Functional Performance Tests Research Articles

25-hydroxyvitamin D Levels are Associated with Cognitive Dysfunction in Type 2 Diabetes and the Metabolic Syndrome: A Preliminary Examination

Background: Type 2 diabetes (T2DM) and metabolic syndrome are linked to pathological changes in the brain and increased likelihood of cognitive impairment. Vitamin D insufficiency is commonly found in this population and is associated with cognitive dysfunction in other patient groups. The present study aims to demonstrate the presence of cognitive deficit in individuals with T2DM and metabolic syndrome, and determine if level of vitamin D is associated with cognitive deficit in this population. Methods: Twenty individuals with T2DM and metabolic syndrome (n = 20, aged 45 to 72) were recruited for this cross-sectional study from a subspecialty diabetes center. All completed computerized cognitive testing and clinical evaluation, including assessment of circulating vitamin D values. Pearson correlations determined the association between vitamin D value and test performance. Results: Cognitive dysfunction was prevalent, particularly in domains of executive function (e.g., Verbal Interference-Color Word, 47%) and attention (e.g., Working Memory Reaction Time, 50%; Digit Span, 30%). Lower vitamin D values were associated with poorer executive function test performance (Switching of Attention-Letters/Numbers, r = 0.64; Maze Errors, r = 0.47). Conclusions: Cognitive dysfunction was prevalent, and lower vitamin D values were associated with poorer executive function test performance. It is unclear if vitamin D directly affects cognition in this population, or if it serves as a proxy for another mechanism affecting cognition, such as poorer glycemic control or sedentary lifestyle. Prospective studies involving vitamin D supplementation may be of benefit in addressing the possible causal role of vitamin D in cognition for this population.

Is there a correlation between the psychological ACL-RSI score and isokinetic and neuromuscular functional performance tests of the knee following primary anterior cruciate ligament reconstruction?

The decision to allow an athlete to return to sport following anterior cruciate ligament (ACL) reconstruction should not only be based on the time since surgery. Physical and psychological readiness to return to sport are essential, and a premature return is a risk factor for recurrent tears. The ACL-Return-to-Sport-after-Injury (ACL-RSI) questionnaire quantifies the influence of psychological factors on the patient's ability to return to play. The main goal of this study was to determine the relationship between the ACL-RSI score and postoperative isokinetic and neuromuscular tests. An analysis of a prospective cohort was performed including athletes who underwent surgery between 2013–2016 for an isolated full-thickness ACL tear, with a healthy contralateral knee and a complete evaluation of their knee's functional performance by isokinetic and neuromuscular tests. The isokinetic tests were performed during flexion and extension at 3 angular velocities on a dynamometer to measure strength: quadriceps 60°/s and 240°/s for concentric movements, hamstrings 30°/s for eccentric movements. The neuromuscular assessment was based on single-limb hop tests. The main judgment criterion was the correlation between the ACL-RSI score at 6-month follow-up and the difference between the 2 knees for isokinetic and neuromuscular tests. The correlations were assessed using Pearson correlation coefficient ( r ). One hundred and eighty-two patients fulfilled the inclusion criteria, 132 men/50 women, mean age 28.7 ± 8.6 years including 4 (2.2%) professional and 89 (48.9%) competitive athletes. The mean follow-up was 6.5 ± 1.7 (4–12) months. The ACL-RSI score was positively and significantly but weakly correlated with the tests ( r = 0.15 to 0.18, P = 0.01 to 0.03). The ACL-RSI score was significantly higher in patients who returned to sport ( P = 0.0001). The ACL-RSI score at 6-month follow-up was significantly and positively, but weakly correlated to isokinetic and neuromuscular tests. This tool provides a good evaluation of the psychological factors involved in the return-to-sport.

Preseason Functional Test Scores Are Associated With Future Sports Injury in Female Collegiate Athletes.

Brumitt, J, Heiderscheit, B, Manske, R, Niemuth, PE, Mattocks, A, and Rauh, MJ. Preseason functional test scores are associated with future sports injury in female collegiate athletes. J Strength Cond Res 32(6): 1692-1701, 2018-Recent prospective cohort studies have reported preseason functional performance test (FPT) measures and associations with future risk of injury; however, the findings associated with these studies have been equivocal. The purpose of this study was to determine the ability of a battery of FPTs as a preseason screening tool to identify female Division III (D III) collegiate athletes who may be at risk for a noncontact time-loss injury to the lower quadrant (LQ = low back and lower extremities). One hundred six female D III athletes were recruited for this study. Athletes performed 3 FPTs: standing long jump (SLJ), single-leg hop (SLH) for distance, and the lower extremity functional test (LEFT). Time-loss sport-related injuries were tracked during the season. Thirty-two (24 initial and 8 subsequent) time-loss LQ injuries were sustained during the study. Ten of the 24 initial injuries occurred at the thigh and knee. At-risk athletes with suboptimal FPT measures (SLJ ≤79% ht; (B) SLH ≤64% ht; LEFT ≥118 seconds) had significantly greater rates of initial (7.2 per 1,000 athletic exposures [AEs]) and total (7.6 per 1,000 AEs) time-loss thigh or knee injuries than the referent group (0.9 per 1,000 AEs; 1.0 per 1,000 AEs, respectively). At-risk athletes were 9 times more likely to experience a thigh or knee injury (odds ratio [OR] = 9.7, confidence interval [CI]: 2.3-39.9; p = 0.002) than athletes in the referent group. At-risk athletes with a history of LQ sports injury and lower off-season training habits had an 18-fold increased risk of a time-loss thigh or knee injury during the season (adjusted OR = 18.7, CI: 3.0-118.1; p = 0.002). This battery of FPTs appears useful as a tool for identifying female D III athletes at risk of an LQ injury, especially to the thigh or knee region.

EVIDENCE-BASED PROCEDURES FOR PERFORMING THE SINGLE LEG SQUAT AND STEP-DOWN TESTS IN EVALUATION OF NON-ARTHRITIC HIP PAIN: A LITERATURE REVIEW

Functional performance tests are commonly utilized in screening for injury prevention, evaluating for athletic injuries, and making return-to-play decisions. Two frequently performed functional performance tests are the single leg squat and step-down tests. The purpose of this study was to systematically review the available psychometric evidence for use of the single leg squat and step-down tests for evaluating non-arthritic hip conditions and construct an evidence-based protocol for test administration. Review of the Literature. A search of the PubMed and SPORTSDiscus databases was performed. Psychometric evidence of reliability, validity, and responsiveness to support the use of the both tests were collected. The protocols used for administering these tests were extracted, summarized, and combined. Of the 3,406 articles that were reviewed, 56 total articles met the inclusion criteria and were included in the review. Evidence for reliability and validity was available to support the use of the single leg squat and step-down tests. Both tests assess for neuromuscular control of the hip and surrounding muscular structures. Evaluation of these functional movement patterns enable the clinician to assess for limitations that may cause an increase in hip pain and dysfunction. The single leg squat and step-down tests can assess for kinematic and biomechanical deficiencies and may be useful in the evaluation process for individuals with non-arthritic hip pain. The authors of this review present a comprehensive evidence-based protocol for standardized performance of these tests. 2b.

Balance- and Strength-Training Protocols to Improve Chronic Ankle Instability Deficits, Part I: Assessing Clinical Outcome Measures.

Functional rehabilitation may improve the deficits associated with chronic ankle instability (CAI). To determine if balance- and strength-training protocols improve the balance, strength, and functional performance deficits associated with CAI. Randomized controlled clinical trial. Athletic training research laboratory. Participants were 39 volunteers with CAI, which was determined using the Identification of Functional Ankle Instability Questionnaire. They were randomly assigned to 1 of 3 groups: balance-training protocol (7 males, 6 females; age = 23.5 ± 6.5 years, height = 175.0 ± 8.5 cm, mass = 72.8 ± 10.9 kg), strength-training protocol (8 males, 5 females; age = 24.6 ± 7.7 years, height = 173.2 ± 9.0 cm, mass = 76.0 ± 16.2 kg), or control (6 males, 7 females; age = 24.8 ± 9.0 years, height = 175.5 ± 8.4 cm, mass = 79.1 ± 16.8 kg). Each group participated in a 20-minute session, 3 times per week, for 6 weeks. The control group completed a mild to moderately strenuous bicycle workout. Participants completed baseline testing of eccentric and concentric isokinetic strength in each ankle direction (inversion, eversion, plantar flexion, and dorsiflexion) and the Balance Error Scoring System (BESS), Star Excursion Balance Test (SEBT), and side-hop functional performance test. The same variables were tested again at 6 weeks after the intervention. Two multivariate repeated-measures analyses of variance with follow-up univariate analyses were conducted. The α level was set a priori at .05. We observed time-by-group interactions in concentric ( P = .02) and eccentric ( P = .01) inversion, eccentric eversion ( P = .01), concentric ( P = .001) and eccentric ( P = .03) plantar flexion, BESS ( P = .01), SEBT ( P = .02), and side hop ( P = .004). With pairwise comparisons, we found improvements in the balance- and strength-training protocol groups in concentric and eccentric inversion and concentric and eccentric plantar flexion and the BESS, SEBT, and side hop (all P values = .001). Only the strength-training protocol group improved in eccentric eversion. The control group did not improve in any dependent variable. Both training protocols improved strength, balance, and functional performance. More clinicians should incorporate hop-to-stabilization exercises into their rehabilitation protocols to improve the deficits associated with CAI.

HOP TEST AS A TOOL FOR THE ASSESSMENT AND PREVENTION OF INJURIES IN FOOTBALLERS DURING PRESEASON

Hop Tests (unipodal horizontal jumps) have been recommended as one of the reliable assessment tests when allowing a return to competition for a sportsperson after an anterior cruciate ligament injury1,2,3,4. Currently, comparison is made of the results with the contralateral limb through the symmetry index, a method which might not provide sufficient security upon the return to competitive sport5. Hop tests can be used in preseason to gain reference values prior to a possible injury. The objective of this review is to analise the scientific literature such as the F-Marc6 (reference manual of FIFA) to confirm whether include said tests in preseason for football teams. A search was conducted in the Pubmed y Cochrane databases (17/04/17) with the search terms “Hop Test”, “Football”, “Soccer”, and “Preseason”. Articles in English and Spanish were both accepted. Articles excluded were those that did not make reference to the knee, to football, and those that did not conduct tests during preseason. From a total of 33 articles, 4 with these search criteria were included, 5 articles were added trough the bibliography of other studies, and the F-Marc manual was analised. 4 of the articles used the hop tests in preseason for some type of study, of which 3 were used as part of a prospective assessment for the season. On the other hand, the F-Marc does not consider Hop Tests as an assessment test. Hop tests were not found to be used in preseason as reference values prior to possible future injuries, data which could be beneficial for a safe return to sport. Harris J, Abrams G, Bach B, Williams D, Heidloff D, Bush-Joseph C, Verma N, Forsythe B, Cole B. Return to Sport After ACL Reconstruction. ORTHOPEDICS. 2014; 37: e103-e108. Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011 Dec;27(12):1697-705. Thomeé R, Kaplan Y, Kvist J, Myklebust G, Risberg MA, Theisen D, Tsepis E, Werner S, Wondrasch B, Witvrouw E. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2011 Nov;19(11):1798-805. Bolgla LA, Keskula DR. Reliability of lower extremity functional performance tests. J Orthop Sports Phys Ther. 1997 Sep;26(3):138-42. Wellsandt E, Failla MJ, Snyder-Mackler L. Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. J Orthop Sports Phys Ther. 2017 Mar 29:1-18. F-MARC. Football Medicine Manual. 2nd Edition. Available from: http://f-marc.com . 2017.

Use of functional performance tests in sports: Evaluation proposal for football players in the rehabilitation phase

Based on the criteria of a group of experts, this study aims to select a set of functional performance tests which can be applied to evaluate the functional status of a football player in the recovery process and make a decision in relation to their return to practice. A total of 16 experts were selected by the coordinator group to judge an initial list of functional performance tests and, thus, reach a consensus about the tests which are best suited to the needs of the injured player. Each of the experts had to evaluate each one of the tests in a scale from 1 to 5 in relation to their suitability. Delphi method was used to reach consensus in the expert group. From the initial list of 25, the tests which obtained the best evaluation were: Counter movement jump (4.3±0.9), Single hop test (4.1±0.8), Triple hop test (4.1±0.9), Crossover hop test (4.1±0.7), Yo-Yo intermittent recovery (4.2±0.6), Barrow test (4.1±0.6), Shuttle run 8¥5 m (4.1±0.8). Star excursion balance test (4±0.7) and Y balance test (4.1±0.7). In the opinion of the experts selected here, these tests are the ones which best respond to the needs involved in a complex decision such as RTP.

THE LOWER EXTREMITY GRADING SYSTEM (LEGS) TO EVALUATE BASELINE LOWER EXTREMITY PERFORMANCE IN HIGH SCHOOL ATHLETES

Lower extremity athletic injuries result in impairments in balance, power, and jump-landing mechanics. Unilateral injury has bilateral effects and the literature supports that it is important to assess neuromuscular impairments such as balance, power, and jumping mechanics following injury and for safe return to sport after injury rehabilitation. Currently, individual tests are established in the literature, but no combined approach or clinical tool exists for this purpose. The purpose of this study is to describe and provide the initial data for the Lower Extremity Grading System (LEGS), comprised of three neuromuscular components for use as a baseline pre-season assessment for high school athletes to assess lower extremity performance. Furthermore, this study focuses on the differences in baseline lower extremity performance outcomes between male and female soccer and basketball athletes. One hundred and eighty-five high school basketball, and soccer athletes (94 female, 91 male; mean age = 15.6 ± 4.4) participated. The participants were administered the LEGS assessment during the preseason for their respective sports, which includes three component tests: (1) Y-balance test, (2) drop vertical jump test, (3) triple-crossover-hop-for-distance test. Participants' scores on each test were recorded, and then totaled to present an overall LEGS composite score. Participants' baseline LEGS scores were then analyzed according to sex and sport, and standard normal distribution was calculated for all scores to enable percentile rankings to be established. Mean scores and standard deviation for each functional performance test are presented. Furthermore, a LEGS composite score combining the test scores was established and presented as a normal distribution curve allowing for further comparison and analysis. The mean LEGS composite score for males was 700.3 ( ± 76.6), while the mean LEGS composite score for females was 587.4 ( ± 51.6). Statistically different LEGS composite scores were found between males and females. The current findings present descriptive data for the utility of the LEGS as a neuromuscular baseline assessment before high school sports participation and/or as a tool for assessing return to sports after injury rehabilitation. The LEGS may augment current assessment tools and may serve as a composite score and combined approach to the assessment of lower extremity risk of injury and readiness to return to sports. 3.

Does hallux valgus impair physical function?

BackgroundThe relationships between radiographic hallux valgus (HV) and various physical functions independent of knee osteoarthritis (KOA) were examined among residents of a mountain village in Japan.MethodsStudy participants were recruited from mountain village residents aged ≥50 years. Participants’ height, weight, and body mass index (BMI) were measured, and baseline data, including age, sex, and foot pain, were obtained using interviews and questionnaires. Radiography of the feet and knees was performed to assess the presence of HV (HV angle ≥20°) and KOA (Kellgren-Lawrence grade ≥ II). Grip strength, 6-m walk at usual and maximum speeds, single-leg stance time, and stand up from a chair time were evaluated as physical function performance tests. Plantar pressure patterns were also examined.ResultsModerate-severe HV (HV angle ≥30 degrees), impaired grip strength and maximum walking speed, and painful HV reduced usual and maximum walking speeds independent of KOA. Hallux plantar pressure decreased according to the HV angle. Hallux plantar pressure was significantly lower in painful HV than in the no HV feet or painless HV.ConclusionsModerate-severe HV deformity and HV-related pain impaired physical function independent of KOA. By controlling the pain and severe deformity of HV by treatments such as surgery, the physical function of HV patients might be improved.

Évaluation fonctionnelle isocinétique et neuromusculaire du genou, retour au sport après reconstruction du ligament croisé antérieur. Étude prospective d’une cohorte de 234 sportifs au recul moyen de 6 mois

BackgroundTen percent or less reduction in isokinetic and functional test performance in comparison with the healthy side is generally considered to be a sign of satisfactory functional recovery after reconstruction of the anterior cruciate ligament (ACL). The main objective of this work was to assess postoperative functional recovery of the knee joint in a large cohort. MethodsThis was a single-center prospective cohort recruited from 2012 among patients undergoing ACL repair performed by four surgeons. A retrospective analysis of data included a series of athletes who underwent the procedure in 2013–2016 for primary ACL tear, had a healthy contralateral knee, and had had postoperative functional tests. Isokinetic tests measured flexion and extension strength: concentric quadriceps 60°/s (Q60°) and 240°/s (Q240°); excentric hamstrings 30°/s (HS30°). Four single leg hop tests were performed: single leg hop for distance (SH), triple hop for distance (TH), cross-over hop for distance (CH), and single leg 6m timed-hop (6mH). The main outcome was postoperative functional recovery (yes/no) defined as≤10 % for Q60° and SH. ResultsThe study included 234 patients; mean age 28.4±8.6 years. At 6.5±1.7 (4–12) months, 44 patients (18.5 %) had recovered satisfactory function, 52 (21.8 %) at Q60° and 125 (54.3 %) at SH. During follow-up there were four cases of recurrent tears in the group with unsatisfactory functional recovery. ConclusionSix-months after ACL reconstruction, functional recovery of the knee joint is generally not satisfactory and appears to constitute a risk factor for recurrent tear.

Higher muscle power training volume is not determinant for the magnitude of neuromuscular improvements in elderly women.

The aim of this study was to compare the effects of 12 weeks of muscle power training using one- and three-sets on neuromuscular adaptations in elderly women. Twenty six healthy elderly women were randomly assigned into two groups: one-set (n = 13) and three-sets (n = 13). Maximal dynamic and isometric strength, rapid force assessed as absolute and normalized rate of force development (RTD) and contractile impulse during unilateral leg knee extension at 0-50 and 0-200 ms, overall quadriceps muscle thickness, muscle power during a countermovement jump (CMJ), and functional performance using time-up-and-go and the timed stair climb tests were evaluated before and after training. After 12 weeks, one-set and three-sets groups exhibited significant (p ≤ 0.05) and comparable increases in dynamic and isometric strength, absolute RTD and contractile impulse at 0-50 and at 0-200 ms and in the performance of both functional tests. No significant differences between groups were evident for any measured parameters (p > 0.05). Furthermore, the normalized RTD did not increase for any group (p > 0.05). Over 12 weeks, the muscle power training performing one- or three-sets induced alike improvements in muscle function, mass and functionally. These evidences suggest that a low training volume is able to induce significant improvements in age-related neuromuscular changes.

The relationship between functional status, physical fitness and cognitive performance in physically active older adults: A pilot study.

ObjectiveAgeing is associated with a progressive decline in physical function and cognitive performance which could result in a shift from an independent to a more dependent lifestyle. The aim of this research study was to assess the fitness, functional performance and cognitive ability in independently living older South Africans and to determine which fitness parameters and functional performance tests best explain the variance in cognitive function.DesignDescriptive observational study.ParticipantsOlder adults with a mean age 71±4.7 years (n = 70; 28 men and 42 women) were recruited. Sixty percent of the sample completed at least secondary schooling and more than two-thirds were taking medication for a chronic medical condition.MeasurementsSelf-reported physical activity was assessed using the Yale Physical Activity Survey. Fitness tests included the 6-minute walk test and Bicep Curls. The functional performance tests were; Static and Dynamic balance, Timed Up and Go, Sit to Stand, Grip strength and Functional Reach. The Stroop Task and 6-Item cognitive impairment test were used to measure cognitive performance. Bivariate and multivariate analyses were conducted between performance on the novel cognitive Stroop Task and functional and cognitive tests.ResultsWe found significant relationships between the number of correct responses on the Stroop Task and scores on the 6-Item Cognitive Impairment test (-0.520, p < 0.01) and grip strength (r = 0.42, p< 0.01). The number of incorrect responses was inversely associated with functional reach (r = -0.445, p< 0.01). The final regression model included: age, dynamic balance, right arm grip strength and the score on the 6-item cognitive impairment test, and explained 44% of the variance in performance of the Stroop Task.ConclusionsThe results of this study showed that measures of physical function were associated with cognitive performance even in highly functioning older South African adults. Further research is needed to determine the extent to which exercise training can improve functional capacity and the effect on cognitive performance.

Arthroscopic Surgical Procedures Versus Sham Surgery for Patients With Femoroacetabular Impingement and/or Labral Tears: Study Protocol for a Randomized Controlled Trial (HIPARTI) and a Prospective Cohort Study (HARP).

Study Design Study protocol for a randomized controlled trial and a prospective cohort. Background The number of arthroscopic surgical procedures for patients with femoroacetabular impingement syndrome (FAIS) has significantly increased worldwide, but high-quality evidence of the effect of such interventions is lacking. Objectives The primary objective will be to determine the efficacy of hip arthroscopic procedures compared to sham surgery on patient-reported outcomes for patients with FAIS (HIP ARThroscopy International [HIPARTI] Study). The secondary objective will be to evaluate prognostic factors for long-term outcome after arthroscopic surgical interventions in patients with FAIS (Hip ARthroscopy Prospective [HARP] Study). Methods The HIPARTI Study will include 140 patients and the HARP Study will include 100 patients. The international Hip Outcome Tool-33 will be the primary outcome measure at 1 year. Secondary outcome measures will be the Hip disability and Osteoarthritis Outcome Score, Arthritis Self-Efficacy Scale, fear of movement (Tampa Scale of Kinesiophobia), Patient-Specific Functional Scale, global rating of change score, and expectations. Other outcomes will include active hip range of motion, hip muscle strength tests, functional performance tests, as well as radiological assessments using radiographs and magnetic resonance imaging. Conclusion To determine the true effect of surgery, beyond that of placebo, double-blinded placebo-controlled trials including sham surgery are needed. The HIPARTI Study will direct future evidence-based treatment of FAIS. Predictors for long-term development and progression of degenerative changes in the hip are also needed for this young patient group with FAIS; hence, responders and nonresponders to treatment could be determined. J Orthop Sports Phys Ther 2018;48(4):325-335. doi:10.2519/jospt.2018.7931.

COMPARISON OF CLINICAL FATIGUE PROTOCOLS TO DECREASE SINGLE-LEG FORWARD HOP PERFORMANCE IN HEALTHY INDIVIDUALS

Return to activity decisions after anterior cruciate ligament reconstruction (ACL-R) are limited by functional performance tests often performed in a non-fatigued state. Fatigue can improve test sensitivity, but current methods to induce fatigue are typically bilateral tasks or focus on the quadriceps muscle in isolation. To determine the effects of a two-minute lateral step-down fatigue test compared to a 30-second side-hop test on single-leg forward hop distance in healthy individuals. It was hypothesized that participants would demonstrate decreased hop distance with both tests, but the two-minute lateral step-down fatigue test would result in greater deficits in single-leg forward hop distance. Randomized crossover. Twenty healthy participants (16 females, 4 males; age = 23.7±3.0 years, height = 153.8±36.2 cm; mass = 64.4±12.8 kg; Tegner = 6.8±1.2) were asked to perform single-leg forward hop for distance pre- and post-fatigue. Participants were randomly assigned to one of the two fatigue tests, 30-second side-hop or 2-minute lateral step-down test, during the first visit. They returned within a week and performed the same sequence of tests but underwent whichever fatigue test was not assigned at the prior visit. There was a significant decrease (p < 0.001) in single-leg forward hop distance following the 30-second side-hop test (pre = 134.1±23.7 cm, post = 126.2±24.4 cm) and the two-minute lateral step-down test (pre = 135.0±26.1 cm, post = 122.7±27.4 cm). The decrease in hop distance was significantly greater (p < 0.001) for the two-minute lateral step-down test compared to the 30-second side-hop test. The two-minute lateral step-down test resulted in a greater decrease in hop performance compared to the 30-second side-hop test. The results establish a threshold for expected changes that occur in a healthy population and that can then be compared with an injured athlete population. The two-minute lateral step-down exercise may be an effective method of inducing fatigue to better mimic performance in a sports environment to inform return-to-sport decisions. Level 1b- Therapy.

Assessing Outcomes in People With Chronic Ankle Instability: The Ability of Functional Performance Tests to Measure Deficits in Physical Function and Perceived Instability.

Study Design Laboratory-based, cross-sectional study. Background Functional performance tests (FPTs) assess short bouts of unilateral hops for either distance or speed. More research is needed to identify specific FPTs that may be useful for measuring asymmetry outcomes related to functional performance and perceived instability deficits in individuals with chronic ankle instability (CAI). Objectives To identify FPTs that are sensitive to subjective and objective deficits associated with CAI. Methods Twenty-four subjects with unilateral CAI (10 male, 14 female; mean ± SD age, 20.7 ± 3.0 years) and 24 healthy, matched controls (10 male, 14 female; age, 20.1 ± 2.6 years) completed 5 unilateral FPTs in random order. Mean FPT scores and functional symmetry percentages were calculated and compared between groups using 2 separate 1-way multivariate analyses of variance (MANOVAs). Perceived instability symmetry percentages were compared between groups using a Mann-Whitney U analysis. Results There were no differences in the mean FPT scores (P>.05) or functional symmetry percentages (P>.05) between groups for any of the 5 FPTs. However, participants with CAI perceived greater instability when using their involved limb during the side hop (P = .02), 6-meter crossover hop (P = .003), lateral hop (P = .007), and figure-of-eight hop (P = .008). Conclusion There were no differences in mean functional scores between groups for all 5 FPTs, and each group performed symmetrically. Regardless, administering a visual analog scale following the completion of the side hop, 6-meter crossover hop, lateral hop, and figure-of-eight hop tests captures subjective reports of perceived instability in the involved limb that can be compared bilaterally throughout treatment. J Orthop Sports Phys Ther 2018;48(5):372-380. Epub 30 Mar 2018. doi:10.2519/jospt.2018.7514.

Restless legs syndrome in Multiple Sclerosis patients: a contributing factor for fatigue, impaired functional capacity, and diminished health-related quality of life

Objectives Restless legs syndrome (RLS) symptoms are common in Multiple Sclerosis (MS) patients. The aim of the current study was to examine for the first time whether RLS could affect the functional capacity and various contributing parameters related to quality of life and fatigue in MS patients.Methods According to their RLS status, 50 relapsing-remitting MS patients were divided into the RLS (n = 10) and non-RLS groups (n = 40). Specific questionnaires were used in order to assess the health-related quality of life (HRQoL), fatigue levels, sleep quality, daily sleepiness, and depression symptoms of the patients. Functional capacity was examined using a battery of functional tests. Total body and visceral fat levels were assessed via bioelectrical impedance analyzers.Results Sleep quality, depression, fatigue, and HRQoL levels were found to be significantly worse in the patients with RLS compared to their free-RLS counterparts (P < 0.05). In addition, patients with RLS were found to exhibit further impairments in their performance in various functional tests related mainly with strength levels of lower extremities (P < 0.05). Finally, the patients with RLS were found to have significantly higher both total and trunk fat levels compared to patients without RLS (P < 0.05). A strong correlation was observed between the severity of RLS symptoms, sleep quality, fatigue, and QoL levels.Discussion It seems that RLS contributes even further to impairments on sleep quality, fatigue, functional capacity, and therefore HRQoL levels in relapsing-remitting MS patients, whilst for the first time a link between high fat levels has been revealed.

Long-term effects of stimulant treatment on ADHD symptoms, social-emotional functioning, and cognition.

Methodological and ethical constraints have hampered studies into long-term lasting outcomes of stimulant treatment in individuals with attention-deficit/hyperactivity disorder (ADHD). Lasting effects may be beneficial (i.e. improved functioning even when treatment is temporarily ceased) or detrimental (i.e. worse functioning while off medication), but both hypotheses currently lack empirical support. Here we investigate whether stimulant treatment history predicts long-term development of ADHD symptoms, social-emotional functioning or cognition, measured after medication wash-out. ADHD symptoms, social-emotional functioning and cognitive test performance were measured twice, 6 years apart, in two ADHD groups (stimulant-treated versus not stimulant-treated between baseline and follow-up). Groups were closely matched on baseline clinical and demographic variables (n = 148, 58% male, age = 11.1). A matched healthy control group was included for reference. All but two outcome measures (emotional problems and prosocial behaviour) improved between baseline and follow-up. Improvement over time in the stimulant-treated group did not differ from improvement in the not stimulant-treated group on any outcome measure. Stimulant treatment is not associated with the long-term developmental course of ADHD symptoms, social-emotional functioning, motor control, timing or verbal working memory. Adolescence is characterised by clinical improvement regardless of stimulant treatment during that time. These findings are an important source to inform the scientific and public debate.

Development and reliability of the rating of compensatory movements in upper limb prosthesis wearers during work-related tasks

Study DesignReliability study. IntroductionQuantifying compensatory movements during work-related tasks may help to prevent musculoskeletal complaints in individuals with upper limb absence. Purpose of the Study(1) To develop a qualitative scoring system for rating compensatory shoulder and trunk movements in upper limb prosthesis wearers during the performance of functional capacity evaluation tests adjusted for use by 1-handed individuals (functional capacity evaluation-one handed [FCE-OH]); (2) to examine the interrater and intrarater reliability of the scoring system; and (3) to assess its feasibility. MethodsMovement patterns of 12 videotaped upper limb prosthesis wearers and 20 controls were analyzed. Compensatory movements were defined for each FCE-OH test, and a scoring system was developed, pilot tested, and adjusted. During reliability testing, 18 raters (12 FCE experts and 6 physiotherapists/gait analysts) scored videotapes of upper limb prosthesis wearers performing 4 FCE-OH tests 2 times (2 weeks apart). Agreement was expressed in % and kappa value. Feasibility (focus area's “acceptability”, “demand,” and “implementation”) was determined by using a questionnaire. ResultsAfter 2 rounds of pilot testing and adjusting, reliability of a third version was tested. The interrater reliability for the first and second rating sessions were к = 0.54 (confidence interval [CI]: 0.52-0.57) and к = 0.64 (CI: 0.61-0.66), respectively. The intrarater reliability was к = 0.77 (CI: 0.72-0.82). The feasibility was good but could be improved by a training program. DiscussionIt seems possible to identify compensatory movements in upper limb prosthesis wearers during the performance of FCE-OH tests reliably by observation using the developed observational scoring system. ConclusionsInterrater reliability was satisfactory in most instances; intrarater reliability was good. Feasibility was established.

Development of Internet-Based Tasks for the Executive Function Performance Test.

The Executive Function Performance Test (EFPT) is a reliable and valid performance-based tool to assess executive functions (EFs). This study's objective was to develop and verify two Internet-based tasks for the EFPT. A cross-sectional study assessed the alternate-form reliability of the Internet-based bill-paying and telephone-use tasks in healthy adults and people with subacute stroke (Study 1). It also sought to establish the tasks' criterion reliability for assessing EF deficits by correlating performance with that on the Trail Making Test in five groups: healthy young adults, healthy older adults, people with subacute stroke, people with chronic stroke, and young adults with attention deficit hyperactivity disorder (Study 2). The alternative-form reliability and initial construct validity for the Internet-based bill-paying task were verified. Criterion validity was established for both tasks. The Internet-based tasks are comparable to the original EFPT tasks and can be used for assessment of EF deficits.

Total knee arthroplasty with unexplained pain: new insights from kinematics.

Up to 20% of total knee arthroplasty patients remain unsatisfied post-surgery, and a large proportion of them report anterior knee pain. This study aims to verify whether patients who experience anterior knee pain after total knee arthroplasty (TKA) will exhibit kinematic characteristics similar to those associated with patellofemoral syndrome, including in the frontal and transverse planes. Using four different assessment methods [radiological, patient-reported outcome, musculoskeletal assessment with functional performance testing, and a 3D kinematic assessment during gait], the clinical and 3D knee kinematic profiles of three groups were compared: a painful and an asymptomatic TKA group and a healthy control group. All three groups underwent a three-dimensional kinematic knee assessment while walking on a treadmill. Prosthetic component rotation was assessed through a CT scan measurement performed by one experienced radiologist. Flexion/extension, ab/adduction, and tibial internal rotation curves were compared, and significant differences were highlighted through ANCOVA analysis performed on SPSS. A total of 62 knees were evaluated, 24 asymptomatic, 21 painful, and 17 control. A dynamic flexion contracture during gait was observed in the painful group, which was associated with a lack of flexibility of the thigh muscles. Moreover, painful TKA cases exhibited a valgus alignment (- 1.5°) during stance, which increases the Q angle and lateralizes the patella. Finally, CT scan evaluation of painful total knee arthroplasty patients revealed that their combined components rotation was in slight internal rotation (- 1.4°, SD 7.0°). Painful TKA patients presented three well-known characteristics that tend to increase patellofemoral forces and that could be the cause of the unexplained pain: a stiff knee gait, a valgus alignment when walking, and combined TKA components slightly internally rotated.