Introduction Return to sports (RTS) clearance after anterior cruciate ligament (ACL) reconstruction typically includes multiple assessments. The ability of these tests to assess the risk of a reinjury remains unknown. Purpose To assess and rate RTS self-reported function and functional tests on prognostic value for reinjury risk after ACL reconstruction and RTS. Study Design: Systematic review on level 2 studies. Methods PubMed, Web of Knowledge, Cochrane Library, and Google Scholar databases were searched for articles published before March 2018. Original articles in English or German that examined reinjury risks/rates after primary (index) ACL injury, ACL reconstruction, and RTS were included. All RTS functional tests used in the included studies were analyzed by retrieving an effect size with predictive value (odds ratio, relative risk (risk ratio), positive predictive value, positive likelihood ratio, or hazard rate). Results A total of 276 potential studies were found; eight studies (moderate to high quality) on 6140 patients were included in the final analysis. The reinjury incidence recorded in the included studies ranged from 1.5% to 37.5%. Four studies reported a combination of isokinetic quadriceps strength at different velocities and a number of hop tests as predictive with various effect sizes. One reported isokinetic hamstring to quadriceps ratio (hazard rate = 10.6) as predictive. Two studies reported functional questionnaires (knee injury and osteoarthritis outcome score and Tampa Scale of Kinesiophobia-11; RR = 3.7–13) and one study showed that kinetic and kinematic measures during drop vertical jumps were predictive (odds ratio, 2.3–8.4) for reinjury and/or future revision surgery. Conclusions Based on level 2 evidence, passing a combination of functional tests with predetermined cutoff points used as RTS criteria is associated with reduced reinjury rates. A combination of isokinetic strength and hop tests is recommended during RTS testing.

BACKGROUND: Physical activity (PA) offers considerable health benefits for diabetic patients. However, extensive high levels of inactivity has been reported among diabetic patients. This study sought to assess the patterns of physical activity and its relationship with two management-relevant outcomes (glycaemic and blood pressure control)among people living with diabetes in the Ho Municipality, Ghana.METHODS: A hospital-based cross-sectional study was carried out from January 2017 to April 2017 among 150 purposively recruited diabetic patients who were receiving care at the diabetes clinics of the Volta Regional Hospital and the Ho Municipal Hospital. A semi structured questionnaire was used in capturing socio-demographic information. Physical activity was assessed using the International Physical Activity Questionnaire Short Form. Glycaemic and blood pressure control were evaluated within a three-month period from patients’ records.RESULTS: Physical activity estimates among participants were 21.33%, 48% and 30.67% for high, moderate and low PA respectively. Glycaemic control among the study participants was 33.33% and blood pressure control was 58.67%. Both glycaemic and blood pressure control were significantly associated with PA.CONCLUSION:In this group of PLWD in the Ho Municipality, high levels of inactivity, uncontrolled glycaemia and blood pressure exist. However, glycaemic and blood pressure control may be modulated by moderate-intensity physical activity.

BackgroundAccessibility implies making public places accessible to every individual, irrespective of his or her disability or special need, ensuring the integration of the wheelchair user into the society and thereby granting them the capability of participating in activities of daily living and ensuring equality in daily life.ObjectiveThis study was carried out to assess the accessibility of the physical infrastructures (public buildings) in the Kumasi metropolis to wheelchairs after the passage of the Ghanaian Disability Law (Act 716, 2006).MethodsEighty-four public buildings housing education facilities, health facilities, ministries, departments and agencies, sports and recreation, religious groups and banks were assessed. The routes, entrances, height of steps, grade of ramps, sinks, entrance to washrooms, toilets, urinals, automated teller machines and tellers’ counters were measured and computed.ResultsOut of a total of 84 buildings assessed, only 34 (40.5%) of the buildings, 52.3% of the entrances and 87.4% of the routes of the buildings were accessible to wheelchair users. A total of 25% (13 out of 52) of the public buildings with more than one floor were fitted with elevators to connect the different levels of floors.ConclusionThe results of this study show that public buildings in the Kumasi metropolis are not wheelchair accessible. An important observation made during this study was that there is an intention to improve accessibility when buildings are being constructed or renovated, but there are no laid down guidelines as how to make the buildings accessible for wheelchair users.

BackgroundThe devastating impact of musculoskeletal injury (MSI) on human lives, the economy, and health services cannot be overemphasised. This has ignited discussion at international fora, as countries have been exhorted to prioritise management of MSI in order to maintain a healthy society. In the Ghanaian context, the knowledge base management of MSI is very low, which has provided the impetus to explore the management of MSI and the rehabilitation systems at a tertiary hospital in Ghana.MethodsThe study was a retrospective cross-sectional study, using the consecutive sampling method to recruit patients who were discharged after admission at the accident and emergency unit, as well as patients undergoing orthopaedic review, at the St. Joseph’s Orthopaedic Hospital in Koforidua over a six-month period.ResultsA total of 269 musculoskeletal injury patients were recruited for the study. Half of the participants (51%) had had surgery in addition to pain medication. The overall mean recovery days were 26.81 ± 33.94 days, and the average disability days spent in the hospital were estimated at 16.54 ± 27.97 days. Individuals reported financial constraints as a major challenge to their full participation in rehabilitation.ConclusionThe findings of this study have implications for policymaking in Ghana. Particularly, the need to improve health facilities to enable MSI patients to seek treatment is highlighted. Also, the need to train health professionals who will be able to administer appropriate medication for MSI patients is discussed extensively.

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BackgroundIn team-sports such as football or basketball, athletes need to rapidly adapt their motor plans and actions to unanticipated changes in the environment. Unanticipated jump-landing tasks have been found to elevate the risk of non-contact anterior cruciate ligament (ACL) injuries compared to an anticipated condition. ACL-reconstructed individuals may have greater difficulties to maintain neuromuscular control under unanticipated conditions exposing them to a higher reinjury risk during the game. The planned trial aims to investigate the acute effects of a team-sport specific injury prevention programme on potential ACL reinjury risk factors under anticipated and unanticipated jump-landings.Methods and design:Single center randomized controlled crossover trial. Female and male ACL-reconstructed participants cleared for return to sports (≥ 6 months and ≤ 24 months post-reconstruction) will be included. In a randomized sequence and with a washout phase of one week in between, the participants will perform an injury preventive warm-up protocol (PEP; strengthening, flexibility, plyometry and agility) and a standard warm-up program (bicycle ergometer). Both interventions will last for 12 minutes and will be conducted at moderate intensity (BORG scale: 12 to 14). After each warm-up, participants will perform counter movement jumps with single-leg landings on a force plate. Prior to the jump, a left or right footprint (equally distributed) will be indicated on a screen. Under the anticipated condition, the participants will be informed before the jump that the displayed footprint will not change after take-off. Under the unanticipated condition, the participants will not know whether the target landing side will remain the same (consistent with pre-movement expectations) or change (inconsistent). Under both unanticipated conditions, this information will be displayed 0.1 second after take-off and thus approximately 0.3 seconds before landing.Parametric/non-parametric crossover-analyses (carryover-tests and crossover test) for between-conditions comparisons will be applied. Trial registration: German Clinical Trials Register, identification number DRKS00016942. Registered on May 24, 2019.

In team sports such as football, athletes are often required to adapt their motor plans in response to unpredictable/unanticipated visual information on the playing field under time pressure. These unanticipated movements lead to high-risk knee mechanics (landing safety decrements) which elevates injury/re-injury risk compared to pre-planned tasks. PURPOSE: To compare the magnititude of landing safety decrements ('unanticipated-landing costs') in athletes with and without a history of anterior cruciate ligament (ACL) reconstruction. METHODS: Matched-paired cross-sectional data from 14 ACL-reconstructed (females: n=6, mean age: 23±5 SD, BMI: 23±4 Kg/m 2 , Tegner activity score (TAS): 8±1; time since surgery: <2 years) and 14 healthy individuals (females: n=6, mean age: 26±3, BMI: 22±2 Kg/m 2 , TAS: 8±2) were analyzed. Participants performed countermovement-jumps with pre-planned or unanticipated single-leg landings on force plates. Landing kinetics (peak vertical ground reaction forces; pGRF), postural landing stability (center of pressure, time to stabilization), and decision-making quality (number of landings on wrong foot) were assessed. RESULTS: In both groups, the unanticipated condition resulted in significantly higher pGRF (ACL: 52 ± 4 vs. 56 ± 5 N/Kg, p = 0.004; Controls: 55 ± 7 vs. 59 ± 5 N/Kg, p = 0.021) and decision errors (ACL: 0 ± 0 vs. 3.2 ± 2, p = 0.001; Controls: 0 ± 0 vs. 2.1 ± 1.7, p = 0.003) compared to the pre-planned condition. The magnitude of unanticipated-landing costs did not differ significantly between groups (p>0.05) for all the outcomes assessed. CONCLUSION: Unanticipated-landing costs occurred in both groups, but their magnitude was not significantly higher in the ACL-reconstructed group. To further elucidate the ACLinjury/re-injury risk associated with unanticipated movements, future biomechanical studies measuring joint kinetics and kinematics are warranted.

In football, unpredictable events (e.g. unexpected landings) seem to play a crucial role in the mechanism of non-contact knee injuries. This study investigated the effects of a single bout of an injury preventive warmup protocol on biomechanical landing stability and decision-making quality during preplanned and unanticipated jump-landings. A crossover study on 18 male amateur football players was performed. The participants completed a standard (ergometer) and an injury-preventive warmup protocol (Prevent injury and Enhance Performance (PEP)) on two different test days. After each protocol, participants performed countermovement jumps with preplanned (landing side displayed before takeoff) and unanticipated (landing side shown after takeoff) single-leg landings on a force plate. Outcomes were landing stability (height and time of the maximum vertical ground reaction force (pGRF), centre of pressure (CoP), the number of standing errors (ground contact with free leg)) and decision-making quality (landing error (wrong foot) count). Carry-over and crossover-tests were performed to find potential between-condition-differences. No carry-over effects occurred (p > .05). The PEP led to a reduced CoP trace length (−18.4 ± 32.2%, p = .021) and earlier occurrence of pGRF (−4.72 ± 6.78%, p = .017) in the preplanned condition. No significant between-treatment-differences occurred within the unanticipated landings and decision-making quality (p > .05). The primarily neuromuscular warmup protocol affects landing stability in the preplanned condition. However, it does not seem to better prepare football players for unpredictable events than a standard warmup. Trial registration: German Clinical Trials Register identifier: DRKS00016942. Highlights . Adapting movements rapidly to unanticipated external stimuli (e.g. unexpected landings) is crutial to prevent injuries in football . It is unclear wether popular neuromuscular injury preventive warmup programmes (e.g. Prevent injury and Enhance Performance (PEP)) adaquatly prepare athletes for these situations . Our study shows that the PEP warm up programme has acute effects on anticipated landing stability, but no influence on unanticipated landings or decision making quality . Classic neuromuscular warm up programmes may not be the optimal choice to prepare athletes properly for the upcoming motor-cognitive demands in a football match