Volume 59: Issue 12

Context

Authors of few studies have used randomized controlled trials (RCTs) to quantify clinical intervention safety of rehabilitation after sport-related concussion across sport levels.

Objective

Describe symptom exacerbation and adverse events (AEs) associated with two concussion rehabilitation interventions.

Design

Cluster RCT (NCT02988596)

Setting

Sports medicine clinic and field settings.

Patients or Other Participants

The RCT enrolled 251 concussed athletes (median age = 20 years; female, n = 48) across 28 sites from New Zealand professional rugby (n = 31), Canadian professional football (n = 52), US/Canadian colleges (n = 128) and US high schools (n = 40).

Interventions

Two medically supervised interventions: (1) enhanced graded exertion (EGE): international return-to-sport strategy and sport-specific activities only (EGE only, n = 119); and (2) multidimensional rehabilitation (MDR) followed by EGE: early symptom-directed exercises once symptoms were stable, followed by EGE after symptoms resolved (MDR + EGE, n = 132).

Main Outcome Measure(s)

Primary outcomes were intrasession total symptom severity score exacerbation and significant intersession (increase 10+ severity points) sustained total symptom severity exacerbation, each measured with the Postconcussion Symptom Scale (132 total severity points on scale). Reported AEs were also described. Activity-based rehabilitation sessions (n = 1437) were the primary analysis unit. Frequencies, proportions, medians, and interquartile ranges were calculated for outcomes by treatment group.

Results

The 251 postinjury participants completed 1437 (MDR + EGE = 819, EGE only = 618) activity-based intervention sessions. A total of 110 and 105 participants contributed data (those missing had no documented session data) to at least 1 activity-based session in the MDR + EGE and EGE-only arms, respectively. Intrasession symptom exacerbations were equivalently low in MDR + EGE and EGE-only arms (MDR + EGE: 16.7%, 95% CI = 14.1%, 19.1%; EGE only: 15.7%, 95% CI = 12.8%, 18.6%). In total, 9/819 MDR + EGE sessions (0.9%) and 1/618 EGE-only sessions (0.2%) resulted in a presession to postsession symptom exacerbation beyond a 10+ severity point increase; 8/9 resolved to <10 points by the next session. Two study-related AEs (1 in each arm) were reported.

Conclusions

Participants in MDR + EGE and EGE-only activities reported equivalently low rates of symptom exacerbation.

Context

There are significant disparities in access to health care, but there are limited data about the impact of race and socioeconomic status on postoperative outcomes following anterior cruciate ligament reconstruction (ACLR) surgery.

Objective

To identify associations between the Area Deprivation Index (ADI), strength measures, and patient-reported outcomes following ACLR and examine differences in outcomes between race, sex, and socioeconomic status.

Design

Case-control study in a single hospital setting.

Setting

Database secondary analysis.

Patients or Other Participants

Data were collected from 340 patients who underwent primary, isolated, unilateral ACLR.

Main Outcome Measure(s)

Strength measures and patient-reported outcomes were obtained at patients’ postoperative assessments at approximately 6 months postsurgery. Area Deprivation Index values were calculated on each patient’s census tract, as determined through medical records review. Correlations were conducted to determine the relationship between the ADI and Knee Injury and Osteoarthritis Outcome Score measures, International Knee Documentation Committee, and limb symmetry on strength measurements. The racial composition of the sample was heavily skewed and was excluded from statistical analyses.

Results

The ADI was weakly correlated with International Knee Documentation Committee (ρ = 0.11, P = .04) outcomes, with more disadvantaged patients reporting better quality of life and knee function. The ADI was not correlated with other outcomes of interest. The median ADI value of the sample was 32 (range, 1–86 [interquartile range, 19–47]).

Conclusions

Our study revealed a weak correlation between higher levels of socioeconomic disadvantage as measured by the ADI and improved subjective assessment of knee function and quality of life as measured by International Knee Documentation Committee. These findings are contrary to what other studies on this subject have found and highlight the importance of further research into the impact of socioeconomic status and other social determinants of health on post-ACLR outcomes.

Context

Anterior cruciate ligament reconstruction (ACLR) patients commonly adopt poor movement patterns that potentially place them at an increased risk for reinjury if untreated. Limb loading characteristics during functional tasks can highlight movement compensations.

Objective

To examine loading symmetry during a bilateral bodyweight squatting task between sexes, compare loading metrics between limbs and sexes, and describe the relationship between loading metrics and patient-reported outcomes (PROs) after ACLR.

Design

Cross-sectional study.

Setting

Laboratory.

Patients or Other Participants

One hundred forty-two patients (71 male, 71 female, age = 24.4 ± 11.10 years) with a primary, unilateral, uncomplicated ACLR completed a squatting assessment and PRO measures at approximately 5.2 months post-ACLR.

Main Outcome Measure(s)

Normalized limb loading peak force (N/kg) and unilateral cumulative load (%) were collected bilaterally during the squatting task. Limb symmetry index (%) was calculated for normalized peak force. First, we compared limb loading symmetry (%) between sexes using an independent-samples t test. Second, we assessed differences in limb loading metrics between limbs and sexes via an analysis of covariance. Third, we used Spearman ρ correlations to determine the relationship between limb loading metrics and PROs.

Results

The majority of individuals (91 of 142, 64.1%) offloaded their ACLR limb (ACLR = 6.6 ± 1.56 N/kg, contralateral = 7.3 ± 1.61 N/kg, P < .001). Females significantly offloaded their ACLR limb (ACLR = 6.3 ± 1.38 N/kg, contralateral = 7.2 ± 1.62 N/kg, P < .001) whereas males did not significantly offload their ACLR limb (ACLR = 6.98 ± 1.65 N/kg, contralateral = 7.4 ± 1.60 N/kg, P = .07). Weak relationships were observed (Ρ value range: −.23 to .19) across limb loading metrics and PROs.

Conclusions

Individuals approximately 5 months after ACLR, on average, offloaded their ACLR limb compared with the contralateral limb. Patients’ tendency to offload their weight during a squat was influenced by sex. Relationships between limb loading metrics and PROs indicate patients who load their limbs disproportionately have a lower perception of their capability to complete activities of daily living and lower subjective knee function.

Abstract #1

A Virtual Interprofessional Patient Care Experience Increases Interprofessional Core Competency Attainment

Henning J, Johnson J, Ebeid A, Werner D: High Point University, High Point, NC

Context: Interprofessional education (IPE) is a requirement in the professional preparation of healthcare providers. Barriers to implementing face-to-face IPE include space restrictions, differences in academic calendars, availability of faculty facilitators, and student schedules. Therefore, alternative strategies for implementing a broad swath of professions into IPE learning activities is desirable.

Objective: The main objective of this teaching strategy was to determine the impact of a virtual interprofessional patient care experience on attainment

Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making

Landon B. LempkePhD, ATC,

Benjamin L. BrettPhD, and

Douglas P. TerryPhD,ABPP