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SportsMedUpdate
  1. Martin P Schwellnus
  1. University of Cape Town, South Africa

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    INTRINSIC PREDICTORS OF LATERAL ANKLE SPRAIN IN ADOLESCENT DANCERS: A PROSPECTIVE COHORT STUDY

    ▸ Hiller CE, Refshauge KM, Herbert RD, Kilbreath SL. Clin J Sport Med 2008;18:44–8.

    Background:

    Lateral ankle ligament sprains are very common, particularly in dancers. Risk factors for ankle sprains in this group require investigation

    Research question/s:

    What are the intrinsic predictors of lateral ankle sprain in adolescent dancers?

    Methodology:

    Subjects: 115 adolescent dancers (female = 94, male = 21, age 14.2 (SD 1.8) years)

    Experimental procedure: All the dancers underwent assessment and 18 possible predictors of ankle injury were measured (15 clinical measures, three laboratory measures — including age, dance history, previous ankle sprain, ankle and foot laxity and range of motion, and balance). Dancers were followed monthly for 13 months and lateral ankle ligament injuries were recorded. One ankle of each dancer was randomly assigned to a test group and used to develop a predictive model (PR = 114), and the other was assigned to a validation group to test the model (VL = 112). Using a backwards stepwise Cox regression model, the PR group was used to predict ankle sprains in the VL group

    Measures of outcome: Hazard ratio (HR) of ankle sprain for each predictor

    Main finding/s:

    A previous sprain of the contralateral ankle predicted ankle sprain in the VL (HR  =  3.90, CI 1.49 to 10.22)

    Conclusion/s:

    In a prospective cohort study in dancers, a past history of a lateral ankle sprain was associated with an increased risk of a future sprain in the contralateral ankle

    Evidence based rating:

    7.5/10

    Clinical interest rating:

    7.5/10

    Type of study:

    Prospective cohort study

    Methodological considerations:

    Well-conducted study, exposure time not well documented

    Keywords:

    ankle, ligament, sprain, risk factors, adolescent, dancers

    EXTRACORPOREAL SHOCK WAVE THERAPY IN TREATMENT OF DELAYED BONE–TENDON HEALING

    ▸ Wang L, Qin L, Lu H-B, . Am J Sports Med 2008;36:340–7.

    Background:

    Healing following injury at the bone–tendon junction is often delayed. Extracorporeal shock wave therapy (ECSWT) has been used to increase healing in other chronic soft tissue and bony injuries

    Research question/s:

    Does extracorporeal shock wave therapy (ECSWT) promote osteogenesis, regeneration of fibrocartilage zone, and remodelling of the tissue in experimentally induced bone–tendon junction surgical repair?

    Methodology:

    Animal material: 28 mature female New Zealand rabbits (18 weeks) (3.82 (SD 0.42) kg)

    Experimental procedure: All the animals underwent surgical repair resulting in a delayed healing model of the patella–patellar tendon complex following a partial patellectomy. Animals were randomly divided into control (CON = 14) and a shock wave treatment group (ECSWT = 14, single treatment 2 weeks post injury) for 6 weeks post surgery. Radiology, bone mineral status, histology, and mechanical evaluation were conducted 8 and 12 weeks (n = 7 in each group) post injury

    Measures of outcome: Radiographic measure of new bone size (mm2), bone mineral status (bone mineral content — BMC, bone mineral density — BMD), histology (density of fibroblast cells — cells/100μm2, thickness of the fibrocartilage — mm), biomechanical testing (failure load — N)

    Main finding/s:

    Bone status: There was significantly greater new bone formation (area) at 8 and 12 weeks and increased bone mineral status (BMD, BMC) at 12 weeks in the ECSWT group than in the CON group

    Histology: There was evidence of more advanced remodelling (better alignment of collagen fibres) and thicker regenerated fibrocartilage zone in the ECSWT group at 8 and 12 weeks than in the CON group

    Conclusion/s:

    In a randomised, controlled trial (animal model) a single treatment of ECSWT significantly improved bone formation, fibrocartilage thickness, tendon area and mechanical strength in an experimentally induced bone–tendon bone healing model in rabbits

    Evidence based rating:

    8/10

    Clinical interest rating:

    8.5/10

    Type of study:

    Randomised, controlled, laboratory study (animal model)

    Methodological considerations:

    Well-conducted study, small sample size, application to human model requires further study, single-dose treatment

    Keywords:

    injury, knee, patella, bone–tendon, extracorporeal shock wave therapy (ECSWT), healing, animal model

    NO DIFFERENCES IN PHYSICAL ACTIVITY IN (UN)DIAGNOSED ASTHMA AND HEALTHY CONTROLS

    ▸ van Gent R, van der Ent CK, van Essen-Zandvliet LEM, . Pediatric Pulmonology 2007;42:1018–23.

    Background:

    Participation in regular physical activity by children is important for health. Asthma, in particular undiagnosed asthma, may reduce physical activity in children.

    Research question/s:

    Does asthma affect physical activity levels in young children (aged 7–10 years)?

    Methodology:

    Subjects: 1641 children (7–10 years) from 41 primary schools (with parental consent)

    Experimental procedure: Parents completed a questionnaire on their child’s respiratory health, and pulmonary function (PF) testing (airway reversibility and bronchial hyperresponsiveness — BHR) was conducted. Physical activity levels were also measured during 5 days with an accelerometer and diary, and with the habitual activity estimation scale (HAES — reviews the physical activity during the past 2 weeks). Based on history and PF results, children were categorised as 1) undiagnosed asthma (UDA = 130, 8%), diagnosed asthma (DA = 81, 5%), and randomly selected healthy controls (CON = 202).

    Measures of outcome: Pulmonary function testing (FEV1%) in three groups, physical activity (score/day, moderate activity/day, vigorous activity/day, minutes active/day by diary and HAES)

    Main finding/s:

    Pulmonary function testing: The baseline FEV1% (% of predicted) was lowest in the UDA group (UDA = 94%, DA = 98%, and CON = 100%)

    Conclusion/s:

    In a cross-sectional study among young children (7–10years), childhood asthma (either diagnosed or undiagnosed) was not associated with a decrease in the level of daily physical activity

    Evidence based rating:

    6.5/10

    Clinical interest rating:

    7.5/10

    Type of study:

    Cross-sectional study

    Methodological considerations:

    Cross-sectional study (descriptive), measures of physical activity are difficult in children, recall bias (diaries), definition of undiagnosed asthma remains controversial

    Keywords:

    asthma, children, exercise, physical activity

    HEART RATE RECOVERY PREDICTS MORTALITY AND CARDIOVASCULAR EVENTS IN PATIENTS WITH TYPE 2 DIABETES

    ▸ Chacko KM, Bauer TA, Dale RA, . Med Sci Sports Exerc 2008;40:288–95.

    Background:

    Heart rate recovery (HRR) immediately after peak exercise has been used to predict all-cause mortality but this has not been studied in patients with type 2 diabetes mellitus (DM)

    Research question/s:

    Does HRR predict all-cause mortality, cardiovascular mortality, and cardiovascular events in asymptomatic patients with type 2 diabetes mellitus (DM)?

    Methodology:

    Subjects: 871 asymptomatic type 2 diabetes mellitus patients (58.5 (SD 8.2) years, men = 549, mean DM = 8.8 (SD 7) years)

    Experimental procedure: All the subjects underwent assessment including a peak exercise treadmill test from which HRR in beats/min was determined at 1 and 2 min post exercise. Subjects were divided into quintiles based on HRR at 1 and 2 min. As part of a larger study, subjects were followed up for a minimum of 5 years and all-cause mortality (ACM), cardiovascular mortality (CM), and cardiovascular events (CE) were documented during the follow-up period

    Measures of outcome: Relationship between HRR quintiles and ACM, CM, and CE (unadjusted and adjusted for traditional CV risk factors)

    Main finding/s:

    ACM and CE were greater among the 1) lowest quintile (<12 beats/min) of 1 min HRR compared with the fourth quintile (23–28 beats/min) and 2) lowest quintile (<28 beats/min) of 2 min HRR compared with the third quintile (37–42 beats/min)

    Attenuated 1 and 2 min HRR remained significantly associated with increased risk of CE (when compared with those without attenuation) following adjustment for traditional cardiac risk factors

    Conclusion/s:

    In patients with type 2 diabetes mellitus, impaired HRR at 1 and 2 min post exercise testing is associated with increased risk of developing future cardiovascular events, independent of the presence of other traditional cardiovascular risk factors — HRR should be included into standard diagnostic treadmill testing reports for these patients

    Evidence based rating:

    8/10

    Clinical interest rating:

    8.5/10

    Type of study:

    Prospective cohort study

    Methodological considerations:

    Well-conducted study, patients included only if they underwent exercise testing at baseline

    Keywords:

    diabetes mellitus, type 2, heart rate variability, mortality, exercise testing, morbidity

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