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Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial
Anterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.
We did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.
Between Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.
Surgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management.
The UK National Institute for Health Research Health Technology Assessment Programme.
Journal Article
Does the Spraino low-friction shoe patch prevent lateral ankle sprain injury in indoor sports? A pilot randomised controlled trial with 510 participants with previous ankle injuries
BackgroundLateral ankle sprains are common in indoor sports. High shoe–surface friction is considered a risk factor for non-contact lateral ankle sprains. Spraino is a novel low-friction patch that can be attached to the outside of sports shoes to minimise friction at the lateral edge, which could mitigate the risk of such injury. We aimed to determine preliminary effectiveness (incidence rate and severity) and safety (harms) of Spraino to prevent lateral ankle sprains among indoor sport athletes.MethodsIn this exploratory, parallel-group, two-arm pilot randomised controlled trial, 510 subelite indoor sport athletes with a previous lateral ankle sprain were randomly allocated (1:1) to Spraino or ‘do-as-usual’. Allocation was concealed and the trial was outcome assessor blinded. Match and training exposure, number of injuries and associated time loss were captured weekly via text messages. Information on harms, fear-of-injury and ankle pain was also documented.Results480 participants completed the trial. They reported a total of 151 lateral ankle sprains, of which 96 were categorised as non-contact, and 50 as severe. All outcomes favoured Spraino with incidence rate ratios of 0.87 (95% CI 0.62 to 1.23) for all lateral ankle sprains; 0.64 (95% CI 0.42 to 0.98) for non-contact lateral ankle sprains; and 0.47 (95% CI 0.25 to 0.88) for severe lateral ankle sprains. Time loss per injury was also lower in the Spraino group (1.8 vs 2.8 weeks, p=0.014). Six participants reported minor harms because of Spraino.ConclusionCompared with usual care, athletes allocated to Spraino had a lower risk of lateral ankle sprains and less time loss, with only few reported minor harms.Trial registration number NCT03311490.
Journal Article
Preventing musculoskeletal injuries among recreational adult volleyball players: design of a randomised prospective controlled trial
Background
Both acute and overuse injuries are common among recreational volleyball players, especially finger/wrist, ankle, shoulder and knee injuries. Consequently, an intervention (‘VolleyVeilig’) was developed to prevent or reduce the occurrence of finger/wrist, shoulder, knee and ankle injuries among recreational volleyball players. This article describes the design of a study evaluating the effectiveness of the developed intervention on the one-season occurrence of finger/wrist, shoulder, knee and ankle injuries among recreational adult volleyball players.
Methods
A randomized prospective controlled trial with a follow-up period of one volleyball season will be conducted. Participants will be healthy recreational adult volleyball players (18 years of age or older) practicing volleyball (training and/or match) at least twice a week. The intervention (‘VolleyVeilig’) consists of a warm-up program based on more than 50 distinct exercises (with different variations and levels). The effect of the intervention programme on the occurrence of injuries will be compared to volleyball as usual. Outcome measures will be incidence of acute injury (expressed as number of injuries per 1000 h of play) and prevalence of overuse injuries (expressed as percentage).
Discussion
This study will be one of the first randomized prospective controlled trials evaluating the effectiveness of an intervention on the occurrence of both acute and overuse injuries among recreational adult volleyball players. Outcome of this study could possibly lead to the nationwide implementation of the intervention in all volleyball clubs in The Netherlands, ultimately resulting in less injuries.
Trial registration
Dutch Trial Registration
NTR6202
, registered February 1st 2017. Protocol: Version 3, February 2017.
Journal Article
Essentials of CRANIOMAXILLOFACIAL TRAUMA
Essentials of Craniomaxillofacial Trauma is destined to become a favorite with all students of plastic surgery, otolaryngology, and maxillofacial surgery, whether residents in training or experienced practitioners. Small enough to fit in a lab coat pocket but comprehensive enough to cover the essential topics in facial trauma, this exceptional manu
eBook
Extended Knee Control programme lowers weekly hamstring, knee and ankle injury prevalence compared with an adductor strength programme or self-selected injury prevention exercises in adolescent and adult amateur football players: a two-armed cluster-randomised trial with an additional comparison arm
ObjectiveTo evaluate the preventive efficacy of an extended version of the Knee Control injury prevention exercise programme (IPEP) compared with an adductor strength programme and to a comparison group using a self-selected IPEP in amateur adolescent and adult male and female football players.MethodsTwo-armed cluster-randomised trial with an additional non-randomised arm. All 251 amateur teams (players 14–46 years) in one regional football district were approached. Teams meeting inclusion criteria were randomised to (1) extended Knee Control or (2) an adductor strength programme. Teams already using an IPEP were allocated to a comparison group and received no new intervention. Players responded to weekly questionnaires about football exposures and injuries during a 7-month season.ResultsSeventeen teams in the extended Knee Control, 12 in the adductor and 17 in the comparison group participated, with 502 players. For the primary outcomes, no difference in injury incidence in three lower-limb injury locations combined (hamstring, knee and ankle) was seen between extended Knee Control and the adductor group, whereas extended Knee Control had 29% lower incidence than the comparison group (incidence rate ratio 0.71, 95% CI 0.52 to 0.98). No between-group differences in groin injury incidence were seen. The weekly injury prevalence rates in the three lower limb locations combined (hamstring, knee and ankle) were 17% lower (prevalence rate ratio (PRR) 0.83, 95% CI 0.69 to 1.00) and 26% lower (PRR 0.74, 95% CI 0.63 to 0.87) in extended Knee Control compared with the adductor and comparison groups, respectively.ConclusionNo difference in injury incidence was seen between the extended Knee Control and the adductor programme whereas extended Knee Control reduced injury incidence by nearly one-third compared with a self-selected IPEP. Players in extended Knee Control had lower injury prevalence compared with an adductor or self-selected IPEP.Trial registration number NCT04272047; Clinical trials.
Journal Article