BACKGROUND: Ankle decision rules are developed to expedite patient care and reduce the number of radiographs of the ankle and foot. Currently, only three systematic reviews have been conducted on the accuracy of the Ottawa Ankle and Foot Rules (OAFR) in adults and children. However, no systematic review has been performed to determine the most accurate ankle decision rule.OBJECTIVES: The purpose of this study is to examine which clinical decision rules are the most accurate for excluding ankle fracture after acute ankle trauma.METHODS: A systematic search was conducted in the databases PubMed, CINAHL, PEDro, ScienceDirect, and EMBASE. The sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of the included studies were calculated. A meta-analysis was conducted if the accuracy of a decision rule was available from at least three different experimental studies.RESULTS: Eighteen studies satisfied the inclusion criteria. These included six ankle decision rules, specifically, the Ottawa Ankle Rules, Tuning Fork Test, Low Risk Ankle Rule, Malleolar and Midfoot Zone Algorithms, and the Bernese Ankle Rules. Meta-analysis of the Ottawa Ankle Rules (OAR), OAFR, Bernese Ankle Rules, and the Malleolar Zone Algorithm resulted in a negative likelihood ratio of 0.12, 0.14, 0.39, and 0.23, respectively.CONCLUSION: The OAR and OAFR are the most accurate decision rules for excluding fractures in the event of an acute ankle injury.
DOCUMENT
The aim of this study is to investigate the predictivevalue of landing stability and technique togain insight into risk factors for ankle and kneeinjuries in indoor team sport players. Seventyfivemale and female basketball, volleyball orkorfball players were screened by measuringlanding stability after a single-leg jump landingand landing technique during a repeated countermovement jump by detailed 3-dimensional kinematicsand kinetics. During the season 11 acuteankle injuries were reported along with 6 acuteand 7 overuse knee injuries by the teams’ physicaltherapist. Logistic regression analysis showedless landing stability in the forward and diagonaljump direction (OR 1.01–1.10, p ≤ 0.05) in playerswho sustained an acute ankle injury. Furthermorelanding technique with a greater ankle dorsiflexionmoment increased the risk for acuteankle injury (OR 2.16, p ≤ 0.05). A smaller kneeflexion moment and greater vertical groundreaction force increased the risk of an overuseknee injury (OR 0.29 and 1.13 respectively,p ≤ 0.05). Less one-legged landing stability andsuboptimal landing technique were shown inplayers sustaining an acute ankle and overuseknee injury compared to healthy players. Determiningboth landing stability and technique mayfurther guide injury prevention programs.
DOCUMENT
OBJECTIVE: The aim of this study was to investigate whether dynamic balance, measured with the anterior component of the Star Excursion Balance Test (SEBT-ANT), is a risk factor for ankle injuries in physical education teacher education (PETE) students.DESIGN AND SETTING: A prospective monocentre study in first-year PETE students.PARTICIPANTS: A total of 196 subjects, of which 137 men (70%) and 59 women (30%).OUTCOME MEASURES: This study consisted of measures of the SEBT-ANT at baseline (September 2015) and an injury registration procedure during a follow-up period (September 2015-June 2016). The association between the SEBT-ANT score and subsequent ankle injury was analysed with generalised estimating equations analysis at the leg level.RESULTS: Men and women had an average SEBT-ANT score of, respectively, 65.1% and 67.7% of leg length. In 20 (15%) subjects, the first injured body site involved the ankle. Across all participants, a below average SEBT-ANT score was not associated with increased ankle injury odds (OR OR=2.43, 95% CI: 0.94 to 6.29, p=0.07). In men, a below average SEBT-ANT score indicated sevenfold increased odds for ankle injury (OR=7.06, 95% CI: 1.43 to 34.92, p=0.02). In women, this relationship was not significant (OR=0.72, 95% CI: 0.19 to 2.71, p=0.62).CONCLUSIONS: Below average normalised SEBT-ANT scores were associated with sevenfold likelihood for ankle injuries in men. In contrast, no relationship was found for the SEBT-ANT score and ankle injuries in woman. These results may provide directions for the implementation of screening tools, as part of an injury prevention programme, to identify male PETE students with an increased likelihood for ankle injuries.
DOCUMENT
BACKGROUND: Non-use of and dissatisfaction with ankle foot orthoses (AFOs) occurs frequently. The objective of this study is to gain insight in the conversation during the intake and examination phase, from the clients’ perspective, at two levels: 1) the attention for the activities and the context in which these activities take place, and 2) the quality of the conversation. METHODOLOGY: Semi-structured interviews were performed with 12 AFO users within a two-week period following intake and examination. In these interviews, and subsequent data analysis, extra attention was paid to the needs and wishes of the user, the desired activities and the environments in which these activities take place. RESULTS AND CONCLUSION: Activities and environments were seldom inquired about or discussed during the intake and examination phase. Also, activities were not placed in the context of their specific environment. As a result, profundity lacks. Consequently, orthotists based their designs on a ‘reduced reality’ because important and valuable contextual information that might benefit prescription and design of assistive devices was missed. A model is presented for mapping user activities and user environments in a systematic way. The term ‘user practices’ is introduced to emphasise the concept of activities within a specific environment.
LINK
Laboratory study using a repeated measures design. The aim of this study was to determine if ankle proprioception is targeted in exercises on unstable surfaces. Lateral ankle sprain (LAS) has recurrence rates over 70%, which are believed to be due to a reduced accuracy of proprioceptive signals from the ankle. Proprioceptive exercises in rehabilitation of LAS mostly consist of balancing activities on an unstable surface. The methods include 100 healthy adults stood barefoot on a solid surface and a foam pad over a force plate, with occluded vision. Mechanical vibration was used to stimulate proprioceptive output of muscle spindles of triceps surae and lumbar paraspinal musculature. Each trial lasted for 60 s; vibration was applied from the 15th till the 30th second. Changes in mean velocity and mean position of the center of pressure (CoP) as a result of muscle vibration were calculated. Results show that on foam, the effect of triceps surae vibration on mean CoP velocity was significantly smaller than on a solid surface, while for paraspinal musculature vibration the effect was bigger on foam than on solid surface. Similar effects were seen for mean CoP displacement as outcome. Exercises on unstable surfaces appear not to target peripheral ankle proprioception. Exercises on an unstable surface may challenge the capacity of the central nervous system to shift the weighting of sources of proprioceptive signals on balance.
LINK
Runners often sustain lower extremity injuries (19-79%) (van Gent et al, 2007). In a theoretical model it has been described that a disturbance in perceived stress and recovery can increase the risk of sustaining an injury (Williams & Andersen, 1998). Therefore, the purpose of this study was to investigate changes in perceived stress and recovery preceding an injury of competitive runners.Methods: Twenty-four competitive runners were monitored over one full training season (46 weeks). Every week, the runners filled an on-line RESTQ-sport (Nederhof et al, 2008). Furthermore, runners and their coaches kept a log with injuries and physical complaints. A non-traumatic injury was defined as any pain, soreness or injury that was not caused by trauma and resulted from training and led to a decrease in training duration or training intensity for at least one week (Jacobsson et al, 2013). Because baseline levels of perception of stress and recovery vary largely between runners, the 19 scales of the RESTQ-Sport were normalized to Z-scores based on the runner’s individual average and standard deviation of the whole season (excl. injured periods). The normalized scores of 1, 2 and 3 weeks before the first sustained injury were compared to 0, which is the average normalized score, by repeated measures ANOVA’s.Results: Twenty-two runners sustained a non-traumatic lower extremity injury. Eight of these runners filled out the RESTQ-Sport all 3 weeks preceding the injury and their data was used for further analysis. The injuries sustained were non-traumatic injuries of the knee, Achilles tendon, ankle, foot and shin. It was shown that 1 week preceding the injury, runners scored lower than the average normalized score on “Success” (Z-score: -0.68±0.62) and 2 weeks preceding the injury runners scored higher than their average on “Fitness/Injuries” (Z-score: 1.04±1.12).Discussion: A decrease in perceived success may be a marker to predict a non-traumatic lower extremity injury. Also an increase in the perception of muscle ache, soreness, pain and vulnerability to injury (“Fitness/Injury”) preceded injuries. Thereby, monitoring changes in individual stress and recovery may help to prevent non-traumatic injuries.
DOCUMENT
OBJECTIVE: To determine whether student characteristics, lower-extremity kinematics, and strength are risk factors for sustaining lower-extremity injuries in preprofessional contemporary dancers.DESIGN: Prospective cohort study.SETTING: Codarts University of the Arts.PATIENTS: Forty-five first-year students of Bachelor Dance and Bachelor Dance Teacher.ASSESSMENT OF RISK FACTORS: At the beginning of the academic year, the injury history (only lower-extremity) and student characteristics (age, sex, educational program) were assessed using a questionnaire. Besides, lower-extremity kinematics [single-leg squat (SLS)], strength (countermovement jump) and height and weight (body mass index) were measured during a physical performance test.MAIN OUTCOME MEASURES: Substantial lower-extremity injuries during the academic year were defined as any problems leading to moderate or severe reductions in training volume or in performance, or complete inability to participate in dance at least once during follow-up as measured with the Oslo Sports Trauma Research Center (OSTRC) Questionnaire on Health Problems. Injuries were recorded on a monthly basis using a questionnaire. Analyses on leg-level were performed using generalized estimating equations to test the associations between substantial lower-extremity injuries and potential risk factors.RESULTS: The 1-year incidence of lower-extremity injuries was 82.2%. Of these, 51.4% was a substantial lower-extremity injury. Multivariate analyses identified that ankle dorsiflexion during the SLS (OR 1.25; 95% confidence interval, 1.03-1.52) was a risk factor for a substantial lower-extremity injury.CONCLUSIONS: The findings indicate that contemporary dance students are at high risk for lower-extremity injuries. Therefore, the identified risk factor (ankle dorsiflexion) should be considered for prevention purposes.
DOCUMENT
Objectives: The strategy for dynamic postural stability might be different for male and female players. Additionally, dynamic and challenging tasks are recommended to measure differences in postural stability between injured and non-injured players. Therefore, the dynamic stability index (DSI) was developed which measures the ability of a player to maintain static balance after a dynamic task. The first aim of this study was to evaluate DSI differences between males and females for different jump directions. The second aim was to examine both preseason DSI differences between players with and without a history of ankle sprain, and between players with and without an ankle sprain during the subsequent season.Design: Prospective cohort design. Setting: Laboratory. Participants: 47 male (22.9 ± 3.9 y, 193.5 ± 7.9 cm, 87.1 ± 10.6) and 19 female (21.5 ± 2.9 y, 175.9 ± 7.3 cm, 69.0 ± 11.7 kg) sub-elite and elite basketball, volleyball and korfball players. Main outcome measures: Ankle sprain history was collected using a general injury history questionnaire. DSI on a single-leg hop-stabilization task measured preseason were calculated by using force plates and a Matlab program. Ankle sprains were reported during subsequent season. Results: Male players demonstrated larger DSI than female players on forward medial/lateral stability index (MLSI) (0.037± 0.007 vs 0.029 ± 0.005) and vertical stability index (VSI) (0.369 ± 0.056 vs 0.319 ± 0.034) (p < 0.001), diagonal VSI (0.363 ± 0.046 vs 0.311 ± 0.033) (p < 0.001), and lateral anterior/posterior stability index (APSI) (0.062 ± 0.015 vs 0.047 ± 0.011) and VSI (0.350 ± 0.054 vs 0.294 ± 0.037) (p < 0.001). Forward (0.384 ± 0.055 vs 0.335 ± 0.033), diagonal (0.379 ± 0.046 vs 0.328 ± 0.032) and lateral (0.368 ± 0.053 vs 0.313 ± 0.035) dynamic postural stability indices (DPSI) were larger for males (p < 0.001). No significant differences were found between players with and without a previous ankle sprain nor between players with and without an ankle sprain during subsequent season.
DOCUMENT
Background/aim We aimed to investigate the magnitude and characteristics of injuries and illnesses in Dutch physical education teacher education (PETE) students.Methods During the first 21 weeks of the academic year, 245 first-year students registered their health problems online using the Oslo Sports Trauma Research Centre (OSTRC) Questionnaire on Health Problems.Results A total of 276 injuries, 140 illnesses and 69 unclassified health problems were reported. We found an injury incidence rate of 11.7 injuries per 1000 hours (95% CI 10.4 to 13.2). Injury characteristics were: 42% overuse injuries, 62% causing absence from sports (median injury time loss=2 days) and 64% reinjuries. Most injuries were located at the knee, lower leg (anterior) and ankle. The duration of the illnesses was short (<1 week).Summary and conclusions We implemented a new registration method in the PETE academic programme. The results show that the risk for health problems is high for PETE students. Prevention is necessary, and to decrease injuries prevention programmes should focus on the lower extremities.
DOCUMENT
Het AZC in Leersum heeft een vaste opvangcapaciteit voor 625 mensen. De vluchtelingen die er worden opgevangen hebben vaak een inactieve leefstijl, zijn belemmerd in het gebruikmaken van regulier sportaanbod, kampen met fysieke en mentale gezondheidsklachten en verkeren in een kwetsbare positie. Het Living Lab Utrechtse Heuvelrug wilde bewoners van het AZC betrekken in haar activiteiten. Samen met het COA en lokale partners is gewerkt aan het opzetten van een duurzaam sport- en beweegaanbod voor deze bewoners. Dit heeft geresulteerd in het aanbieden en opzetten van verschillende sportactiviteiten als voetbal, walk & talk, hardlopen, fitness, boulderen en bootcamp. Er is ook veel energie gestoken om zwemlessen aan te bieden, maar dat is nog niet gelukt (wel veelbelovend vervolg). Het voetbal liep zo goed op de locatie van het AZC, dat er al snel contact is gezocht met een lokale club om een veld te gebruiken. Dit, een toernooi en oefenwedstrijden zorgde ook voor positieve zichtbaarheid van de bewoners en brengt weer nieuwe mogelijkheden zoals vaste deelname binnen de voetbalvereniging voor bewoners van het AZC. Bewoners geven aan dat deelname aan de activiteiten enorme positieve impact kan hebben op hun welzijn. Ook bleken betrokken vrijwilligers eens te meer onmisbaar voor de organisatie van de activiteiten. Ook studenten van de HU hebben hierin een rol gespeeld.
DOCUMENT
