Current perspectives of New Zealand physiotherapists on rehabilitation and return to sport following anterior cruciate ligament reconstruction: A survey.

OBJECTIVE: To investigate the clinical beliefs and practices of New Zealand physiotherapists regarding pre- and post-surgical rehabilitation and return to sport (RTS) criteria following anterior cruciate ligament reconstruction (ACLR). DESIGN: Online cross-sectional survey. METHODS: A survey was adapted from a previously published survey and disseminated to New Zealand physiotherapists who were considered more likely to be involved in post-ACLR rehabilitation. RESULTS: The number of completed surveys was 318. Most physiotherapists (85%) preferred to first consult patients within 14 days of ACLR. In the first six weeks following ACLR, 89% of physiotherapists see patients at least once per week. Between 3- and 6-months post-ACLR, 76% of physiotherapists see patients at least once a fortnight. Pre-operative rehabilitation and post-operative rehabilitation exceeding six months are considered essential or important to patient outcomes by over 95% of physiotherapists. While 63% of physiotherapists support RTS 9-12 months after ACLR, 11% permit RTS within 6-9 months of surgery. Common RTS considerations include functional capacity, movement quality during functional tasks, time from ACLR, and knee strength. CONCLUSION: The survey revealed variability in the beliefs and practices of NZ physiotherapists regarding post-ACLR rehabilitation, and these beliefs and practices are at times inconsistent with best practice recommendations.

INJURY INCIDENCE IN COMPETITIVE CROSS-COUNTRY SKIERS: A PROSPECTIVE COHORT STUDY.

BACKGROUND/PURPOSE: Endurance sports, including cross-country skiing, require long hours of repetitive training potentially increasing the chance of injury, yet injury incidence and risk factors for adult cross-country skiers remain relatively unexplored. Data for elite adult north American competitive cross-country skiers is unexplored. A 12 month prospective surveillance study was undertaken to calculate the injury incidence and exposure of cross-country skiers. Injuries by anatomic location and mechanism of injury were calculated. Further, the relationships between new injury and the participant's demographics and physical assessment parameters were examined. The aims of this study were to determine the injury incidence and any risk factors for injury in elite adult north American cross-country skiers. METHODS: Elite cross-country skiers (35 men, 36 women) self-reported demographics, injury history, and injury and training surveillance monthly over 12 months. t-tests compared the mean number of injuries per individual, per 1,000 training/exposure hours between anatomic regions, type of injuries, and seasons. Spearman's correlation analyses tested the relationship between new injury and Movement Competency Screen (MCS) score, past injury, total training time, and running training time. To determine if new injury could be predicted from any demographic data, intake physical measures, or, monthly injury, training and racing data, a regression model was developed. RESULTS: Overall, 58% of participants (18 men, 23 women) completed the study, and reported 3.81 injuries per 1,000 training/exposure hours. Over 12-months, lower extremity injury incidence (2.13) was higher than upper extremity (0.46) and trunk injury incidence (0.22) (p < 0.05). Non-traumatic/overuse injury incidence (2.76) was higher than acute injury incidence (1.05) (p < .05). Non-ski-season injury incidence (5.25) was not statistically higher than ski-season injury incidence (2.27) (p = 0.07). New injuries were positively correlated with previous injury (p < 0.05), but not with any other variables (p > 0.05). CONCLUSION: In this year-long monthly survey of injuries and training load in elite adult north American cross-country skiers, new injuries were positively correlated with previous injury. Lower extremity, and non-traumatic/overuse injuries had the highest incidence rates. There was no significant correlation between new injuries and physical assessment parameters or training load. LEVEL OF EVIDENCE: Level 3, Prospective Longitudinal Cohort Study.

Validation of an Inertial Sensor System for Physical Therapists to Quantify Movement Coordination During Functional Tasks.

Physical therapists evaluate patients' movement patterns during functional tasks; yet, their ability to interpret these observations consistently and accurately is unclear. Physical therapists would benefit from a clinic-friendly method for accurately quantifying movement patterns during functional tasks. Inertial sensors, which are inexpensive, portable sensors capable of monitoring multiple body segments simultaneously, are a relatively new rehabilitation technology. We sought to validate an inertial sensor system by comparing lower limb and lumbar spine kinematic data collected simultaneously with a commercial inertial sensor system and a motion camera system while 10 subjects performed functional tasks. Mean and peak segment angular displacement data were calculated and compared between systems. Mean angular displacement root mean square error between the systems across all tasks and segments was <5°. Mean differences in peak displacements were generally acceptable (<5°) for the femur, tibia, and pelvis segments for all tasks; however, the inertial system overestimated lumbar flexion compared to the motion camera system. These data suggest that the inertial system is capable of measuring angular displacements within 5° of a system widely accepted for its accuracy. Standardization of sensor placement, better attachment methods, and improvement of inertial sensor algorithms will further increase the accuracy of the system.

The inter and intra rater reliability of the Netball Movement Screening Tool.

OBJECTIVES: To establish the inter- and intra-rater reliability of the Netball Movement Screening Tool, for screening adolescent female netball players. DESIGN: Inter- and intra-rater reliability study. METHODS: Forty secondary school netball players were recruited to take part in the study. Twenty subjects were screened simultaneously and independently by two raters to ascertain inter-rater agreement. Twenty subjects were scored by rater one on two occasions, separated by a week, to ascertain intra-rater agreement. Inter and intra-rater agreement was assessed utilising the two-way mixed inter class correlation coefficient and weighted kappa statistics. RESULTS: No significant demographic differences were found between the inter and intra-rater groups of subjects. Inter class correlation coefficients' demonstrated excellent inter-rater (two-way mixed inter class correlation coefficients 0.84, standard error of measurement 0.25) and intra-rater (two-way mixed inter class correlation coefficients 0.96, standard error of measurement 0.13) reliability for the overall Netball Movement Screening Tool score and substantial-excellent (two-way mixed inter class correlation coefficients 1.0-0.65) inter-rater and substantial-excellent intra-rater (two-way mixed inter class correlation coefficients 0.96-0.79) reliability for the component scores of the Netball Movement Screening Tool. Kappa statistic showed substantial to poor inter-rater (k=0.75-0.32) and intra-rater (k=0.77-0.27) agreement for individual tests of the NMST. CONCLUSIONS: The Netball Movement Screening Tool may be a reliable screening tool for adolescent netball players; however the individual test scores have low reliability. The screening tool can be administered reliably by raters with similar levels of training in the tool but variable clinical experience. On-going research needs to be undertaken to ascertain whether the Netball Movement Screening Tool is a valid tool in ascertaining increased injury risk for netball players.

Effects of an acute hamstring stretch in people with and without osteoarthritis of the knee.

OBJECTIVE: To compare the effects of an acute stretching intervention on knee extension range of motion, passive resistive torque and stiffness in subjects with osteoarthritis of the knee, and to compare these variables with subjects without osteoarthritis. DESIGN: Cross-sectional experimental study. SETTING: Human performance laboratory. PARTICIPANTS: A total of 55 participants were recruited: 28 subjects (males and females) with osteoarthritis of the knee joint and 27 subjects of a similar age without osteoarthritis of the knee joint. INTERVENTION: Using the Kincom dynamometer, three 60-second stretches with 60seconds of rest between stretches were applied to the hamstring muscle group. MAIN OUTCOME MEASURES: Peak knee extension range of motion, peak passive torque and stiffness in the final 10% of knee extension range of motion. RESULTS: A significant (P<0.05) increase in knee extension range of motion, peak passive torque and stiffness was observed in both groups. For knee extension range of motion, the mean difference for the osteoarthritis group and non-osteoarthritis group was 4.9 degrees [95% confidence interval (CI) 0.9 to 8.5] and 4.4 degrees (95% CI 1.8 to 6.8), respectively. For peak passive torque, the mean difference in the osteoarthritis group and the non-osteoarthritis group was 4.4Nm (95% CI 0.8 to 6.9) and 1.0Nm (95% CI -1.4 to 3.5), respectively. For stiffness in the final 10% of knee extension range of motion, the mean difference for the osteoarthritis group and the non-osteoarthritis group was 0.19Nm/degree (95% CI 0.08 to 0.3) and 0.04Nm/degree (95% CI -0.05 to 0.1), respectively. Stiffness in the final 10% of knee extension range of motion was significantly higher in the osteoarthritis group compared with the non-osteoarthritis group after stretching. CONCLUSIONS: Elderly individuals with and without osteoarthritis of the knee are able to demonstrate immediate beneficial adaptations to a stretching intervention. This is important as stretching is often used in preparation for exercise programmes.

Passive force, angle, and stiffness changes after stretching of hamstring muscles.

UNLABELLED: Periodic or long-term stretching programs have demonstrated changes in joint range of motion. The suggested mechanisms for these increases in range of motion are changes in the tissue properties of the muscle and more recently stretch tolerance. However, few studies have examined changes in passive resistive forces and related these changes to increases in range of motion. PURPOSE: The purpose of this study was to investigate the influence of a 6-wk hamstring-stretching program on knee extension range of motion, passive resistive forces, and muscle stiffness. METHODS: A randomized control trial with repeated measures was undertaken with 43 school-age subjects. Hamstring extensibility was assessed by a passive knee extension test using a Kincom isokinetic dynamometer. The intervention group participated in a 6-wk hamstring-stretching program. Stretches were performed 5 d x wk(-1), once per day, held for 30 s, and for 3 repetitions. The control group did not stretch over the 6-wk intervention period. Measurements of hamstring extensibility were repeated at the end of the 6-wk intervention. RESULTS: After the intervention period, significant (P < 0.05) increases in knee extension range of motion, passive resistive force, and stiffness were observed in the experimental group. No significant differences were observed in the control group's findings for the same variables. CONCLUSIONS: The findings of this study are consistent with other literature that shows periodic stretching programs over a 6-wk time frame produce significant changes in knee extension range of motion. The finding of increased stiffness in the new range of motion, gained as a result of the stretching program, provides some evidence that structural changes had occurred in the stretched muscles.