six months after an acute lateral ankle sprain

BACKGROUND

This study investigated whether functional tests performed in the acute-subacute phase after a lateral ankle sprain and demographic data are predictive of ongoing ankle instability.

METHODS

Thirty-three subjects (mean age 23.6±3.6 years, 63.6% males) were tested within three weeks of injury using the Balance Error Scoring System (BESS) modified with a dual cognitive task, the single-leg drop landing task (SLDL) and the drop vertical jump task (DVJ). The Cumberland Ankle Instability Tool (CAIT) at six months and the occurrence of a new sprain during follow-up were used to define potential ankle instability. Associations between functional tests and demographic variables to ankle instability outcomes were measured with χ², Mann-Whitney U Test, and logistic regressions.

RESULTS

Twenty-one participants (63.6%) met the ankle instability criteria at six months from injury. Each extra point in the Modified-BESS Foam-Tandem sub-task increased the likelihood of ankle instability (OR=1.55, P=0.037). Unwillingness to perform SLDL increased the likelihood of ankle instability (OR=10.0, 95% CI: 1.1-91.9, RR=1.8, 95% CI: 1.1-2.8), as did non-dominant ankle sprain (OR=6.0, 95% CI: 1.2-29.4, RR=1.88, 95% CI: 1.03-3.4). These three outcomes explained between 33.6% to 45.9% of the variance and correctly classified 75.8% of cases (sensitivity, 85.7%; specificity, 58.3%; P=0.004).

CONCLUSIONS

The variables studied may help identify individuals who have an increased potential to develop ankle instability and may be used in decision-making. Further studies should validate these findings with a larger and broader sample.

Healthcare providers have insufficient up-to-date knowledge of lower limb sports injuries, and their knowledge is similar to that of athletes

BACKGROUND

Being up-to-date with evidence-based knowledge of lower limb sports injuries is essential for Healthcare professionals (HCPs).

PURPOSE

To assess whether HCPs possess up-to-date knowledge of lower limb sports injuries by comparing their knowledge to that of athletes.

METHODS

With an expert panel, we developed an online quiz of 10 multiple-choice questions on various topics related to lower-limb sports injuries. Maximal score was 100. We used social media to invite HCPs (5 groups: Physiotherapists, Chiropractors, Medical Doctors, Trainers, and Other therapists) and athletes of all levels (amateur, semi-pro, and pro) to participate. We drafted the questions according to conclusions from the latest systematic reviews and meta-analyses.

RESULTS

1526 participants completed the study. Final quiz scores ranged from zero (n = 28, 1.8%) to 100 (n = 2, 0.1%) and were distributed normally with a mean score of 45.4 ± 20.6. None of the 6 groups' means surpassed the set threshold of 60 points. Multiple linear regressions of covariates indicated that age, gender, engagement in physical activity, learning hours per week, reading scientific journals, reading popular magazines and blogs, trainers, and other therapists' groups explained 19% of the variances (-5.914<β < 15.082, 0.000<p < 0.038).

CONCLUSIONS

HCPs have insufficient up-to-date knowledge of lower limb sports injuries, and their knowledge is similar to that of athletes of all levels. HCPs probably do not possess the proper tools to assess scientific literature Academic and sports medicine societies should look into ways to improve the scientific knowledge integration of HCPs.

Dynamic postural control in individuals with and without chronic ankle instability-do the modified star-excursion balance test and jump-landing stabilization have the same control mechanism?

OBJECTIVE

To examine the relationship between two dynamic postural tasks in subjects with and without chronic ankle instability (CAI).

DESIGN

Cross-sectional study.

SETTING

Biomechanics lab.

PARTICIPANTS

Thirty subjects with CAI and 30 healthy controls.

MAIN OUTCOME MEASURE

Performance of two dynamic postural control tests: the modified Star-Excursion Balance Test (mSEBT) and an assessment of a single limb jump-landing on a force plate that yielded two outcomes: time to stabilization (TTS) and the absolute average force in the mediolateral plane during the first 0.4 s after landing (AAF_ML).

RESULTS

In the CAI group, a significant correlation was found between the mSEBT score and the AAF_ML (ρ = -0.54, p < 0.01), but not between the mSEBT or TTS or between the AAF_ML and the TTS. However, in the control group, a significant correlation was found between AAF_ML and the TTS (ρ = 0.43, p < 0.05), but not between the mSEBT and TTS or between the mSEBT and AAF_ML.

CONCLUSION

These results suggest that there is no association between the different dynamic balance tasks. The different pattern of association in individuals with CAI may indicate altered central neural control. Clinicians and researchers should therefore not use a single task to assess dynamic postural control.

Random walk: Random number generation during backward and forward walking- the role of aging

Deficits in executive function, visuospatial abilities, and cognitive embodiment may impair gait performance. This study aimed to investigate the effect of age on random number generation (RNG) performance during forward and backward locomotion to assess cognitive flexibility and cognitive embodiment during walking. Another aim was to examine the effect of age on the associations of RNG performance during walking with stride time variability (STV), the percentage of double support (DS%), and visuospatial abilities as measured by a spatial orientation test (SOT). Twenty old (age 68.8 ± 5.3, 65% female) and 20 young (age 25.2 ± 2.2, 45% female) adults generated random numbers during backward walking (BW) and forward walking (FW) over-ground and over a treadmill with an internal focus of attention and visual-attentive distraction; six walking conditions in total. To assess cognitive flexibility, sample entropy was calculated for each RNG sequence. The average of the first 5 numbers in each RNG task was calculated to assess the relationship between small/large numbers and movement direction. STV and DS% were recorded using inertial measurement units, and spatial orientation was measured using a computerized test. The older subjects had less flexibility in generating random numbers in three of the six walking conditions. A negative correlation between RNG flexibility and STV was found in older adults during treadmill BW with visual-attentive distraction and forward over-ground walking, whereas no correlations were demonstrated in the young group. The spatial orientation score (a higher value means a worse outcome) correlated positively with RNG flexibility in the older group under all walking conditions, suggesting that older adults with better visuospatial orientation have lower cognitive flexibility, and vice versa. There was no correlation between small/large numbers and direction of motion in either group. The correlation between RNG flexibility and STV may indicate similar executive control of verbal and gait rhythmicity in old adults. Conversely, our results suggest that cognitive flexibility and visuospatial ability may decline differently.

Reliability and Validity of Patient-Reported Outcome Measures for Ankle Instability in Hebrew

Background

The International Ankle Consortium has recommended several instruments for assessing and diagnosing chronic ankle instability. These include the Ankle Instability Instrument (AII), Cumberland Ankle Instability Tool (CAIT), Identification of Functional Ankle Instability (IdFAI), and Foot and Ankle Ability Measure (FAAM). This study aimed to translate, culturally adapt, and assess the reliability, validity, discriminative power, and classification agreement of the Hebrew online versions of the AII, CAIT, IdFAI, and FAAM.

Material/Methods

After translation and cross-cultural adaptation of the questionnaires, we recruited 87 participants with self-reported ankle disorders to evaluate the psychometric properties of the questionnaires. To evaluate each questionnaire’s discriminative power, we recruited 75 healthy participants. Reliability was assessed by calculating internal consistency (Cronbach’s alphas) and test-retest intraclass correlation coefficients. Convergent and divergent validity were assessed by Spearman’s correlation between each instrument and the Short-Form-12 (SF-12) score for physical and mental components, respectively.

Results

All instruments had acceptable internal consistency (α>0.7) and good test-retest reliability (ICC_2,1>0.8), except for the IdFAI (ICC_2,1=0.73). All instruments had moderate convergent validity (ρ>0.4 with SF-12 physical component) except for AII (ρ=0.36). No instrument was correlated with the SF-12 mental component score (good divergent validity, ρ<0.3). All instruments had excellent discriminative power (area under the receiver operator characteristic curve >0.9). Strong correlations were found between all instruments.

Conclusions

The Hebrew online versions of the AII, CAIT, IdFAI, and FAAM are valid, consistent, and reliable and may be used in research or clinical settings.

Can stabilization analysis following a single leg drop jump be compared between young and middle-aged adults

We aimed to verify whether the computational approaches previously proposed to analyze stability after a single-leg drop-jump (SLDJ) could be applied to a population of middle-aged adults. Fifteen middle-aged (56.4 ± 4.6 years) and 15 young adults (26.7 ± 3.9 years) performed five SLDJs. Stabilization measurements included (1) time to stabilization (TTS) based on vertical ground reaction force (GRF) (TTSv) and a fixed stabilization threshold; (2) TTS based on medio-lateral GRF (TTSml) using five different methods to preprocess the signal and stabilization threshold; (3) early medio-lateral stabilization- the averaged absolute values of the GRF in 0.2-1.4 s post-landing; (4) late medio-lateral stabilization - the averaged absolute values of the GRF at 1 s-5 s after landing. TTSv showed longer TTS values in middle-aged participants. In addition, middle-aged adults showed greater sway in late stabilization. However, TTSml values varied considerably between calculation methods, and early stabilization showed no significant differences between groups except in the first 0.2 s after landing. The results of the current study suggest that TTS calculations are sensitive to signal and threshold selection, and to the processing method. Calculations based on a fixed threshold are more appropriate for studying dynamic postural stability in middle age. With appropriate method selection, a decreased stabilizing performance can be demonstrated in middle-aged adults compared to young adults.

Attitudinal responses to current concepts and opinions from pain neuroscience education on social media

BACKGROUND

Pain neuroscience education (PNE) programs have become popular among clinicians and are widely promoted through social and mainstream media.

PURPOSE

To test the hypothesis that people with persistent pain are likely to express negative attitudes to PNE statements and compare their responses to other social media user groups.

METHODS

A total of 1319 respondents completed an online survey and were directed into four groups: persistent pain, healthcare professionals with persistent pain, pain-free healthcare professionals, and pain-free controls. The survey included ten statements of popular PNE concepts. Feedback was invited by offering seven attitudinal response categories (three positives, three negatives, and one neutral). A two-step hierarchical regression model was used to assess the likelihood of reporting negatively.

RESULTS

Compared to controls, respondents from the persistent pain group were more likely to report negatively towards all statements (OR 1.6-2.16), except for two statements (#3 and #5). Healthcare professionals were less likely to report negative attitudes for 4 out of 10 statement (OR 0.35-0.58). Health care professionals living with persistent responded to most statements like the pain-free controls (besides statement #2, OR 0.59).

CONCLUSION

People living with persistent pain are more likely to express negative attitudes to PNE statements on social media, unlike healthcare professionals who were less likely to express negativity. Healthcare professionals living with persistent pain responded to most PNE statements like the pain-free control group. The study's main weaknesses include the lack of psychometric information of the questionnaire used, selection bias, small samples of the healthcare professionals and the overrepresentation of young social media users.

High Levels of Self-Reported Depressive Symptoms Among Physical Therapists and Physical Therapist Students Are Associated With Musculoskeletal Pain: A Cross-Sectional Study

OBJECTIVE

Depressive symptoms and musculoskeletal (MSK) pain are 2 of the most common health conditions. Their relationship, however, remains unclear. As depressive symptoms in physical therapists have not been well assessed, the purpose of this work was to assess self-reported depressive symptoms and MSK pain prevalence-and their possible association-in physical therapists and physical therapist students.

METHODS

An online cross-sectional survey was used to gather data from 707 physical therapists and 116 physical therapist students from Israel. The Patient Health Questionnaire-9 was used to assess depressive symptoms, and the Extended Nordic Musculoskeletal Questionnaire was used to evaluate the prevalence and characteristics of MSK pain.

RESULTS

Overall, 108 participants (13.1%) scored in the moderate to severe depressive symptoms category (Patient Health Questionnaire-9 score >10), and 261 participants (31.7%) scored in the mild depressive symptoms category. In total, 84 physical therapists (11.9%) and 24 physical therapist students (20.7%) reported moderate to severe depressive symptoms during the last 2 weeks. Neck and back pain had the highest point prevalence (26.7%-35.3%) and lifetime prevalence (75.9%-78.5%), respectively. Mild depressive symptoms were associated with current pain (adjusted odds ratio [OR] = 1.58) and smoking (adjusted OR = 1.79-1.84). Current pain was also associated with severe depressive symptoms (adjusted OR = 2.76-3.07). Physical therapists with higher salaries were less likely to report severe depressive symptoms (adjusted OR = 0.11-0.36).

CONCLUSION

The prevalence estimates generated from this study sample imply that 11.9% of physical therapists and 20.7% of physical therapist students in Israel experienced moderate to severe depressive symptoms. Neck and back pain had the highest point and lifetime prevalence.

IMPACT

The prevalence of self-reported depressive symptoms in this sample places physical therapists and physical therapist students alongside physicians, nurses, and medical profession students who have been previously reported to have elevated depressive symptoms. Future studies should further explore the nature of the association between pain and depressive symptoms in these populations.

Tattoo artists and dental workers have similar musculoskeletal pain patterns

BACKGROUND

Tattoo artists are an understudied population with regards to musculoskeletal (MSK) pain.

AIMS

To explore the characteristics of MSK pain among Israeli tattoo artists and determine whether they are similar to those of dental workers.

METHODS

An online survey including demographics and the Hebrew version of the Extended Nordic Musculoskeletal Questionnaire was disseminated via Israeli social media groups. We directly compared tattoo artists, dental workers and office workers as a reference group.

RESULTS

Altogether, 114 tattoo artists, 161 dental workers and 296 office workers responded. The most prevalent pain sites were lower back (56%), neck (47%) and hand (36%) among office workers; neck (67%), lower back (62%) and upper back (42%) among the dental workers; and lower back (72%), neck (66%) and hand (55%) among tattoo artists. Contrast analysis suggested office workers were less likely to report pain in the previous 12 months compared with dental workers and tattoo artists (adjusted odds ratios [95% confidence intervals]: ORs [95% CIs] for upper limb pain: 1.13 [1.01-1.28], neck pain: 1.3 [1.15-1.47], upper back pain: 1.27 [1.12-1.43] and low back pain: 1.15 [1.02-1.3]). No significant differences were observed between dental workers and tattoo artists (upper limb pain: 1.18 [0.9-1.54], neck pain: 1.06 [0.81-1.4], upper back pain: 1.22 [0.94-1.58] and low back pain: 1.24 [0.95-1.64]).

CONCLUSIONS

Tattoo artists and dental workers have similar MSK pain characteristics and are different from those of office workers. These characteristics are seemingly a direct result of the physical demands associated with their line of work.

Individuals with back and neck pain on medical forums: What do they mention? What do they fear?

BACKGROUND

The use of online medical forums is on the rise globally. Data scraping is a method of extracting website content using an automated computer program. We scraped users' questions regarding back and neck pain (BNP) from popular Israeli online medical forums. We aimed to identify the sort of questions being asked about BNP, and to analyse explicit themes that characterize their questions.

METHODS

Six leading Israeli BNP forums were identified. In phase 1, Python scripts scraped 12,418 questions into a data set. In phase 2 - five themes were identified: Surgery (n = 2,957); health care professions (n = 2,361); Sports (n = 2,304); drugs (n = 1,419) and interpretation of imaging (n = 845). Phase 3 - included the categorization of explicit fear-related words by the authors. Phase 4 - analysis of explicit fear-related themes yielded 402 questions.

RESULTS

Gender was identified for 394 users, and age was identified for 181 users. A total of 248 users (61.6%) were women and 146 men (36.3%). Mean age 36.3 ± 16.15 for women and 35.5 ± 16.1 for men. The most commonly expressed fears were related to: invasive procedures, 30.9% (131 questions); fear of serious condition or misdiagnosis, 17.0% (72 questions); General concerns, 13.7% (58 questions); fear of worsening or relapse, 12.3% (52 questions); adverse effects of oral drugs or radiation, 10.8% (46 questions) and concerns related to lifestyle, 9.7% (41 questions).

CONCLUSIONS

Web scraping is a feasible strategy with which to explore medical forums and the above-mentioned themes, all of which are of potential clinical significance.

SIGNIFICANCE

Using automated algorithms, a total of 12,369 questions from online back and neck medical forums were scraped and analysed. Secondary analysis categorized fear-related themes that were mentioned by users. Identifying and addressing patients' fear has potential to improve communication and therapeutic outcome. For example, questions regarding surgery were typically asked after the option was mentioned by a physician. This insight should encourage physicians to devote extra time explaining the possible implications of surgery, should they consider it as an option.

Muscle activation patterns during backward walking in people with chronic ankle instability

Background

Altered walking patterns are often described in individuals with chronic ankle instability (CAI). Contemporary treatment paradigms recommend backward walking (BW) to improve locomotion in people with musculoskeletal disorders. The purpose of this study was to determine whether muscle activity and activation variability during BW differs between subjects with and without CAI.

Methods

Sixteen participants with CAI and 16 healthy controls walked on a treadmill at their self-selected speed under BW and forward walking (FW) conditions. Surface electromyography (EMG) data for the peroneus longus, tibialis anterior, medial gastrocnemius and gluteus medius muscles were collected. EMG amplitude normalized to maximum voluntary isometric contraction (%MVIC) and the standard deviation (SD) of the %MVIC EMG amplitude was calculated throughout the gait cycle. In addition, the area under the curve (AUC) of the %MVIC EMG amplitude was calculated before and after initial contact (pre-IC: 90–100% of stride; post-IC: 0–10% of stride).

Results

No differences between groups were noted in the %MVIC amplitude or activation variability (SD of %MVIC EMG) under BW or FW. In both groups, decreased tibialis anterior (p < 0.001) and gluteus medius (p = 0.01), and increased medial gastrocnemius (p < 0.001) activation were observed during pre- and post-IC under BW condition.

Conclusion

Participants with CAI and healthy controls have similar muscle activity patterns during BW. Yet, the results should be interpreted with caution due to the heterogeneity of the CAI population.

Translation and validation of a Hebrew version of the Western Ontario Shoulder Instability index

BACKGROUND

The Western Ontario Shoulder Instability index (WOSI) is a questionnaire designed to measure health-related quality of life in patients with shoulder instability. The aim of the current study was to translate the WOSI into Hebrew and assess its psychometric properties.

METHODS

The WOSI was translated into Hebrew according to World Health Organization guidelines. Twenty-five patients completed the WOSI and the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire 2 weeks and 2 months after surgical shoulder stabilization. Internal consistency (Cronbach's α), criterion validity (Pearson's correlation coefficient with DASH), responsiveness, and floor and ceiling effects were assessed.

RESULTS

Cronbach's α was 0.88-0.95 for total WOSI (range 0.68-0.95 for different sections). Strong correlation with DASH score (r = 0.76-0.84) indicated good criterion validity. Changes between baseline and follow-up for WOSI and DASH scores were moderately correlated (r = 0.68), suggesting moderate responsiveness. Some items demonstrated floor and ceiling effects, especially at baseline, but no floor or ceiling effects were observed for total WOSI or for the WOSI sections.

CONCLUSIONS

The results of the current study demonstrate that the Hebrew version of the WOSI is a valid instrument that can be used to assess disability in patients with shoulder instability. Additional studies are warranted to assess its psychometric properties among various subpopulations.

TRIAL REGISTRATION

The study was pre-registered at the ClinicalTrials.gov website, registration number NCT02978365 .

Functional electrical stimulation following anterior cruciate ligament reconstruction: a randomized controlled pilot study

Background

Inadequate quadriceps strength following anterior cruciate ligament reconstruction (ACLR) often results in alterations in gait pattern that are usually reported during loading response. Neuro-muscular electrical stimulation (NMES) is frequently used to overcome this quadriceps weakness. Despite the beneficial effects of NMES, persistent deficits in strength and gait are reported. The aim of this study was to investigate the feasibility of applying quadriceps functional electrical stimulation (FES) during walking in addition to standard rehabilitation, in the initial stage of ACLR rehabilitation.

Methods

Subjects were randomized to quadriceps FES synchronized with walking group (n = 10) or quadriceps NMES (duty cycle of 10 s on/10 s off) group (n = 13). Both interventions were performed for 10 min three days a week, in addition to a standard rehabilitation program. Assessments were performed up to 2 weeks before the ACLR (pre-ACLR), and 4 weeks postoperatively. Outcomes measured were gait speed, single limb stance gait symmetry, quadriceps isometric peak strength ratio (peak strength at 4 weeks/peak strength pre-ACLR) and peak strength inter-limb symmetry. Gait outcomes were also assessed 1-week post-surgery.

Results

Subjects in both groups regained pre-ACLR gait speed and symmetry after 4 weeks of rehabilitation, with no difference between groups. However, although pre-ACLR quadriceps peak strength was similar between groups (FES - 205 Nm, NMES − 225 Nm, p = 0.605), subjects in the FES group regained 82% of their pre-quadriceps strength compared to 47% in the NMES group (p = 0.02). In addition, after 4 weeks, the FES group had significantly better inter-limb strength symmetry 0.63 ± 0.15 vs. 0.39 ± 0.18 in the NMES group (p = 0.01).

Conclusions

Quadriceps FES combined with traditional rehabilitation is a feasible, early intervention treatment option, post-ACLR. Furthermore, at 4 weeks post-surgery, FES was more effective in recovering quadriceps muscle strength than was NMES. While spatiotemporal gait parameters did not differ between groups, kinetic and kinematic studies may be useful to further understand the effects of quadriceps FES post-ACLR. The promising results of this preliminary investigation suggest that such studies are warranted.

Trial registration

ISRCTN 02817399. First posted June 29, 2016.

Evaluation of Two Simple Functional Tests to Predict Attrition from Combat Service in Female Light Infantry Soldiers

BACKGROUND Worldwide, there is a high attrition rate, or dropout rate, from combat in trained soldiers, mainly due to musculoskeletal injuries. This study aimed to determine whether the use of an upper limb stability test, the Upper Quarter Y-Balance Test (UQYBT), and a modified version of the Ranger Test (MRT) that included a lower limb step-up endurance test, could predict attrition from combat service in female infantry soldiers. MATERIAL AND METHODS In 2015, a group of 167 newly recruited female light infantry soldiers were evaluated using the UQYBT and the MRT. Data regarding attrition from combat service were collected in 2017, 18 months after screening. Multiple logistic regression analysis was used to determine the predictive effect of body mass index (BMI), UQYBT, and MRT scores on attrition from combat service. RESULTS Fifty-three female soldiers (31.7%) dropped out of combat service during the 18 months following recruitment. The MRT score was a significant predictor of attrition, with each additional incremental increase in the MRT score reducing the attrition rate by 6.8% (OR=0.934; 95% CI, 0.895-0.975). A cutoff MRT score of 12 increments predicted attrition with 73.7% sensitivity and 50.9% specificity. The UQYBT scores and BMI were not significant predictors. CONCLUSIONS The use of the MRT during military training, was a predictive screening method to predict attrition from combat service in Israeli female infantry soldiers. Further studies are required to evaluate the use of the MRT in other groups of women in the military.

Knee position sense: does the time interval at the target angle affect position accuracy?

[Purpose] This study examined whether the interval at the target angle during knee joint position sense (JPS) affected reposition accuracy, and evaluated the consequence of this factor on test-retest reliability. [Subjects and Methods] Twenty healthy subjects participated in this study. Reposition ability was measured after the knee was placed at a target angle (ranging from 40° to 60°) for intervals of 3, 6, 9, and 12 seconds, in randomized order. Two trials were performed for each condition. The measurement was repeated after a week. The absolute error (AE) of each trial and average AE under each condition within the two measures were used for data analysis. [Results] No significant difference was found in comparing the AE or the average AE during all trials and between the two measures. Fair-to-good reliability was found for the AE results of all trials under the conditions of 3, 6, and 12 seconds. Poor reliability was found with time interval of 9 seconds. [Conclusion] The length of time needed to memorize the target angle during knee JPS test might affect test reliability. Practitioners can use this information when collecting JPS data.

Effects of dual-task and walking speed on gait variability in people with chronic ankle instability: a cross-sectional study

Background

Recent evidence suggests that impaired central sensorimotor integration may contribute to deficits in movement control experienced by people with chronic ankle instability (CAI). This study compared the effects of dual-task and walking speed on gait variability in individuals with and without CAI.

Methods

Sixteen subjects with CAI and 16 age- and gender-matched, able-bodied controls participated in this study. Stride time variability and stride length variability were measured on a treadmill under four different conditions: self-paced walking, self-paced walking with dual-task, fast walking, and fast walking with dual-task.

Results

Under self-paced walking (without dual-task) there was no difference in stride time variability between CAI and control groups (P = 0.346). In the control group, compared to self-paced walking, stride time variability decreased in all conditions: self-paced walking with dual-task, fast speed, and fast speed with dual-task (P = 0.011, P = 0.016, P = 0.001, respectively). However, in the CAI group, compared to self-paced walking, decreased stride time variability was demonstrated only in the fast speed with dual-task condition (P = 1.000, P = 0.471, P = 0.008; respectively). Stride length variability did not change under any condition in either group.

Conclusions

Subjects with CAI and healthy controls reduced their stride time variability in response to challenging walking conditions; however, the pattern of change was different. A higher level of gait disturbance was required to cause a change in walking in the CAI group compared to healthy individuals, which may indicate lower adaptability of the sensorimotor system. Clinicians may use this information and employ activities to enhance sensorimotor control during gait, when designing intervention programs for people with CAI.

The study was registered with the Clinical Trials network (registration NCT02745834, registration date 15/3/2016).