Injury Experience Research Articles

An Exploration of the Sources of Self-Efficacy Information in Athletic Injury Rehabilitation

Self-efficacy plays a vital role in an athlete’s injury and rehabilitation experience and is linked to successful rehabilitation outcomes. We sought to develop a deeper understanding of self-efficacy sources throughout injury rehabilitation using an interpretative phenomenological analysis design grounded in a pragmatist paradigm. Semistructured interviews were conducted with nine male Division II collegiate athletes throughout injury rehabilitation. Seven themes were identified as sources of athletes’ self-efficacy during rehabilitation phases, and two themes were identified as influencing participants in their selection and weighing of the sources of self-efficacy. Athletes described several sources as negatively impacting their self-efficacy, and differences were observed in the sources reported across the phases of injury rehabilitation. Results suggest the influence of sources of efficacy information fluctuates over the course of injury rehabilitation. These findings can contribute to further research in the area, as well as strategies and interventions to better assist athletes through injury rehabilitation.

Accessory respiratory muscles performance among people with spinal cord injury while singing songs with different musical parameters.

People with spinal cord injury (SCI) experience respiratory dysfunctions which include hypersecretions, bronchospasm, and respiratory muscles weakness. Singing therapy has been implemented as part of respiratory muscle training (RMT) to improve their muscle strength. Singing different types and genres of songs may elicit specific recruitment of respiratory muscles, attributed to the variation of the songs' characteristics including tempo, pitch, and rhythmic complexity. This study aims to determine the effect of singing songs with different characteristics on the accessory respiratory muscle performance among people with SCI. Thirteen male SCI participants of ASIA A and B (C4 -T11) were recruited. Respiratory muscle signals were retrieved by placing two mechanomyography (MMG) sensors on the sternocleidomastoid (SCM) and rectus abdominis (RA) muscles. Eight music experts categorized several songs into four categories based on their pitch, tempo, and rhythmic complexity. Each participant sang one song from each category. Findings showed statistically significant difference in RA and SCM responses among all categories (P < 0.01). The SCM muscle is most active while singing high pitch songs. While the RA is most active during slow tempo and easy rhythmic complexity. This shows that different accessory respiratory muscle is activated by people with SCI while singing songs with different characteristics. Clinicians could benefit from this knowledge while prescribing singing therapy or exercise among people with SCI in the future.

The Effects of Injury Experience in Lower Extremities on Joint Range of Motion, Muscle Extensibility, and Dynamic Stability in Elite Volleyball Players

PURPOSE This study investigates the impact of injury experience on ankle dorsiflexion, quadriceps extensibility, and dynamic stability in elite adolescent and adult volleyball players.METHODS A total of 485 players (adolescents=337, adults=115) reported lower extremities injuries, with measurements taken for ankle dorsiflexion and quadriceps extensibility using the weight- bearing lunge test and Ely’s test, respectively. The Y-balance test was used for dynamic stability. Measurements were conducted on the injured leg of players with knee and/or ankle injuries and the dominant leg of healthy players. Four groups were classified based on injury experience, and comparisons were made between both legs. Additionally, the variables of adolescent players were compared to those of adults.RESULTS Adolescent players with knee injuries exhibited a larger difference in ankle dorsiflexion between both legs, while adult players with ankle injuries demonstrated an asymmetry of ankle dorsiflexion. Regardless of age, players with knee or ankle injuries displayed lower dynamic stability compared to healthy players. Notably, adults with knee injuries showed a larger difference in dynamic stability between both legs.CONCLUSIONS To prevent and rehabilitate volleyball-related injuries, comprehensive injury risk factors, including age, should be managed in the injury prevention strategies.

A preliminary study evaluating self-reported effects of cannabis and cannabinoids on neuropathic pain and pain medication use in people with spinal cord injury.

Approximately 60% of individuals with a spinal cord injury (SCI) experience neuropathic pain, which often persists despite the use of various pharmacological treatments. Increasingly, the potential analgesic effects of cannabis and cannabinoid products have been studied; however, little research has been conducted among those with SCI-related neuropathic pain. Therefore, the primary objective of the study was to investigate the perceived effects of cannabis and cannabinoid use on neuropathic pain among those who were currently or had previously used these approaches. Additionally, the study aimed to determine if common pain medications are being substituted by cannabis and cannabinoids. Participants (N = 342) were recruited from existing opt-in listserv sources within the United States. Of those, 227 met the inclusion criteria and were enrolled in the study. The participants took part in an anonymous online survey regarding past and current use of cannabis and their perceived effects on neuropathic pain, including the use of pain medication. Those in the sample reported average neuropathic pain intensity scores over the past week of 6.8 ± 2.1 (0 to 10 scale), reflecting a high moderate to severe level of pain. Additionally, 87.9% noted that cannabis reduced their neuropathic pain intensity by more than 30%, and 92.3% reported that cannabis helped them to better deal with their neuropathic pain symptoms. Most participants (83.3%) also reported substituting their pain medications with cannabis, with the most substituted medication categories being opioids (47.0%), gabapentinoids (42.8%) and over-the-counter pain medications (42.2%). These preliminary results suggest that cannabis and cannabinoids may be effective in reducing neuropathic pain among those with SCI and may help to limit the need for certain pain medications.

The meaning of injury to the elite athlete: A systematic review

In the pursuit of a successful career in elite sports, athletes mostly rely on their physical abilities. An injury can threaten such a career, thereby representing a potentially critical life event that carries considerable meaning to the affected athlete. Qualitative literature exploring injury experiences in elite athletes is therefore seeking to frame injury through the athlete’s own voice. With this systematic review, we aimed to answer the research question What is the meaning of injuries to the elite athlete? by reviewing existing qualitative research exploring the meaning of injury as told from the athlete’s perspective. We constructed five overarching themes of meaning through thematic synthesis of 29 original studies: (1) unwelcome disruption – Injury as potential career threat; (2) destruction – My life (as an athlete) is over; (3) reinforcement – Relighting the fire; (4) going through the motions – Injury as an inherent part of elite sport; and (5) time-out – Respite and perspective. These meanings were neither exclusive nor static but constructed according to the situation at the moment of injury and could later be adapted depending on social context and specific circumstances. To better support injured athletes, practitioners need to be aware of the importance of the subjective meaning that athletes construct for individual injuries. Understanding these meanings enables practitioners to aid athletes in changing previously negative meanings into more positive ones. Our findings therefore call for improvements in the individualized support of elite athletes that leaves space for open communication about the meanings that athletes attach to their injury experiences.

User-Guided Enhancements to a Technology-Facilitated Resilience Program to Address Opioid Risks Following Traumatic Injury in Youth: Qualitative Interview Study.

Youth with traumatic injury experience elevated risk for behavioral health disorders, yet posthospital monitoring of patients' behavioral health is rare. The Telehealth Resilience and Recovery Program (TRRP), a technology-facilitated and stepped access-to-care program initiated in hospitals and designed to be integrated seamlessly into trauma center operations, is a program that can potentially address this treatment gap. However, the TRRP was originally developed to address this gap for mental health recovery but not substance use. Given the high rates of substance and opioid use disorders among youth with traumatic injury, there is a need to monitor substance use and related symptoms alongside other mental health concerns. This study aimed to use an iterative, user-guided approach to inform substance use adaptations to TRRP content and procedures. We conducted individual semistructured interviews with adolescents (aged 12-17 years) and young adults (aged 18-25 years) who were recently discharged from trauma centers (n=20) and health care providers from two level 1 trauma centers (n=15). Interviews inquired about reactions to and recommendations for expanding TRRP content, features, and functionality; factors related to TRRP implementation and acceptability; and current strategies for monitoring patients' postinjury physical and emotional recovery and opioid and substance use. Interview responses were transcribed and analyzed using thematic analysis to guide new TRRP substance use content and procedures. Themes identified in interviews included gaps in care, task automation, user personalization, privacy concerns, and in-person preferences. Based on these results, a multimedia, web-based mobile education app was developed that included 8 discrete interactive education modules and 6 videos on opioid use disorder, and TRRP procedures were adapted to target opioid and other substance use disorder risk. Substance use adaptations included the development of a set of SMS text messaging-delivered questions that monitor both mental health symptoms and substance use and related symptoms (eg, pain and sleep) and the identification of validated mental health and substance use screening tools to monitor patients' behavioral health in the months after discharge. Patients and health care providers found the TRRP and its expansion to address substance use acceptable. This iterative, user-guided approach yielded novel content and procedures that will be evaluated in a future trial.

Prediction of cognitive outcome after mild traumatic brain injury from acute measures of communication within brain networks

A considerable but ill-defined proportion of patients with mild traumatic brain injury (mTBI) experience persistent cognitive sequelae; the ability to identify such individuals early can help their neurorehabilitation. Here we tested the hypothesis that acute measures of efficient communication within brain networks are associated with patients’ risk for unfavorable cognitive outcome six months after mTBI. Diffusion and T1-weighted magnetic resonance imaging, alongside cognitive measures, were obtained to map connectomes both one week and six months post injury in 113 adult patients with mTBI (71 males). For task-related brain networks, communication measures (characteristic path length, global efficiency, navigation efficiency) were moderately correlated with changes in cognition. Taking into account the covariance of age and sex, more unfavorable communication within networks were associated with worse outcomes within cognitive domains frequently impacted by mTBI (episodic and working memory, verbal fluency, inductive reasoning, and processing speed). Individuals with more unfavorable outcomes had significantly longer and less efficient pathways within networks supporting verbal fluency (all t > 2.786, p < .006), highlighting the vulnerability of language to mTBI. Participants in whom a task-related network was relatively inefficient one week post injury were up to eight times more likely to have unfavorable cognitive outcome pertaining to that task. Our findings suggest that communication measures within task-related networks identify mTBI patients who are unlikely to develop persistent cognitive deficits after mTBI. Our approach and findings can help to stratify mTBI patients according to their expected need for follow-up and/or neurorehabilitation.

‘Attachment is such a core issue’: Therapist perspectives on attachment injuries in marriages in India

AbstractBackgroundMarital distress is a risk factor for a panoply of mental and physical health disorders. One of the causes of marital distress that is increasingly gaining relevance is attachment injuries in the marital relationship. Emerging from the confluence of adult attachment theory and emotionally focussed couples therapy, attachment injuries refer to tears in the relationship bond caused by abandonment or betrayal in the marriage, especially at times of critical need when attachment needs are salient.ObjectiveThe objective of this study was to investigate how therapists in India conceptualise and assess attachment injuries in marital relationships.MethodA qualitative design was used, whereby in‐depth interviews were conducted with 13 therapists and the transcripts were analysed using thematic analysis.ResultsThe analysis resulted in two overarching themes. The first was ‘Attachment Injuries are a Common Phenomenon in Couples undergoing Marital Distress’, which included themes related to markers of attachment injuries, injurious events, the gendered nature of attachment injury experiences and the impact of attachment injuries. The second overarching theme was ‘Therapists Utilize Diverse Methods for the Crucial Process of Identification of Attachment Injuries’, which included themes related to the methods used for assessment, the significance of attachment lens, the role of early experiences and the utility of identifying attachment injuries.ConclusionThe results highlighted how attachment injuries, originating from various injurious events, are often a component of marital distress in couples accessing therapy. The findings also pointed towards the need for therapists to develop competency in assessing and addressing attachment injuries, irrespective of their primary therapy orientation.

What Is the Pathway to the Best Model of Care for Traumatic Spinal Cord Injury? Evidence-Based Guidance.

People with traumatic spinal cord injury (tSCI) experience lifelong physical and emotional health impacts, needing specialized care that is complex to navigate. The non-standardized care pathways used by different jurisdictions to address these needs lead to care inequities and poor health outcomes. To develop an evidence-based integrated tSCI Care Pathway, from time of injury to life in the community. Eighty key partners engaged in planning, providing, and receiving tSCI care (1) identified existing guidelines, pathways, and care models; (2) created the tSCI Care Pathway with key elements or building blocks ("the what"), not specific recommendations ("the how") for each care stage (Acute, Rehabilitation, and Community), with elements highlighting the role of primary care and equity considerations on the pathway; (3) identified regional gaps in the tSCI Pathway and prioritized them for implementation; and (4) developed quality indicators. The tSCI Pathway was drafted in overarching and detailed formats. For Acute Care, building blocks focused on appropriate assessment, initial management, and transition planning; for Rehabilitation, building blocks focused on access to specialized rehabilitation and assessment and planning of community needs; for Community, building blocks focused on follow-up, mechanisms for re-access, and holistic support for persons and families; and for equity considerations, building blocks focused on those at-risk or requiring complex supports. Team-based primary care and navigation supports were seen as crucial to reduce inequities. This is the first comprehensive care pathway for tSCI. The Pathway is grounded in person-centred care, integrated care and services, and up-to-date clinical practice guidelines. The tSCI Care Pathway is flexible to regional realities and individual needs to ensure equitable care for all.

Psychiatry as a vocation: Moral injury, COVID-19, and the phenomenology of clinical practice.

In this article, we focus on a particular kind of emotional impact of the pandemic, namely the phenomenology of the experience of moral injury in healthcare professionals. Drawing on Weber's reflections in his lecture Politics as a Vocation and data from the Experiences of Social Distancing during the COVID-19 Pandemic Survey, we analyse responses from healthcare professionals which show the experiences of burnout, sense of frustration and impotence, and how these affect clinicians' emotional state. We argue that this may relate to the ethical conflicts they experience when they are forced to make clinical decisions where there are no optimal outcomes, and how in turn that impacts on their own emotional state. We then further examine the notion of 'burnout' and the phenomenology of 'moral injury'. Our argument is that these experiences of moral injury across a range of clinicians during the pandemic may be more prevalent and long-standing in psychiatry and mental health than in other areas of healthcare, where ethically difficult decisions and resource constraints are common outside times of crisis. Hence, in these clinical arenas, moral injury and the phenomenology of emotional changes may be independent of the pandemic. The insights gained during the pandemic may provide wider insights into the challenges of developing services and training the workforce to provide appropriate mental health care.

Knowledge and Self-Assessment of Dental Injuries and Oral Health among Croatian Professional Water Polo Players: A Cross-Sectional Study.

The purpose of this study was to evaluate oral health knowledge, and the incidence of self-reported dental injuries incidence, the frequency of mouthguard use, oral hygiene habits, and oral health status among professional water polo players. During the 2022/2023 season, 114 water polo players from the Croatian First League participated in a questionnaire-based online survey. The data collected included sociodemographic and professional attributes, oral health knowledge questions, dental injury experiences, and practices related to mouthguard use. Respondents also rated their own oral health status and oral hygiene habits. The data were analyzed using descriptive statistics and a regression analysis. The respondents demonstrated inadequate knowledge of oral health, with a mean score of 6.4 ± 2.6 out of 12. Better knowledge correlated positively with older age (p ˂ 0.05) and consistent flossing (p = 0.014). Additionally, 27.2% (31 of 114) of reported dental injuries were related directly to incidents which occurred while participating in water polo. These injuries occurred more frequently during games (54.8%) and often involved the anterior maxillary incisors (71.0%) due to player contact (87.1%). Awareness of mouthguards was high (93.9%), whereas their actual use was low (7.0%) because 35.1% of respondents reported discomfort wearing them. The respondents' self-assessments revealed widespread dental problems, including tooth sensitivity (13.3%), erosion (15.8%), calculus (28.1%), and pigmentation (7.9%). The research results indicate a lack of adequate knowledge among the respondents regarding oral health. This deficit was not associated with oral hygiene habits or oral cavity conditions. These findings highlight the disparities in oral health awareness and practices associated with water polo participation and emphasize the importance of education and prevention efforts.

The impact of competitive youth athlete injury on parents: a narrative review

Athletic injuries are common in youth sports, and much research has focused on the injury experience of athletes. However, less attention has been given to the impact of adolescent injury on relevant others within athletes’ recovery orbit, particularly parents. This narrative review examines the impact of adolescent injury on parents using the Multilevel Model of Sport Injury (MMSI). Results revealed that parents’ experience of their adolescent’s injury is influenced by intra- and interpersonal factors (e.g., thoughts, emotions, behaviors, and interactions with coaches, and sport medicine providers), as well as institutional, cultural, and policylevel factors (e.g., lack of organizational support, internalization of sport norms about playing with pain, and sport injury policies and guidelines). The review provides a more nuanced understanding of the factors and interactions that parents have following adolescent sport injury. Further research using the MMSI can extend current conceptualization and theorizing regarding parents’ experiences following adolescent injury.

Demographic adjustments to driver death rates by vehicle type and size

Objective Driver death rates per million registered vehicles are often used to compare the real-world crash experiences of vehicles of different types and sizes. However, these rates are affected by the risky behavior of drivers (e.g., speeding, impaired driving, lack of restraint use) that differs by age and gender. This paper presents a method for adjusting driver death rates to account for differences in driver age and gender. Methods Driver death rates per million registered vehicles per year were calculated for passenger vehicles of model year 2020. To account for potential differences in driver exposure by age and gender, which can affect motor vehicle crash and injury experience, an algebraic method was used to standardize these rates to a common distribution of female drivers ages 25–64. The standardization depends upon an independent estimate of the relative fatality risk for female drivers ages 25–64. Results The smallest vehicles tended to have higher driver death rates compared with larger vehicles. However, for sports cars, this trend was reversed; larger sports cars had higher driver death rates. Vehicle types popular with male drivers, such as sports cars and pickups, had standardized death rates that were much lower than the raw rates. Conclusions The adjustment for driver age and gender greatly reduced the variability of driver death rates among vehicle types. The procedure used here to adjust driver death rates for driver age and gender can be extended to any situation where it is desired to compare the crash rates of two or more subgroups of a population.

The use of mouthguards and related factors among basketball players in Indonesia

BackgroundBasketball is a sport with a higher injury rate. Regardless, few basketball players use mouthguards, which predisposes them to injuries. The use of mouthguards (UoM) could be related to several factors. This study aims to identify factors associated with UoM and to construct a model from the factors among basketball players in Indonesia.MethodsThrough convenience sampling, a total of 286 among basketball players in Indonesia was included in this cross-sectional study. These participants filled out online a modified questionnaires regarding demographic and several factors related to UoM. The data was analyzed using chi-square test, independent-sample t-test, binary logistic regression, and structural equation modeling (SEM).ResultsThere were 286 players. 127 of them were males and 159 were females. Of them, 86 (30.1%) used mouthguards. Age, duration (in year), and weekly practicing basketball (in hour) were all significantly different between mouthguards users and non-users with (p = 0.005, p = 0.036 and p = 0.035), respectively. The UoM was significantly associated with level of awareness, injury experience, social support, and oral health professional (OHP) support with (p = 0.002, p < 0.001, p < 0.001 and p < 0.001), respectively. This result was also supported by a variety of variables’ ORs, which range from 1.28 to 5.97. The coefficient of determination (R2) was 0.27.ConclusionsThe UoM among basketball players in Indonesia was related to several factors, including the level of knowledge, level of awareness, duration of basketball career, injury experiences, social support, and oral health professionals’ support which was constructed to propose a model. The model could explain 27% of the relationship between variables and UoM among Indonesian basketball players. This model will be useful for more comprehensive initiatives to promote oral health. It might be applicable for other countries as well as other sports communities / physical activities.

Harnessing the pedagogical power of art for learning about occupation in an entry-to-practice neurorehabilitation occupational therapy course

ABSTRACT Introduction Art can be a transformative pedagogical tool for teaching occupation. Research on arts-based pedagogies to teach occupation within educational programs is emergent and remains limited. Objectives To explore the use of art created by people with acquired brain injury to develop understandings of the lived experiences and occupational impacts of acquired brain injury for graduate students in an entry-to-practice occupational therapy graduate program. Methods First, development of the arts-based pedagogical tool was undertaken through an online review to select works of art that reflected acquired brain injury experience as depicted by people with lived experience. These art pieces were then used to develop a class that facilitated learning of the occupational impacts of acquired brain injury in an entry-to-practice occupational therapy graduate program. A descriptive qualitative approach was then used to explore the learning experiences of five graduate students who participated in a focus group. Reflexive thematic analysis was used to understand the data. Findings Art facilitated transformative learning experiences for students and was described by three themes: (1) captivating the learner, (2) “whole ‘nother layer”, and (3) inviting exploration and expansion. Conclusions Arts-based pedagogy holds potential to be an enriching teaching and learning tool for critically reflexive engagement, awareness, and deep understanding of the lived experiences and occupational impacts experienced by individuals with acquired brain injury.

‘I guess you just have to deal with it’: pre-professional ballet dancers’ experiences of pain, injury, and social support

ABSTRACT Pre-professional ballet dancers are at high risk for musculoskeletal injuries, some of which are not reported and are self-managed by dancers themselves. Understanding the decisions that adolescent dancers make related to their dancing, pain, and injuries is relatively under-researched. Sociocultural contexts and the presence of social support (or not) may influence decisions and experiences of elite adolescent ballet dancers regarding their pain and injury. Therefore, the purpose of this study was to examine pre-professional ballet dancers’ experiences of pain and injury in relation to the culture of ballet and social support. Twelve semi-structured interviews were conducted with pre-professional dancers (11–19 years) enrolled in a summer intensive programme at a ballet school. Using reflexive thematic analysis, five themes were developed: ignoring injuries and making risky choices, expectation of perseverance, influence of dominant constructions of the ballet body, self-assessment and self-management, and the role of various individuals in injury management and prevention. Findings from this research provide greater understanding of the way sociocultural influence and social support shapes pre-professional ballet dancers’ experiences. Strategies to better support the health and wellness of this unique dancer population are recommended.

32 Pediatric traumatic brain injury and the interruption of premorbid hallucinations: a case study

Objective:Research has shown that a small, yet significant minority of individuals with traumatic brain injuries (TBI) experience psychotic symptoms post-TBI. TBI has also been associated with earlier onset schizophrenia in individuals with a genetic risk for psychosis.The current case presents a 15-year-old female with pre-existing psychotic symptoms (auditory and visual hallucinations [AVH] and delusions) who stopped experiencing AVH a few weeks post-injury. The, at least temporary, cessation of her hallucinations raises several important questions about the neuroanatomy of pediatric psychosis and the impact of TBI on a potentially divergently developing brain.Participants and Methods:Patient is a 15-year-old female who identifies as Hispanic (adopted, of Central American origin). Prior to her injury her developmental history was notable probable neglect prior to adoption, and her psychiatric history was notable for major depressive disorder, anxiety, chronic insomnia, and AVH. AVH were religious in nature and involved command hallucinations. AVH had been attributed to her chronic insomnia, per medical records. Participant was in a motorcycle accident with her caregiver and sustained a severe traumatic brain injury (GCS=3-8). Medical workup, including MRI, indicated a right basal ganglia hemorrhage, right thalamic hemorrhage, as well as injury of the brain stem at the pons, resulting in left-sided hemiparesis. She was ultimately diagnosed with traumatic right-sided intracerebral hemorrhage, traumatic subdural hematoma, traumatic hemorrhage of basal ganglia, traumatic encephalopathy, and a left homonymous hemianopia (left visual field cut) from her right temporal parietal injury. She received a neuropsychological evaluation 10 months post-TBI. Testing included: subtests of the WISC-V, measures of sustained attention and executive functioning, tasks of orientation and memory, and questionnaire measures assessing social-emotional, executive, and adaptive functioning. Parent and adolescent clinical interviews were conducted.Results:Results indicated appropriate orientation, broadly intact intelligence presumed consistent with premorbid functioning, average sustained attention, and deficits in aspects executive functioning, visual-motor processing speed, and fine motor skills. Although she performed well on objective measures of memory, she reported significant long term social memory loss (e.g., difficulties remembering friends and memories of emotional connectedness) during the clinical interview. Interview and questionnaire measures also indicated continued challenges with depression and anxiety, as well as post-traumatic personality changes, tics, and symptoms of trauma. Patient reported that her hallucinations, both visual and auditory, stopped early in her recovery post-TBI; patient’s premorbid delusions were still present post-TBI.Conclusions:This case raises questions related to the impact of structural or axonal injury to regions or networks in the brain that may be associated with psychosis. It also adds to a minimal literature examining AVH in pediatric TBI. Using the current literature as a framework we will explore 1) the injury to this patient’s thalamus as it relates to both her emotional memory deficits as well as the interruption of her AVH hallucinations, and 2) the relationship between her visual field cut and the interruption of her visual hallucinations. Overall, this case study highlights the unique nature of the developing brain both in terms of the TBI and psychosis.

Effect of Loaded Plyometric Training on Physical Fitness, Lower Extremity Isokinetic Muscle Function and Dynamic Balance

OBJECTIVES This study purposed to investigate the effects of an 8-week intervention of loaded plyometric training on physical fitness, lower limb isokinetic muscle function, and dynamic balance in healthy adults.METHODS The participants were 12 undergraduate students at K University in Chungcheong-do, South Korea, who had no experience of injury in the past year and who showed ≥250 peak torque/body weight(%) in the test of lower limb isokinetic muscle function. At pre-test and post-test, an identical set of tests was conducted to assess the physical fitness, lower limb isokinetic muscle function, and dynamic balance.RESULTS After exercise intervention, Loaded plyometric training group(LPTG) had significant differences in sit-ups, standing long jump, T agility test, extensor muscle strength-right(EMS-R), flexor muscle strengthright( FMS-R), extensor muscle power-left(EMP-L), flexor muscle power-left(FMP-L), flexor muscle powerright( FMP-R) and anterior-left(AN-L). Unloaded plyometric training gruop(UPTG) had significant differences in standing long jump, T agility test, EMS-R, EMP-L, and posterolateral-right(PL-R). Between the two groups, there were significant differences in standing long jump, extensor muscle strength-left(EMS-L), and EMP-L.CONCLUSIONS Thus, compared to the UPTG, the LPTG has been shown to exert a stronger effect on thestanding long jump, muscle strength, and muscle power, and it is predicted to be a more effective methodof exercise.

Hazard and Injury Experiences of Latino Day Laborers in Houston, Texas.

Latino day laborers in the United States provide skilled labor to businesses and homeowners through informal work arrangements. We conducted exploratory qualitative research with Latino day laborers in Houston, Texas, to investigate their perceptions of safety risks and circumstances related to work-related injuries. We conducted focus groups with 34 participants and used risk mapping and body mapping activities to elicit greater engagement by the Latino day laborers in the conversations. Participants described physical, occupational, and psychosocial hazards that affected their risk for workplace injuries. They indicated a significant risk for injury was employers failing to provide proper tools or equipment for the job being done. The themes that emerged from the analysis were lack of control over employment conditions and the risk of performing unsafe work in order to meet financial needs. This formative qualitative research informed a pilot test and subsequent clinical trial of injury risk reduction strategies for Latino day laborers. Interventions to protect day laborers from work-related injuries should be informed by recognizing the employment and social dilemmas they confront.

Moral injury among western healthcare missionaries: a qualitative study

Introduction Moral injury among healthcare missionaries leads to negative consequences for the individual, healthcare team, patients, and sending agencies. Conflicting values in clinical care, culture, and spirituality provide unique potentially morally injurious experiences. The purpose of this qualitative study is to explore the phenomenon of moral injury among western healthcare missionaries to develop effective support and treatment strategies. Methods A qualitative interview guide was developed based on the existing literature on moral injury. Twenty-one key informant interviews were completed by two former healthcare missionaries. Participants were based in Africa, Asia, and Eastern Europe healthcare mission settings. Questions were based on clinical, cultural, and spiritual domains of potential ethical and moral conflicts. Protective factors were also explored based on one’s faith and spiritual practices. Interviews were transcribed and coded independently by two analysts. The team reviewed the codes and determined themes from across the three domains. Results Seven themes emerged from the interviews ranging from morally injurious experiences with cultural leadership practices and unfamiliar clinical care experiences to guilt over practicing outside of one’s scope of practice and addressing suffering alongside God’s sovereignty. The themes led to the development of an injury/growth pathway as a potential model for helping healthcare missionaries describe and move through potentially morally injurious experiences. Conclusion The themes allow for healthcare missionary sending agencies to develop strategies, training, and support systems for teams preparing to enter the mission field and for individuals already in the field. Recommendations for growing through potentially morally injurious experiences are suggested to guide practice and support for missionaries in the field. The growth values and strategies could inform the development of a screening tool to assess moral injury among healthcare missionaries.