Reference: Wang XQ, Zheng JJ, Yu ZW, et al. A metaanalysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012;7(12):e52082.Clinical Questions: Is core stability exercise more effective than general exercise in the treatment of patients with nonspecific low back pain (LBP)?Data Sources: The authors searched the following databases: China Biological Medicine disc, Cochrane Library, Embase, and PubMed from 1970 through 2011. The key medical subject headings searched were chronic pain, exercise, LBP, lumbosacral region, and sciatica.Study Selection: Randomized controlled trials comparing core stability exercise with general exercise in the treatment of chronic LBP were investigated. Participants were male and female adults with LBP for at least 3 months that was not caused by a specific known condition. A control group receiving general exercise and an experimental group receiving core stability exercise were required for inclusion in the meta-analysis. Core stability was defined as the ability to ensure a stable neutral spine position, but the type of exercise was not specified. Outcome measures of pain intensity, back-specific functional status, quality of life, and work absenteeism were recorded at 3-, 6-, and 12-month intervals.Data Extraction: The study design, participant information, description of interventions in the control and experimental groups, outcome measures, and follow-up period were extracted. The mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate statistical significance. Risk of bias was assessed using the Cochrane Collaboration Recommendations, and all articles were rated as high risk for other bias with no further explanation given.Main Results: Five studies involving 414 patients were included. Four studies assessed pain intensity using the visual analog scale or numeric rating scale. In the core stability exercise group, the reduction in pain was significant at 3 months (MD ¼ À1.29, 95% CI ¼ À2.47, À0.11; P ¼ .003) but not at 6 months (MD ¼À0.50, 95% CI ¼À1.36, 0.35; P ¼ .26). Functional status was improved at 3 months (MD ¼ À7.14, 95% CI ¼ À11.64, À2.65; P ¼ .002) but not at 6 months (MD ¼À0.50, 95% CI ¼ 0.36, 0.35; P ¼ .26) or 12 months (MD ¼ À0.32, 95% CI ¼ À0.87, 0.23; P ¼ .25). All of the included studies assessed backspecific functional status: 4 used the Oswestry Disability Index and 1 used the Roland-Morris Disability Questionnaire. Patients in the core stability exercise groups experienced improved functional status versus the general exercise group at 3 months (MD ¼À7.14, 95% CI ¼À11.64, À2.65; P ¼ .002); no results were recorded at 6 or 12 months.Conclusions: In the short term, core stability exercise was more effective than general exercise for decreasing pain and increasing back-specific functional status in patients with LBP.

Context Medical documentation is a required component of patient care in all health care professions. Objective To evaluate athletic trainers' perceived behaviors toward, barriers to, and confidence in their medical documentation. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants We purchased a list of randomly selected e-mails from the National Athletic Trainers' Association. Of the 9578 participants, 1150 accessed our questionnaire (12.0% access rate), 1053 completed at least 1 portion, and 904 completed the questionnaire in its entirety (85.8% completion rate). Of the participants, 60.1% (n = 569/947) were female, 66.6% (n = 632/949) held a master's degree, 39.3% (n = 414/1053) worked in a collegiate or university setting, and 36.1% (n = 381/1053) worked in a secondary school setting. Main Outcome Measure(s) We used a 31-item questionnaire with demographics (12 items), medical documentation behaviors (16 items), barriers (2 items), and perceptions (1 multipart item) sections. The questionnaire explored athletic trainers' behaviors as well as confidence in, comfort with, and concerns about their documentation practices (Cronbach α = 0.887). We used descriptive statistics to identify characteristics of central tendency (mean, standard deviation, mode, frequency). Results Participants always (45.7%, n = 478/1046) or very frequently (39.0%, n = 408/1046) used a double documentation system consisting of electronic and paper records (50.4%, n = 523/1038). They most often documented to provide legal protection (86.8%, n = 914/1053), because it is a legal obligation (79.1%, n = 833/1053), or to track patient progress (83.9%, n = 883/1053). The most frequently cited barriers to medical documentation were time (76.5%, n = 806/1053), managing too many patients (51.9%, n = 547/1053), technological concerns (17.2%, n = 181/1053), and software limitations (17.2%, n = 181/1053). Respondents believed they were competent, comfortable, and confident in their documentation practices. Conclusions We were able to evaluate the generalizability of previous research while adding to the understanding of the behaviors toward, barriers to, and perceptions about medical documentation. We confirmed that time and patient load affected the ability to perform high-quality medical documentation.

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Reference/Citation: Roos KG, Marshall SW. Definition and usage of the term ''overuse injury'' in the US high school and collegiate sport epidemiology literature: a systematic review. Sports Med. 2014;44(3):405À421.Clinical Question: What is the current context of the term overuse in the epidemiologic sports injury literature?Data Sources: The authors performed a database search of PubMed and SPORTDiscus. The Boolean phrases athletics AND injury and overuse OR epidemiology were searched.Study Selection: Studies were included in the review based on the following criteria: (1) epidemiologic in nature, (2) involved US high school or collegiate athletes, and (3) published in English between 1996 and 2012. In addition, a study was classified as epidemiologic in nature if appropriate exposure data were collected in order to calculate injury incidence rates. One reviewer initially read the titles or abstracts of the studies to determine their relevance for the systematic review. Studies were excluded if they (1) were biomechanical or anatomical in nature, (2) were clinical in nature, or (3) assessed the effectiveness of an intervention.Data Extraction: The reviewer extracted statistics and definitions of the word and phrase overuse and no contact. The reviewer adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as much as possible.Main Results: A total of 5182 titles of articles were initially identified in the databases searched. Then 232 studies were read to determine if they included overuse statistics. A total of 35 articles were included in the final review. Two main surveillance programs were used in these studies, with the authors of 12 articles (n ¼ 12/35, 34.3%) using data from the High School Reporting Information Online (RIO) and the authors of 13 articles (n ¼ 13/35, 37.1%) using data from the National Collegiate Athletic Association's Injury Surveillance System (ISS). One group (n ¼ 1/35, 2.9%) used both surveillance systems, whereas 9 groups (n ¼ 9/35, 25.7%) used other surveillance systems. Articles were categorized as (1) high school or collegiate studies using neither ISS nor RIO data, (2) high school studies using RIO data, or (3) collegiate studies using ISS data. The authors of only 1 article of the 35 (2.9%) provided a comprehensive definition of the word overuse. Collectively, 14 groups classified overuse as a mechanism of injury, 7 classified it as a category of diagnosis, and 8 classified it as both a mechanism of injury and a category of diagnosis. Specifically, 12 of the 35 articles combined overuse with other terms such as chronic, gradual onset, and repetitive stress, whereas 4 of the 35 articles defined overuse in the context of no-contact injuries.Conclusions: A great deal of inconsistency exists within the sports injury epidemiological literature regarding the term overuse. The authors of the systematic review recommended using the term overuse when referencing the mechanism of injury. A working definition of the term overuse should be used...

Context Athletic trainers (ATs) recognize patient care documentation as an important part of clinical practice. However, ATs using 1 electronic medical record (EMR) platform reported low accountability and lack of time as barriers to documentation. Whether ATs using paper, other EMRs, or a combined paper-electronic system exhibit similar behaviors or experience similar challenges is unclear. Objective To explore ATs' documentation behaviors and perceived challenges while using various systems to document patient care in the secondary school setting. Design Qualitative study. Setting Individual telephone interviews. Patients or Other Participants Twenty ATs (12 women, 8 men; age = 38 ± 14 years; clinical experience = 15 ± 13 years; from National Athletic Trainers' Association Districts 2, 3, 6, 7, 8, 9, and 10) were recruited via purposeful and snowball-sampling techniques. Data Collection and Analysis Two investigators conducted semistructured interviews, which were audio recorded and transcribed verbatim. Following the consensual qualitative research tradition, 3 researchers independently coded transcripts in 4 rounds using a codebook to confirm codes, themes, and data saturation. Multiple researchers, member checking, and peer reviewing were the methods used to triangulate data and enhance trustworthiness. Results The secondary school setting was central to 3 themes. The ATs identified challenges to documentation, including lack of time due to high patient volume and multiple providers or locations where care was provided. Oftentimes, these challenges affected their documentation behaviors, including the process of and criteria for whether to document or not, content documented, and location and timing of documentation. To enhance patient care documentation, ATs described the need for more professional development, including resources or specific guidelines and viewing how documentation has been used to improve clinical practice. Conclusions Challenges particular to the secondary school setting affected ATs' documentation behaviors, regardless of the system used to document care. Targeted professional development is needed to promote best practices in patient care documentation.