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The sequelae of concussion may have psychological consequences that affect an athlete’s ability to return to play. While a lingering lack of confidence may decrease athletes’ performance and lead to fear, anxiety, and reinjury, confidence or other psychological measures are not currently monitored after a concussion. This study aimed to examine the acute and longitudinal effects of concussion on an athlete’s confidence (Aim 1), examine the relationship between standard clinical assessments and athlete confidence after concussion (Aim 2), and explore the interactions between symptoms, sex, sport type (contact vs. noncontact), and confidence after concussion (Aim 3). Forty-six collegiate athletes sustained a concussion, provided informed consent per an IRB-approved protocol, and completed the Injury Psychological Readiness to Return to Sport Scale (I-PRRS) at three time points: within 72 hours after a concussion (Acute) upon beginning the return-to-play (RTP) protocol (Pre-RTP), and after being cleared for nonrestricted return to competition (Post-RTP). The I-PRRS was modified to make it appropriate for concussion (e.g., “pain and/or symptoms”) and scored out of 60 possible points. Linear mixed models examined how concussion impacts confidence and how confidence changes over time. Athletes reported low confidence acutely (I-PRRS mean [SD] = 32.59[18.45], which improved over time [Pre-RTP mean [SD] = 52.11[9.60]; Post-RTP mean [SD] = 57.45[5.96]). Some athletes returned to competition (Post-RTP) with lingering confidence concerns (i.e., I-PRRS < 50; 95% CI [0.03, 0.26]). There was no relationship between clinical balance performance and confidence (p = 0.1760), but symptom severity acutely after concussion was associated with worse confidence longitudinally (p < 0.0001). Sex and sport type (contact vs. noncontact) similarly had no relationship with confidence (p = 0.4063, p = 0.3314, respectively). These results show that athletes have a lack of confidence acutely (within 72 hours of impact) following concussion. While confidence improves over time, those who report greater acute symptoms also exhibit decreased confidence, and some athletes are returning to play with lingering concerns about their confidence (I-PRRS < 50). These results support the growing evidence of the importance of psychological factors after injury, specifically concussions. This preliminary evidence of the decreased confidence following concussion encourages the assessment and monitoring of confidence throughout the return to play concussion protocol.

Wearable sensors are increasingly popular in concussion research because of their objective quantification of subtle balance deficits. However, normative data and minimal detectable change (MDC) values are necessary to serve as references for diagnostic use and tracking longitudinal recovery. To identify normative and MDC values for instrumented static- and reactive-balance tests, an instrumented static mediolateral (ML) root mean square (RMS) sway standing balance assessment and the instrumented, modified push and release (I-mP&R), respectively. Cross-sectional study. Clinical setting. Normative static ML RMS sway and I-mP&R data were collected on 377 (n = 184 female) healthy National Collegiate Athletic Association Division I athletes at the beginning of their competitive seasons. Test-retest data were collected in 36 healthy control athletes based on standard recovery timelines after concussion. Descriptive statistics, intraclass correlation coefficients (ICCs), and MDC values were calculated for primary outcomes of ML RMS sway in a static double-limb stance on firm ground and a foam block, and time to stability and latency from the I-mP&R in single- and dual-task conditions. Normative outcomes across static ML RMS sway and I-mP&R were sensitive to sex and type of footwear. Mediolateral RMS sway demonstrated moderate reliability in the firm condition (ICC = 0.73; MDC = 2.7 cm/s2) but poor reliability in the foam condition (ICC = 0.43; MDC = 11.1 cm/s2). Single- and dual-task times to stability from the I-mP&R exhibited good reliability (ICC = 0.84 and 0.80, respectively; MDC = 0.25 and 0.29 seconds, respectively). Latency from the I-mP&R had poor to moderate reliability (ICC = 0.38 and 0.55; MDC = 107 and 105 milliseconds). Sex-matched references should be used for instrumented static- and reactive-balance assessments. Footwear may explain variability in static ML RMS sway and time to stability of the I-mP&R. Moderate-to-good reliability suggests time to stability from the I-mP&R and ML RMS static sway on firm ground can be used for longitudinal assessments.

Background: Malpositioning of the glenoid component in total shoulder arthroplasty (TSA) remains the primary source of loosening. The purpose of this study is firstly, to quantify postoperative glenoid component position in patients having a TSA and secondly, to explore whether glenoid component radiolucency is associated with glenoid position, clinical outcomes and patient-reported measures in the short-term (two year) follow-up period. Methods: This study was a sub-study of a larger clinical trial that included patients who underwent a TSA and who were randomized into two different glenoid types with a minimum two-year follow-up period. Post-operative radiographic assessments (six weeks and two years) were used to measure glenoid component position (version, inclination, offset) and humeral head centering anterior–posterior (AP) and superior–inferior (SI), and to assess glenoid component radiolucent scoring (modified Lazarus). Pre-operative X-rays were used to measure glenoid version, inclination and Walch classification. Patient-reported measures (PROMs) included the EQ-5D health slider and the Western Ontario Osteoarthritis (WOOS) and American Shoulder and Elbow Surgeons (ASES) score and were captured at baseline and two years postoperative. Clinical outcomes including range of motion and complications were also documented. Statistical analysis included t-tests and regression modeling. Results: Ninety-one patients with an average age of 69.9 ± 6.2 years were included in this study. Glenoid component position improved significantly in version (−19.4 ± 8.6° to −17.7 ± 8.5°; p < 0.045) and inclination (11.5 ± 7.1° to 5.9 ± 6.3°; p < 0.00001) from preoperative to six weeks postoperative. Glenoid component offset in SI and humeral head centering in AP remained unchanged throughout the follow-up. Radiolucency (Lazarus classification) was recorded in 21 cases (17.3%) with a Lazarus score of 1 (15 cases) and 2 (6 cases). The EQ-5D health slider, WOOS and ASES, and ROM confirmed continuous improvements from the preoperative scores to the two-year follow-up (p < 0.05). Regression models showed no correlation between glenoid component radiolucency at two years and the postoperative week six glenoid component position; however, female gender was a significant variable. Conclusion: Glenoid component changes from its original native glenoid were observed following TSA. Glenoid inclination was improved more than version from baseline, and the humeral head remained well-centered in AP and SI at two years. Radiolucency of the glenoid at two years is not negatively associated with PROMs or component position; however, female gender was identified as a significant predictor and warrants further investigation. Complications are not associated with glenoid position or radiolucency, but longer-term follow-up is required.