Sudden death in sport at the high school and collegiate levels has been described extensively in the literature. However, few epidemiologic data exist on the incidence of sudden death specifically in American youth sport before secondary school athletics. To describe the epidemiology of sudden death in organized youth sports in the United States from 2007 through 2015. Descriptive epidemiology study. Organized American youth sports. Cases of sudden death that occurred in youth athletes 17 years of age and younger in non-high school organized sports were included. Information on sudden deaths between August 1, 2007, and December 31, 2015, was obtained via LexisNexis and other publicly available news or media reports. Total youth sport participation rates from 2007 to 2015 were provided by the Sport & Fitness Industry Association. Athlete age, sex, sport, level of play, event type, date of death, setting, and official and speculated causes of death were examined. Data are presented as deaths per year, percentage of total sudden deaths, and deaths per 10 million participants. From 2007 to 2015, 45 sudden deaths were reported in American youth sports. The mean age of patients was 13 ± 2 years. The overall incidence rate was 1.83 deaths/10 million athlete-years. Males experienced a greater number of sudden deaths than females (n = 36/45, 80%). Basketball had the highest number of sudden deaths from 2007 to 2015, with a total of 16 occurrences. The most frequent cause of sudden death was cardiac related (n = 34/45, 76%). Most sudden deaths occurred during practices (n = 32/45, 71%). Sudden deaths in organized youth sports in the United States from 2007 through 2015 were most often experienced during practices by males, were cardiac related, and occurred while playing basketball. These findings are similar to those in high school and collegiate sports. This study affirms the need for further epidemiologic research into sudden deaths at the organized youth sport level.Context
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The socioecological framework is a multilevel conceptualization of health that includes intrapersonal, interpersonal, organizational, environmental, and public policy factors. The socioecological framework emphasizes multiple levels of influence and supports the idea that behaviors both affect and are affected by various contexts. At present, the sports medicine community's understanding and application of the socioecological framework are limited. In this article, we use the socioecological framework to describe potential avenues for interventions to reduce sport-related deaths among adolescent participants.
Implementation of health and safety best practices for the leading causes of sudden death and catastrophic injury has been shown to mitigate risk. However, to our knowledge, no authors have examined progress toward health and safety policy implementation at the state level. To investigate the progress made by state secondary school leaders in developing and implementing health and safety policies (ie, exertional heat stroke, sudden cardiac arrest, concussion, emergency action plans) and to explore perceived barriers to and strategies for implementation. Mixed-methods study. State high school athletics associations and sports medicine advisory committees. Collaborative Solutions for Safety in Sport meeting attendees participated in this study. Thirty-five state leaders (current role experience = 8 ± 6 years) completed the survey. Ten of the 35 participated in follow-up interviews. A survey assessing progress on health and safety policy implementation was administered. Respondents indicated whether their state had implemented a policy, made progress without implementation, or made no progress. We conducted follow-up telephone interviews so they could expand on the survey responses. The data were analyzed using descriptive statistics and the general inductive approach. A total of 89% of respondents reported their states made progress on or implemented health and safety policies during the 2015–2016 academic year. Barriers to policy implementation included cost, a lack of understanding regarding policies versus recommendations, the content and value of policy change, and a false sense of security. Strategies for implementation included varying approaches to change, education of all constituents, and collaborative relationships among key stakeholders. Although a majority of respondents reported progress in implementing health and safety policies in their states, perceived barriers pointed to the need for the continued education of state leaders in charge of developing and implementing health and safety policies. Despite these barriers, collaboration among key stakeholders is crucial to successful implementation of best-practice policies in secondary school athletics.Context
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Field hockey is popular worldwide; however, it entails a risk of injury. Injuries hamper players' participation in the sport and impose a burden on public health. To investigate the effectiveness of a structured exercise program among youth field hockey players on the injury rate, severity, and burden. Quasi-experimental study. On field during 1 season of field hockey (October 2016 through June 2017). A convenience sample of 22 teams (291 players): 10 teams (135 players, mean age = 11.5 years [95% confidence interval (CI) = 11.2, 11.7 years]) in the intervention group and 12 teams (156 players, mean age = 12.9 years [95% CI = 12.6, 13.2 years]) in the control group. The Warming-up Hockey program, a sex- and age-specific, structured, evidence-informed warm-up program consisting of a preparation phase (ie, agility and cardiovascular warm-up exercises), movement skills (ie, stability and flexibility exercises), and sport-specific skills (ie, speed and strength exercises in field hockey situations). Participants in the control group performed their usual warm-up routines. Injury rate (ie, the number of injuries per 1000 player-hours of field hockey exposure), severity (ie, days of player time-loss), and burden on athletes' availability to play (ie, days of time loss due to injury per 1000 player-hours of field hockey exposure). The injury rate was lower in the intervention group (hazard ratio of 0.64 [95% CI = 0.38, 1.07]); however, this result was not statistically significant. The severity of injuries was similar in both groups (t statistic P = .73). The burden of injuries on players' field hockey participation was lower in the intervention group (difference of 8.42 [95% CI = 4.37, 12.47] days lost per 1000 player-hours of field hockey). Exposure to the Warming-up Hockey program was not significantly associated with a lower injury rate. No reduction was observed in the severity of injuries alone; however, the burden of injuries on players' field hockey participation was lower in the intervention group.Context
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Individuals with chronic ankle instability (CAI) experience disease- and patient-oriented impairments that contribute to both immediate and long-term health detriments. Investigators have demonstrated the ability of targeted interventions to improve these impairments. However, the combined effects of a multimodal intervention on a multidimensional profile of health have not been evaluated. To examine the effects of a 4-week rehabilitation program on disease- and patient-oriented impairments associated with CAI. Controlled laboratory study. Laboratory. Twenty adults (5 males, 15 females; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, mass = 70.58 ± 12.90 kg) with self-reported CAI participated. Inclusion criteria were at least 1 previous ankle sprain, at least 2 episodes of “giving way” in the 3 months before the study, and a Cumberland Ankle Instability Tool score ≤24. Individuals participated in 12 sessions over 4 weeks that consisted of ankle stretching and strengthening, balance training, and joint mobilizations. They also completed home ankle-strengthening and -stretching exercises daily. Dorsiflexion range of motion (weight-bearing–lunge test), isometric ankle strength (inversion, eversion, dorsiflexion, plantar flexion), isometric hip strength (abduction, adduction, flexion, extension), dynamic postural control (Y-Balance test), static postural control (eyes-open and -closed time to boundary in the anterior-posterior and medial-lateral directions), and patient-reported outcomes (Foot and Ankle Ability Measure–Activities of Daily Living and Foot and Ankle Ability Measure–Sport, modified Disablement in the Physically Active scale physical and mental summary components, and Fear-Avoidance Beliefs Questionnaire–Physical Activity and Fear-Avoidance Beliefs Questionnaire–Work) were assessed at 4 times (baseline, preintervention, postintervention, 2-week follow-up). Dorsiflexion range of motion, each direction of the Y-Balance test, 4-way ankle strength, hip-adduction and -extension strength, the Foot and Ankle Ability Measure–Activities of Daily Living score, the modified Disablement in the Physically Active scale–physical summary component score, and the Fear-Avoidance Beliefs Questionnaire–Physical Activity score were improved at postintervention (P < .001; effect-size range = 0.72–1.73) and at the 2-week follow-up (P < .001; effect-size range = 0.73–1.72) compared with preintervention. Hip-flexion strength was improved at postintervention compared with preintervention (P = .03; effect size = 0.61). Hip-abduction strength was improved at the 2-week follow-up compared with preintervention (P = .001; effect size = 0.96). Time to boundary in the anterior-posterior direction was increased at the 2-week follow-up compared with preintervention (P < .04; effect-size range = 0.61–0.78) and postintervention (P < .04) during the eyes-open condition. A 4-week rehabilitation program improved a multidimensional profile of health in participants with CAI.Context
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The accurate evaluation of self-reported changes in function throughout the rehabilitation process is important for determining patient progression. Currently, how a response shift (RS) may affect the accuracy of self-reported functional assessment in a population with chronic ankle instability (CAI) is unknown. To examine the RS in individuals with CAI after a 4-week multimodal rehabilitation program. Controlled laboratory study. Laboratory. Twenty adults (5 men, 15 women; age = 24.35 ± 6.95 years, height = 169.29 ± 10.10 cm, mass = 70.58 ± 12.90 kg) with self-reported CAI participated. Inclusion criteria were at least 1 previous ankle sprain, at least 2 episodes of the ankle “giving way” in the 3 months before the study, and a score ≤24 on the Cumberland Ankle Instability Tool. Individuals participated in 12 intervention sessions over 4 weeks and daily home ankle strengthening and stretching. Patient-reported outcomes (PROs) were assessed at 4 times (baseline, preintervention, postintervention, and 2-week follow-up). At the postintervention and 2-week follow-up, participants completed then-test assessments to measure RS. Then-test assessments are retrospective evaluations of perceived baseline function completed after an intervention. The PROs consisted of the Foot and Ankle Ability Measure-Activities of Daily Living and Sport subscales, the modified Disablement in the Physically Active scale physical and mental summary components, and the Fear-Avoidance Beliefs Questionnaire Physical Activity and Work subscales. We used repeated-measures analyses of variance to compare preintervention with then-test measurements. Individual-level RSs were examined by determining the number of participants who experienced preintervention to then-test differences that exceeded the calculated minimal detectable change. We did not identify an RS for any PRO (F > 2.338, P > .12), indicating no group-level differences between the preintervention and retrospective then-test assessments. Individual-level RS was most prominent in the Foot and Ankle Ability Measure-Sport subscale (n = 6, 30%) and the Fear-Avoidance Beliefs Questionnaire Physical Activity subscale (n = 9, 45%). No group-level RS was identified for any PRO after a 4-week multimodal rehabilitation program in individuals with CAI. This finding indicates that traditional assessment of self-reported function was accurate for evaluating the short-term effects of rehabilitation in those with CAI. Low levels of individual-level RS were identified.Context
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To conduct a systematic review with meta-analysis assessing the effectiveness of joint mobilizations for improving dorsiflexion range of motion (DFROM) and dynamic postural control in individuals with chronic ankle instability. Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to January 2017. Included studies examined the isolated effects of joint mobilizations to enhance DFROM and dynamic postural control in individuals with chronic ankle instability and provided adequate data to calculate effect sizes (ESs) and 95% confidence intervals (CIs). Two investigators independently assessed the methodologic quality, level of evidence, and strength of recommendation using the Physiotherapy Evidence Database scale and the Strength of Recommendation Taxonomy. We extracted the sample sizes, means, and standard deviations for DFROM and dynamic postural control and filtered the data based on control-to-intervention and preintervention-to-postintervention (pre-post) comparisons. We included 7 level 1 and 3 level 2 studies that had a median Physiotherapy Evidence Database score of 60% (range = 40%–80%). The magnitudes of control-to-intervention and pre-post differences were examined using bias-corrected Hedges g ESs. Random-effects meta-analyses were conducted for each outcome measure and comparison. Positive ESs indicated better outcome scores in the intervention group than in the control group and at postintervention than at preintervention. The α level was set at .05. Meta-analysis revealed weak and moderate ESs for overall control-to-intervention (ES = 0.41; 95% CI = 0.14, 0.68; P = .003) and pre-post (ES = 0.34; 95% CI = 0.20, 0.48; P < .001) DFROM analyses. Overall, dynamic postural control meta-analysis revealed moderate control-to-intervention (ES = 0.42; 95% CI = −0.14, 0.98; P = .14) and weak and moderate ESs for pre-post (ES = 0.37; 95% CI = −0.12, 0.87; P = .14) analyses. We observed grade A evidence that joint mobilizations can mildly improve DFROM among individuals with chronic ankle instability compared with controls and preintervention. We observed grade B evidence that indicated conflicting effects of joint mobilizations on dynamic postural control compared with controls and preintervention.Objective
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To describe the effects of proprioceptive training on pain, stiffness, function, and functional test outcomes among patients with knee osteoarthritis (OA). All studies completed from 1946 to 2017 were obtained from 4 databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus). Three reviewers independently identified appropriate studies and extracted data. Methodologic quality and level of evidence were assessed using the Physiotherapy Evidence Database scale and Oxford Centre for Evidence-Based Medicine guidelines. The standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for pain, stiffness, function, and functional test outcomes. Seven randomized controlled trials involving 558 patients with knee OA met the inclusion criteria. The selected studies had Physiotherapy Evidence Database scores of 6 to 8. All randomized controlled trials had an Oxford Centre for Evidence-Based Medicine level of evidence of 2. Meta-analysis of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (SMD = −0.56; 95% CI = −1.06, −0.07; P = .026), function subscale (SMD = −0.40; 95% CI = −0.59, −0.21; P < .001), and non-WOMAC walking speed test (SMD = −1.07; 95% CI = −2.12, −0.01; P = .048) revealed that proprioceptive training had significant treatment effects. Proprioceptive training was not associated with reductions in WOMAC stiffness subscale scores and did not improve non-WOMAC get-up-and-go scores. Proprioceptive training effectively promoted pain relief and completion of functional daily activity among patients with knee OA and should be included in rehabilitation programs. Stiffness and other mobility measures were unchanged after proprioceptive training. Modified proprioceptive training programs are needed to target stiffness and improve additional physical function domains.Objective
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In longitudinal studies tracking recovery after concussion, researchers often have not considered the timing of return to play (RTP) as a factor in their designs, which can limit the understanding of how RTP may affect the analysis and resulting conclusions. To evaluate the recovery of balance and gait in concussed athletes using a novel linear mixed-model design that allows an inflection point to account for changes in trend that may occur after RTP. Cohort study. University athletics departments, applied field setting. Twenty-three concussed (5 women, 18 men; age = 20.1 ± 1.3 years) and 25 healthy control (6 women, 19 men; age = 20.9 ± 1.4 years) participants were studied. Participants were referred by their team athletic trainers. Measures consisted of the Balance Error Scoring System (BESS) total score, sway (instrumented root mean square of mediolateral sway), single-task gait speed, gait speed while simultaneously reading a handheld article (dual-task gait speed), dual-task cost of reading on gait speed, and dual-task cost of walking on reading. We observed no significant effects or interactions for the BESS. Instrumented sway was worse in concussed participants, and a change in the recovery trend occurred after RTP. We observed group and time effects and group × time and group × RTP change interactions (P ≤ .046). No initial between-groups differences were found for single-task or dual-task gait. Both groups increased gait speed initially and then leveled off after the average RTP date. We noted time and RTP change effects and positive group × time interactions for both conditions (P ≤ .042) and a group × RTP change interaction for single-task gait speed (P = .005). No significant effects or interactions were present for the dual-task cost of reading on gait speed or the dual-task cost of walking on reading. Changes in the rate of recovery were coincident with the timing of RTP. Although we cannot suggest these changes were a result of the athletes returning to play, these findings demonstrate the need for further research to evaluate the effects of RTP on concussion recovery.Context
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Balance tests are a recommended assessment of motor function in concussion protocols. The BTrackS Balance Test (BBT) is a tool for concussion balance testing that uses low-cost force-plate technology to objectively measure postural sway. To provide normative data for the BBT in a large population of athletes. Cross-sectional study. Concussion baseline testing at multiple facilities. Male and female athletes (n = 10 045) ages 8 to 21 years. Athletes performed three 20-second trials of eyes-closed standing on the BTrackS Balance Plate with feet shoulder-width apart and hands on hips. Postural sway was measured as the average total center-of-pressure path length over 3 testing trials. Postural sway was reduced (ie, balance improved) as athlete age increased and was less in female athletes than in male athletes. Percentile ranking tables were calculated based on sex and 2-year age groupings. Our findings (1) provide context for BBT results performed in the absence of a baseline test, (2) can help mitigate athlete malingering, and (3) might identify individuals with latent neuromuscular injuries during baseline tests.Context
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The Vestibular/Ocular Motor Screening (VOMS) is a newly developed measure that evaluates vestibular and ocular motor symptom provocation after sport-related concussion. The effects of sex on baseline VOMS scores in youth athletes have not been established. To examine sex differences on baseline VOMS assessment among youth athletes. No sex differences were demonstrated between male and female youth athletes on individual VOMS items (P range = .07–.98). Female sex was not associated with increased odds for VOMS scores over clinical-cutoff levels (range: odds ratio = 0.64; 95% confidence interval = 0.35, 1.15; P = .13; odds ratio = 0.91; 95% confidence interval = 0.48, 1.71; P = .77). No sex differences were present on baseline VOMS scores in youth athletes, nor was sex a risk factor for an abnormal VOMS score. These findings highlight the need for continual baseline and postconcussion assessments using multifaceted assessment strategies.Context
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Current evidence suggests that a low percentage of athletic trainers (ATs) routinely use patient-reported outcome measures (PROMs). An understanding of the perceptions of ATs who use (AT-USE) and who do not use (AT-NON) PROMs as well as any differences due to demographic characteristics (eg, use for patient care or research, job setting, highest education level) may help facilitate the use of PROMs in athletic training. To describe commonly used PROMs by AT-USE, the criteria by which AT-USE select PROMs, and reasons for non-use by AT-NON. Cross-sectional study. Online survey. A convenience sample of 1784 ATs (response rate = 10.7% [1784/17972]; completion rate = 92.2% [1784/1935]) who worked in a variety of settings. Participants completed an anonymous electronic online survey. Descriptive statistics were used to describe commonly used PROMs, PROM selection criteria, and reasons for PROM non-use. Participants were classified as AT-USE (n = 370, 20.7%) or AT-NON (n = 1414, 79.3%). For the AT-USE group, the most common type of PROMs used were specific (eg, region, joint; n = 328, 88.6%), followed by single-item (n = 258, 69.7%) and generic (n = 232, 62.7%). Overall, the PROMs most frequently endorsed by the AT-USE group were the Numeric Pain Rating Scale (n = 128, 34.6%); Lower Extremity Functional Scale (n = 108, 29.2%); Disability of the Arm, Shoulder and Hand (n = 96, 25.9%); Owestry Disability Index (n = 80, 21.6%); and Foot and Ankle Ability Measure (n = 78, 21.1%). The most important criteria reported by AT-USE for selecting PROMs were that the measure was valid and reliable, easy for patients to understand, and easy for clinicians to understand and interpret. Common reasons for non-use were that PROMs were too time consuming for the clinician, too time consuming for the patient, and more effort than they were worth. The Numeric Pain Rating Scale; Lower Extremity Functional Scale; Disability of the Arm, Shoulder and Hand; Owestry Disability Index; and Foot and Ankle Ability Measure were the PROMs most commonly endorsed by AT-USE and should be considered for athletic training use. To further facilitate the use of PROMs in athletic training, future authors should identify strategies to address organizational and time-constraint obstacles. Interpretation of our study findings may require caution due to a relatively low response rate and because “routine use” was not operationalized.Context
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Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making
Driving After Concussion: Clinical Measures Associated with Post-concussion
The role of shoulder posture in pitching mechanics and injury risk in high school baseball pitchers
Corticospinal Excitability during Standing and Its Association with Postural Control Following Acute Lateral Ankle Sprain.
The socio-economic cost of anterior cruciate ligament injuries and lateral ankle sprains in amateur football and basketball.
JAT eISSN: 1938-162X
JAT ISSN: 1062-6050
ATEJ ISSN: 1947-380X