Background:The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between “no pain” and “worst pain.”Methods:One hundred consecutive patients aged ≥18 years who presented with a chief complaint of pain were asked to record pain scores via a paper VAS and digitally via both the laptop computer and mobile phone. Ninety-eight subjects, 51 men (age, 44 ± 16 years) and 47 women (age, 46 ± 15 years), were included. A mixed-model analysis of covariance with the Bonferroni post hoc test was used to detect differences between the paper and digital VAS scores. A Bland–Altman analysis was used to test for instrument agreement between the platforms. The minimal clinically important difference was set at 1.4 cm (14% of total scale length) for detecting clinical relevance between the three VAS platforms. A paired one-tailed Student t-test was used to determine whether differences between the digital and paper measurement platforms exceeded 14% (P < 0.05).Results:A significant difference in scores was found between the mobile phone–based (32.9% ± 0.4%) and both the laptop computer– and paper-based platforms (31.0% ± 0.4%, P < 0.01 for both). These differences were not clinically relevant (minimal clinically important difference <1.4 cm). No statistically significant difference was observed between the paper and laptop computer platforms. Measurement agreement was found between the paper- and laptop computer–based platforms (mean difference, 0.0% ± 0.5%; no proportional bias detected) but not between the paper- and mobile phone–based platforms (mean difference, 1.9% ± 0.5%; proportional bias detected).Conclusion:No clinically relevant difference exists between the traditional paper-based VAS assessment and VAS scores obtained from laptop computer– and mobile phone–based platforms.

Background: Few investigations have examined dance-specific injury prevention programs (IPPs), and no published randomized controlled trials are available that evaluate IPPs for dance. Hypothesis: The implementation of an IPP will significantly reduce the risk of injury in professional ballet dancers. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A randomized controlled trial was designed that entailed a superiority model for the intervention group. All professional dancers from a single ballet company were eligible to participate. Randomization and allocation were performed before the start of the season. The control group practiced and performed without change to preexisting standard operating practice. The IPP group was instructed to perform a 30-minute exercise program 3 times per week over the 52-week study period. Injuries were recorded. Standard continuous and categorical data comparisons and correlations were used. Cox proportional hazards regression models for recurrent failures were used wherein the hazard ratio indicates the relative likelihood of injury in the control versus intervention groups. Results: Of the 52 eligible dancers, 75% (n = 39) participated. Of these 39 dancers, 19 (9 males, 10 females; mean age, 26.6 ± 4.0 years) were randomized to the control group and 20 (11 males, 9 females; mean age, 25.1 ± 5.1 years) to the IPP group. No significant ( P > .05) difference was found in baseline demographics between groups. A total of 116 injuries were recorded for the entire study population (49 IPP; 67 control). Traumatic and chronic injuries accounted for 54% and 46% of injuries, respectively. The injury rate was 82% less (IPP hazard ratio, 0.18; z = –2.29; P = .022) in the IPP group after adjustment for confounding variables, and time between injuries was 45% longer (IPP hazard ratio, 0.55; z = –2.20; P = .028) than for controls. Conclusion: The present study is the first prospective randomized controlled investigation of an IPP for professional ballet. The results showed an 82% decrease in injury rate for the intervention group and an extended period from previous injury to subsequent injury. Registration: NCT04110002 ( ClinicalTrials.gov identifier ).

Early return to play among athletes before Jones fracture union is associated with increased risk of failure. This study introduces a plantar-lateral plating construct that performed more favorably than intramedullary screw fixation when applied to simulated Jones fractures in cadaveric foot specimens. Further clinical comparative studies are needed to assess the clinical use of this construct.

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Level III, systematic review of Level II-III studies.

Objectives: Patients often experience atrophy and bone loss immediately following anterior cruciate ligament (ACL) reconstruction. Rehabilitation (rehab) combined with blood flow restriction (BFR) therapy have been shown to mitigate muscle atrophy and reduce timelines for earlier return to function. Little is known about how BFR may impact bone loss. The objectives this study were to determine if BFR provides additional benefits when added to standard rehab in young active patients following ACL reconstruction with regards to preserving bone, recovering muscle, and regaining physical function. Methods: Fourteen active young adults (M=8, F=6; 23±7 yr; 170±10 cm, 75±14 kg) undergoing ACL repair via patellar tendon autograft were recruited, provided informed consent, and were randomized into two groups (CONTROL, n=7 & BFR, n=7) who performed 12wks of rehab beginning at 10 days post-surgery (2/wk). Both groups performed the same rehab protocol. However, during select exercises [quadriceps contractions wks1-3, bilateral leg press wk3-12, eccentric leg press wk4-12, hamstring curl wk4-6, eccentric hamstring curl wk7-12.], the BFR group exercised with 80% arterial limb occlusion using an automated tourniquet around the proximal thigh outfitted with Doppler (Delfi®). Exercise resistance was set at 20% of predicted 1-repetition maximum assessed in the contralateral limb. Exercises were performed for 4 sets of 30-15-15-15 repetitions separated by 30 s of rest. Functional assessments were performed at wk8 and wk12 post-surgery. Bone mineral density (BMD), bone mass, and lean muscle mass (LM) were measured using DEXA (Figure 1, GE®) at pre-surgery as well as wk6 and wk12 of rehab. Statistical Analysis: A 2(group) x 3(time) ANCOVA (co-varied on pre-surgery measures) was used to detect and compare changes in muscle and bone measures from pre-surgery at wk6 and wk12. A 2(group) x 2(time) ANOVA was used to detect and compare changes in functional outcomes tested at wk8 and wk12 between groups. Significant interactions were followed with a Tukey’s post hoc test for pairwise comparisons. Type I error was set at α=0.05. Results: Results are shown in Table 1. Both groups experienced similar decreases from pre-surgery measures in total LM at wk6 (p<0.05) with total lean mass in only the CONTROL group remaining diminished at wk12 (p<0.05). Whole leg LM in the injured limb was decreased in the CONTROL group, but not the BFR group, at both wk6 and wk12 (p<0.05). Thigh LM was found to be decreased in both groups at wk6 but to a greater extent in the CONTROL compared to the BFR group and remained decreased in only the CONTROL group at wk12. Whole leg bone mass was decreased in the control group at wk6 and in both groups wk12 (p<0.05). The CONTROL group was observed to have a decrease in BMD at the distal femur and proximal tibia as wk12 as well as the proximal fibula at wk6 and wk12 (p<0.05). Both groups demonstrated similar improvements in single leg squat distance, Y-balance, leg curl, and leg press from wk8 to wk12 of rehab (p<0.05). (Completed Data, N=32 anticipated by time of conference). Conclusion: In addition to recovering muscle to a greater extent than standard rehab alone, the addition of BFR to ACL rehab exercises appears to have a protective effect on bone. This effect also appears to not be limited to the site of cuff compression. Future studies are needed to examine the biochemical and mechanical mechanisms by which BFR may simultaneously act on bone and muscle. [Table: see text]

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