Preseason Assessment Research Articles

Are Self-Reported and Parent-Reported Attention Problems and Hyperactivity Associated With Higher Rates of Concussion in Youth Ice Hockey Players?

To examine the association between self-reported and parent-reported attention problems and hyperactivity and rates of injury and concussion in Canadian youth ice hockey players. Secondary analyses of 2 prospective cohort studies. Canadian youth ice hockey teams. Ice hockey players (ages 11-17 years) were recruited by team, over 4 seasons (2011-2016). A combined 1709 players contributing 1996 player-seasons were analyzed (257 players participated in more than one season). Data were collected from preseason baseline questionnaires, including child and parent proxy forms of the Behavior Assessment System for Children, second edition. Injury and concussion rates and incidence rate ratios (IRR) comparing players with and without self-identified or parent-identified attention problems and hyperactivity, adjusted for covariates (ie, body checking policy, previous injury/concussion, and age) and a random effect for team, were estimated using multiple multilevel negative binomial regression. When analyzed continuously, rates of concussion increased with higher self-reported and parent-reported measures of attention problems [IRR SELF = 1.025; 95% confidence interval (CI): 1.011-1.040; IRR PARENT = 1.032; 95% CI: 1.008-1.057]. Self-reported hyperactivity was significantly associated with concussion (IRR = 1.021; 95% CI: 1.007-1.035), but parent-reported hyperactivity was not (IRR = 1.005; 95% CI: 0.983-1.028). A T score ≥ 60 cutoff combining attention problems and hyperactivity scores (an estimate of probable attention-deficit hyperactivity disorder) was not significantly associated with rates of injury or concussion. Attention problems and hyperactivity may place youth ice hockey players at increased risk of concussion and injury. Preseason assessments could identify players for targeted concussion education and risk reduction strategies.

The development of a HAMstring InjuRy (HAMIR) index to mitigate injury risk through innovative imaging, biomechanics, and data analytics: protocol for an observational cohort study

BackgroundThe etiology of hamstring strain injury (HSI) in American football is multi-factorial and understanding these risk factors is paramount to developing predictive models and guiding prevention and rehabilitation strategies. Many player-games are lost due to the lack of a clear understanding of risk factors and the absence of effective methods to minimize re-injury. This paper describes the protocol that will be followed to develop the HAMstring InjuRy (HAMIR) index risk prediction models for HSI and re-injury based on morphological, architectural, biomechanical and clinical factors in National Collegiate Athletic Association Division I collegiate football players.MethodsA 3-year, prospective study will be conducted involving collegiate football student-athletes at four institutions. Enrolled participants will complete preseason assessments of eccentric hamstring strength, on-field sprinting biomechanics and muscle–tendon volumes using magnetic-resonance imaging (MRI). Athletic trainers will monitor injuries and exposure for the duration of the study. Participants who sustain an HSI will undergo a clinical assessment at the time of injury along with MRI examinations. Following completion of structured rehabilitation and return to unrestricted sport participation, clinical assessments, MRI examinations and sprinting biomechanics will be repeated. Injury recurrence will be monitored through a 6-month follow-up period. HAMIR index prediction models for index HSI injury and re-injury will be constructed.DiscussionThe most appropriate strategies for reducing risk of HSI are likely multi-factorial and depend on risk factors unique to each athlete. This study will be the largest-of-its-kind (1200 player-years) to gather detailed information on index and recurrent HSI, and will be the first study to simultaneously investigate the effect of morphological, biomechanical and clinical variables on risk of HSI in collegiate football athletes. The quantitative HAMIR index will be formulated to identify an athlete’s propensity for HSI, and more importantly, identify targets for injury mitigation, thereby reducing the global burden of HSI in high-level American football players.Trial Registration The trial is prospectively registered on ClinicalTrials.gov (NCT05343052; April 22, 2022).

Lower limb musculoskeletal profiling in Malaysian professional footballers during pre-season pre-competition medical assessments

Background: Lower limb musculoskeletal profiling is important in pre-competition medical assessment (PCMA) as it helps to identify musculoskeletal pathologies that need rehabilitation and risk factors for injury that need specific prevention programme. However, a normative value is needed to identify which is normal or pathological. Our objective in this study is to establish a normative value for football-specific adaptation of lower limb musculoskeletal examination among Malaysian professional footballers. Materials and Methods: This is a prospective cross-sectional examining 83 Malaysian footballers from a single club during PCMA from 17 January 2022 to 17 February 2022. We included anthropometric assessments using body impedance analysis, objective lower limb muscle strength assessments using handheld dynamometer, range of motion and objective dynamic balance test using the Biodex system. Results: The mean age of our study was 20.3 ± 3 years. Goalkeepers and defenders have a higher body mass index and a higher skeletal muscle mass. Strikers and midfielders have a higher quadriceps and hamstring strength. Non-dominant leg has a better overall stability and anterior posterior stability index compared to dominant leg. Defender has a better overall stability. Sixty-six footballers (80%) have at least 1 low Add: Abd ratio of less than 0.9, which requires preventive programme for groin injury. Conclusion: This study demonstrates a position-specific adaptation in different positions in football.

Sex-related Anthropometrics in a Lower-Body Mobility Assessment Among Professional Soccer Athletes.

BackgroundThe functional movement screen (FMS™) and Y-balance test (YBT) are commonly used to evaluate mobility in athletes.PurposeThe primary aim of this investigation was to determine the relationship between demographic and anthropometric factors such as sex, body composition, and skeletal dimension and scoring on YBT and FMS™ in male and female professional soccer athletes.Study DesignCross SectionalMethodsDuring pre-season assessments, athletes from two professional soccer clubs were recruited and underwent body composition and skeletal dimension analysis via dual-energy X-ray absorptiometry (DEXA) scans. Balance and mobility were assessed using the YBT and FMS™. A two-tailed t-test was used to compare YBT between sexes. Chi-square was used for sex comparisons of FMS™ scores. Correlation analysis was used to determine if body composition and/or skeletal dimensions correlated with YBT or FMS™ measures. Type-I error; α=0.05.Results40 Participants were successfully recruited: (24 males: 27±5yr, 79±9kg; |16 females: 25±3yr, 63±4kg). YBT: Correlations were found between anterior reach and height (r=-0.36), total lean mass (LM)(r=-0.39), and trunk LM(r=-0.39) as well as between posterolateral reach and pelvic width (PW)(r=0.42), femur length (r=0.44), and tibia length (r=0.51)(all p<0.05). FMS™: The deep squat score was correlated with height(r=-0.40), PW(r=0.40), LM(r=-0.43), and trunk LM (r =-0.40)(p<0.05). Inline lunge scores were correlated with height(r=-0.63), PW(r=0.60), LM(r=-0.77), trunk LM(r=-0.73), and leg LM(r=0.70)(all p<0.05). Straight leg raise scores were correlated with PW (r=0.45, p<0.05). Females scored higher for the three lower body FMS™ measures where correlations were observed (p<0.05).ConclusionsLower body FMS™ scores differ between male and female professional soccer athletes and are related to anthropometric factors that may influence screening and outcomes for the FMS™ and YBT, respectively. Thus, these anatomical factors likely need to be taken into account when assessing baseline performance and risk of injury to improve screening efficacy.Level of EvidenceLevel 3b

Exploring the Y-Balance-Test scores and inter-limb asymmetry in soccer players: differences between competitive level and field positions

BackgroundThe postural stability seems to be important in the physical development of the soccer player and the specific tasks related to the game. In addition, it is related to the injury risk and therefore, with the injury prevention and retraining processes. In this context, the Y Balance Test (YBT) is presented as a tool to assess dynamic postural control.ObjectiveThis study aimed to explore the differences and possible correlations in the YBT scores and inter-limb asymmetry for anterior (ANT), posteromedial (PM) and posterolateral (PL) directions by category and field position in soccer players.Methods173 males soccer players aged between 14 and 33 years old agreed to participate. Five categories and six field position were considered in this study. A standardised protocol was used at multiple clubs during the pre-season assessment of musculoskeletal function in soccer players. All the players performed the Y Balance Test (YBT) (official YBT Kit), assessing the dominant and non-dominant leg for three YBT directions (anterior-AN, posteromedial-PM and posterolateral-PL), inter-limb asymmetry and composite score.ResultsFor AN, amateur and semiprofessional obtained the highest values for Dominant and Non-Dominant legs (Rangemean = 101.8–109.4%) and the lowest level in PRO players (mean: 62.0%). Concerning PM-PL, semiprofessional (Rangemean = 126.4–132.7%, dominant and non-Dominant respectively), followed by professional and amateur reported higher scores compared to youth categories. Inter-limb asymmetry showed higher values in lower age categories. The best composite scores were detected in semiprofessionals (Rangemean = 113.3–126.7% for dominant and Rangemean = 113.8–129.7% for non-Dominant leg), compared with the rest of the categories and for each field position evaluated.ConclusionComparisons between field-positions revealed that centre-backs were worse than wingers and forwards. In order to explain variations in dynamic balance between competitive levels within the same age-group, special considerations about training programmes and related co-variables should be considered.

To Do or Not to Do? - The Value of the Preseason Assessment in Sport Injury Prevention.

To Do or Not to Do? - The Value of the Preseason Assessment in Sport Injury Prevention.

Can a Modified Y-Balance Test Predict Running Overuse Injuries over the Course of a Division I Collegiate Cross-Country Season?

BackgroundCollegiate distance runners often suffer from running overuse injuries (ROI). The Y-Balance Test (YBT) has the potential to predict ROI risk in collegiate runners.PurposeTo investigate whether a preseason clinical assessment of dynamic balance, through a modified version of the YBT (mYBT), can predict risk of ROIs during one NCAA Division I cross-country (XC) season.Study DesignProspective case-control studyMethodsParticipants from a Division I XC team were screened for mYBT performance in four directions: anterior (AN), posteromedial (PM), posterolateral (PL), and posterior (PO). ROIs were tracked over the course of the XC season. Receiver operating characteristic (ROC) curve analysis (α = 0.05) was utilized to investigate the effectiveness of the mYBT in predicting injury risk.ResultsNine (5 female, 4 male) of 29 runners developed an ROI during the XC season. Five components of the mYBT were found to predict injuries, including normalized nondominant PO score (AUC = 0.756, p = 0.03; RR = 1.90), AN raw difference and limb asymmetry (AUC = 0.808, p = 0.01), and PM raw difference and limb asymmetry in males (AUC = 0.958, p = 0.02).ConclusionSpecific components of the mYBT can help predict the risk of developing a running overuse injury over one Division I XC season.Level of EvidenceScreening, Level 3

Preventive effect of tailored exercises on patellar tendinopathy in elite youth athletes: A cohort study

ObjectiveTo investigate the effects of an intervention with tailored exercises on the incidence of patellar tendinopathy (PT) in elite youth jumping athletes. DesignProspective crossover cohort. SettingOne sport club facility. Participants271 elite youth basketball and volleyball player were followed in the first year of the study (Observation year) and 270 athletes were followed in the second year (intervention year). Main outcome measureIncidence rates of PT per 1,000h of exposure. Cox survival analysis was used to verify the effects of the intervention (exercises implemented according to the findings of a preseason assessment) on PT incidence. ResultsThe exercise prevention program significantly reduced the number of cases of PT, with athletes submitted to the intervention showing 51% less risk of developing PT. The overall PT incidence in the Observation year (5.9 per 1,000h of exposure) was significantly higher than that in the intervention year (2.8 per 1,000h of exposure) (P = .037). Twenty-six athletes developed PT in the observation year, whereas 13 athletes developed PT in the intervention year. ConclusionsA tailored preventive program may be able to reduce the incidence of patellar tendinopathy, especially in male youth volleyball athletes. Randomized controlled trials are encouraged to confirm these findings.

Baseline concussion assessment performance of community-based senior rugby players: a cross-sectional study

ABSTRACT Objective To report pre-season baseline concussion assessment performance among senior rugby players and explore associations between assessment performance and player demographics. Design A cross-sectional study using the New Zealand Rugby Concussion Assessments (NZRCA), comprising symptom, cognitive and dynamic coordination assessments was conducted in the 2018–2019 season. Methods Players’ baseline assessments were characterised using descriptive statistics; effect sizes (ES) and t-tests were used to explore associations between player demographic characteristics and NZRCA performance. Results A total of 733 players (11.4% female) aged between 16 and 52 years completed the NZRCA. The median (range) value for symptom severity, endorsed symptoms and “percentage normal” was respectively, 5 (0–40), 5 (0–21) and 90% (30–100%). A perfect standardised assessment of concussion score was achieved by one participant; seven achieved ≥27/30 for immediate recall, and 22 achieved a perfect delayed recall score. Most participants (n = 674, 92%) passed the tandem gait test. Associations between NZRCA performance and gender, concussion history, and Pasifika ethnicity were observed with effect sizes ranging from small (0.18) to large (0.70). Six hundred and twenty-three (85%) participants reported at least one symptom. Conclusions The results from this study could help support decision-making by clinicians, improving the management of concussions in the community setting.

How injury registration and preseason assessment are being delivered: An international survey of sports physical therapists

ObjectiveTo identify the role of sports physical therapists (PT) in the organization of injury registration and preseason assessment, applied in athletic organizations and sports teams of different gender and level world-wide. Designcross-sectional study. SettingLimeSurvey platform. ParticipantsSports PTs working with athletes invited through International Federation of Sports Physical Therapy. Main outcome measuresinjury registration and athlete's screening. Results414 sports PTs participated in this international survey (mean age of 37.66 (SD = 9.38) years). 340 participants indicated that the PT as the responsible for injury registration. Barriers to properly register injury throughout the season were indicated by 157 sports PT and 86 (54.77%) indicated a lack of time on their routine as the main factor. 93 participants (30.09%) indicated that they customize the prevention program based on the preseason assessment. Sports PTs who reported not performing a preseason assessment (92 participants - 22.22%) mainly indicated this to be consequence of lack of structure in the organization (44 participants – 47.82%). ConclusionThe majority of the sports PTs participate on injury registration and perform preseason assessment in athletes. However, lack of time in their routine and structure in the organization were recognized as the most important barriers to organize these properly.

Test-Retest Reliability of Remote ImPACT Administration.

To evaluate the performance and test-retest reliability obtained when administering a computerized baseline neurocognitive exam to NCAA Division I student-athletes in a controlled laboratory setting versus an uncontrolled remote location. A sample of 129 (female = 100) Division I student-athletes completed Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) pre-season assessments for two distinct and respective sports seasons in a controlled laboratory environment and an uncontrolled remote environment. Depending on the environment, participants were given verbal (controlled) or written (uncontrolled) guidelines for taking the test. Multivariate repeated-measures ANOVA's determined that there were no within-subject differences between testing environments on ImPACT composite scores and cognitive efficiency index (CEI). The Chi-square test did not find any significant differences in impulse control or the number of invalid test scores, as determined by ImPACT, between environments. Intraclass correlations found the ImPACT subtest scores to range in test-retest reliability across testing environments, demonstrating moderate (verbal memory composite, r = 0.46; visual memory composite, r = 0.64; reaction time, r = 0.61; impulse control, r = 0.52; and CEI, r = 0.61) and good (visual motor composite, r = 0.77) test-retest reliability. Results indicate that ImPACT is reliable between controlled and uncontrolled testing environments. This further suggests that ImPACT can be administered in a remote environment, pending specific adherence to testing instructions, or in the event of social distancing or isolation policies.

The Association between Baseline Eye Tracking Performance and Concussion Assessments in High School Football Players.

Concussions are complex injuries that require a multifaceted testing battery. Vision impairments are common after concussion, but it is unknown exactly how eye tracking may be affected after injury and how it is associated with other clinical concussion assessments. This study aimed to (1) examine the relationship between eye tracking performance (BOX score) and other common concussion evaluations, (2) identify if eye tracking adds novel information that augments baseline concussion evaluations, and (3) examine the effect of age, concussion history, and attention-deficit/hyperactivity disorder on eye tracking and other ophthalmological measures. A total of 102 male high school football athletes (age, 16.0 years; 95% confidence interval, 15.8 to 16.2 years) completed a series of visual and neurocognitive tests during their pre-season baseline assessment. The main outcome measures were BOX score, near point of convergence (NPC) distance, binocular accommodative amplitude (BAA) distance, Standardized Assessment of Concussion score, and Immediate Post-Concussion Assessment and Cognitive Testing composite scores. BOX score was not significantly associated with symptoms, Standardized Assessment of Concussion score, NPC distance, BAA distance, or any Immediate Post-Concussion Assessment and Cognitive Testing composite scores. Age, concussion history, attention-deficit/hyperactivity disorder, and number of prior years playing football were not significantly associated with BOX score or NPC distance, but there was a significant association between concussion history and greater BAA distance (β = 1.60; 95% confidence interval = 0.19 to 3.01; P < .03). The BOX score cutoff of 10 resulted in a 12% false-positive rate. Eye tracking was not significantly associated with the commonly used clinical concussion assessments. These results suggest that an objective eye tracking variable may be a valuable addition to the current concussion battery.

Hip Abductor Muscle Strength Deficit as a Risk Factor for Inversion Ankle Sprain in Male College Soccer Players: A Prospective Cohort Study

Background:Previous studies have attempted to determine whether certain risk factors can predict the occurrence of inversion ankle sprains in male collegiate soccer players. However, no consensus has been reached on the predictive risk factors of inversion ankle sprain in this population.Purpose:To identify risk factors for inversion ankle sprains among male collegiate soccer players.Study Design:Cohort study; Level of evidence, 2.Methods:Included were 145 male collegiate soccer players in Japan who were assessed during a preseason medical checkup for potential risk factors of inversion ankle sprain. The preseason assessment included anthropometric measurements, joint laxity and flexibility, muscle flexibility, muscle strength, and balance ability, with a total of 33 variables. The participants were monitored during the 2019 season for inversion ankle sprains as diagnosed by physicians.Results:A total of 31 inversion ankle sprains in 31 players (21.4%) occurred during the season. Only the measured isometric hip abductor strength was significantly lower in injured players as compared with uninjured players. Logistic regression analysis revealed measured hip abductor muscle strength deficit as a significant risk factor for inversion ankle sprain (odds ratio, 0.978 [95% CI, 0.976-0.999]; P = .05).Conclusion:Hip abductor strength deficit was a risk factor for inversion ankle sprain in the study population. This finding could be useful for the prevention of inversion ankle sprains in male collegiate soccer players.

Expansion of cognitive testing for off-field concussion screening in elite rugby players: A cohort study

ObjectivesCurrent off-field concussion screening instruments have sub-optimal accuracy and additional testing domains may be necessary to detect the full spectrum of concussion presentations. This study aimed to determine if additional cognitive tests add utility to off-field screening for sport-related concussion. DesignReproducibility and diagnostic accuracy cohort studies were performed in the 2017 and 2018 seasons of the Super Rugby competition, conducted in Argentina, Australia, Japan, New Zealand, and South Africa. MethodsAbridged versions of Stroop (score, time), Spatial Memory (score, failed trials), and Trail Making Trial-B (time, errors) cognitive tests, modified for off-field use, were examined. Players performed baseline testing prior to each season. Cases undergoing off-field screening as part of the World Rugby Head Injury Assessment Process underwent evaluation with the same cognitive tests during competition matches. Agreement between repeated pre-season baseline measurements, and the diagnostic accuracy of off-field testing against a clinical reference standard of concussion, was evaluated. ResultsData were available for repeated preseason baseline testing in 644 players, and 100 cases undergoing off-field concussion screening. There was little individual agreement across pre-season baseline assessments for all tests (Lin's correlation and Gwets AC1 coefficients ranging between 0.2 and 0.3). There was significantly worse performance for the time taken to complete the modified Stroop Test in concussed players undergoing off-field screening, compared to non-concussed players (median time 21.1 v 18.4 s, p < 0.01; area under the receiver operating characteristic curve 0.7 (95% CI 0.5–0.8)). Other cognitive measures did not discriminate between injured and un-injured players, with no-statistically significant differences in distribution medians (p = 0.6–0.9) and AUROC values close to 0.5. ConclusionsThe time taken to perform a modified Stroop Test may provide additional diagnostic accuracy if added to current off-field concussion screening tools. Abridged Spatial Memory and Trail Making Trial-B tests did not discriminate between concussed and non-concussed players.

Prospective Exploration of Cognitive-Communication Changes With Woodcock-Johnson IV Before and After Sport-Related Concussion.

Purpose The purpose of this study was to evaluate changes in cognitive-communication performance using Woodcock-Johnson IV Tests (WJIV) from pre-injury baseline to post sport-related concussion. It was hypothesized that individual subtest performances would decrease postinjury in symptomatic individuals. Method This prospective longitudinal observational nested cohort study of collegiate athletes assessed cognitive-communicative performance at preseason baseline and postinjury. Three hundred and forty-two male and female undergraduates at high risk for sport-related concussion participated in preseason assessments, and 18 individuals met criteria post injury. WJIV subtest domains included Word Finding, Speeded Reading Comprehension, Auditory Comprehension, Verbal Working Memory, Story Retell, and Visual Processing (letter and number). The power calculation was not met, and therefore data were conservatively analyzed with descriptive statistics and a planned subgroup analysis based on symptomatology. Results Individual changes from baseline to postinjury were evaluated using differences in standard score performance. For symptomatic individuals, mean negative decreases in performance were found for Retrieval Fluency, Sentence Reading Fluency, Pattern Matchings, and all cluster scores postinjury. Individual performance declines also included decreases in story retell, verbal working memory, and visual processing. Conclusions This study identified within-subject WJIV performance decline in communication domains post sport-related concussion and reinforces that cognitive-communication dysfunction should be considered in mild traumatic brain injury. Key cognitive-communication areas included speeded naming, reading, and verbal memory, though oral comprehension was not sensitive to change. Future clinical research across diverse populations is needed to expand these preliminary findings.

Past-season, pre-season and in-season risk assessment of groin problems in male football players: a prospective full-season study

ObjectiveWe assessed past-season, pre-season and in-season risk factors to investigate their association with an in-season groin problem in male amateur football players.MethodsPast-season groin-pain information and pre-season short-lever and long-lever adductor...

Predictive Accuracy of the Sport Concussion Assessment Tool 3 and Vestibular/Ocular-Motor Screening, Individually and In Combination: A National Collegiate Athletic Association–Department of Defense Concussion Assessment, Research and Education Consortium Analysis

Background: Vestibular and ocular symptoms in sport-related concussions are common. The Vestibular/Ocular-Motor Screening (VOMS) tool is a rapid, free, pen-and-paper tool that directly assesses these symptoms and shows consistent utility in concussion identification, prognosis, and management. However, a VOMS validation study in the acute concussion period of a large sample is lacking. Purpose: To examine VOMS validity among collegiate student-athletes, concussed and nonconcussed, from the multisite National Collegiate Athletic Association–Department of Defense Concussion Assessment, Research and Education (CARE) Consortium. A secondary aim was to utilize multidimensional machine learning pattern classifiers to deduce the additive power of the VOMS in relation to components of the Sport Concussion Assessment Tool 3 (SCAT3). Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Preseason and acute concussion assessments were analyzed for 419 student-athletes. Variables in the analysis included the VOMS, Balance Error Scoring System, Standardized Assessment of Concussion, and SCAT3 symptom evaluation score. Descriptive statistics were calculated for all tools, including Kolmogorov-Smirnov significance and Cohen d effect size. Correlations between tools were analyzed with Spearman r, and predictive accuracy was evaluated through an Ada Boosted Tree machine learning model’s generated receiver operating characteristic curves. Results: Total VOMS scores and SCAT3 symptom scores demonstrated significant increases in the acute concussion time frame (Cohen d = 1.23 and 1.06; P < .0001), whereas the Balance Error Scoring System lacked clinical significance (Cohen d = 0.17). Incorporation of VOMS into the full SCAT3 significantly boosted overall diagnostic ability by 4.4% to an area under the curve of 0.848 (P < .0001) and produced a 9% improvement in test sensitivity over the existing SCAT3 battery. Conclusion: The results from this study highlight the relevance of the vestibular and oculomotor systems to concussion and the utility of the VOMS tool. Given the 3.8 million sports-related and 45,121 military-related concussions per year, the addition of VOMS to the SCAT3 is poised to identify up to an additional 304,000 athletes and 3610 servicemembers annually who are concussed, thereby improving concussion assessment and diagnostic rates. Health care providers should consider the addition of VOMS to their concussion assessment toolkits, as its use can positively affect assessment and management of concussions, which may ultimately improve outcomes for this complex and common injury.

Forest Roads and Operational Wildfire Response Planning

Supporting wildfire management activities is frequently identified as a benefit of forest roads. As such, there is a growing body of research into forest road planning, construction, and maintenance to improve fire surveillance, prevention, access, and control operations. Of interest here is how road networks directly support fire control operations, and how managers incorporate that information into pre-season assessment and planning. In this communication we briefly review and illustrate how forest roads relate to recent advances in operationally focused wildfire decision support. We focus on two interrelated products used on the National Forest System and adjacent lands throughout the western USA: potential wildland fire operational delineations (PODs) and potential control locations (PCLs). We use real-world examples from the Arapaho-Roosevelt National Forest in Colorado, USA to contextualize these concepts and illustrate how fire analytics and local fire managers both identified roads as primary control features. Specifically, distance to road was identified as the most important predictor variable in the PCL boosted regression model, and 82% of manager-identified POD boundaries aligned with roads. Lastly, we discuss recommendations for future research, emphasizing roles for enhanced decision support and empirical analysis.

Are muscle weakness and stiffness risk factors of the development of rotator cuff tendinopathy in overhead athletes: a systematic review.

Background:Underlying muscle weakness and stiffness may increase the risk of developing rotator cuff tendinopathy. This systematic review aims to assess existing prospective studies to summarize whether muscle weakness and stiffness are risk factors for the development of rotator cuff tendinopathy in overhead athletes.Methods:A systematic search was performed using PRISMA guidelines. Prospective studies measuring muscle strength or stiffness and the incidence of rotator cuff tendinopathy were included. Quality assessment was performed with the Newcastle-Ottawa quality assessment scale.Results:The search yielded six studies, with a total of 523 trained overhead athletes followed up for one season. External rotation (ER) and internal rotation (IR) strength were described as protective factors against the development of rotator cuff tendinopathy. Athletes who did not sustain shoulder injuries had statistically stronger eccentric IR (p < 0.01) and ER (p < 0.05) strength in the pre-season assessment. Muscle stiffness indicated by limited range of motion of <106° for shoulder ER was described as a risk factor with an odds ratio of 1.12 (p < 0.001). Imbalance between ER and IR strength was reported as risk factors for shoulder injuries in two studies, with a relative risk of 2.57 (p < 0.05) reported in one study. Supraspinatus weakness was also reported as a risk factor for shoulder injuries in one study.Conclusion:Limited evidence support ER, IR weakness, limited ER range of motion, and very limited evidence support imbalance in ER/IR strength, and supraspinatus weakness as risk factors for rotator cuff tendinopathy in overhead athletes. No existing studies investigated the general population on this topic. Future cohort studies may improve on existing evidence with investigations on the general public, a longer follow-up time, clearly documented injury history, and a stringent diagnosis to rotator cuff tendinopathy.

Feasibility of Predicting In-Season Mental Health Problems in College Student-Athletes From Pre-season Assessment.

To examine whether pre-season assessment using a validated assessment tool, the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), could predict college student-athletes identified as experiencing in-season mental health (MH) problems. A prospective study of athletes who completed a pre-season evaluation in August 2018. A total of 195 National Collegiate Athletic Association Division 1 student-athletes from a large midwestern university in northeast Ohio. The MMPI-2-RF, a 338-item self-report measure of constructs relevant to the assessment of psychopathology and personality. Mental health problems of student-athletes tracked throughout the competitive season (August 2018-May 2019) by a team of athletic department personnel who met weekly with a licensed clinical psychologist. In pre-season assessment, 71.8% of athletes clinically elevated at least one MMPI-2-RF scale and underreporting was higher in student-athletes than normative controls. Pre-season levels of internalizing psychopathology, diffuse physical symptoms, and unusual thoughts predicted increased likelihood of experiencing MH problems during the competitive season. The current findings suggest that the MMPI-2-RF may be a promising tool for identifying student-athletes at risk for MH concerns.