Jumping into recovery: A systematic review and meta-analysis of discriminatory and responsive force plate parameters in individuals following anterior cruciate ligament reconstruction during countermovement and drop jumps.

Purpose: Comprehensive understanding of force plate parameters distinguishing individuals postprimary anterior cruciate ligament reconstruction (ACLR) from healthy controls during countermovement jumps (CMJ) and/or drop jumps (DJ) is lacking. This review addresses this gap by identifying discriminative force plate parameters and examining changes over time in individuals post-ACLR during CMJ and/or DJ. Methods: We conducted a systematic review and meta analyses following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Nine databases were searched from inception to March 2022. We included cross-sectional papers comparing post-ACLR with healthy controls or longitudinal studies of individuals at least 6 months postprimary ACLR while performing CMJ and/or DJ on force plates. The methodological quality was appraised using the Modified Downs and Black Checklist. Results: Thirty-three studies including 1185 (50.38%) participants post-ACLR, and 1167 (49.62%) healthy controls, were included. Data were categorised into single-leg CMJ, double-leg CMJ, single-leg DJ, and double-leg DJ. Jump height was reduced in both single (mean difference [MD] = -3.13; p < 0.01; 95% confidence interval [CI]: [-4.12, -2.15]) and double-leg (MD = -4.24; p < 0.01; 95% CI: [-5.14, -3.34]) CMJs amongst individuals with ACLR. Similarly, concentric impulse and eccentric/concentric impulse asymmetry could distinguish between ACLR (MD = 3.42; p < 0.01; 95% CI: [2.19, 4.64]) and non-ACLR (MD = 5.82; p < 0.01; 95% CI: [4.80, 6.80]) individuals. In double-leg DJs, peak vertical ground reaction forces were lower in the involved side (MD = -0.10; p = 0.03; 95% CI: [-0.18, -0.01]) but higher in the uninvolved side (MD = 0.15; p < 0.01; 95% CI: [0.10, 0.20]) when compared to controls and demonstrated significant changes between 6 months and 3 years post-ACLR. Conclusion: This study identified discriminative kinetic parameters when comparing individuals with and without ACLR and also monitored neuromuscular function post-ACLR. Due to heterogeneity, a combination of parameters may be required to better identify functional deficits post-ACLR. Level of Evidence: Level III.

The knowledge and attitude concerning sport-related concussion among coaches: A survey study.

Background: There are no studies investigating the level of knowledge about and attitude towards sports-related concussions (SRC) among sports coaches in Jordan. Objectives: This study aimed to examine the knowledge about and attitude towards SRC among Jordanian sports coaches. Method: Our study was based on a cross-sectional survey. An Arabic version of the questionnaire from the Centers for Disease Control and Prevention was used to collect data. The survey identified participants' demographics and knowledge about (0-10 points with higher scores indicating a higher knowledge) and attitude towards (8-40 with lower scores indicating favourable attitudes) SRC. Descriptive statistics and the Kruskal-Wallis test were used to examine knowledge and attitude differences by demographic factors. Spearman's correlation examined the correlation between the total knowledge and attitude scores. Results: Participants included 193 coaches (62 basketball, 66 martial arts, 30 soccer, and 35 swimming). The median total knowledge and attitude scores were 4 and 30, respectively. The total knowledge score was the highest in martial arts coaches (median = 4) and those with graduate degrees (median = 5). The total attitude score was the lowest among basketball coaches (median = 28) and those who were 40-50 years old (median = 28). No significant correlation between knowledge and attitude scores was observed. Conclusion: Jordanian coaches have a deficiency in knowledge about SRC and hold attitudes that are not consistent with current practice recommendations. Clinical implications: Knowledge and attitude about SRC can be improved through education, access to healthcare providers, and adherence to SRC management guidelines.

The Functional Assessment of Balance in Concussion (FAB-C) Battery.

BACKGROUND: There is no clinical tool that assesses multiple components of postural control potentially impacted by sport-related concussion (SRC). OBJECTIVE: To develop and assess the feasibility and construct validity of the Functional Assessment of Balance in Concussion (FAB-C) battery. STUDY DESIGN: Cross-sectional study. METHODS: Tests for inclusion in the FAB-C battery were identified through a search of the literature. The feasibility and construct validity of the battery was assessed with a convenience sample of active individuals (13-24 years) with and without a SRC. Feasibility outcomes included battery completion (yes/no), number of adverse events, time to administer (minutes) and cost of the battery (Canadian Dollars). Construct validity was assessed by examining correlations between tests included in the battery, and describing differences [mean (standard deviation), median (range) or proportion] in outcomes between uninjured participants and participants with SRC. RESULTS: Seven tests were included in the FAB-C battery. All 40 uninjured participants [12 female; median age 17 years] completed the FAB-C assessment compared to 86% of seven participants with SRC [1 female; median age 17]. No participants demonstrated adverse effects. The median administration time of the battery was 49 minutes (range 44-60). The cost of the battery was low (~$100 Canadian Dollars). Limited correlations (r<0.7) between tests in the battery were observed. A greater percentage of uninjured participants (52% to 82%) passed individual tests in the battery compared to participants with SRC (17% to 66%). CONCLUSION: Although promising, the FAB-C battery requires further evaluation before adoption for widespread clinical use. LEVEL OF EVIDENCE: Level 3b.

Kinetic measurement system use in individuals following anterior cruciate ligament reconstruction: a scoping review of methodological approaches.

PURPOSE: Our primary objectives were to (1) describe current approaches for kinetic measurements in individuals following anterior cruciate ligament reconstruction (ACLR) and (2) suggest considerations for methodological reporting. Secondarily, we explored the relationship between kinetic measurement system findings and patient-reported outcome measures (PROMs). METHODS: We followed the PRISMA extension for scoping reviews and Arksey and O'Malley's 6-stage framework. Seven electronic databases were systematically searched from inception to June 2020. Original research papers reporting parameters measured by kinetic measurement systems in individuals at least 6-months post primary ACLR were included. RESULTS: In 158 included studies, 7 kinetic measurement systems (force plates, balance platforms, pressure mats, force-measuring treadmills, Wii balance boards, contact mats connected to jump systems, and single-sensor insoles) were identified 4 main movement categories (landing/jumping, standing balance, gait, and other functional tasks). Substantial heterogeneity was noted in the methods used and outcomes assessed; this review highlighted common methodological reporting gaps for essential items related to movement tasks, kinetic system features, justification and operationalization of selected outcome parameters, participant preparation, and testing protocol details. Accordingly, we suggest considerations for methodological reporting in future research. Only 6 studies included PROMs with inconsistency in the reported parameters and/or PROMs. CONCLUSION: Clear and accurate reporting is vital to facilitate cross-study comparisons and improve the clinical application of kinetic measurement systems after ACLR. Based on the current evidence, we suggest methodological considerations to guide reporting in future research. Future studies are needed to examine potential correlations between kinetic parameters and PROMs.

Re-conceptualizing postural control assessment in sport-related concussion: Transitioning from the reflex/hierarchical model to the systems model.

Background: While postural control impairment is common following sport-related concussion, few investigations have studied the physiological basis for this impairment. Both the Reflex/Hierarchical Model and the Systems Model are commonly used to characterize the physiological basis of postural control.Purpose: To discuss the physiological basis of postural control impairment resulting from sport-related concussion based on these models and suggest directions for future research.Methods: Narrative literature review.Findings: Postural control impairment seen with sport-related concussion is a multifaceted construct that can result from deficits in numerous systems that underlie postural control as described by the Systems Model, rather than a unidimensional construct that stems from the central nervous systems' inability to integrate sensory input to control posture as per the Reflex/Hierarchical Model.Conclusion: We recommend a transition away from the Hierarchical/Reflex Model of postural control towards the Systems Model in the conceptualization of sport-related concussion. Future research on postural control following sport-related concussion should account for the multifaceted nature of the resulting postural control impairment based on the Systems Model. Clinically, there is a need for a clinical postural control test that allows examination across the affected systems under single-task, dual-task, and sport-specific paradigms.

THE RELIABILITY OF CLINICAL BALANCE TESTS UNDER SINGLE-TASK AND DUAL-TASK TESTING PARADIGMS IN UNINJURED ACTIVE YOUTH AND YOUNG ADULTS.

BACKGROUND: Previous researchers have suggested that balance control deficits are detected more accurately with dual-task testing than single-task testing. However, it is necessary to examine the clinimetric properties of dual-task testing before employing it in clinical and research settings. OBJECTIVE: To examine and compare the relative and absolute reliability of the Balance Error Scoring System (BESS), Tandem Gait Test (TGT), and Clinical Reaction Time (CRT) under single and dual-task conditions in uninjured active youth and young adults.Study Design: Single-group, repeated-measures study. METHODS: Twenty-three individuals [9 female; median age 17 years] completed three trials of the BESS, TGT, and CRT under single and dual-task testing conditions during testing session one. Two raters assessed participants to assess inter-rater reliability. Either later on the same day or the following day, the protocol was repeated by one rater to assess intra-rater reliability. The average of three trials was used to calculate intra-rater (between-session) and inter-rater (within-session) intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Cohen's Kappa coefficient for tests as appropriate under both conditions. Bland-Altman plots (mean difference and 95% limits of agreement) were used to assess for a systematic error associated with a learning effect. RESULTS: Only one participant attended the second session on the following day, while 22 participants (95%) attended the second session within four hours after testing session one. Under single-task testing, estimated ICCs, SEMs, MDCs, and Kappa coefficients ranged from 0.24 to 0.99, 0.3 to 23, 0.8 to 64, and 0.03 to 0.64, respectively. Under dual-task testing, estimated ICCs, SEMs, MDCs, and Kappa coefficients ranged from 0.70 to 0.99, 0.4 to 17, 1.1 to 47, and 0.39 to 0.83, respectively. A learning effect was identified for all tests under all conditions. CONCLUSION: The BESS is the only clinical test that demonstrated acceptable reliability for clinical use under single-task testing conditions. The BESS, TGT, and CRT all demonstrated acceptable reliability for clinical use under dual-task testing conditions. A practice session should be used to reduce the possible learning effect seen. Further studies examining sources of the systematic error observed are needed. LEVEL OF EVIDENCE: 2b.

Gait Deviations Associated With Concussion: A Systematic Review.

BACKGROUND: Gait deviations resulting from concussion are important to consider in the diagnosis, treatment progression, and return to activity after a concussion. OBJECTIVE: To identify quantifiable gait deviations associated with concussion across populations and time since injury. METHODS AND MATERIALS: Six electronic databases were systematically searched from January 1974 to September 2016. Studies selected included original data, had an analytic design, and reported a quantifiable gait parameter in individuals who had sustained a concussion as defined by the American Congress of Rehabilitation Medicine or related definitions. Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. Two independent authors assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Center of Evidence-Based Medicine Model). RESULTS: Of 2650 potentially relevant articles, 21 level 4 studies were included. The median DB score was 12/33 (range 10-16). Heterogeneity in gait parameters and timing of postconcussion testing precluded meta-analysis. There is consistent level 4 evidence of increased medial-lateral center-of-mass displacement, and inconsistent level 4 evidence of decreased gait velocity after concussion. Further, there is preliminary level 4 evidence that gait deficits may exist beyond the typical 10-day recovery period and return to activity. CONCLUSION: These findings suggest that individuals who have suffered a concussion may sway more in the frontal plane, and walk slower compared to healthy controls. Consensus about the most important gait parameters for concussion diagnosis and clinical management are lacking. Further, high-quality prospective cohort studies evaluating changes in gait from time of concussion to return to activity, sport, recreation and/or work are needed.