Context After a lower extremity injury, patients often return to sport (RTS) when the injured limb's performance on unilateral hopping tests is similar to that of the uninjured limb. However, the exact target symmetry value patients must reach before the RTS is unclear. Objective To identify variables that predict limb symmetry index (LSI) values on 6 unilateral hopping tests in healthy, physically active adults. Design Cross-sectional study. Setting Research laboratory. Patients or Other Participants In total, 275 healthy, physically active adults, consisting of recreational athletes (n = 198), National Collegiate Athletic Association Division I student-athletes (n = 56), and Army Reserve Officer Training Corps cadets (n = 21), volunteered to participate (143 men, 132 women, age = 20.16 ± 2.19 years, height = 172.66 ± 10.22 cm, weight = 72.64 ± 14.29 kg). Intervention(s) Each participant completed 3 speed (6-m crossover hop, side hop, figure-8 hop) and 3 distance (triple-crossover hop, lateral hop, medial hop) functional performance tests on both limbs. Main Outcome Measure(s) Mean performance of the dominant and nondominant limbs and LSI values. Two multiple regression models were used to find variables that might help to predict a participant's LSI for each functional performance test. Results The models helped to predict limb symmetry for 10 of the 12 multiple regressions. Unilateral limb performance was the best predictor of LSI values, as it was statistically significant in 11 of the 12 regression models. Sex and body mass index were significant predictor variables for the side hop and figure-8 hop, respectively. Conclusions We found significant predictor variables that clinicians can use in the absence of baseline testing to determine patient-specific LSI values. Individualizing RTS decisions in this way may help to minimize subjectivity in the decision-making process and ensure a safe and timely return to competition.
Context: The Patient-Reported Outcomes Measurement Information System (PROMIS) item banks have been validated for general populations, but their application to high-functioning patient populations remains speculative.Objective: To examine the measurement properties of the PROMIS physical function item bank, version 1.0, when applied to individuals representing high levels of physical ability.Design: Cross-sectional study. Setting: National Collegiate Athletic Association Division I and III collegiate athletic training rooms and intramural events.Patients or Other Participants: A heterogeneous sample of 215 adults from Division I or Division III collegiate or recreational sports volunteered for this study. Participants were divided into 4 groups depending on sport activity and injury status: healthy collegiate (HC; 33 men, 37 women; age ¼ 19.7 6 1.1 years), injured and currently active in sport (IP; 21 men, 29 women; age ¼ 19.9 6 1.2 years), injured and currently not active in sport (INP; 12 men, 18 women; age ¼ 19.7 6 1.3 years), and healthy recreational (HR; 47 men, 18 women; age ¼ 20.1 6 1.4 years).Main Outcome Measure(s): Participants completed 2 assessments: (1) an injury-history questionnaire and (2) the PROMIS physical function item bank, version 1.0, in computeradaptive form. Mean PROMIS physical function scores were determined for each group.Results: The PROMIS physical function score for the HC group (61.7 6 6.0) was higher than for the IP (54.9 6 7.5) and INP (44.1 6 8.2) groups (P , .001). The IP group had a higher score than the INP group (P , .001). Mean PROMIS scores were not different between the HC and HR participants (mean difference ¼ 1.9, P ¼ .10).Conclusions: The computer-adaptive PROMIS physical function item bank, version 1.0, accurately distinguished injury status in elite-level athletes on a physical function latent trait continuum. Although it was unable to distinguish HC athletes from HR athletes, exposing a possible ceiling effect, it offers potential for use as an outcome instrument for athletic trainers and other sports medicine clinicians.Key Words: athletic injuries, clinical decision making, PROMIS Key PointsThe Patient-Reported Outcomes Measurement Information System (PROMIS) physical function item bank, version 1.0, accurately differentiated physical function in collegiate athletes who were healthy, injured and participating, or injured and not participating. The PROMIS did not distinguish healthy collegiate athletes from healthy recreational athletes. The most difficult sport-related items address running speed and distance, which may not accurately distinguish elite athletes from the general population. Based on these findings, the PROMIS may be a useful tool for assessing physical ability in the early stages of rehabilitation. However, it seems to lack the ability to identify healthy individuals with unrestricted participation.
Study Design Laboratory-based, cross-sectional study. Background Functional performance tests (FPTs) assess short bouts of unilateral hops for either distance or speed. More research is needed to identify specific FPTs that may be useful for measuring asymmetry outcomes related to functional performance and perceived instability deficits in individuals with chronic ankle instability (CAI). Objectives To identify FPTs that are sensitive to subjective and objective deficits associated with CAI. Methods Twenty-four subjects with unilateral CAI (10 male, 14 female; mean ± SD age, 20.7 ± 3.0 years) and 24 healthy, matched controls (10 male, 14 female; age, 20.1 ± 2.6 years) completed 5 unilateral FPTs in random order. Mean FPT scores and functional symmetry percentages were calculated and compared between groups using 2 separate 1-way multivariate analyses of variance (MANOVAs). Perceived instability symmetry percentages were compared between groups using a Mann-Whitney U analysis. Results There were no differences in the mean FPT scores (P>.05) or functional symmetry percentages (P>.05) between groups for any of the 5 FPTs. However, participants with CAI perceived greater instability when using their involved limb during the side hop (P = .02), 6-meter crossover hop (P = .003), lateral hop (P = .007), and figure-of-eight hop (P = .008). Conclusion There were no differences in mean functional scores between groups for all 5 FPTs, and each group performed symmetrically. Regardless, administering a visual analog scale following the completion of the side hop, 6-meter crossover hop, lateral hop, and figure-of-eight hop tests captures subjective reports of perceived instability in the involved limb that can be compared bilaterally throughout treatment. J Orthop Sports Phys Ther 2018;48(5):372-380. Epub 30 Mar 2018. doi:10.2519/jospt.2018.7514.
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