Comparison of frequency and magnitude of head impacts experienced by Peewee boys and girls in games of youth ice hockey.

In youth ice hockey, girls are reported to suffer more concussions than boys, peaking around 13-14 years old, which may be related to differences in the level of brain trauma experienced by the players. The purpose of this research was to describe the differences in brain trauma characteristics, specifically the magnitude and frequency of head impacts between Peewee boys and girls from playing ice hockey. Thirty games of Peewee boys and Peewee girl's ice hockey were recorded to document the head impact events. These events were reconstructed using physical and computational techniques to estimate the strain to the brain tissue. The results found that Peewee boys experienced more head impacts than girls, specifically from the shoulder, ice, boards, and fist/punches (p < 0.05). The boys also experienced more medium strain category impacts (p < 0.05). These results identify that Peewee boys and girls engage in ice hockey differently, which affects the risk of brain trauma likely to be encountered while during game play, suggesting that the increased rate of concussion for girls may not be related to impact magnitudes within the sport but increased reporting of symptoms of concussion or gender differences in brain tissue response to an impact.

Methodological quality of clinical practice guidelines with physical activity recommendations for people diagnosed with cancer: A systematic critical appraisal using the AGREE II tool.

Evidence suggests physical activity (PA) is beneficial for people diagnosed with cancer. Clinical practice guidelines provide specific recommendations based on available research and are useful in informing evidence-based practice and guiding future research. Little is known on the extent and quality of guidelines on PA targeted to the cancer population. The objectives of this systematic review were to: 1) identify recent clinical practice guidelines including PA or exercise recommendations for people with cancer and 2) critically appraise the methodological quality of the included guidelines. A systematic search of four electronic databases (MEDLINE, EMBASE, CINAHL and PEDro) and supplementary sources was conducted. Two reviewers independently scanned articles and selected guidelines for inclusion according to the following criteria: published in English, developed or updated in previous five years (January 2012-June 2017), published in peer-reviewed scientific journals, including ≥1 specific recommendation on PA or exercise, and relevant to adults diagnosed with cancer. Subsequently, two trained assessors independently appraised the included guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Average scores for six domains (scope and purpose; stakeholder involvement; rigour of development; clarity of presentation; applicability; and editorial independence) and overall quality were calculated. From the literature search, we identified 29 articles, representing 20 sets of guidelines meeting the selection criteria. The guidelines were applicable to the following cancer populations: general (n = 9), breast (n = 5), lung (n = 2), colorectal (n = 1), head and neck (n = 1), myeloma (n = 1) and prostate (n = 1). The guidelines were generally of moderate methodological quality (mean AGREE II overall quality score: 4.6/7, range 2.5-6). The area of lowest quality was in the domain of applicability (mean AGREE II quality domain score: 40%), whereas the strongest domains were related to scope and purpose (81%) and clarity of presentation (77%). Although there are limitations in the primary research informing the recommendations, guidelines of acceptable quality exist to direct stakeholders on targeted PA recommendations for a range of cancer populations. Improvement is needed in the applicability of guidelines to enhance their relevance and clinical use. Health professionals can play an important role in supporting people with cancer throughout the disease trajectory and benefit from access to well-developed and appropriate materials to interpret research knowledge on effective rehabilitation strategies, including PA.

Evidence synthesis of types and intensity of therapeutic land-based exercises to reduce pain in individuals with knee osteoarthritis.

The objective of this study is to construct an evidence synthesis to identify the types of land-based exercises most investigated in the current literature, the intervention duration, frequency of the programs and the exercises which are most frequently implemented. A search was performed on the reference list of included and excluded studies of one systematic review, on land-based exercises for knee osteoarthritis and, an updated search of The Cochrane Library, Embase, CINAHL and PEDro was completed. Two authors independently selected the studies and a third author was consulted for an additional opinion. The inclusion criteria were male or female with tibiofemoral knee osteoarthritis, land-based exercises, non-exercise control group and randomized clinical trials. The exclusion criteria were mixed diagnosis or comparison to other types of exercise. The data were extracted by two authors. Fifty-five full-text articles were included. Strengthening, proprioception and aerobic exercises resulted in significant pain reduction. The intervention durations which were significant for pain reduction were either the period of 8-11 weeks or 12-15 weeks. The frequency of three times per week was found significant in comparison to a non-exercise control group. The results, which formed an evidence synthesis, demonstrate that there is substantial evidence regarding the benefits of strengthening exercises to reduce pain in knee osteoarthritis patients. Based on the included studies analysis, exercises should be performed three times weekly for a duration of 8-11 or 12-15 weeks. Health professionals working with knee osteoarthritis patients can use this evidence synthesis as a fast and pragmatic instrument to obtain information about several effective types of exercises for pain reduction.

The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis.

OBJECTIVE:: To identify programmes involving therapeutic exercise that are effective for the management of hand osteoarthritis and to provide stakeholders with updated, moderate to high-quality recommendations supporting exercises for hand osteoarthritis. METHODS:: A systematic search and adapted selection criteria included comparable trials with exercise programmes for managing hand osteoarthritis. Based on the evaluated evidence, a panel of experts reached consensus through a Delphi approach endorsing the recommendations. A hierarchical alphabetical grading system (A, B, C+, C, C-, D-, D, D+, E, F) was based on clinical importance (≥15%) and statistical significance ( P < 0.05). RESULTS:: Ten moderate- to high-quality studies were included. Eight studies with programmes involving therapeutic exercise (e.g. range of motion (ROM) + isotonic + isometric + functional exercise) seemed to be effective. Forty-six positive grade recommendations (i.e. A, B, C+) were obtained during short-term (<12 weeks) trials for pain, stiffness, physical function, grip strength, pinch strength, range of motion, global assessment, pressure pain threshold, fatigue and abductor pollicis longus moment and during long-term (>12 weeks) trials for physical function and pinch strength. CONCLUSION:: Despite that many programmes involving exercise with positive recommendations for clinical outcomes are available to healthcare professionals and hand osteoarthritis patients that aid in the management of hand osteoarthritis, there is a need for further research to isolate the specific effect of exercise components.

Assessment of the content reporting for therapeutic exercise interventions among existing randomized controlled trials on knee osteoarthritis.

Purpose/Rationale: Physical exercise interventions for the management of knee osteoarthritis are well known to be effective and accessible forms of rehabilitation and symptom management. However, without adequate reporting of these interventions, accurate replication and clinical use is negatively impacted. OBJECTIVES: The main objective of this article was to assess content reporting using The Consensus on Exercise Reporting Template list and 2016 American College of Sports Medicine guidelines among moderate- to high-quality exercise interventions randomized controlled trials (total score of ≥6/10 on the PEDro scale) involving individuals with knee osteoarthritis. RESULTS: The Consensus on Exercise Reporting Template mean total score for all 47 included randomized controlled trials was 4.42 out of 19, demonstrating generally low quality of reporting. The Consensus on Exercise Reporting Template list and the 2016 American College of Sports Medicine guidelines scores were moderately correlated (based on 95% confidence interval, intraclass correlation coefficient = 0.508) for aerobic interventions only. CONCLUSION: The content analysis of exercise interventions in knee osteoarthritis demonstrated low scores for moderate- to high-quality trials. Improved standardized reporting is recommended to ensure knowledge transfer and replication of effective exercise programs for individuals with knee osteoarthritis.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs.

OBJECTIVE: To identify effective mind-body exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning non-traditional land-based exercises for knee osteoarthritis. METHODS: A systematic search and adapted selection criteria included comparative controlled trials with mind-body exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, D-) was used, based on statistical significance ( P < 0.5) and clinical importance (⩾15% improvement). RESULTS: The four high-quality studies identified demonstrated that various mind-body exercise programs are promising for improving the management of knee osteoarthritis. Hatha Yoga demonstrated significant improvement for pain relief (Grade B) and physical function (Grade C+). Tai Chi Qigong demonstrated significant improvement for quality of life (Grade B), pain relief (Grade C+) and physical function (Grade C+). Sun style Tai Chi gave significant improvement for pain relief (Grade B) and physical function (Grade B). CONCLUSION: Mind-body exercises are promising approaches to reduce pain, as well as to improve physical function and quality of life for individuals with knee osteoarthritis.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs.

OBJECTIVES: To identify effective aerobic exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. METHODS: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) was used, based on statistical significance ( P < 0.5) and clinical importance (⩾15% improvement). RESULTS: The five high-quality studies included demonstrated that various aerobic training exercises are generally effective for improving knee osteoarthritis within a 12-week period. An aerobic exercise program demonstrated significant improvement for pain relief (Grade B), physical function (Grade B) and quality of life (Grade C+). Aerobic exercise in combination with strengthening exercises showed significant improvement for pain relief (3 Grade A) and physical function (2 Grade A, 2 Grade B). CONCLUSION: A short-term aerobic exercise program with/without muscle strengthening exercises is promising for reducing pain, improving physical function and quality of life for individuals with knee osteoarthritis.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs.

OBJECTIVE: To identify effective strengthening exercise programs and provide rehabilitation teams and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. METHODS: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+ or D-) was based on statistical significance ( p < 0.5) and clinical importance (⩾15% improvement). RESULTS: The 26 high-quality studies identified demonstrated that various strengthening exercise programs with/without other types of therapeutic exercises are generally effective for improving knee osteoarthritis management within a six-month period. Strengthening exercise programs demonstrated a significant improvement for pain relief (four Grade A, ten Grade B, two Grade C+), physical function (four Grade A, eight Grade B) and quality of life (three Grade B). Strengthening in combination with other types of exercises (coordination, balance, functional) showed a significant improvement in pain relief (three Grade A, 11 Grade B, eight Grade C+), physical function (two Grade A, four Grade B, three Grade C+) and quality of life (one Grade A, one Grade C+). CONCLUSION: There are a variety of choices for strengthening exercise programs with positive recommendations for healthcare professionals and knee osteoarthritis patients. There is a need to develop combined behavioral and muscle-strengthening strategies to improve long-term maintenance of regular strengthening exercise programs.