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Posterior cruciate ligament (PCL) injuries can be debilitating knee injuries, having involvement in up to 44% of traumatic knee injuries. However, isolated PCL injuries are relatively infrequent. Therefore, effective evidence-based rehabilitation protocols have proven to be elusive. This systematic review aims to summarize the latest evidence on postoperative rehabilitation protocols for patients undergoing PCL reconstruction. Studies included in this paper included those published from 1991 to 2019 with a grade 1 to 5 level of evidence discussing the postoperative PCL rehabilitation. A multidatabase search using largely PubMed and Ovid was conducted using relevant keywords such as "PCL," "postoperative," and "rehabilitation," initially leading to 955 papers, which were narrowed by relevance to 12 final published studies used in the analysis. Through careful review of the evidence, crucial principles of rehabilitation, such as an initial focus on protecting the graft during strengthening, as well as an optimized PCL reconstruction protocol are presented here. Rehabilitation following PCL reconstruction continues to be limited by a lack of high-quality evidence-based publications. [ABSTRACT FROM AUTHOR]

Background: Concerns about the cost and convenience of postsurgical physical therapy (PT) have sparked interest in unsupervised, home-based rehabilitation. However, the effectiveness of unsupervised home exercise after primary TKA has not been previously evaluated.Questions/purposes: (1) Can unsupervised home exercise after surgery provide noninferior recovery of passive knee flexion compared with formal outpatient PT? (2) Does a web-based platform for home-based exercise provide an advantage compared with a printed PT manual?Methods: We conducted a randomized, noninferiority trial involving 290 patients (20% of the 1464 eligible patients who could be contacted) who underwent primary TKA from March 2016 to April 2018. We included patients > 18 years old who were undergoing primary, unilateral TKA and provided written consent. We excluded patients with preoperative knee flexion < 90°, patients considering surgical intervention in a hip or the contralateral knee, patients discharged to an extended care facility, and revision or conversion TKA. We randomized patients to one of three groups: outpatient PT, unsupervised home exercise using a web-based platform (web PT), or unsupervised home exercise using a printed paper manual (paper PT). We also implemented a "delayed recovery intervention" within the home exercise program, in which patients were obliged to begin outpatient PT if knee flexion was < 70° at 2 weeks or < 90° at 4 weeks. The primary outcome was change in knee flexion from preoperative baseline after 4 to 6 weeks and 6 months. Secondary outcomes included Knee Injury and Osteoarthritis Outcome Score (KOOS), time back to activities of daily living, and time off narcotics. All analyses were intention to treat, and the noninferiority margin was 5% with maximum flexion as the outcome of interest for this parameter.Results: Adjusted differences in change in passive flexion for web PT +3° (95% confidence interval [CI], -1.2° to 6.4°) and paper PT +5° (95% CI, 0.99°-8.6°) were not inferior to outpatient PT based on a predefined 5° margin. Change in knee flexion from baseline was 0° for outpatient PT, -2° for web PT, and -1° for paper PT after 4 to 6 weeks and 8°, 8°, and 12° for the three groups, respectively, after 6 months. Additionally, there was no difference in the change in KOOS from baseline at 4 to 6 weeks or 6 months postoperatively as well as time back to work, driving, and walking without an assistive device.Conclusions: Unsupervised home exercise is an effective rehabilitation strategy after primary TKA and was noninferior to formal outpatient PT in selected patients. It is worthwhile to reconsider the current practice of automatically designating patients for outpatient PT after primary TKA, because appropriately selected patients with adequate clinical support can achieve similar results at home.Level Of Evidence: Level I, therapeutic study. [ABSTRACT FROM AUTHOR]

Beato, M, Wren, C, and de Keijzer, KL. The interunit reliability of global navigation satellite systems Apex (STATSports) metrics during a standardized intermittent running activity. J Strength Cond Res 38(2): e49-e55, 2024--This study aimed to evaluate the interunit reliability of global navigation satellite systems (GNSS) STATSports Apex metrics and to assess which metrics can be used by practitioners for the monitoring of short-distance intermittent running activities. Fifty-four male soccer players were enrolled (age 5 20.7 6 1.9 years, body mass 5 73.2 6 9.5 kg, and height 5 1.76 6 0.07 m) in this observational study. 10-Hz GNSS Apex (STATSports, Northern Ireland, Newry) units recorded total distance, high speed running (HSR), accelerations, decelerations, peak speed, average metabolic power, metabolic distance, dynamic stress load (DSL), relative distance, and speed intensity. The standardized intermitted running protocol used was a Yo-Yo intermittent recovery level 1. This study reported that Apex interunit analysis did not show any significant difference (delta difference and 95% confidence interval [CIs]) in total distance52.6 (22.6; 7.9) m, HSR 5 3.2 (20.2; 6.8) m, accelerations 5 0.09 (20.9; 1.1), decelerations 5 0.3 (20.4; 1.1), peak speed 5 0.02 (20.03; 0.07) m·s21, average metabolic power50.01 (20.02; 0.04)W·kg21, metabolic distance50.9 (26.2; 8.0) m, DSL52.8 (25.6; 10.7) au, relative distance 5 0.14 (20.19; 0.47) m·min21, and speed intensity 5 0.21 (20.21; 0.64) au. All metrics presented a delta d between trivial to small. The interunit intraclass correlation coefficient (ICC) was good or excellent for all metrics, with the exception of DSL, which was considered questionable. In conclusion, this study reports that all the metrics analysis in this study presents a low interunit bias and high reliability (ICC), with the exception of DSL. [ABSTRACT FROM AUTHOR]

Background and Purpose: Individuals with cardiorespiratory dysfunction demonstrate postural instability and increased risk of falls. Given that coronavirus disease (COVID-19) is commonly defined as a respiratory condition, it could be presumed that these patientsmay demonstrate similar balance deficits. This study aimed to determine deficits and characterize balance dysfunction (sensory or motor) in hospitalized patients classified as "COVID-19 recovered." Methods: Twenty-five participants consented for this study. Participants completed the Activity- Specific Balance Confidence Scale (ABC), a questionnaire about dizziness, the Timed "Up & Go" (TUG), and the modified Clinical Test of Sensory Interaction and Balance in a single session. The percentage of subjects who scored abnormal on the outcome measures was calculated. Correlations between demographics, respiratory function, and clinical outcome measures were determined using Spearman correlation coefficient. Results: All participants had abnormal scores on the TUG, 88%had abnormal scores on the ABC, and 48%of the subjects had abnormal scores on standing on foam eyes closed indicating difficulty using vestibular information. No correlation coefficient above 0.50 was found between the demographic information, respiratory function, and clinical outcome measures. Discussion: Clinical outcome measure scores did not correlate with respiratory function indicating that the deficits may be due to the extrapulmonary components of COVID-19. Conclusion: Both young and older adults presented withmotor and sensory balance deficits acutely after COVID-19 infection. It is recommended that individuals acutely post-COVID-19 receive education and interventions to increase mobility, improve balance, decrease fall risk, and specifically receive activities that stimulate the vestibular system. [ABSTRACT FROM AUTHOR]

Background: Displaced mid-third clavicle fractures are common, and their management remains unclear. Although several meta-analyses have compared specific operative techniques with nonoperative management, it is not possible to compare different operative constructs with one another using a standard meta-analysis. Conversely, a network meta-analysis allows comparisons among more than two treatment arms, using both direct and indirect comparisons between interventions across many trials. To our knowledge, no network meta-analysis has been performed to compare the multiple treatment options for displaced clavicle fractures.Questions/purposes: We performed a network meta-analysis of randomized, controlled trials (RCTs) to determine from among the approaches used to treat displaced midshaft clavicle fractures: (1) the intervention with the highest chance of union at 1 year, (2) the intervention with the lowest risk of revision surgery, and (3) the intervention with the highest functional outcome scores. Secondarily, we also (4) compared the surgical subtypes in the available RCTs on the same above endpoints.Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were reviewed for relevant randomized controlled trials published up to July 25, 2018. Two hundred and eighty four papers were reviewed, with 22 meeting inclusion criteria of RCTs with appropriate randomization techniques, adult population, minimum of 1 year follow-up and including at least one operative treatment arm. In total, 1002 patients were treated with a plate construct, 378 with an intramedullary device, and 585 patients were managed nonoperatively. Treatment subtypes included locked intramedullary devices (56), unlocked intramedullary devices (322), anterior plating (89), anterosuperior plating (150), superior plating (449) or plating not otherwise specified (314). We performed a network meta-analysis to compare and rank the treatments for displaced clavicle fractures. We considered the following outcomes: union achievement, revision surgery risk and functional outcomes (DASH and Constant Scores). The minimal clinically important difference (MCID) was considered for both Constant and DASH scores to be at 8 points, representing the average of MCID scores reported for both DASH and Constant in the evidence, respectively.Results: Union achievement was lower in patients treated nonoperatively (88.9%), and higher in patients treated operatively (96.7%, relative risk [RR] 1.128 [95% CI 1.1 to 1.17]; p < 0.001), Number needed to treat (NNT) = 10). Union achievement increased with any plate construct (97.8%, RR 1.13 [95% CI 1.1 to 1.7]; p < 0.0001, NNT = 9) and with anterior or anterosuperior plates (99.3%, RR 1.14 [95% CI 1.1 to 1.8]; p < 0.0001, NNT = 8). Risk of reoperation, when considering planned removal of hardware, was similar across all treatment arms. Lastly, operative treatment outperformed nonoperative treatment with minor improvements in DASH and Constant scores, though not approaching the MCID. At the subtype level, anterosuperior plating ranked highest in DASH and Constant functional scores with mean differences reaching 10-point improvement for Constant scores (95% CI 4.4 to 2.5) and 7.6 point improvement for DASH (95% CI 5.2 to 20).Conclusions: We found that surgical treatment led to a greater likelihood of union at 1 year of follow-up among adult patients with displaced mid-third clavicle fractures. In aggregate, surgical treatment did not increase functional scores by amounts that patients were likely to consider clinically important. Use of specific subtypes of plating (anterior, anterosuperior) resulted in improvements in the Constant score that were slightly above the MCID but did not reach the MCID for the DASH score, suggesting that any outcomes-score benefits favoring surgery were likely to be imperceptible or small. In light of these findings, we believe patients can be informed that surgery for this injury can increase the likelihood of union incrementally (about 10 patients would need to undergo surgery to avoid one nonunion), but they should not expect better function than they would achieve without surgery; most patients can avoid surgery altogether with little absolute risk of nonunion. Patients who opt for surgery must be told that the decision should be weighed against complications and the possibility of undergoing a second procedure for hardware removal. Patients opting not to have surgery for acute midshaft clavicle fractures can be told that nonunion occurs in slightly more than 10% of patients, and that these can be more difficult to manage than acute fractures.Level Of Evidence: Level I, therapeutic study. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the effects of different rest interval lengths (RILs) on repetition performance, rating of discomfort, and blood lactate responses during lower-body single-joint and multijoint exercises. This study used a counterbalanced design where each subject performed the Smith machine back squat (BS) and leg extension (LE) using 3 different RIL configurations (1, 2, and 3 minutes) in a randomized fashion. Data collection occurred over the span of 3 separate days. Volunteers were randomly allocated to perform the independent variables (RILs and exercises) in 1 of 12 potential configurations. The initial session was allotted for familiarization with the rating of discomfort scale and 10 repetition maximum testing. The other 2 sessions involved training with the different configurations of RIL length using both the BS and LE. Randomization ensured that the BS was performed first in one of the training sessions and the LE was performed first in the other session. Results indicated that longer RILs had a small positive effect on repetition performance, with longer rest durations allowing for more repetitions compared with shorter durations. The largest difference in repetition performance between RILs was observed between 1 minute and 2-3 minutes rest; there were trivial differences in repetition performance between 2 and 3 minutes rest for both the BS and LE. Blood lactate levels were slightly higher with longer RILs. Overall, BS showed greater increases in blood lactate compared with LE, and these differences were magnified over time. Exercise selection and RIL both influenced rating of discomfort, with LE producing less discomfort than BS and longer RILs reducing perceived discomfort. Our findings suggest that RIL influences the repetition performance, blood lactate, and rating of discomfort responses between single-joint and multijoint exercises. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Purpose: Functional recovery after lung transplant is crucial to long-term outcomes. Despite rehabilitation, few reach the threshold of healthy function. The purpose of this study was to assess the potential benefit of rehabilitation in the Center of Life for Thoracic Transplant (COLTT) program by (1) measuring time to functional recovery, (2) identifying factors associated with functional recovery, (3) examining program outcomes, and (4) examining COLTT impact on unplanned hospital readmission. Methods: The study retrospectively examined 105 patients in COLTT after hospital discharge. Functional measures collected at enrollment and completion included 6-minute walk distance, walking speed, 1-minute sit-to-stand test, and single-leg stance. Demographic and hospital stay data were examined for associations between time to achieve COLTT goals and readmissions. Results: The median number of visits in COLTT was 18 (9–53). Significant functional gains were made across all outcome measures and near thresholds for healthy individuals. Age, hospital and intensive care unit (ICU) length of stay (LOS), lung disease type, and ventilation time were significantly associated with COLTT visits. The 30-day hospital readmission free rate after hospital discharge was 71.4%. Conclusions: Healthy adult functional outcomes were achieved in 18 visits. Age, hospital and ICU LOS, lung disease type, and prolonged ventilation are associated with functional recovery. [ABSTRACT FROM AUTHOR]

The Ebola virus disease (EVD) epidemic killed almost 12,000 people across Sierra Leone, Liberia and Guinea, causing significant psychological distress and suffering. This paper describes International Medical Corps' innovative and comprehensive model for integrating mental health and psychosocial support (MHPSS) considerations and activities into Ebola treatment units (ETUs) across Sierra Leone and Liberia. This includes staff capacity building as well as psychosocial considerations and activities to address needs and challenges at the ETUs. This model was aimed at reducing patient and family distress and promoting healthy behaviours and recovery. We also include data describing mental health-related symptoms reported by our ETU patients, as well as psychosocial support interventions utilised. We discuss recommendations and lessons learnt and conclude that in line with global guidelines, MHPSS considerations and activities should be integral to all aspects of EVD care. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper was to study the effect of transforming growth factor beta (TGFβ) signaling pathway on reloading-mediated restoration of disuse muscle loss induced by hind limb suspension in rats. Design: Rats were divided into 4 groups: control group (CON), HLS group (hind limb suspension for 2 weeks), HLS + R group (hind limb suspension for 2 weeks followed by 2 weeks of natural reloading), and HRS + E group (hind limb suspension for 2 weeks followed by 2 weeks of treadmill exercise). Body weight, and weight and protein concentration of gastrocnemius were determined. The expression of members of canonical and noncanonical TGFβ signaling pathways, including TGFβ1, myostatin (MSTN), phospho-smad2/3, phospho-mitogen-activated protein kinases (p38, JNK1/2, and extracellular signal-regulated kinase 1 [ERK1]/ERK2), as well as the corresponding downstream effectors of muscle mass--p21, Pax7, MyoD, and MyoG--was determined at protein or messenger RNA (mRNA) levels. Results: Reloading increased MyoD mRNA and restored the decreased gastrocnemius weight/body weight ratio, protein concentration of gastrocnemius, phospho-ERK2, Pax7 and the increased TGFβ1, MSTN, phospho-smad2/3, phospho-p38, phospho-JNK1/2, and p21 induced by hind limb suspension. Moreover, the effects of exercise reloading on the restoration of gastrocnemius weight/body weight ratio, TGFβ1, MSTN, phospho-smad2, phospho-p38, phospho-JNK2, Pax7, as well as the induction of MyoD mRNA were stronger than those of natural reloading. Conclusions: Disuse muscle loss can be recovered by reloading in an intensity-dependent manner through canonical and noncanonical TGFβ signaling pathways. Pax7 and MyoD might be the effectors of TGFβ pathway in mediating the recovery effect of reloading. [ABSTRACT FROM AUTHOR]

The article presents the author's views on the article No Difference in 2-year Functional Outcomes Using Kinematic versus Mechanical Alignment in TKA: A Randomized Controlled Clinical Trial, published in a previous issue. He opines that kinematic and mechanical-axis alignment is the main focus on the paper and compares them in a well-designed randomized trial.

Practitioners' perceptions regarding the use and effectiveness of research evidence in sport is not well understood. The purpose of the present study was to examine practitioners' perceptions around the use, implementation, and barriers to evidence-based practice (EBP) in sport science in the United States of America (USA). A survey (28 items) was completed by 67 full-time staff who were a physical performance team member employed by universities or professional sporting organizations in the USA. Questions included the use of research, contribution of research areas, barriers to accessing and implementing EBP, and methods of feedback to the coach and players. All respondents (100%) stated they used research evidence in their performance/training program, ranking research as contributing most (largest contribution = 1 to smallest contribution = 4) to individualized preparation or recovery recommendations (1.98 ± 1.02). The top 3 preferred sources of information were "peer-reviewed research" (100% of respondents), "conferences/seminars" (76%), and "practitioners within your sport" (63%). Commonly reported perceived barriers between accessing and implementing research were "lack of staff" (accessing = 33%, implementing = 46%) "time" (accessing = 38%, implementing = 48%) and nonapplicable research (accessing = 33%, implementing = 37%), whereas "poor player compliance" was a clear barrier to implementing EBP (56%). Practitioners most preferred, and actual, method of feedback for coaching staff (87% for both) and players (94 and 95%, respectively) was "informal conversations/speaking." Improved access to educational and financial resources, increased integration of staff in coach settings and understanding of player/coach contexts may help to alleviate barriers to EBP. [ABSTRACT FROM AUTHOR]

Recently, an interest has developed in the potential to rinse the oral cavity with key nutrients to impact various types of exercise and presumably sporting performance. Although multiple studies examining carbohydrate mouth rinsing have been completed, conflicting evidence surrounding caffeine mouth rinsing persists, and no research has explored its ability to impact high-intensity, intermittent running performance. This study investigated the independent and synergistic ability of carbohydrate and caffeine mouth rinsing to improve intermittent running performance. The Yo-Yo Intermittent Recovery Test-Level 1 (Yo-Yo Level 1) was completed in 10 collegiate (National Collegiate Athletic Association [NCAA] Division II) male lacrosse players after a 10-second mouth rinse with a solution of either carbohydrate (CHO), caffeine (CAF), carbohydrate + caffeine (CHO + CAF), placebo (H2O), or a no rinse control (CON). No significant improvements in Yo-Yo IRT-1 performance were found (p > 0.05). Perceptual indications of effort (i.e., rating of their perceived exertion [RPE]) were significantly lower (p ≤ 0.05) in CHO and CHO + CAF when compared with CON after speed level 11. Interestingly, RPE levels were nonsignificantly lower in all but one level of the Yo-Yo Level 1 for CHO in comparison with other groups. Carbohydrate and caffeine mouth rinsing seems to exert no impact on running performance before maximal intermittent running in a group of male collegiate lacrosse players. [ABSTRACT FROM AUTHOR]