Rehabilitation interventions need more than methodological standardisation: an individualised approach

Welch, Neil; Richter, Chris; Moran, Kieran; Franklyn-Miller, Andrew

doi:10.1136/bmjsem-2020-000899

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…Data established seems to strongly agree with the current evidence [8,44,45]; COD is considered an evocative and provocative movement in groin pain [46,47] and both a sport-specific movement and a reliable outcome measure [48,49].…”

Section: Performance Testssupporting

confidence: 78%

Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts

Vergani

Cuniberti

Zanovello³

et al. 2022

Sports Med - Open

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Background Groin pain is a very common injury in multidirectional sports such as soccer, ice hockey, rugby and Australian football. Long-standing adductor-related groin pain is a persistent clinical condition and a frequent complaint in athletes involved in sports that require multiplanar movement patterns (change of direction, high-speed sprinting and kicking). To date, the lack of rehabilitation guidelines and return-to-play criteria makes this clinical entity difficult to manage. The aim of the present Delphi was to suggest, based on opinion and practical experience of a panel of experts, potential criteria that could be taken into consideration by clinicians in the RTP decision-making process in athletes suffering from long-standing adductor-related groin pain. Methods Thirty two out of 40 experts participated to a 3-Round Delphi questionnaire. In round 1, open-ended and closed questions about 9 different sections (palpation, flexibility, strength, patient-reported outcome measures, imaging, intersegmental control, performance tests, sport-specific skills, training load) were proposed to investigate return to play evaluation criteria used by each expert. Responses were analysed and coded to produce round 2 questionnaire that investigated only the sections and the items that reached the cut-off value (≥ 70%). Round 3 questionnaire was based on sections and items that reached cut-off value in previous rounds and experts rated their agreement for return to play criteria with a 5-point Likert Scale. Descriptive statistics enabled interpretation of consensus. Results High participation rate (80%) and response rate across the 3 rounds (100%) were recorded. 6 sections reached positive consensus in round 1, 1 section reached negative consensus. In round 2 positive consensus was confirmed only for 3 sections and negative consensus for 1 section. In round 3, positive agreement was established for strength (3 items), performance tests (3 items) and sport-specific skills (2 items) sections. Negative consensus was confirmed for imaging section. Conclusion Experts agreed that strength, performance tests and sport-specific skills can be used to support RTP decision, while imaging cannot be used. These findings could be useful in assisting clinicians in the RTP decision making.

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Section: Performance Testssupporting

confidence: 78%

Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts

Vergani

Cuniberti

Zanovello³

et al. 2022

Sports Med - Open

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“…Considering the large inter-individual variability observed in the functional recovery patterns, this analysis presents the major advantage to consider all tests, variables and their variations in the acute and delayed recovery periods, thus characterizing more specifically the individual profiles. The interest of inter-individual analysis has recently been demonstrated by Welch et al (2020) for the analysis of injured individuals based on their physical performance analysis. This overall analysis is thus considered of importance to define the optimal time for returning to the running practice depending on the recovery phase and on the tests where the decrements were observed.…”

Section: Discussionmentioning

confidence: 99%

Sex Influence on the Functional Recovery Pattern After a Graded Running Race: Original Analysis to Identify the Recovery Profiles

et al. 2021

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This study investigated the sex influence on the acute and delayed fatigue effects of a 20 km graded running race. Eighteen recreational runners, 10 women and 8 men, completed the race. The testing protocol included five sessions: a week before the race (PRE), 35 ± 15 min after (POST), 2 h, 2 and 4 days (2D and 4D) later. Each session included uni- and bilateral maximal isometric voluntary contractions of the knee extensors (MVC), a squat jump (SJ), and a drop jump (DJ). Acute and delayed muscle soreness (DOMS) were evaluated for the quadriceps, hamstring and triceps surae muscle groups. The 2D and 4D sessions included also a horizontal force-velocity test (HF-V) performed under five resistive conditions. For each test, a set of key variables was computed to characterize the lower limb functional recovery. Mixed ANOVA analyses revealed significant (sex × time) interactions, with larger acute drops for men in MVCs and earlier recovery for women in the bilateral MVC (p < 0.001) and DJ (p < 0.05) tests. Only women reported DOMS for the hamstrings at 2D (p < 0.001) and showed small improvements in pure concentric SJ (p < 0.05) and HF-V (p < 0.01) tests at 4D. As expected, DOMS disappeared prior to the complete functional recovery. These results confirmed the combined influence of testing task and sex on the functional recovery pattern while supporting a lesser and faster recovery in women. The originality of this study lies in the complexity and sex-dependence of the functional recovery pattern revealed by a multiple factorial analysis which was used to identify the most discriminating tests and variables in the recovery pattern. The obtained clusters highlighted some recovery profiles associated with greater risks of injury when starting to run again. However, the lack of sex × time interaction for normalized values emphasizes the major influence of men’s initially higher functional values compared to women.

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“…Patients must be informed of the lengthy rehabilitation process, and rehabilitation should be tailored to the individual (Proctor et al, 2008 ; Welch et al, 2020 ). This study, as well as other studies, have identified that this individualized care is lacking (Eastwood et al, 2002 ; Röding et al, 2003 ).…”

Section: Comprehensive Understanding and Discussionmentioning

confidence: 99%

Lingering challenges in everyday life for adults under age 60 with hip fractures – a qualitative study of the lived experience during the first three years

Rönnquist

Svensson

Jensen

et al. 2023

International Journal of Qualitative Studies on Health and Well

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Purpose We aimed to illuminate the lived experiences and the path of recovery for adults sustaining a hip fracture before the age of 60. Methods Participants were purposively sampled from a prospective multicenter cohort study in Sweden and Denmark, and narrative interviews were conducted with 19 individuals 0.7–3.5 years after the fracture. We used a phenomenological hermeneutic method to describe the participants’ expressed essential meaning. Results The experience of sustaining a hip fracture was expressed as a painful and protracted process of regaining self-confidence, function, and independence. It also implied a sense of growing old from one day to the next. Participants were afraid of new falls and fractures, resulting in an increased wariness. When expressing fears and persisting symptoms, participants described being neglected and marginalized by the healthcare system, which was perceived as non-receptive and routinely driven by a notion that hip fractures affect only the elderly. Rehabilitation targeted towards needs different from those of elderly individuals was requested. Conclusion The lived experience of sustaining a hip fracture in individuals under 60 includes substantial challenges in everyday life, even up to 3.5 years after the injury. Rehabilitation pathways tailored to the needs of younger patients are requested.

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Rehabilitation interventions need more than methodological standardisation: an individualised approach

Cited by 6 publications

References 31 publications

Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts

Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts

Sex Influence on the Functional Recovery Pattern After a Graded Running Race: Original Analysis to Identify the Recovery Profiles

Lingering challenges in everyday life for adults under age 60 with hip fractures – a qualitative study of the lived experience during the first three years

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