British Journal of Sports Medicine

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Correction: Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions

Sonnery-Cottet B, Saithna A, Quelard B, et al. Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions. Br J Sports Med 2019;53:289–98. doi: 10.1136/bjsports-2017-098401
The study protocol (trial registration number: CRD42017067499) was prospectively registered with PROSPERO (International prospective register of systematic reviews) on 21st May 2017 but was withdrawn on the 8th October 2019 because the article was ultimately published as a scoping review. The originally submitted study protocol is available from the corresponding author.

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'Are women grateful to be here or do women kick ass? #Sportskongres2020

#sportskongres2020 is a congress that is rated among the best sports medicine congresses in the world. A congress that in the past has failed to live up to Danish gender equality goals, but now recognises the value of gender equality and strives to take it one step further—pay attention to women and let them kick ass. ‘Are women grateful to be here or do women kick ass’ was the question Abby Wambach, former US soccer national team captain, posed in her graduation speech at the Barnard College in 2018. Wambach made the important point that women, herself included, are often brought up to be grateful, nice girls, staying on the career path and not mouthing off. Abby nails it; gender equality is a complex matter that draws attention to children’s upbringing and the perception of how women ought to behave. The quest for gender equality does not start nor...

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Exercise trials for blood pressure control: keeping it REAL

A pill that mimicked the effects of physical activity and exercise on the cardiovascular system would be the biggest blockbuster ever. It would be a poly-pill in its range of action with few serious adverse effects. On its patent expiry, the drug would be put in the water supply. Regrettably, there is no such pharmacological miracle in sight. Moreover, the current landscape is such that the dialogue around the expected benefits of exercise is omnipresent but doctors rarely ‘prescribe’ it and relatively few people initiate or adhere to it in the long term. Naci and colleagues1 recently reported the outcomes of an elegant network meta-analysis, comparing exercise and drug interventions in lowering systolic blood pressure (SBP). They catalogued 391 randomised controlled trials (RCTs) involving nearly 40 000 subjects. After this mammoth effort, they conclude that there are modest but consistent reductions in SBP in exercise interventions across...

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Keep calm and carry on testing: a substantive reanalysis and critique of 'what is the evidence for and validity of return-to-sport testing after anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis

Clinicians rely on rigorous systematic reviews to guide practice. We therefore suspect many clinicians will note the results of the 2019 systematic review and meta-analysis by Webster and Hewett, ‘What is the Evidence for and Validity of Return-to-Sport Testing after Anterior Cruciate Ligament Reconstruction Surgery? A Systematic Review and Meta-Analysis’.1 We agree that it is important to evaluate the association between return-to-sport (RTS) test batteries and outcomes after ACL reconstruction. The third review question in Webster and Hewett (2019) is particularly pertinent: ‘Is passing RTS test batteries associated with reduced rates of subsequent knee injury (all knee injuries and ACL injury)?’1 We are authors of several of the original data papers cited in the systematic review, and we are concerned about the study methodology and its conclusions. We highlight major problems with including two studies and present revised analyses that demonstrate the impact these studies...

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Imaging with ultrasound in physical therapy: What is the PTs scope of practice? A competency-based educational model and training recommendations

Physical therapists employ ultrasound (US) imaging technology for a broad range of clinical and research purposes. Despite this, few physical therapy regulatory bodies guide the use of US imaging, and there are limited continuing education opportunities for physical therapists to become proficient in using US within their professional scope of practice. Here, we (i) outline the current status of US use by physical therapists; (ii) define and describe four broad categories of physical therapy US applications (ie, rehabilitation, diagnostic, intervention and research US); (iii) discuss how US use relates to the scope of high value physical therapy practice and (iv) propose a broad framework for a competency-based education model for training physical therapists in US. This paper only discusses US imaging—not ‘therapeutic’ US. Thus, ‘imaging’ is implicit anywhere the term ‘ultrasound’ is used.

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Knee osteoarthritis risk is increased 4-6 fold after knee injury - a systematic review and meta-analysis

Objective
To estimate knee osteoarthritis (OA) risk following anterior cruciate ligament (ACL), meniscus or combined ACL and meniscus injury.

Design
Systematic review and meta-analysis.

Data sources
MEDLINE, Embase, SPORTDiscus, CINAHL and Web of Science until November 2018.

Eligibility criteria for selecting studies
Prospective or retrospective studies with at least 2-year follow-up including adults with ACL injury, meniscal injury or combined injuries. Knee OA was defined by radiographs or clinical diagnosis and compared with the contralateral knee or non-injured controls.

Study appraisal and synthesis
Risk of bias was assessed using the SIGN50 checklist. ORs for developing knee OA were estimated using random effects meta-analysis.

Results
53 studies totalling ~1 million participants were included: 185 219 participants with ACL injury, mean age 28 years, 35% females, 98% surgically reconstructed; 83 267 participants with meniscal injury, mean age 38 years, 36% females, 22% confirmed meniscectomy and 73% unknown; 725 362 participants with combined injury, mean age 31 years, 26% females, 80% treated surgically. The OR of developing knee OA were 4.2 (95% CI 2.2 to 8.0; I2=92%), 6.3 (95% CI 3.8 to 10.5; I2=95%) and 6.4 (95% CI 4.9 to 8.3; I2=62%) for patients with ACL injury, meniscal injury and combined injuries, respectively.

Conclusion
The odds of developing knee OA following ACL injury are approximately four times higher compared with a non-injured knee. A meniscal injury and a combined injury affecting both the ACL and meniscus are associated with six times higher odds compared with a non-injured knee. Large inconsistency (eg, study design, follow-up period and comparator) and few high-quality studies suggest that future studies may change these estimates.

Clinical relevance
Patients sustaining a major knee injury have a substantially increased risk of developing knee OA, highlighting the importance of knee injury prevention programmes and secondary prevention strategies to prevent or delay knee OA development.
PROSPERO registration number CRD42015016900

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Hamstring rehabilitation in elite track and field athletes: applying the British Athletics Muscle Injury Classification in clinical practice

Rationale
Hamstring injuries are common in elite sports. Muscle injury classification systems aim to provide a framework for diagnosis. The British Athletics Muscle Injury Classification (BAMIC) describes an MRI classification system with clearly defined, anatomically focused classes based on the site of injury: (a) myofascial, (b) muscle–tendon junction or (c) intratendinous; and the extent of the injury, graded from 0 to 4. However, there are no clinical guidelines that link the specific diagnosis (as above) with a focused rehabilitation plan.

Objective
We present an overview of the general principles of, and rationale for, exercise-based hamstring injury rehabilitation in British Athletics. We describe how British Athletics clinicians use the BAMIC to help manage elite track and field athletes with hamstring injury. Within each class of injury, we discuss four topics: clinical presentation, healing physiology, how we prescribe and progress rehabilitation and how we make the shared decision to return to full training. We recommend a structured and targeted diagnostic and rehabilitation approach to improve outcomes after hamstring injury.

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It is good to feel better, but better to feel good: whether a patient finds treatment 'successful or not depends on the questions researchers ask

Introduction
In sports physiotherapy, medicine and orthopaedic randomised controlled trials (RCT), the investigators (and readers) focus on the difference between groups in change scores from baseline to follow-up. Mean score changes are difficult to interpret (‘is an improvement of 20 units good?’), and follow-up scores may be more meaningful. We investigated how applying three different responder criteria to change and follow-up scores would affect the ‘outcome’ of RCTs. Responder criteria refers to participants’ perceptions of how the intervention affected them.

Methods
We applied three different criteria—minimal important change (MIC), patient acceptable symptom state (PASS) and treatment failure (TF)—to the aggregate Knee injury and Osteoarthritis Outcome Score (KOOS4) and the five KOOS subscales, the primary and secondary outcomes of the KANON trial (ISRCTN84752559). This trial included young active adults with an acute ACL injury and compared two treatment strategies: exercise therapy plus early reconstructive surgery, and exercise therapy plus delayed reconstructive surgery, if needed.

Results
MIC: At 2 years, more than 90% in the two treatment arms reported themselves to be minimally but importantly improved for the primary outcome KOOS4. PASS: About 50% of participants in both treatment arms reported their KOOS4 follow-up scores to be satisfactory. TF: Almost 10% of participants in both treatment arms found their outcomes so unsatisfactory that they thought their treatment had failed. There were no statistically significant or meaningful differences between treatment arms using these criteria.

Conclusion
We applied change criteria as well as cross-sectional follow-up criteria to interpret trial outcomes with more clinical focus. We suggest researchers apply MIC, PASS and TF thresholds to enhance interpretation of KOOS and other patient-reported scores. The findings from this study can improve shared decision-making processes for people with an acute ACL injury.

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Online multifactorial prevention programme has no effect on the number of running-related injuries: a randomised controlled trial

Objective
To examine the effect of a multifactorial, online injury prevention programme on the number of running-related injuries (RRIs) in recreational runners.

Methods
Adult recreational runners who registered for a running event (distances 5 km up to 42.195 km) were randomised into the intervention group or control group. Participants in the intervention group were given access to the online injury prevention programme, which consisted of information on evidence-based risk factors and advices to reduce the injury risk. Participants in the control group followed their regular preparation for the running event. The primary outcome measure was the number of self-reported RRIs in the time frame between registration for a running event and 1 month after the running event.

Results
This trial included 2378 recreational runners (1252 men; mean [SD] age 41.2 [11.9] years), of which 1196 were allocated to the intervention group and 1182 to the control group. Of the participants in the intervention group 37.5% (95% CI 34.8 to 40.4) sustained a new RRI during follow-up, compared with 36.7% (95% CI 34.0 to 39.6) in the control group. Univariate logistic regression analysis showed no significant difference between the intervention and control group (OR 1.08; 95% CI 0.90 to 1.30). Furthermore, the prevention programme seemed to have a negative impact on the occurrence of new RRIs in the subgroup of runners with no injuries in the 12 months preceding the trial (OR 1.30; 95% CI 0.99 to 1.70).

Conclusion
A multifactorial, online injury prevention programme did not decrease the total number of RRIs in recreational runners.

Trial registration number
NTR5998.

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Infographic:The effects of residential relocation on walking, physical activity and travel behaviour

Increasing evidence suggests that attributes of neighbourhood environments may play an important role in physical activity.1 2 However, nearly all studies in the field are cross-sectional and are subject to substantial bias.3 Residential relocation provides an opportunity for natural experiments where relocating to a new neighbourhood may ‘interrupt’ habitual behaviours and help establish new behavioural patterns.4 We conducted a systematic review on the effects of residential relocation on physical activity, walking and travel behaviour (PROSPERO registration number CRD42017077681, available at https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=77681).5 We found 23 publications based on 16 studies (11 prospective and 5 retrospective), a much smaller body of research than the existing plethora of cross-sectional studies. Findings from these studies differ markedly by study design. Retrospective/quasi-longitudinal studies, which were rated lower on study quality, were more likely to report consistent evidence supporting the association between favourable...

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