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  • 1.
    Andrade, Renato
    et al.
    FIFA Med Ctr Excellence, Portugal; Univ Porto, Portugal; Dom Henrique Res Ctr, Portugal.
    Pereira, Rogerio
    FIFA Med Ctr Excellence, Portugal; Univ Porto, Portugal; Dom Henrique Res Ctr, Portugal; Fernando Pessoa Univ, Portugal.
    Weir, Adam
    Erasmus MC, Netherlands; Aspetar Orthopaed and Sports Med Hosp, Qatar.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Espregueira-Mendes, Joao
    FIFA Med Ctr Excellence, Portugal; Dom Henrique Res Ctr, Portugal; Minho Univ, Portugal; Univ Minho, Portugal; ICVS 3Bs PT Govt Associate Lab, Portugal.
    Zombie reviews taking over the PROSPERO systematic review registry. Its time to fight back!2019In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 53, no 15, p. 919-921Article in journal (Other academic)
    Abstract [en]

    n/a

  • 2.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar; La Trobe University, Australia.
    Editorial Material: Systematic review hacks for the sports and exercise clinician: five essential methodological elements in BRITISH JOURNAL OF SPORTS MEDICINE, vol 50, issue 8, pp 447-4492016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 8, p. 447-449Article in journal (Other academic)
    Abstract [en]

    n/a

  • 3.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed Sports Medical Hospital, Qatar; La Trobe University, Australia.
    Serving the clinician and the patient: three ways that quality clinical guidelines can build on expert consensus statements and systematic reviews2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 7, p. 557-+Article in journal (Other academic)
    Abstract [en]

    n/a

  • 4.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar.
    Bizzini, Mario
    Schulthess Clin, Switzerland.
    Bahr, Roald
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; Norwegian School Sports Science, Norway.
    Editorial Material: It is time for consensus on return to play after injury: five key questions in BRITISH JOURNAL OF SPORTS MEDICINE, vol 50, issue 9, pp 506-5082016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 9, p. 506-508Article in journal (Other academic)
    Abstract [en]

    n/a

  • 5.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Dupont, Gregory
    Edinburgh Napier Univ, Scotland; FFF, France.
    Impellizzeri, Franco M.
    Univ Technol Sydney, Australia.
    ODriscoll, Gary
    Arsenal Football Club, England.
    Reurink, Guus
    Sports Phys Grp, Netherlands.
    Lewin, Colin
    Arsenal Football Club, England.
    McCall, Alan
    Edinburgh Napier Univ, Scotland; Arsenal Football Club, England.
    Infographic. Unravelling confusion in sports medicine and science practice: a systematic approach2019In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 53, no 13, p. 835-836Article in journal (Other academic)
    Abstract [en]

    n/a

  • 6.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Dupont, Gregory
    Edinburgh Napier Univ, Scotland; Univ Lille, France.
    Impellizzeri, Franco M.
    Schulthess Clin, Switzerland.
    ODriscoll, Gary
    Arsenal Football Club, England.
    Reurink, Guus
    OLVG, Netherlands.
    Lewin, Colin
    Arsenal Football Club, England.
    McCall, Alan
    Edinburgh Napier Univ, Scotland; Arsenal Football Club, England.
    Unravelling confusion in sports medicine and sports science practice: a systematic approach to using the best of research and practice-based evidence to make a quality decision2019In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 53, no 1, p. 50-56Article, review/survey (Refereed)
    Abstract [en]

    n/a

  • 7.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Ekas, Guri
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    Grindem, Hege
    Norwegian Sch Sport Sci, Norway.
    Moksnes, Havard
    Norwegian Sch Sport Sci, Norway.
    Anderson, Allen
    Chotel, Franck
    Hop Femme Mere Enfant, France.
    Cohen, Moises
    Univ Fed Sao Paulo, Brazil.
    Forssblad, Magnus
    Karolinska Inst, Sweden.
    Ganley, Theodore J.
    Childrens Hosp Philadelphia, PA 19104 USA.
    Feller, Julian A.
    Epworth Healthcare, Australia; La Trobe Univ, Australia.
    Karlsson, Jon
    Univ Gothenburg, Sweden.
    Kocher, Mininder S.
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA.
    LaPrade, Robert F.
    Steadman Philippon Res Inst, CO USA; Steadman Clin, CO USA.
    McNamee, Mike
    Swansea Univ, Wales.
    Mandelbaum, Bert
    Santa Monica Orthopaed and Sports Med Grp, CA USA.
    Micheli, Lyle
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA; Micheli Ctr Sports Injury Prevent, MA USA.
    Mohtadi, Nicholas
    Univ Calgary, Canada.
    Reider, Bruce
    Univ Chicago, IL 60637 USA.
    Roe, Justin
    North Sydney Orthopaed and Sports Med Ctr, Australia.
    Seil, Romain
    Ctr Hosp Luxembourg, Luxembourg; Luxembourg Inst Hlth, Luxembourg.
    Siebold, Rainer
    Ruprecht Karls Univ Heidelberg, Germany; HKF Int Ctr Hip Knee Foot Surg and Sportstraumatol, Germany.
    Silvers-Granelli, Holly J.
    FIFA Med Ctr Excellence, CA USA.
    Soligard, Torbjorn
    Int Olymp Comm, Switzerland; Univ Calgary, Canada.
    Witvrouw, Erik
    Univ Ghent, Belgium.
    Engebretsen, Lars
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway; Int Olymp Comm, Switzerland.
    2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 4, p. 989-1010Article in journal (Refereed)
    Abstract [en]

    In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric anterior cruciate ligament (ACL) injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery and Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.

  • 8.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Ekas, Guri Ranum
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    Grindem, Hege
    Norwegian Sch Sport Sci, Norway.
    Moksnes, Havard
    Norwegian Sch Sport Sci, Norway.
    Anderson, Allen
    Tennessee Orthopaed Alliance, TN USA.
    Chotel, Franck
    Hop Femme Mere Enfant, France.
    Cohen, Moises
    Univ Fed Sao Paulo, Brazil.
    Forssblad, Magnus
    Karolinska Inst, Sweden.
    Ganley, Theodore J.
    Childrens Hosp Philadelphia, PA 19104 USA.
    Feller, Julian A.
    Epworth Healthcare, Australia; La Trobe Univ, Australia.
    Karlsson, Jon
    Univ Gothenburg, Sweden.
    Kocher, Mininder S.
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA.
    LaPrade, Robert F.
    Steadman Philippon Res Inst, CO USA; Steadman Clin, CO USA.
    McNamee, Michael
    Swansea Univ, Wales.
    Mandelbaum, Bert
    Santa Monica Orthopaed and Sports Med Grp, CA USA.
    Micheli, Lyle
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA; Micheli Ctr Sports Injury Prevent, MA USA.
    Mohtadi, Nicholas G. H.
    Univ Calgary, Canada.
    Reider, Bruce
    Univ Chicago, IL 60637 USA.
    Roe, Justin P.
    North Sydney Orthopaed and Sports Med Ctr, Australia.
    Seil, Romain
    Ctr Hosp Luxembourg, Luxembourg; Luxembourg Inst Hlth, Luxembourg.
    Siebold, Rainer
    Ruprecht Karls Univ Heidelberg, Germany; ATOS Klin, Germany.
    Silvers-Granelli, Holly J.
    FIFA Med Ctr Excellence, CA USA.
    Soligard, Torbjorn
    Int Olymp Comm, Switzerland; Univ Calgary, Canada.
    Witvrouw, Erik
    Univ Ghent, Belgium.
    Engebretsen, Lars
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway; Int Olymp Comm, Switzerland.
    Prevention, diagnosis and management of paediatric ACL injuries2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 20, p. 1297-1298Article in journal (Other academic)
    Abstract [en]

    n/a

  • 9.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Ekas, Guri Ranum
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    Grindem, Hege
    Norwegian Sch Sport Sci, Norway.
    Moksnes, Havard
    Norwegian Sch Sport Sci, Norway.
    Anderson, Allen F.
    Tennessee Orthopaed Alliance, TN USA.
    Chotel, Franck
    Hop Femme Mere Enfant, France.
    Cohen, Moises
    Univ Fed Sao Paulo, Brazil.
    Forssblad, Magnus
    Karolinska Inst, Sweden.
    Ganley, Theodore J.
    Childrens Hosp Philadelphia, PA 19104 USA.
    Feller, Julian A.
    Epworth Healthcare, Australia; La Trobe Univ, Australia.
    Karlsson, Jon
    Univ Gothenburg, Sweden.
    Kocher, Minider S.
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA.
    LaPrade, Robert F.
    Steadman Philippon Res Inst, CO USA; Steadman Clin, CO USA.
    McNamee, Michael
    Swansea Univ, Wales.
    Mandelbaum, Bert
    Santa Monica Orthopaed and Sports Med Grp, CA USA.
    Micheli, Lyle
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA; Micheli Ctr Sports Injury Prevent, MA USA.
    Mohtadi, Nicholas
    Univ Calgary, Canada.
    Reider, Bruce
    Univ Chicago, IL 60637 USA.
    Roe, Justin
    North Sydney Orthopaed and Sports Med Ctr, Australia.
    Seil, Romain
    Ctr Hosp Luxembourg, Luxembourg; Luxembourg Inst Hlth, Luxembourg.
    Siebold, Rainer
    Ruprecht Karls Univ Heidelberg, Germany; ATOS Klin, Germany.
    Silvers-Granelli, Holly J.
    FIFA Med Ctr Excellence Veloc Phys Therapy, CA USA.
    Soligard, Torbjorn
    Int Olymp Comm, Switzerland; Univ Calgary, Canada.
    Witvrouw, Erik
    Univ Ghent, Belgium.
    Engebretsen, Lars
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway; Int Olymp Comm, Switzerland.
    2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 7, p. 422-438Article in journal (Refereed)
    Abstract [en]

    In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery amp; Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/ guardians make the best possible decisions.

  • 10.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe University, Melbourne, Australia.
    Glasgow, Philip
    Sports Medicine, Sports Institute of Northern Ireland, Newtownabbey, UK.
    Schneiders, Anthony G
    School of Human, Health and Social Sciences, Central Queensland University, Branyan, Australia.
    Witvrouw, Erik
    Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Clarsen, Benjamin
    Oslo Sports Trauma Research Center, Oslo, Norway.
    Cools, Ann Mj
    Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Gojanovic, Boris
    Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Switzerland; Sports Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
    Griffin, Steffan
    College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
    Khan, Karim
    Department of Family Practice, The University of British Columbia, Vancouver, Canada; Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada.
    Moksnes, Håvard
    Oslo Sports Trauma Research Center, Oslo, Norway.
    Mutch, Stephen
    SPACE Clinics, Edinburgh, UK; Scottish Rugby, Edinburgh, UK.
    Phillips, Nicola
    Postgraduate Healthcare Studies, Cardiff University, Cardiff, UK.
    Reurink, Guus
    Sports Medicine, Sports Physicians Group, Amsterdam, The Netherlands.
    Sadler, Robin
    Sports Medicine, Manchester City Football Club Ltd, Manchester, UK; Derby County FC, Derby, UK.
    Gravare Silbernagel, Karin
    Department of Physical Therapy, University of Delaware, Newark, USA.
    Thorborg, Kristian
    Sports Orthopaedic Research Center Copenhagen (SORC-C), Amager-Hvidovre Hospital, Copenhagen, Denmark; Department of Orthopaedic Surgery and Physical Therapy, Amager-Hvidovre Hospital, Copenhagen, Denmark.
    Wangensteen, Arnlaug
    Oslo Sports Trauma Research Center, Oslo, Norway; Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Wilk, Kevin
    Champion Sports Medicine, Birmingham, USA.
    Bizzini, Mario
    Schulthess Clinic, Zürich, Switzerland.
    Infographic: 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 13, p. 995-995Article in journal (Other academic)
  • 11.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar; La Trobe University, Australia.
    Glasgow, Philip
    Sport Northern Ireland Sports Institute, North Ireland; University of Ulster, North Ireland.
    Schneiders, Anthony
    Central Queensland University, Australia.
    Witvrouw, Erik
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; University of Ghent, Belgium.
    Clarsen, Benjamin
    Norwegian School Sports Science, Norway; Olymp Elite Sports Program Olympiatoppen, Norway.
    Cools, Ann
    University of Ghent, Belgium.
    Gojanovic, Boris
    Hop La Tour, Switzerland; Lausanne University of and Hospital, Switzerland.
    Griffin, Steffan
    University of Birmingham, England.
    Khan, Karim M.
    University of British Columbia, Canada.
    Moksnes, Havard
    Norwegian School Sports Science, Norway; Olymp Elite Sports Program Olympiatoppen, Norway.
    Mutch, Stephen A.
    SPACE Clin, Scotland; Murrayfield Stadium, Scotland.
    Phillips, Nicola
    Cardiff University, Wales.
    Reurink, Gustaaf
    Sports Phys Grp, Netherlands.
    Sadler, Robin
    Manchester City Football Club, England.
    Gravare Silbernagel, Karin
    University of Delaware, DE USA.
    Thorborg, Kristian
    University of Copenhagen, Denmark.
    Wangensteen, Arnlaug
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; Norwegian School Sports Science, Norway.
    Wilk, Kevin E.
    Champ Sports Med, AL USA.
    Bizzini, Mario
    Schulthess Clin, Switzerland.
    2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 14, p. 853-864Article in journal (Refereed)
    Abstract [en]

    Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athletes return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.

  • 12.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Grindem, Hege
    Norwegian Sch Sport Sci, Norway.
    Ekas, Guri Ranum
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    Seil, Romain
    Ctr Hosp Luxembourg, Luxembourg; Luxembourg Inst Hlth, Luxembourg.
    McNamee, Michael
    Swansea Univ, Wales.
    Applying ethical standards to guide shared decision-making with youth athletes2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 20, p. 1289-1290Article in journal (Other academic)
    Abstract [en]

    n/a

  • 13.
    Ardern, Clare
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia; Univ British Columbia, Canada; Sophiahemmet Univ, Sweden.
    Hooper, Nicholas
    Virginia Commonwealth Univ, VA USA.
    O´Halloran, Paul
    La Trobe Univ, Australia.
    Webster, Kate E.
    La Trobe Univ, Australia.
    Kvist, Joanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    A Psychological Support Intervention to Help Injured Athletes "Get Back in the Game": Design and Development Study2022In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 6, no 8, article id e28851Article in journal (Refereed)
    Abstract [en]

    Background: After a serious knee injury, up to half of athletes do not return to competitive sport, despite recovering sufficient physical function. Athletes often desire psychological support for the return to sport, but rehabilitation clinicians feel ill-equipped to deliver adequate support. Objective: We aimed to design and develop an internet-delivered psychological support program for athletes recovering from knee ligament surgery. Methods: Our work for developing and designing the Back in the Game intervention was guided by a blend of theory-, evidence-, and target population-based strategies for developing complex interventions. We systematically searched for qualitative evidence related to athletes experiences with, perspectives on, and needs for recovery and return to sport after anterior cruciate ligament (ACL) injury. Two reviewers coded and synthesized the results via thematic meta-synthesis. We systematically searched for randomized controlled trials reporting on psychological support interventions for improving ACL rehabilitation outcomes in athletes. One reviewer extracted the data, including effect estimates; a second reviewer checked the data for accuracy. The results were synthesized descriptively. We conducted feasibility testing in two phases-(1) technical assessment and (2) feasibility and usability testing. For phase 1, we recruited clinicians and people with lived experience of ACL injury. For phase 2, we recruited patients aged between 15 and 30 years who were within 8 weeks of ACL reconstruction surgery. Participants completed a 10-week version of the intervention and semistructured interviews for evaluating acceptability, demand, practicality, and integration. This project was approved by the Swedish Ethical Review Authority (approval number: 2018/45-31). Results: The following three analytic themes emerged from the meta-synthesis (studies: n=16; participants: n=164): (1) tools or strategies for supporting rehabilitation progress, (2) barriers and facilitators for the physical readiness to return to sport, and (3) barriers and facilitators for the psychological readiness to return to sport. Coping strategies, relaxation, and goal setting may have a positive effect on rehabilitation outcomes after ACL reconstruction (randomized controlled trials: n=7; participants: n=430). There were no trials of psychological support interventions for improving the return to sport. Eleven people completed phase 1 of feasibility testing (technical assessment) and identified 4 types of software errors, which we fixed. Six participants completed the feasibility and usability testing phase. Their feedback suggested that the intervention was easy to access and addressed the needs of athletes who want to return to sport after ACL reconstruction. We refined the intervention to include more multimedia content and support access to and the use of the intervention features. Conclusions: The Back in the Game intervention is a 24-week, internet-delivered, self-guided program that comprises 7 modules that complement usual rehabilitation, changes focus as rehabilitation progresses, is easy to access and use, and includes different psychological support strategies.

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  • 14.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar; La Trobe University, Australia.
    Khan, Karim M.
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; University of British Columbia, Canada.
    Editorial Material: The old knee in the young athlete: knowns and unknowns in the return to play conversation in BRITISH JOURNAL OF SPORTS MEDICINE, vol 50, issue 9, pp 505-U892016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 9, p. 505-U89Article in journal (Other academic)
    Abstract [en]

    n/a

  • 15.
    Ardern, Clare
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden; La Trobe Univ, Australia.
    Kvist, Joanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    BAck iN the Game (BANG) - a smartphone application to help athletes return to sport following anterior cruciate ligament reconstruction: protocol for a multi-centre, randomised controlled trial2020In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 21, no 1, article id 523Article in journal (Refereed)
    Abstract [en]

    Background: Sustaining injury is a common consequence of playing sport. At least one in every three recreational athletes with anterior cruciate ligament (ACL) reconstruction do not return to their preinjury sport following treatment. Psychological factors including confidence and fear of new injury exert large effects on returning to sport. The primary aim of this trial is to test whether a custom smartphone application delivering cognitive-behavioural therapy is effective for improving the number of people who return to their preinjury sport and level following ACL reconstruction. Methods: Participants scheduled for primary ACL reconstruction are recruited prior to surgery from one of six trial sites in Sweden. We aim to recruit 222 participants (111 in each group) for the BANG trial. Participants are randomly allocated to receive either usual rehabilitation care alone or usual rehabilitation care plus the Back in the Game smartphone application intervention. Back in the Game is a 24-week Internet-delivered programme, based on cognitive-behavioural therapy. The primary outcome is return to the preinjury sport and level at 12 months follow-up. The secondary outcomes assess physical activity participation, new knee injuries, psychological factors, quality of life and physical function. Physical activity participation and new injuries are self-reported every two weeks for 12 months, then every 4 weeks to 24 months follow-up. Psychological readiness to return to sport, knee self-efficacy, motivation to participate in leisure time physical activity, knee-related quality of life, and self-reported knee function are also assessed at 3, 6, 9, 12 and 24 months after surgery. A clinical assessment of strength, knee range of motion, effusion and hopping performance is completed by a blinded assessor at 12 months to assess physical function. Discussion: This protocol outlines how we plan to assess the efficacy of a custom smartphone application, delivering cognitive-behavioural therapy to address fear, confidence and recovery expectations, for improving return to sport following serious sports-related musculoskeletal injury. The BANG trial employs a pragmatic design to best reflect the reality of, and inform, clinical practice.

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  • 16.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    What is the evidence to support a psychological component to rehabilitation programs after anterior cruciate ligament reconstruction?2016In: Current Orthopaedic Practice, ISSN 1940-7041, Vol. 27, no 3, p. 263-268Article, review/survey (Refereed)
    Abstract [en]

    One of the main indications for anterior cruciate ligament reconstruction is the athlete’s desire to return to his or her preinjury level of sports. Postoperative rehabilitation has a strong focus on recovery of the physical capabilities necessary to manage a return to sports. On average, athletes achieve good physical function after surgery, based on standard impairment-based and activity-based measures. Yet the return to sports rate is disappointingly low; only two in every three return to their preinjury level sport and only half of the athletes return to competitive sports after surgery. There are a range of factors, many of them nonmodifiable (e.g. age, sex, and preinjury level of competition), that affect returning to a specific sport. However, recent research has identified psychological factors as key influences on returning to sports after anterior cruciate ligament reconstruction. This is particularly important for clinicians given that these factors may be modifiable with appropriate intervention. However, they are not systematically discussed during standard postoperative rehabilitation. In this review, we examine the evidence for the effect of psychological factors on return to sport outcomes after anterior cruciate ligament reconstruction and provide a rationale for the inclusion of interventions that specifically and systematically affect these factors during postoperative rehabilitation.

  • 17.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. School of Allied Health, La Trobe University, Melbourne, Australia.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Webster, Kate E.
    School of Allied Health, La Trobe University, Melbourne, Australia.
    Psychological Aspects of Anterior Cruciate Ligament Injuries2016In: Operative techniques in sports medicine, ISSN 1060-1872, E-ISSN 1557-9794, Vol. 24, no 1, p. 77-83Article in journal (Refereed)
    Abstract [en]

    Impairment-based evaluation has, until recently, been the mainstay of orthopaedic research in anterior cruciate ligament (ACL) reconstruction. However, participation-based outcomes, in particular returning to sport, have lately garnered increased research attention. This is important because returning to sport is typically a main concern of injured athletes. Recent metaanalyses have demonstrated that the return to sport rate after ACL reconstruction is disappointingly low, and that a range of contextual factors including age, sex, sport participation level, and psychological factors may affect the return to sport rate. Moderate to large effect sizes have been demonstrated for greater psychological readiness to return to sport, and lower fear of reinjury favoring returning to the preinjury level sport after ACL reconstruction. Understanding the relationship between psychological factors and returning to sport is essential in light of the fact that most athletes recover good physical function after surgery, and many athletes with good knee function do not return to sport. Psychological factors are potentially modifiable with appropriate intervention, yet these factors are not systematically addressed in routine postoperative rehabilitation. This review summarizes the recent evidence for the relationship between psychological factors and ACL injury, including recovery from injury and returning to sport. Oper Tech Sports Med 24:77-83 Crown Copyright (C) 2015 Published by Elsevier Inc. All rights reserved.

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  • 18.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar; La Trobe University, Australia; Uppsala University, Sweden.
    Peterson, Gunnel
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.
    Landén Ludvigsson, Maria
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Satisfaction With the Outcome of Physical Therapist-Prescribed Exercise in Chronic Whiplash-Associated Disorders: Secondary Analysis of a Randomized Clinical Trial2016In: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 46, no 8, p. 640-+Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Secondary analysis of a randomized clinical trial. BACKGROUND: Patient perception of the benefits gained from treatment is important, yet satisfaction with the outcome of treatment for chronic whiplash-associated disorders (WADs) has not been investigated. OBJECTIVES: To investigate whether satisfaction with the outcome of treatment for chronic WAD changed over time, and whether there were group differences. METHODS: Two hundred sixteen people with chronic WAD (66% women; mean age, 40.4 years) participated in a 3-month program of physical therapist-led neck-specific exercises with or without a behavioral approach, or received a prescription of general physical activity. The main outcome was satisfaction with the outcome of treatment, assessed at baseline and 3, 6, and 12 months later. Additional outcomes were enablement and expectation fulfillment. RESULTS: Satisfaction improved over time in the 3 groups (odds ratio = 1.15; 95% confidence interval: 1.10, 1.20; P amp;lt; .001). There was a significant group-by-time interaction (P amp;lt; 001), with increased odds of being satisfied in the groups receiving neck-specific exercises compared to general physical activity. Enablement increased after completion of the intervention in all groups (P amp;lt; .001). People who received neck-specific exercises reported greater enablement and expectation fulfillment than people prescribed general physical activity (P amp;lt; .01). CONCLUSION: Exercise interventions for chronic WAD led to increased satisfaction for 12 months following treatment that was unrelated to the type of exercise intervention received.

  • 19.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. School of Allied Health, La Trobe University, Melbourne, Australia, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Tagesson (Sonesson), Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Forssblad, M
    Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden. Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden..
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Comparison of patient-reported outcomes among those who chose ACL reconstruction or non-surgical treatment.2017In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 27, no 5, p. 535-544Article in journal (Refereed)
    Abstract [en]

    The aim of our study was to cross-sectionally compare patient-reported knee function outcomes between people who chose non-surgical treatment for ACL injury and those who chose ACL reconstruction. We extracted Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQoL-5D data entered into the Swedish National ACL Registry by patients with a non-surgically treated ACL injury within 180 days of injury (n = 306), 1 (n = 350), 2 (n = 358), and 5 years (n = 114) after injury. These data were compared cross-sectionally to data collected pre-operatively (n = 306) and at 1 (n = 350), 2 (n = 358), and 5 years (n = 114) post-operatively from age- and gender-matched groups of patients with primary ACL reconstruction. At the 1 and 2 year comparisons, patients who chose surgical treatment reported superior quality of life and function in sports (1 year mean difference 12.4 and 13.2 points, respectively; 2 year mean difference 4.5 and 6.9 points, respectively) compared to those who chose non-surgical treatment. Patients who chose ACL reconstruction reported superior outcomes for knee symptoms and function, and in knee-specific and health-related quality of life, compared to patients who chose non-surgical treatment.

  • 20.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Winters, Marinus
    Aalborg Univ, Denmark.
    Synthesising best evidence in systematic reviews when randomised controlled trials are absent: three tips for authors to add value for clinician readers2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 15, p. 948-+Article in journal (Other academic)
    Abstract [en]

    n/a

  • 21.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. School of Allied Health, La Trobe University, Melbourne, Australia.
    Österberg, Annika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Tagesson, Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Gauffin, Håkan
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Webster, Kate E.
    La Trobe University, Australia.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity2016In: Arthroscopy: The Journal of Arthroscopy And Related, ISSN 0749-8063, E-ISSN 1526-3231, Vol. 32, no 8, p. 1631-1638Article in journal (Refereed)
    Abstract [en]

    Purpose: To assess whether patient-reported outcomes (psychological factors, appraisals of knee function, and physical activity participation) were associated with satisfaction with knee function after anterior cruciate ligament (ACL) reconstruction. Methods: Participants who were aged 18 to 45 years and a minimum 12 months post primary ACL reconstruction completed a questionnaire battery evaluating knee self-efficacy, knee-related quality of life, self-reported function, and physical activity participation. Participants responses to the question "If you were to spend the rest of your life with your knee just the way it has been in the last week, would you feel.... (7-point ordinal scale; 1 = happy, 7 = unhappy)" were categorized as satisfied, mostly satisfied, or dissatisfied and used as the primary outcome. Ordinal regression was used to examine associations between independent variables and the primary outcome. Results: A total of 177 participants were included at an average of 3 years after primary ACL reconstruction. At follow-up, 44% reported they would be satisfied, 28% mostly satisfied, and 28% dissatisfied with the outcome of ACL reconstruction. There were significant differences in psychological responses and appraisal of knee function between the 3 groups (P = .001), and significantly more people in the satisfied group had returned to their preinjury activity (58%) than in the mostly satisfied (28%) and dissatisfied (26%) groups (P = .001). Multivariable analysis demonstrated that the odds of being satisfied increased by a factor of 3 with higher self-efficacy, greater knee-related quality of life, and returning to the preinjury activity. Conclusions: People who had returned to their preinjury physical activity and who reported higher knee-related self-efficacy and quality of life were more likely to be satisfied with the outcome of ACL reconstruction.

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  • 22.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Österberg, Annika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden.
    Tagesson (Sonesson), Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Gauffin, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Webster, Kate E.
    La Trobe University, Australia.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 22, p. 1613-U50Article in journal (Refereed)
    Abstract [en]

    Background This cross-sectional study aimed to examine whether appraisal of knee function, psychological and demographic factors were related to returning to the preinjury sport and recreational activity following anterior cruciate ligament (ACL) reconstruction. Method 164 participants completed a questionnaire battery at 1-7 years after primary ACL reconstruction. The battery included questionnaires evaluating knee self-efficacy, health locus of control, psychological readiness to return to sport and recreational activity, and fear of reinjury; and self-reported knee function in sport-specific tasks, knee-related quality of life and satisfaction with knee function. The primary outcome was returning to the preinjury sport or recreational activity. Results At follow-up, 40% (66/164) had returned to their preinjury activity. Those who returned had more positive psychological responses, reported better knee function in sport and recreational activities, perceived a higher knee-related quality of life and were more satisfied with their current knee function. The main reasons for not returning were not trusting the knee (28%), fear of a new injury (24%) and poor knee function (22%). Psychological readiness to return to sport and recreational activity, measured with the ACL-Return to Sport after Injury scale (was most strongly associated with returning to the preinjury activity). Age, sex and preinjury activity level were not related. Conclusions Less than 50% returned to their preinjury sport or recreational activity after ACL reconstruction. Psychological readiness to return to sport and recreation was the factor most strongly associated with returning to the preinjury activity. Including interventions aimed at improving this in postoperative rehabilitation programmes could be warranted to improve the rate of return to sport and recreational activities.

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  • 23.
    Burgi, Ciara R.
    et al.
    Duke Univ Hlth Syst, NC USA.
    Peters, Scott
    Toronto Blue Jays Major League Baseball Club, Canada.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Magill, John R.
    Duke Univ Hlth Syst, NC USA.
    Gomez, Christina D.
    Land Hosp, TX USA.
    Sylvain, Jonathan
    Hartford Healthcare Rehabilitaiton Network, CT USA.
    Reiman, Michael P.
    Duke Univ, NC USA.
    Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review2019In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 53, no 18, p. 1154-1161Article, review/survey (Refereed)
    Abstract [en]

    Objective To describe the criteria used to clear athletes to return to sport (RTS) following primary ACL reconstruction. Design Scoping review. Data sources MEDLINE, Embase, CINAHL and SPORTDiscus electronic databases were searched using keywords related to ACL and RTS. Eligibility criteria Prospective or retrospective studies reporting at least one RTS criterion for athletes who had primary ACL reconstruction with an autograft. Results In total, 209 studies fulfilled the inclusion criteria. RTS criteria were categorised into six domains: time, strength, hop testing, clinical examination, patient-report and performance-based criteria. From the 209 included studies, time was used in 178 studies (85%), and in 88 studies (42%) was the sole RTS criterion. Strength tests were reported in 86 studies (41%). Sixteen different hop tests were used in 31 studies (15%). Clinical examination was used in 54 studies (26%), patient report in 26 studies (12%) and performance-based criteria in 41 studies (20%). Summary Time and impairment-based measures dominated RTS criteria, despite sport being a complex physical and biopsychosocial activity with demands across all aspects of function. Time was included as a criterion in 85% of studies, and over 80% of studies allowed RTS before 9 months. Whether RTS tests are valid-do they predict successful RTS?-is largely unknown.

  • 24.
    Buttner, Fionn
    et al.
    Univ Coll Dublin, Ireland.
    Winters, Marinus
    Aalborg Univ, Denmark.
    Delahunt, Eamonn
    Univ Coll Dublin, Ireland.
    Elbers, Roy
    Univ Bristol, England.
    Lura, Carolina B.
    Aalborg Univ, Denmark.
    Khan, Karim M.
    Univ British Columbia, Canada.
    Weir, Adam
    Aspetar Orthopaed & Sports Med Hosp, Qatar; Erasmus MC, Netherlands; Sport Med & Exercise Clin Haarlem SBK, Netherlands.
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia; Karolinska Inst, Sweden.
    Identifying the incredible! Part 1: assessing the risk of bias in outcomes included in systematic reviews2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 13, p. 798-800Article, review/survey (Refereed)
    Abstract [en]

    n/a

  • 25.
    Buttner, Fionn
    et al.
    Univ Coll Dublin, Ireland.
    Winters, Marinus
    Aalborg Univ, Denmark.
    Delahunt, Eamonn
    Univ Coll Dublin, Ireland.
    Elbers, Roy
    Univ Bristol, England.
    Lura, Carolina B.
    Aalborg Univ, Denmark.
    Khan, Karim M.
    Univ British Columbia, Canada.
    Weir, Adam
    Aspetar Orthopaed & Sports Med Hosp, Qatar; Erasmus MC, Netherlands; Sport Med & Exercise Clin Haarlem SBK, Netherlands.
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia; Karolinska Inst, Sweden.
    Identifying the incredible! Part 2: Spot the difference-a rigorous risk of bias assessment can alter the main findings of a systematic review2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 13, p. 801-808Article, review/survey (Refereed)
    Abstract [en]

    n/a

  • 26.
    Devitt, Brian M
    et al.
    OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia; School of Allied Health, La Trobe University, Melbourne, Australia.
    Bell, Stuart W.
    OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Hartwig, Taylor
    OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.
    Porter, Tabitha J
    OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.
    Feller, Julian A
    OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.
    Webster, Kate E
    School of Allied Health, La Trobe University, Melbourne, Australia.
    The Role of Lateral Extra-articular Tenodesis in Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review With Meta-analysis and Best-Evidence Synthesis2017In: The Orthopaedic Journal of Sports Medicine, ISSN 2325-9671, Vol. 5, no 10, article id 2325967117731767Article in journal (Refereed)
    Abstract [en]

    The role of lateral extra-articular tenodesis (LEAT) to augment primary anterior cruciate ligament reconstruction (ACLR) remains controversial.

  • 27.
    Dunlop, Gordon
    et al.
    Arsenal Football Club, England; Edinburgh Napier Univ, Scotland.
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Andersen, Thor Einar
    Oslo Sports Trauma Res Ctr, Norway.
    Lewin, Colin
    Lewin Sports Injury Clin, England.
    Dupont, Gregory
    French Football Federat, France.
    Ashworth, Ben
    Arsenal Football Club, England.
    ODriscoll, Gary
    AC Sparta Prague Football Club, Czech Republic.
    Rolls, Andrew
    Bristol City Football Club, England.
    Brown, Susan
    Edinburgh Napier Univ, Scotland.
    McCall, Alan
    Edinburgh Napier Univ, Scotland.
    Return-to-Play Practices Following Hamstring Injury: A Worldwide Survey of 131 Premier League Football Teams2020In: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035, Vol. 50, no 4, p. 829-840Article in journal (Refereed)
    Abstract [en]

    Purpose Return-to-play (RTP) is an on-going challenge in professional football. Return-to-play related research is increasing. However, it is unknown to what extent the recommendations presented within research are being implemented by professional football teams, and where there are gaps between research and practice. The purposes of this study were (1) to determine if premier-league football teams worldwide follow a RTP continuum, (2) to identify RTP criteria used and (3) to understand how RTP decision-making occurs in applied practice. Methods We sent a structured online survey to practitioners responsible for the RTP programme in 310 professional teams from 34 premier-leagues worldwide. The survey comprised four sections, based on hamstring muscle injury: (1) criteria used throughout RTP phases, (2) the frequency with which progression criteria were achieved, (3) RTP decision-making process and (4) challenges to decision-making. Results One-hundred and thirty-one teams responded with a completed survey (42%). One-hundred and twenty-four teams (95%) used a continuum to guide RTP, assessing a combination of clinical, functional and psychological criteria to inform decisions to progress. One-hundred and five (80%) teams reported using a shared decision-making approach considering the input of multiple stakeholders. Team hierarchy, match- and player-related factors were common challenges perceived to influence decision-making. Conclusions General research recommendations for RTP and the beliefs and practices of practitioners appear to match with, the majority of teams assessing functional, clinical and psychological criteria throughout a RTP continuum to inform decision-making which is also shared among key stakeholders. However, specific criteria, metrics and thresholds used, and the specific involvement, dynamics and interactions of staff during decision-making are not clear.

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  • 28.
    Ekas, Guri Ranum
    et al.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway; Norwegian Sch Sports Sci, Norway.
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia; Karolinska Inst, Sweden.
    Grindem, Hege
    Norwegian Sch Sports Sci, Norway; Karolinska Inst, Sweden.
    Engebretsen, Lars
    Oslo Univ Hosp, Norway; Univ Oslo, Norway; Norwegian Sch Sports Sci, Norway.
    Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 9, p. 520-+Article, review/survey (Refereed)
    Abstract [en]

    Objective To investigate the risk of new meniscal tears after treatment for anterior cruciate ligament (ACL) injury, in children and adults with and without ACL reconstruction. Design Prognosis systematic review (PROSPERO registration number CRD42016036788). Methods We searched Embase, Ovid Medline, Cochrane, CINAHL, SPORTDiscus, PEDro and Google Scholar from inception to 3rd May 2018. Eligible articles included patients with ACL injury (diagnosis confirmed by MRI and/or diagnostic arthroscopy), reported the number of meniscal tears at the time of ACL injury diagnosis/start of treatment and reported the number of new meniscal tears that subsequently occurred. Articles with fewer than 20 patients at follow-up, and articles limited to ACL revision surgery or multi-ligament knee injuries were excluded. Two independent reviewers screened articles, assessed eligibility, assessed risk of bias and extracted data. We judged the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology. Results Of 75 studies included in the systematic review, 54 studies with 9624 patients and 501 new meniscal tears were appropriate for quantitative analysis. Heterogeneity precluded data pooling. The risk of new meniscal tears was 0%-21% when follow-up was <2 years, 0%-29% when follow-up was 2 to 5 years, 5%-52% when follow-up was 5 to 10 years and 4%-31% when follow-up was longer than 10 years. The proportion of studies with high risk of selection, misclassification and detection bias was 84%, 69% and 68%, respectively. Certainty of evidence was very low. Conclusion New meniscal tears occurred in 0%-52% of patients between 4 months and 20 years (mean 4.9 +/- 4.4 years) following treatment for ACL injury. The certainty of evidence was too low to guide surgical treatment decisions. This review cannot conclude that the incidence of new meniscal tears is lower if ACL injury is treated with surgery compared with treatment with rehabilitation only.

  • 29.
    Ekas, Guri Ranum
    et al.
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Grindem, Hege
    Norwegian Sch Sport Sci, Norway.
    Engebretsen, Lars
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    New meniscal tears after ACL injury: what is the risk? A systematic review protocol2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 6, article id 386Article, review/survey (Refereed)
    Abstract [en]

    Background Secondary meniscal tears after ACL injuries increase the risk of knee osteoarthritis. The current literature on secondary meniscal injuries after ACL injury is not consistent and may have methodological shortcomings. This protocol describes the methods of a systematic review investigating the rate of secondary meniscal injuries in children and adults after treatment (operative or non-operative) for ACL injury. Methods We will search electronic databases (Embase, Ovid Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, PEDro and Google Scholar) from database inception. Extracted data will include demographic data, methodology, intervention details and patient outcomes. Risk of bias will be assessed using the Newcastle Ottawa checklist for cohort studies. Article screening, eligibility assessment, risk of bias assessment and data extraction will be performed in duplicate by independent reviewers. A proportion meta-analysis will be performed if studies are homogeneous (I-2 amp;lt; 75%). If meta-analysis is precluded, data will be synthesised descriptively using best-evidence synthesis. The strength of recommendations and quality of evidence will be assessed using the Grading of Recommendations Assessment Development and Evaluation working group methodology. Ethics and dissemination This protocol is written according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses, and was registered in the International Prospective Register of Systematic Reviews on 22 March 2016.

  • 30.
    Forsdyke, Dale
    et al.
    York St John University, England.
    Gledhill, Adam
    Leeds Beckett University, England.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar; Trobe University, Australia.
    Psychological readiness to return to sport: three key elements to help the practitioner decide whether the athlete is REALLY ready?2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 7, p. 555-556Article in journal (Other academic)
    Abstract [en]

    n/a

  • 31.
    Gomez-Piqueras, Pedro
    et al.
    Lille LOSC FC, France.
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Prieto-Ayuso, Alejandro
    Univ Castilla La Mancha, Spain.
    Javier Robles-Palazon, Francisco
    Univ Murcia, Spain.
    Cejudo, Antonio
    Univ Murcia, Spain.
    Sainz de Baranda, Pilar
    Univ Murcia, Spain.
    Olmedilla, Aurelio
    Univ Murcia, Spain.
    Psychometric Analysis and Effectiveness of the Psychological Readiness of Injured Athlete to Return to Sport (PRIA-RS) Questionnaire on Injured Soccer Players2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, Vol. 17, no 5, article id 1536Article in journal (Refereed)
    Abstract [en]

    The decision-making process about when an athlete may safely return to training and competition after an injury is a difficult decision. Safe return to training and competition is characterised by physical and psychological readiness to return to the sport. The objectives of this study are (1) to assess the measurement properties of the Psychological Readiness of Injured Athlete to Return to Sport questionnaire (PRIA-RS), and (2) to analyse the effectiveness which the PRIA-RS questionnaire possesses when applied during four consecutive seasons on professional soccer players. One hundred and nine male soccer players from the Albacete Soccer Club (Spain) were involved during four consecutive seasons for the current study: 2012-2013, 2013-2014, 2014-2015 and 2015-2016. Psychometric analysis (validity, reliability, internal consistency and effectiveness) and external psychometric analysis (evaluating measures of patient-reported outcomes (EMPRO)) were confirmed and supported. The main results of the study reveal that the psychometric properties of this questionnaire are optimum for their application in a professional sports context.

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  • 32.
    Grassi, Alberto
    et al.
    Ist Ortoped Rizzoli, Italy.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar; La Trobe University, Australia.
    Marcheggiani Muccioli, Giulio Maria
    Ist Ortoped Rizzoli, Italy.
    Neri, Maria Pia
    Ist Ortoped Rizzoli, Italy.
    Marcacci, Maurilio
    Ist Ortoped Rizzoli, Italy.
    Zaffagnini, Stefano
    Ist Ortoped Rizzoli, Italy.
    Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 716-724Article, review/survey (Refereed)
    Abstract [en]

    Purpose To compare patient-reported and clinician-reported outcomes, and radiographic results between patients who had had revision ACL reconstruction and those who had had primary ACL reconstruction. Design Systematic review and meta-analysis Data sources The MEDLINE, CINAHL, EMBASE and SPORTDiscus electronic databases were searched on 6 August 2015, using 3 main concepts: (1) revision ACL reconstruction, (2) primary ACL reconstruction and (3) treatment outcomes. Eligibility criteria for selecting studies Articles that compared patient-reported or clinician-reported outcomes or radiographic results between patients who had had revision ACL reconstruction and those who had had primary surgery with a minimum of 2 years follow-up were included. The outcomes evaluated were the Lysholm Knee Scoring Scale, objective International Knee Documentation Committee (IKDC) classification, Tegner Activity Scale, side-to-side difference in anterior tibial translation measured with KT-1000/2000 arthrometer, pivot shift test, tibiofemoral osteoarthritis grading on plain radiographs and subsequent knee surgeries. Results 8 studies (300 revision ACL reconstructions and 413 primary ACL reconstructions) were included in the meta-analysis. Patients who had had revision surgery reported inferior Lysholm Knee Scoring Scale scores (mean difference: 7.8 points), had inferior clinician-reported knee function as assessed with the objective IKDC classification (IKDC category A: 27% vs 57%; IKDC category C or D: 22% vs 8%) and pivot shift test (grade II or III: 7% vs 2%), and more radiographic evidence of tibiofemoral osteoarthritis (50% vs 25%) compared with patients who had had primary surgery. Conclusions Revision ACL reconstruction restored similar anterior-posterior knee laxity compared with primary ACL reconstruction. Patients who had had revision surgery reported inferior Lysholm Knee Scoring Scale scores, had inferior clinician-reported knee function and more radiographic signs of tibiofemoral osteoarthritis compared with patients with primary ACL reconstruction.

  • 33.
    Grindem, Hege
    et al.
    Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
    Arundale, Amelia
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Faculty of Health Sciences, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.
    Alarming underutilisation of rehabilitation in athletes with anterior cruciate ligament reconstruction: four ways to change the game2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 18, p. 1162-1163Article in journal (Other academic)
    Abstract [en]

    To help clinicians improve outcomes through better utilisation of rehabilitation after ACLR, we offer four suggestions:

    1. The importance of regaining function after ACLR must be recognised by all stakeholders: policymakers (third-party payers), orthopaedic surgeons, rehabilitation clinicians, coaches and athletes (and their parents/guardians when under age).

    2. Orthopaedic surgeons and rehabilitation clinicians must join forces to promote evidence-based practice, including the use of objective measures for progression and RTS.

    3. Evidence-based patient education should occur before all surgical or rehabilitation decision-making, and continue as rehabilitation progresses. This will ensure that the athlete can make an informed commitment to a treatment plan.

    4. Orthopaedic surgeons and rehabilitation clinicians must acknowledge their roles in building and maintaining athlete motivation for rehabilitation.

  • 34.
    Grindem, Hege
    et al.
    Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
    Mansournia, Mohammad Ali
    Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
    Øiestad, Britt Elin
    Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.
    Was it a good idea to combine the studies? Why clinicians should care about heterogeneity when making decisions based on systematic reviews2019In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 53, no 7, p. 399-401Article in journal (Other academic)
    Abstract [en]

    n/a

  • 35.
    Karjalainen, Teemu V.
    et al.
    Monash Univ, Australia; Monash Univ, Australia; Univ Helsinki, Finland.
    Jain, Nitin B.
    Vanderbilt Univ, TN 37212 USA; Vanderbilt Univ, TN 37212 USA.
    Page, Cristina M.
    Vanderbilt Univ, TN 37212 USA; Vanderbilt Univ, TN 37212 USA.
    Lahdeoja, Tuomas A.
    Univ Helsinki, Finland; Toolo Hosp, Finland.
    Johnston, Renea V.
    Monash Univ, Australia; Monash Univ, Australia.
    Salamh, Paul
    Univ Indianapolis, IN 46227 USA.
    Kavaja, Lauri
    Univ Helsinki, Finland; South Carelia Cent Hosp, Finland.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Agarwal, Arnav
    Univ Toronto, Canada.
    Vandvik, Per O.
    Lovisenberg Diaconal Hosp, Norway; Univ Oslo, Norway.
    Buchbinder, Rachelle
    Monash Univ, Australia; Monash Univ, Australia.
    Subacromial decompression surgery for rotator cuff disease2019In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 1, article id CD005619Article, review/survey (Refereed)
    Abstract [en]

    Background Surgery for rotator cuff disease is usually used after non-operative interventions have failed, although our Cochrane Review, first published in 2007, found that there was uncertain clinical benefit following subacromial decompression surgery. Objectives To synthesise the available evidence of the benefits and harms of subacromial decompression surgery compared with placebo, no intervention or non-surgical interventions in people with rotator cuff disease (excluding full thickness rotator cuff tears). Search methods We searched CENTRAL, MEDLINE, Embase, Clinicaltrials. gov and WHO ICRTP registry from 2006 until 22 October 2018, unrestricted by language. Selection criteria We included randomised and quasi-randomised controlled trials (RCTs) of adults with rotator cuff disease (excluding full-thickness tears), that compared subacromial decompression surgery with placebo, no treatment, or any other non-surgical interventions. As it is least prone to bias, subacromial decompression compared with placebo was the primary comparison. Other comparisons were subacromial decompression versus exercises or non-operative treatment. Major outcomes were mean pain scores, shoulder function, quality of life, participant global assessment of success, adverse events and serious adverse events. The primary endpoint for this review was one year. For serious adverse events, we also included data from prospective cohort studies designed to record harms that evaluated subacromial decompression surgery or shoulder arthroscopy. Data collection and analysis We used standard methodologic procedures expected by Cochrane. Main results We included eight trials, with a total of 1062 randomised participants with rotator cuff disease, all with subacromial impingement. Two trials (506 participants) compared arthroscopic subacromial decompression with arthroscopy only (placebo surgery), with all groups receiving postoperative exercises. These trials included a third treatment group: no treatment (active monitoring) in one and exercises in the other. Six trials (556 participants) compared arthroscopic subacromial decompression followed by exercises with exercises alone. Two of these trials included a third arm: sham laser in one and open subacromial decompression in the other. Trial size varied from 42 to 313 participants. Participant mean age ranged between 42 and 65 years. Only two trials reported mean symptom duration (18 to 22 months in one trial and 30 to 31 months in the other), two did not report duration and four reported it categorically. Both placebo-controlled trials were at low risk of bias for the comparison of surgery versus placebo surgery. The other trials were at high risk of bias for several criteria, most notably at risk of performance or detection bias due to lack of participant and personnel blinding. We have restricted the reporting of results of benefits in the Abstract to the placebo-controlled trials. Compared with placebo, high-certainty evidence indicates that subacromial decompression provides no improvement in pain, shoulder function, or health-related quality of life up to one year, and probably no improvement in global success (moderate-certainty evidence, downgraded due to imprecision). At one year, mean pain (on a scale zero to 10, higher scores indicate more pain), was 2.9 points after placebo surgery and 0.26 better (0.84 better to 0.33 worse), after subacromial decompression (284 participants), an absolute difference of 3%(8% better to 3% worse), and relative difference of 4% (12% better to 5% worse). At one year, mean function (on a scale 0 to 100, higher score indicating better outcome), was 69 points after placebo surgery and 2.8 better (1.4 worse to 6.9 better), after surgery (274 participants), an absolute difference of 3% (7% better to 1% worse), and relative difference of 9% (22% better to 4% worse). Global success rate was 97/148 (or 655 per 1000), after placebo and 101/142 (or 708 per 1000) after surgery corresponding to RR 1.08 (95% CI 0.93 to 1.27). Healthrelated quality of life was 0.73 units (European Quality of Life EQ-5D, -0.59 to 1, higher score indicating better quality of life), after placebo and 0.03 units worse (0.011 units worse to 0.06 units better), after subacromial decompression (285 participants), an absolute difference of 1.3% (5% worse to 2.5% better), and relative difference of 4% (15% worse to 7% better). Adverse events including frozen shoulder or transientminor complications of surgery were reported in approximately 3% of participants across treatment groups in two randomised controlled trials, but due to low event rates we are uncertain if the risks differ between groups: 5/165 (37 per 1000) reported adverse events with subacromial decompression and 9/241 (34 per 1000) with placebo or nonoperative treatment, RR 0.91 (95% CI 0.31 to 2.65) (moderate-certainty evidence, downgraded due to imprecision). The trials did not report serious adverse events. Based upon moderate-certainty evidence from two observational trials from the same prospective surgery registry, which also included other shoulder arthroscopic procedures (downgraded for indirectness), the incidence proportion of serious adverse events within 30 days following surgery was 0.5% (0.4% to 0.7%; data collected 2006 to 2011), or 0.6% (0.5 % to 0.7%; data collected 2011 to 2013). Serious adverse events such as deep infection, pulmonary embolism, nerve injury, and death have been observed in participants following shoulder surgery. Authors conclusions The data in this review do not support the use of subacromial decompression in the treatment of rotator cuff disease manifest as painful shoulder impingement. High-certainty evidence shows that subacromial decompression does not provide clinically important benefits over placebo in pain, function or health-related quality of life. Including results from open-label trials (with high risk of bias) did not change the estimates considerably. Due to imprecision, we downgraded the certainty of the evidence to moderate for global assessment of treatment success; there was probably no clinically important benefit in this outcome either compared with placebo, exercises or non-operative treatment. Adverse event rates were low, 3% or less across treatment groups in the trials, which is consistent with adverse event rates reported in the two observational studies. Although precise estimates are unknown, the risk of serious adverse events is likely less than 1%.

  • 36.
    King, Jonny
    et al.
    AFC Bournemouth, England.
    Roberts, Craig
    AFC Bournemouth, England.
    Hard, Steve
    AFC Bournemouth, England.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Want to improve return to sport outcomes following injury? Empower, engage, provide feedback and be transparent: 4 habits!2019In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 53, no 9, p. 527-Article in journal (Other academic)
    Abstract [en]

    n/a

  • 37.
    Kvist, Joanna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Filbay, Stephanie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Oxford, England.
    Andersson, Christer A.
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden; La Trobe Univ, Australia.
    Gauffin, Håkan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Radiographic and Symptomatic Knee Osteoarthritis 32 to 37 Years After Acute Anterior Cruciate Ligament Rupture2020In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 48, no 10, p. 2387-2394Article in journal (Refereed)
    Abstract [en]

    Background: The long-term prevalence of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is unknown, especially in patients without a history of ACL surgery. Purpose: To (1) describe the prevalence of radiographic OA, symptomatic OA, and knee replacement surgery 32 to 37 years after acute ACL injury and to (2) compare the prevalence of radiographic OA, symptomatic OA, and knee symptoms between patients allocated to early ACL surgery or no ACL surgery and patients who crossed over to ACL surgery. Study Design: Cohort study; Level of evidence, 2. Methods: Participants aged 15 to 40 years at the time of ACL injury were allocated to surgical (augmented or nonaugmented ACL repair) or nonsurgical ACL treatment within 14 days of injury. At 32 to 37 years after the initial injury, 153 participants were followed up with plain weightbearing radiographs and completed 4 subscales from the Knee injury and Osteoarthritis Outcome Score (KOOS). Radiographic OA was defined as Kellgren and Lawrence grade 2 or higher. Symptomatic OA was defined as radiographic OA plus knee symptoms measured with the KOOS. Results: Participants allocated to ACL surgery (n = 64) underwent surgery at a mean +/- SD of 5 +/- 4 days (range, 0-11 days) after injury. Of the 89 participants allocated to no ACL surgery, 53 remained nonsurgically treated, 27 had ACL surgery within 2 years, and 9 had ACL surgery between 3 and 21 years after injury. In the total sample, 95 participants (62%) had radiographic tibiofemoral OA, including 11 (7%) who had knee replacement. The prevalence of radiographic tibiofemoral OA was lower in the group allocated to ACL surgery compared with the group who never had ACL surgery (50% vs 75%;P= .005). The prevalence of symptomatic OA (50% in the total sample) and patellofemoral radiographic OA (35% in the total sample) was similar between groups. Conclusion: Patients allocated to early ACL surgery, performed a mean 5 days after injury, had a lower prevalence of tibiofemoral radiographic OA at 32 to 37 years after injury compared with patients who never had ACL surgery. The prevalences of symptomatic OA, radiographic patellofemoral OA, and knee symptoms were similar irrespective of ACL treatment. Overall, the prevalence of OA after ACL injury was high. Registration: NCT03182647 (ClinicalTrials.gov identifier)

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  • 38.
    Kvist, Joanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Karolinska Inst, Sweden.
    Gauffin, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Tigerstrand Grevnerts, Hanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Stalman, Anders
    Capio ArtroClin, Sweden.
    Frobell, Richard
    Lund Univ, Sweden.
    Natural corollaries and recovery after acute ACL injury: the NACOX cohort study protocol2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 6, article id e020543Article in journal (Refereed)
    Abstract [en]

    Introduction Anterior cruciate ligament (ACL) injury can result in joint instability, decreased functional performance, reduced physical activity and quality of life and an increased risk for post-traumatic osteoarthritis. Despite the development of new treatment techniques and extensive research, the complex and multifaceted nature of ACL injury and its consequences are yet to be fully understood. The overall aim of the NACOX study is to evaluate the natural corollaries and recovery after an ACL injury. Methods and analysis The NACOX study is a multicentre prospective prognostic cohort study of patients with acute ACL injury. At seven sites in Sweden, we will include patients aged 15-40 years, within 6 weeks after primary ACL injury. Patients will complete questionnaires at multiple occasions over the 3 years following injury or the 3 years following ACL reconstruction (for participants who have surgical treatment). In addition, a subgroup of 130 patients will be followed with clinical examinations, several imaging modalities and biological samples. Data analyses will he specific to each aim. Ethics and dissemination This study has been approved by the regional Ethical committee in Linkoping, Sweden (Dnr 2016/44-31 and 2017/221-32). We plan to present the results at national and international conferences and in peer-reviewed scientific journals. Participants will receive a short summary of the results following completion of the study.

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  • 39.
    Lahdeoja, Tuomas
    et al.
    Univ Helsinki, Finland; HUS Helsinki Univ Hosp, Finland;.
    Karjalainen, Teemu
    Univ Helsinki, Finland; Monash Univ, Australia; .
    Jokihaara, Jarkko
    Univ Helsinki, Finland; Tampere Univ Hosp, Finland; .
    Salamh, Paul
    Univ Indianapolis,USA.
    Kavaja, Lauri
    Univ Helsinki, Finland; South Karelia Cent Hosp, Finland; .
    Agarwal, Arnav
    Univ Toronto, Canada.
    Winters, Marinus
    Aalborg Univ, Denmark.
    Buchbinder, Rachelle
    Monash Univ, Australia; .
    Guyatt, Gordon
    McMaster Univ, Canada.
    Vandvik, Per Olav
    Lovisenberg Diaconal Hosp, Norway; Univ Oslo, Norway; .
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 11, p. 665-+Article, review/survey (Refereed)
    Abstract [en]

    Objective To determine the benefits and harms of subacromial decompression surgery in adult patients with subacromial pain syndrome lasting for more than 3 months. Design Systematic review with meta-analysis. Main outcome measures Pain, physical function and health-related quality of life. Data sources Systematic searches for benefits and harms were conducted to 23 July 2018 in MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Database of Abstracts of Reviews of Effects, and Health Technology Assessment. Eligibility criteria for selecting studies Randomised controlled trials comparing subacromial decompression surgery for subacromial pain syndrome with any other treatment(s). For harms, we included prospective cohort studies. Review methods Two reviewers independently determined eligibility, extracted the data and assessed the risk of bias of eligible studies. Thirty patients seeking primary or outpatient care for subacromial pain syndrome and a parallel guideline committee (BMJ Rapid Recommendations) provided input regarding systematic review design and interpretation. Results There was high certainty evidence of no additional benefit of subacromial decompression surgery over placebo surgery in reducing pain at 1 year following surgery (mean difference [MD] -0.26, 95% CI -0.84 to 0.33, minimally important difference [MID] 1.5) or improving physical function at 1-2 years (MD 2.8, 95% CI -1.4 to 6.9, MID 8.3). There was moderate certainty evidence for no additional benefit of subacromial decompression surgery on health-related quality of life at 1 year (MD -0.03 points, 95% CI -0.11 to 0.06, MID 0.07). There was moderate certainty evidence for six serious harms per 1000 (95% CI 5 to 7) patients undergoing subacromial decompression. Conclusion Subacromial decompression surgery provided no important benefit compared with placebo surgery or exercise therapy, and probably carries a small risk of serious harms. Systematic reviewregistration number CRD42018086862.

  • 40.
    Lai, Courtney C. H.
    et al.
    La Trobe University, Australia.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe University, Australia; Aspetar Orthopaed and Sports Medical Hospital, Qatar.
    Feller, Julian A.
    OrthoSport Victoria, Australia.
    Webster, Kate E.
    La Trobe University, Australia.
    Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 2, p. 128-138Article, review/survey (Refereed)
    Abstract [en]

    Objectives The primary objective was to calculate the rate of return to sport (RTS) following anterior cruciate ligament (ACL) reconstruction in elite athletes. Secondary objectives were to estimate the time taken to RTS, calculate rates of ACL graft rupture, evaluate postsurgical athletic performance and identify determinants of RTS. Design Pooled RTS and graft rupture rates were calculated using random effects proportion meta-analysis. Time to RTS, performance data and determinants of RTS were synthesised descriptively. Data sources MEDLINE, EMBASE, AMED, CINAHL, AMI, PEDro, SPORTDiscus and The Cochrane Library were searched from inception to 19 January 2016. Hand searching of 10 sports medicine journals and reference checking were also performed. Eligibility criteria for selecting studies Studies were included if they reported the ratio of elite athletes who returned to their preinjury level of sport following ACL reconstruction. Twenty-four studies were included. Results The pooled RTS rate was 83% (95% CI 77% to 88%). The mean time to RTS ranged from 6 to 13 months. The pooled graft rupture rate was 5.2% (95% CI 2.8% to 8.3%). Six out of nine studies that included a noninjured control group found no significant deterioration in athletic performance following ACL reconstruction. Indicators of greater athletic skill or value to the team were associated with RTS. Summary and conclusions Eighty-three per cent of elite athletes returned to sport following ACL reconstruction, while 5.2% sustained a graft rupture. Most athletes who returned to sport performed comparably with matched, uninjured controls. This information may assist in guiding expectations of athletes and clinicians following ACL reconstruction.

  • 41.
    Levinger, Pazit
    et al.
    Victoria University, Australia; Australian Institute Musculoskeletal Science AIMSS, Australia.
    Hallam, Karen
    Victoria University, Australia.
    Fraser, Darren
    Western Hospital, Australia.
    Pile, Rebecca
    Western Hospital, Australia.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe University, Australia.
    Moreira, Brett
    Western Hospital, Australia.
    Talbot, Simon
    Western Hospital, Australia.
    A novel web-support intervention to promote recovery following Anterior Cruciate Ligament reconstruction: A pilot randomised controlled trial2017In: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 27, p. 29-37Article in journal (Refereed)
    Abstract [en]

    Background: Self-efficacy is positively associated with adherence behaviours and rehabilitation outcomes following Anterior Cruciate Ligament (ACL) reconstruction. An internet resource can be an effective way to provide information, goal setting, patient monitoring and hence support overall self management. Purpose: This study examined the feasibility of a three month Internet-based intervention (mobile oriented site) to enhance recovery for patients, following ACL reconstruction. The potential effect of the internet-based intervention on knee pain, function, self-efficacy and fear of pain were also assessed. Method: This was a pilot randomised controlled trial (RCT) with pre and post intervention design (assessments at one week and three months following ACL reconstruction) comparing: (1) a control group and (2) an intervention group (internet-based intervention). A set of qualitative and quantitative assessments were included to evaluate potential improvements in self-efficacy, pain and function and perception of the internet intervention. Results and conclusion: Seventeen participants were available for analysis (n =10 intervention and n = 7 control group). Participants reported the internet-based intervention to be a useful tool for information, reminder and reinforcement for performing their exercise rehabilitation with 30.3% ( 35.3%) adherence to the internet-based intervention. No differences were observed between the groups over time on the outcome questionnaires (p amp;gt; 0.05). Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616001379404. (C) 2017 Elsevier Ltd. All rights reserved.

  • 42.
    McCall, Alan
    et al.
    Arsenal Football Club, England; Edinburgh Napier University, Scotland.
    Lewin, Colin
    Arsenal Football Club, England.
    ODriscoll, Gary
    Arsenal Football Club, England.
    Witvrouw, Erik
    University of Ghent, Belgium.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar; La Trobe University, Australia.
    Return to play: the challenge of balancing research and practice2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 9, p. 702-703Article in journal (Other academic)
    Abstract [en]

    n/a

  • 43.
    McClean, Gavin
    et al.
    Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.
    Riding, Nathan R.
    Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; School of Allied Health, La Trobe University, Melbourne, Australia .
    Farooq, Abdulaziz
    Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Pieles, Guido E.
    National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Congenital Heart Unit, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol, UK; School of Clinical Sciences, University of Bristol, Bristol, UK.
    Watt, Victoria
    Department of Sports Medicine, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Adamuz, Carmen
    Department of Sports Medicine, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    George, Keith P.
    Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.
    Oxborough, David
    Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.
    Wilson, Mathew G.
    Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK; Research Institute of Sport and Exercise Sciences, University of Canberra, Australia.
    Electrical and structural adaptations of the paediatric athletes heart: a systematic review with meta-analysis2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 4, article id 230Article, review/survey (Refereed)
    Abstract [en]

    To describe the electrocardiographic (ECG) and echocardiographic manifestations of the paediatric athletes heart, and examine the impact of age, race and sex on cardiac remodelling responses to competitive sport.

  • 44.
    Mohtadi, Nicholas
    et al.
    Department of Surgery, University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Engebretsen, Lars
    Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
    Why all the fuss about paediatric ACL rupture: isnt the meniscus much more important?2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 7, p. 417-418Article in journal (Other academic)
    Abstract [en]

    n/a

  • 45.
    Nielsen, Rasmus Oestergaard
    et al.
    Aarhus Univ, Denmark; Res Unit Gen Practice, Denmark.
    Shrier, Ian
    McGill Univ, Canada.
    Casals, Marti
    Univ Vic, Spain; Barca Innovat Hub, Spain.
    Nettel-Aguirre, Albertro
    Univ Calgary, Canada.
    Moller, Merete
    Univ Southern Denmark, Denmark.
    Bolling, Caroline
    Vrije Univ Amsterdam, Netherlands.
    Netto Bittencourt, Natalia Franco
    Vrije Univ Amsterdam, Netherlands; Minas Tenis Clube, Brazil; Ctr Univ UniBH, Brazil.
    Clarsen, Benjamin
    Norwegian Inst Publ Hlth, Norway; Norwegian Sch Sport Sci, Norway.
    Wedderkopp, Niels
    Univ Southern Denmark, Denmark; Hosp Southwestern Jutland, Denmark.
    Soligard, Torbjorn
    Int Olymp Comm, Switzerland.
    Timpka, Toomas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Emery, Carolyn
    Univ Calgary, Canada.
    Bahr, Roald
    Norwegian Sch Sport Sci, Norway.
    Jacobsson, Jenny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Whiteley, Rod
    Aspetar Orthopaed & Sports Med Hosp, Qatar.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    van Dyk, Nicol
    Irish Rugby Football Union, Ireland.
    Pluim, Babette M.
    Vrije Univ Amsterdam, Netherlands; Univ Pretoria, South Africa; Royal Netherlands Lawn Tennis Assoc, Netherlands.
    Stamatakis, Emmanuel
    Univ Sydney, Australia; UCL, England.
    Palacios-Derflingher, Luz
    Univ Calgary, Canada.
    Fagerland, Morten Wang
    Norwegian Sch Sport Sci, Norway.
    Khan, Karim M.
    Univ British Columbia, Canada; British Journal Sports Med, England.
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Verhagen, Evert
    Vrije Univ Amsterdam, Netherlands.
    Statement on methods in sport injury research from the 1st METHODS MATTER Meeting, Copenhagen, 20192020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 15, p. 941-947Article, review/survey (Refereed)
    Abstract [en]

    High quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best practice methods-methods matter (greatly!). The 1st METHODS MATTER Meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting.

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  • 46.
    Patricios, Jon S.
    et al.
    Univ Pretoria, South Africa; Univ Witwatersrand, South Africa.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Hislop, Michael David
    World Rugby, Ireland.
    Aubry, Mark
    Int Ice Hockey Federat, Switzerland.
    Bloomfield, Paul
    Natl Rugby League, Australia.
    Broderick, Carolyn
    Natl Rugby League, Australia.
    Clifton, Patrick
    Australian Football League, Australia; Australian Inst Sport, Australia.
    Echemendia, Ruben J.
    Natl Hockey League, NY USA; Univ Orthoped Ctr, PA USA; Univ Missouri, MO 64110 USA.
    Ellenbogen, Richard G.
    Natl Football League, NY USA; Univ Washington, WA 98195 USA.
    Falvey, Eanna Cian
    Irish Rugby Football Union, Ireland.
    Fuller, Gordon Ward
    Univ Sheffield, England.
    Grand, Julie
    Natl Hockey League, NY USA.
    Hack, Dallas
    Natl Coll Athlet Assoc, IN USA.
    Harcourt, Peter Rex
    Australian Football League, Australia.
    Hughes, David
    Australian Football League, Australia; Australian Inst Sport, Australia.
    McGuirk, Nathan
    Natl Rugby League, Australia.
    Meeuwisse, Willem
    Natl Hockey League, NY USA.
    Miller, Jeffrey
    Natl Football League, NY USA.
    Parsons, John T.
    Natl Coll Athlet Assoc, IN USA.
    Richiger, Simona
    Int Ice Hockey Federat, Switzerland.
    Sills, Allen
    Natl Football League, NY USA; Federat Equestre Int, Switzerland.
    Moran, Kevin B.
    Gael Athlet Assoc, Ireland.
    Shute, Jenny
    Federat Int Ski, Switzerland; Federat Int Ski, Switzerland.
    Raftery, Martin
    World Rugby, Ireland.
    Implementation of the 2017 Berlin Concussion in Sport Group Consensus Statement in contact and collision sports: a joint position statement from 11 national and international sports organisations2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 10, p. 635-641Article in journal (Refereed)
    Abstract [en]

    The 2017 Berlin Concussion in Sport Group Consensus Statement provides a global summary of best practice in concussion prevention, diagnosis and management, underpinned by systematic reviews and expert consensus. Due to their different settings and rules, individual sports need to adapt concussion guidelines according to their specific regulatory environment. At the same time, consistent application of the Berlin Consensus Statements themes across sporting codes is likely to facilitate superior and uniform diagnosis and management, improve concussion education and highlight collaborative research opportunities. This document summarises the approaches discussed by medical representatives from the governing bodies of 10 different contact and collision sports in Dublin, Ireland in July 2017. Those sports are: American football, Australian football, basketball, cricket, equestrian sports, football/soccer, ice hockey, rugby league, rugby union and skiing. This document had been endorsed by 11 sport governing bodies/national federations at the time of being published.

  • 47.
    Rambaud, Alexandre J. M.
    et al.
    Univ Jean Monnet, France; Sport Ctr, France.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Thoreux, Patricia
    Univ Paris, France; Arts and Metiers ParisTech, France.
    Regnaux, Jean-Philippe
    French Sch Publ Hlth EHESP, France; INSERM, France.
    Edouard, Pascal
    Univ Jean Monnet, France; Univ Hosp St Etienne, France.
    Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 22, p. 1437-1444Article, review/survey (Refereed)
    Abstract [en]

    Objective To describe the criteria used to guide clinical decision-making regarding when a patient is ready to return to running (RTR) after ACL reconstruction. Design Scoping review. Data sources The MEDLINE (PubMed), EMBASE, Web of Science, PEDro, SPORT Discus and Cochrane Library electronic databases. We also screened the reference lists of included studies and conducted forward citation tracking. Eligibility criteria for selecting studies Reported at least one criterion for permitting adult patients with primary ACL reconstruction to commence running postoperatively. Results 201 studies fulfilled the inclusion criteria and reported 205 time-based criteria for RTR. The median time from when RTR was permitted was 12 postoperative weeks (IQR=3.3, range 5-39 weeks). Fewer than one in five studies used additional clinical, strength or performance-based criteria for decision-making regarding RTR. Aside from time, the most frequently reported criteria for RTR were: full knee range of motion or amp;gt;95% of the non-injured knee plus no pain or pain amp;lt;2 on visual analogue scale; isometric extensor limb symmetry index (LSI)amp;gt; 70% plus extensor and flexor LSIamp;gt; 70%; and hop test LSIamp;gt; 70%. Conclusions Fewer than one in five studies reported clinical, strength or performance-based criteria for RTR even though best evidence recommends performance-based criteria combined with time-based criteria to commence running activities following ACL reconstruction.

  • 48.
    Ringberg, Magnus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Eldh, Ann Catrine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ British Columbia, Canada; La Trobe Univ, Australia.
    Kvist, Joanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Athletes experiences of using a self-directed psychological support, the BAck iN the Game (BANG) smartphone application, during rehabilitation for return to sports following anterior cruciate ligament reconstruction2023In: BMC SPORTS SCIENCE MEDICINE AND REHABILITATION, ISSN 2052-1847, Vol. 15, no 1, article id 113Article in journal (Refereed)
    Abstract [en]

    BackgroundFollowing anterior cruciate ligament reconstruction (ACLR), many athletes do not return to their sport, often driven by concerns about re-injury. Psychological support strategies might help, but are not routinely included in rehabilitation after ACLR. The BAck iN the Game (BANG) intervention is a 24-week eHealth program delivered via smartphone application (app), beginning directly after ACLR, with a self-directed approach that aims to target the specific challenges athletes encounter in rehabilitation.AimTo describe athletes experiences of using the BANG app during rehabilitation, to support returning to sport following ACLR.MethodParticipants were athletes, in contact and/or non-contact pivoting sports, who had ACLR with the goal to return to sports. Semi-structured, individual interviews were conducted 6-10 months after their ACLR; all had access to the BANG intervention. Verbatim transcripts were analysed with a qualitative content analysis.ResultsThe 19 participants were 17-30 years, mean 21.6 years (SD 3.5); 7 men and 12 women. The analysis generated three main categories. (A) Interacting with the app illustrated how, when, or why the participants engaged with the app. The app was helpful because of its varying content, the notifications served as reminders and participants stopped using the app when no longer needing it. (B) Challenging experiences with the app illustrated that the app itself came with some difficulties e.g., content not appearing with the right timing and material not tailored to their sport. (C) Supportive experiences with the app reflected how the app facilitated the participants rehabilitation progress; it included positive aspects of the app content and navigation, boosting their confidence to return to sport, and motivated them to continue with rehabilitation.ConclusionThe analysis of the interviews illustrates athletes awareness in interacting with, and the challenging and supportive experiences of using the app. The BANG app might provide support for returning to sport, primarily psychological support, as an adjunct to regular physiotherapy-guided rehabilitation. Athletes experiences of the BANG app could be improved by healthcare professionals providing additional advice about when to use which content and why.Trial registrationClinicalTrials.gov, NCT03959215. Registered 22 May 2019.

  • 49.
    Slater, Diane
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Karolinska Inst, Sweden.
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia; Univ British Columbia, Canada.
    Biopsychosocial Factors Associated With Return to Preinjury Sport After ACL Injury Treated Without Reconstruction: NACOX Cohort Study 12-Month Follow-up2023In: SPORTS HEALTH-A MULTIDISCIPLINARY APPROACH, ISSN 1941-7381, Vol. 15, no 2, p. 176-184Article in journal (Refereed)
    Abstract [en]

    Background: The limited research on prognosis after nonsurgical management of anterior cruciate ligament (ACL) injury has focused on physical factors. We aimed to assess relationships between key patient-reported outcomes, in line with a biopsychosocial approach, and returning to preinjury sport at 12 months after ACL injury treated without reconstruction. Hypothesis: We hypothesized that biopsychosocial factors would be associated with returning to preinjury sport at 12 months after ACL injury. Study Design: Prospective single cohort study. Level of Evidence: Level 2. Methods: Patients who had an ACL injury and did not have reconstruction during the first year after injury were recruited from healthcare clinics in Sweden, and followed up at 3, 6, and 12 months after injury. Return to preinjury sport at 12 months was the primary outcome. Explanatory variables were psychological readiness to return to sport, knee-related quality of life, and self-reported knee function. Using generalized estimating equations, we evaluated the relationships between the explanatory variables and the primary outcome at each timepoint. Results: Data were analyzed for 88 participants with a median age of 27 years (15-40 years). Soccer was the most frequently reported preinjury sport (n = 22). Forty participants (46%) had returned to their preinjury sport at 12 months after ACL injury. The odds of returning to preinjury sport at 12 months increased with higher self-reported knee function at 6 months (odds ratio [OR], 1.1; 95% CI, 1.0-1.1), and the odds of being returned to the preinjury sport at 12 months doubled for every 1-point increase (1-10 scale) in psychological readiness to return to sport measured at 12 months (OR, 1.9; 95% CI, 1.2-3.2). Conclusion: Superior self-reported knee function at 6 months and greater psychological readiness to return to sport at 12 months were associated with returning to the preinjury sport 1 year after ACL injury treated without reconstruction.

  • 50.
    Sonesson, Sofi
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Österberg, Annika
    Uppsala Univ, Sweden; Kullbergska Hosp, Sweden.
    Gauffin, Håkan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Ardern, Clare
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Kvist, Joanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Low correlation between functional performance and patient reported outcome measures in individuals with non-surgically treated ACL injury2021In: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 47, p. 185-192Article in journal (Refereed)
    Abstract [en]

    Objective: Describe a consecutive cohort of people with a non-surgically treated ACL injury and evaluate correlations between functional performance and patient reported outcome measures (PROMs). Design: Cross-sectional. Participants: Sixty-eight individuals (38 males, 18-45 years old) 2-5 years after ACL injury. Main outcome measures: Tegner Activity Scale, International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Anterior Cruciate Ligament Return to Sport after Injury scale (ACL-RSI) and ACL-Quality of Life (ACL-QoL) were completed. Functional performance was assessed using 4 hop tests and a squat test. Results: Mean IKDC-SKF score was 72 +/- 17 and mean LSI on performance tests were above 90%. Tegner Activity Scale was reduced from median 8 pre-injury to 5 at follow up. Satisfaction with activity level was median 7 on a 10-point ordinal scale. Correlations were moderate to strong (r = 0.552-0.856) between PROMs, negligible to weak (r = 0.003-0.403) between performance tests and PROMs and negligible to moderate (r = 0.142-0.683) between performance tests. Conclusion: Functional performance had negligible or weak correlation to PROMs, which indicates the need for multi-modal assessment strategies. Activity level was reduced 2-5 years after a non-surgically treated ACL injury, but most patients were able to resume physical activity at a sufficient level to maintain health and displayed symmetrical functional performance. (C) 2020 The Authors. Published by Elsevier Ltd.

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