Rienk Dekker

Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline

Ankle injuries are a huge medical and socioeconomic problem. Many people have a traumatic injury of the ankle, most of which are a result of sports. Total costs of treatment and work absenteeism due to ankle injuries are high. The prevention of recurrences can result in large savings on medical costs. A multidisciplinary clinical practice guideline was developed with the aim to prevent further health impairment of patients with acute lateral ankle ligament injuries by giving recommendations with respect to improved diagnostic and therapeutic opportunities. The recommendations are based on evidence from published scientific research, which was extensively discussed by the guideline committee. This clinical guideline is helpful for healthcare providers who are involved in the management of patients with ankle injuries.

Chronic Disease and Sexuality: A Generic Conceptual Framework

Although sexual dysfunctions are frequently comorbid with many chronic diseases and their treatments, until recently, these dysfunctions have been neglected in both research and clinical practice. Fortunately, sexual functioning in the context of chronic disease has now begun to receive more scientific attention. Studies in the field are, however, quite diverse in terms of topics and methodology, not only making comparisons across studies on a single disease difficult, but also making comparisons across different diseases impossible. In an attempt to inspire researchers, this article presents a “generic” conceptual framework regarding the impact of chronic diseases (and their treatments) on sexual function. The major goals of this conceptual framework are to provide an in-depth analysis of, and insight into, the process by which disease-related psychological and relational factors impact the sexual functioning and well-being of patients, their partners, and their relationships. Some of the associations within the conceptual framework have already been supported by the results of empirical studies on various diseases. This review ends with an overview of the limitations of previous research, proposes a research agenda for the field, and presents a research tool that may be helpful in developing new studies investigating the association between chronic diseases and sexuality.

Amputees and sports: a systematic review

Amputation of a limb may have a negative impact on the psychological and physical well-being, mobility and social life of individuals with limb amputations. Participation in sports and/or regular physical activity has a positive effect on the above mentioned areas in able-bodied individuals. Data concerning participation in sports or regular physical activity together with its benefits and risks for individuals with limb amputations are scarce. No systematic review exists that addresses a wide range of outcomes such as biomechanics, cardiopulmonary function, psychology, sport participation and sport injuries. Therefore, the aim of this article is to systematically review the literature about individuals with limb amputations and sport participation.MEDLINE (PubMed), EMBASE, CINAHL® and SportDiscus® were searched without time or language restrictions using free text words and MeSH terms. The last search date was 31 March 2010. Books, internet sites and references of included papers were checked for papers relevant to the topic under review.Papers were included if the research topic concerned sports and a minimum of ten individuals with limb amputations were part of the study population. Papers were excluded if they included individuals with amputations of body parts other than upper or lower limbs or more distal than the wrist or ankle, or if they consisted of case reports, narrative reviews, books, notes or letters to the editor.Title, abstract and full-text assessments were performed by two independent observers following a list of preset criteria.Of the 3689 papers originally identified, 47 were included in the review. Most of the included studies were older than 10 years and had cross-sectional designs. Study participants were generally younger and often had more traumatic amputations than the general population of individuals with limb amputations. Heterogeneity in population characteristics, intervention types and main outcomes made data pooling impossible. In general, sports were associated with a beneficial effect on the cardiopulmonary system, psychological well-being, social reintegration and physical functioning. Younger individuals with unilateral transtibial amputations achieve better athletic performance and encounter fewer problems when participating in sports compared with older individuals with bilateral transfemoral amputations. Regardless of their amputation level, individuals with limb amputations participate in a wide range of recreational activities. The majority of them were not aware of the sport facilities in their area and were not informed about available recreational activities. Sport prosthetic devices were used mostly by competitive athletes. For football, the injury rate and pattern of the players with an amputation were similar to those of able-bodied players.Individuals with limb amputations appear to benefit both physically and psychologically from participation in sports and/or regular physical activity. Therefore, sports should be included in rehabilitation programmes, and individuals with limb amputations should be encouraged to pursue a physically active life following hospital discharge.

Barriers to and facilitators of sports participation for people with physical disabilities: A systematic review

Most people with physical disabilities do not participate in sports regularly, which could increase the chances of developing secondary health conditions. Therefore, knowledge about barriers to and facilitators of sports participation is needed. Barriers and facilitators for people with physical disabilities other than amputation or spinal cord injuries (SCI) are unknown. The aim of this study was to provide an overview of the literature focusing on barriers to and facilitators of sports participation for all people with various physical disabilities. Four databases were searched using MeSH terms and free texts up to April 2012. The inclusion criteria were articles focusing on people with physical disabilities, sports and barriers and/or facilitators. The exclusion criteria were articles solely focusing on people with cognitive disabilities, sensory impairments or disabilities related to a recent organ transplant or similar condition. Fifty‐two articles were included in this review, with 27 focusing on people with SCI. Personal barriers were disability and health; environmental barriers were lack of facilities, transport and difficulties with accessibility. Personal facilitators were fun and health, and the environmental facilitator was social contacts. Experiencing barriers to and facilitators of sports participation depends on age and type of disability and should be considered when advising people about sports. The extent of sports participation for people with physical disabilities also increases with the selection of the most appropriate sport.

Epidemiology of ankle and foot overuse injuries in sports: A systematic review.

Studies regarding ankle and foot overuse injuries are quite diverse in research methodology, data reporting, and outcomes. The aims of this systematic review were to analyze the methodology of published studies regarding ankle and foot overuse injuries in different sports disciplines and to summarize epidemiological data of ankle and foot overuse injuries. Four electronic databases, PubMed (MEDLINE), EMBASE, CINAHL, and SPORTDiscus® were systematically searched up to June 2011. A total of 89 articles on 23 sports disciplines were included in this review. Soccer, running, and gymnastics were the most frequently studied sports. Achilles tendinopathy, plantar fasciitis, and stress fracture were the most frequently studied injuries. Study design and reporting methods were heterogeneous. Most studies suffered from a weak methodology and poor reporting. The most common weaknesses were lack of a clear case definition, describing assessment procedures and reporting sample characteristics. Due to methodological heterogeneity of studies, inter‐sports and intra‐sports comparisons and meta‐analysis were not possible. Methodology of most studies on incidence and prevalence of ankle and foot overuse injuries is insufficient. Based on the results, we recommend authors to clearly define cases, describe assessment procedures and report sample characteristics adequately.

Do patients with chronic patellar tendinopathy have an altered somatosensory profile? A Quantitative Sensory Testing (QST) study

The prevalence of tendinopathies in sports is high. The etiology and pain mechanisms of tendinopathies are not completely understood. Currently, little is known whether, or to which degree, somatosensory changes within the nervous system may contribute to the pain in tendinopathies. We conducted a patient controlled study in which we used the standardized QST protocol developed by the German Research Network on Neuropathic Pain. This protocol consists of seven different tests that measures 13 somatosensory parameters and can be seen as the gold standard to measure somatosensory function. Twelve athletes with clinically diagnosed chronic patellar tendinopathy (PT) mean duration 30 months (range 6–120) and 20 controls were included in the study. In two of the 13 QST parameters namely Mechanical Pain Threshold (P < 0.05) and Vibration Disappearance Threshold (P < 0.5) injured athletes were significantly more sensitive for the applied stimuli. None of the athletes had signs of Dynamic Mechanical Allodynia. Reduced mechanical pain thresholds or pinprick allodynia reflects the involvement of central sensitization upon the myelinated (Aδ‐fibre) nociceptive input. From this explorative study, we conclude that sensitization may play a prominent role in the pain during and after sports activity in patella tendinopathy patients.

Participation in sports by lower limb amputees in the Province of Drenthe, The Netherlands

The numbers of lower limb amputees participating in recreational activity date back more than 25 years. Previous studies have shown that 60% of lower limb amputees participated in recreational activities, including sports. To date, research in The Netherlands into sports participation of this specific amputee population is insufficient. The purpose of the reported survey was to investigate the sports participation habits of lower limb amputees in the Province of Drenthe, The Netherlands, using a self-constructed questionnaire. A total of 105 lower limb amputees responded (36%), a large proportion of whom were traumatic amputees (31%). Of the respondents, 34 (32%) participated in some form of sport. Results indicated that participation in sport before the amputation was a predetermining factor for amputees to participate in sports whilst the level of amputation, age and etiology were not predetermining factors of participation in sports after a lower limb amputation.

Running with a minimalist shoe increases plantar pressure in the forefoot region of healthy female runners

OBJECTIVES Minimalist running shoes have been proposed as an alternative to barefoot running. However, several studies have reported cases of forefoot stress fractures after switching from standard to minimalist shoes. Therefore, the aim of the current study was to investigate the differences in plantar pressure in the forefoot region between running with a minimalist shoe and running with a standard shoe in healthy female runners during overground running. DESIGN Randomized crossover design. METHODS In-shoe plantar pressure measurements were recorded from eighteen healthy female runners. Peak pressure, maximum mean pressure, pressure time integral and instant of peak pressure were assessed for seven foot areas. Force time integral, stride time, stance time, swing time, shoe comfort and landing type were assessed for both shoe types. A linear mixed model was used to analyze the data. RESULTS Peak pressure and maximum mean pressure were higher in the medial forefoot (respectively 13.5% and 7.46%), central forefoot (respectively 37.5% and 29.2%) and lateral forefoot (respectively 37.9% and 20.4%) for the minimalist shoe condition. Stance time was reduced with 3.81%. No relevant differences in shoe comfort or landing strategy were found. CONCLUSIONS Running with a minimalist shoe increased plantar pressure without a change in landing pattern. This increased pressure in the forefoot region might play a role in the occurrence of metatarsal stress fractures in runners who switched to minimalist shoes and warrants a cautious approach to transitioning to minimalist shoe use.

Long-term outcome of equestrian injuries in children

Purpose: To investigate the possible development of long-term disabilities arising from paediatric equestrian injuries. Method: All patients, aged 17 years or younger, treated in a hospital setting because of an equestrian injury during a five-year period received a questionnaire. A reference population and healthy friends served as controls. Results: Four years post-injury, 41 of the 100 respondents still experienced disabilities following the injury. The median Injury Severity Score was 4. Absenteeism from school lasted 2 weeks, and from horse riding, 4 months. Compared to the reference population, the results of the Child Health Questionnaire were poorer considering most of its subscales. In comparison with the friends, the patients only scored lower on ‘physical functioning’. The risk factors concerning poor long-term outcomes were being an advanced rider, sustaining injuries other than fractures of the extremities or sustaining subsequent injuries following the riding accident. Conclusions: Although equestrian injuries in children are minor to moderate in their severity, these injuries are significant considering that a large proportion of patients experience long-term disabilities.

Barriers and facilitators of sports in Dutch Paralympic athletes: An explorative study

The purpose of this study was to gain insight in barriers and facilitators of sports in paralympic athletes. An online questionnaire was distributed through the Netherlands Olympic Committee and National Sports Confederation to determine personal and environmental barriers and facilitators of sports participation. The International Classification of Functioning, Disability and Health model and theory of planned behavior were used to respectively categorize the results in environmental and personal factors, and attitude, subjective norm and perceived behavioral control. Seventy‐six Dutch Paralympic athletes completed the questionnaire (51% response rate). Barriers and facilitators experienced by ambulant and wheelchair athletes were compared. Most frequently mentioned personal barrier was dependency of others (22%), while most frequently mentioned environmental barrier was lack of sports facilities (30%). Wheelchair athletes mentioned more barriers (median = 3, interquartile range: 0.5–6), than ambulant athletes (median = 1.0,interquartile range:0.0–3.0, P = 0.023). One‐third of the athletes did not experience any barriers. Most frequently mentioned personal facilitators to initiate sports participation were fun (78%), health (61%), and competition (53%). Most frequently mentioned environmental facilitator was social support (40%). This study indicated that barriers of sport were mostly environmental, while facilitators were usually personal factors. Attitude and subjective norm were considered the most important components for intention to participation in sports. The facilitators outweighed the barriers and kept the athletes being active in sports.