Statistical Methods for Health Care Research

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Biomechanics And Motor Control Of Human Movement

Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist. Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity. We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields. One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with high-quality studies (0.54 vs 11.55 per 1,000 exposures). Ankle sprain prevalence period estimates were similar across sub-groups. Lateral ankle sprain was the most commonly observed type of ankle sprain. Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity. Studies at a greater risk of bias were more likely to underestimate the risk of ankle sprain. Participants were at a significantly higher risk of sustaining a lateral ankle sprain compared with syndesmotic and medial ankle sprains.

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The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies.

This paper overviews the importance for sports biomechanics of movement variability, which has been studied for some time by cognitive and ecological motor skills specialists but, until quite recently, had somewhat been overlooked by sports biomechanists. The paper considers biomechanics research reporting inter- and intra-individual movement variability in javelin and discus throwing, basketball shooting, and locomotion. The overview does not claim to be comprehensive and we exclude such issues as the theoretical background to movement and coordination variability and their measurement. We overview evidence, both theoretical and empirical, of inter-individual movement variability in seeking to achieve the same task goal, in contrast to the concept of “optimal” movement patterns. Furthermore, even elite athletes cannot reproduce identical movement patterns after many years of training, contradicting the ideas of motor invariance and “representative” trials. We contend that movement variability, far from b...

/pdf/is-movement-variability-important-for-sports-biomechanists-3hsy5ls8l0.pdf

Is movement variability important for sports biomechanists

Purpose: The purpose of this randomized controlled trial was to determine the effect of a 4-wk balance training program on static and dynamic postural control and self-reported functional outcomes in those with chronic ankle instability (CAI)

Methods: Thirty-one young adults with self-reported CAI were randomly assigned to an intervention group (six males and 10 females) or a control group (six males and nine females) The intervention consisted of a 4-wk supervised balance training program that emphasized dynamic stabilization in single-limb stance Main outcome measures included the following: self-reported disability on the Foot and Ankle Disability Index (FADI) and the FADI Sport scales; summary center of pressure (COP) excursion measures including area of a 95% confidence ellipse, velocity, range, and SD; time-to-boundary (TTB) measures of postural control in single-limb stance including the absolute minimum TTB, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions with eyes open and closed; and reach distance in the anterior, posteromedial, and posterolateral directions of the Star Excursion Balance Test (SEBT)

Results: The balance training group had significant improvements in the FADI and the FADI Sport scores, in the magnitude and the variability of TTB measures with eyes closed, and in reach distances with the posteromedial and the posterolateral directions of the SEBT Only one of the summary COP-based measures significantly changed after balance training

Conclusions: Four weeks of balance training significantly improved self-reported function, static postural control as detected by TTB measures, and dynamic postural control as assessed with the SEBT TTB measures were more sensitive at detecting improvements in static postural control compared with summary COP-based measures

Balance training improves function and postural control in those with chronic ankle instability.

In recent years, concepts and tools from dynamical systems theory have been successfully applied to the study of movement systems, contradicting traditional views of variability as noise or error. From this perspective, it is apparent that variability in movement systems is omnipresent and unavoidable due to the distinct constraints that shape each individual's behaviour. In this position paper, it is argued that trial-to-trial movement variations within individuals and performance differences observed between individuals may be best interpreted as attempts to exploit the variability that is inherent within and between biological systems. That is, variability in movement systems helps individuals adapt to the unique constraints (personal, task and environmental) impinging on them across different timescales. We examine the implications of these ideas for sports medicine, by: (i) focusing on intra-individual variability in postural control to exemplify within-individual real-time adaptations to changing informational constraints in the performance environment; and (ii) interpreting recent evidence on the role of the angiotensin-converting enzyme gene as a genetic (developmental) constraint on individual differences in physical performance. The implementation of a dynamical systems theoretical interpretation of variability in movement systems signals a need to re-evaluate the ubiquitous influence of the traditional 'medical model' in interpreting motor behaviour and performance constrained by disease or injury to the movement system. Accordingly, there is a need to develop new tools for providing individualised plots of motor behaviour and performance as a function of key constraints. Coordination profiling is proposed as one such alternative approach for interpreting the variability and stability demonstrated by individuals as they attempt to construct functional, goal-directed patterns of motor behaviour during each unique performance. Finally, the relative contribution of genes and training to between-individual performance variation is highlighted, with the conclusion that dynamical systems theory provides an appropriate multidisciplinary theoretical framework to explain their interaction in supporting physical performance.

Movement systems as dynamical systems: The functional role of variability and its implications for sports medicine

In recent years, concepts and tools from dynamical systems theory have been successfully applied to the study of movement systems, contradicting traditional
views of variability as noise or error. From this perspective, it is apparent that
variability in movement systems is omnipresent and unavoidable due to the distinct constraints that shape each individual’s behaviour. In this position paper, it is argued that trial-to-trial movement variations within individuals and performance differences observed between individuals may be best interpreted as attempts to exploit the variability that is inherent within and between biological systems.

That is, variability in movement systems helps individuals adapt to the unique constraints (personal, task and environmental) impinging on them across different
timescales. We examine the implications of these ideas for sports medicine, by: (i)
focusing on intra-individual variability in postural control to exemplify within-individual real-time adaptations to changing informational constraints in the performance environment; and (ii) interpreting recent evidence on the role of
the angiotensin-converting enzyme gene as a genetic (developmental) constraint
on individual differences in physical performance.

The implementation of a dynamical systems theoretical interpretation of variability in movement systems signals a need to re-evaluate the ubiquitous influence of the traditional ‘medical model’ in interpreting motor behaviour and performance constrained by disease or injury to the movement system. Accordingly, there is a need to develop new tools for providing individualised plots of motor behaviour and performance as a function of key constraints. Coordination profiling is proposed as one such alternative approach for interpreting the variability and stability demonstrated by individuals as they attempt to construct functional, goal-directed patterns of motor behaviour during each unique performance.

Finally, the relative contribution of genes and training to between-individual
performance variation is highlighted, with the conclusion that dynamical systems
theory provides an appropriate multidisciplinary theoretical framework to explain
their interaction in supporting physical performance.

Movement systems as dynamical systems : The functional role of variability and its implications for sports medicine

This article discusses the main substantive issues surrounding performance analysis and considers future directions in this recently formed sub-discipline of sport science. It is argued that it is insufficient to bring together sport biomechanics and notational analysis on the basis that they share a number of commonalities, such as they both aim to enhance performance, they both make extensive use of information and communications technology, and both are concerned with producing valid and reliable data. Rather, it is suggested that the common factor linking sport biomechanics and notational analysis is that they can both be used to measure and describe the same phenomenon (i.e. emergent pattern formation) at different scales of analysis (e.g. intra-limb, inter-limb and torso, and inter-personal). Key concepts from dynamical system theory, such as self-organization and constraints, can then be used to explain stability, variability and transitions among coordinative states. By adopting a constraints-based approach, performance analysis could be effectively opened up to sport scientists from other sub-disciplines of sport science, such as sport physiology and psychology, rather than solely being the preserve of sport biomechanists and notational analysts. To conclude, consideration is given to how a more unified approach, based on the tenets of dynamical systems theory, could impact on the future of performance analysis.

Game, set and match? Substantive issues and future directions in performance analysis.

Towards a Grand Unified Theory of sports performance.

In sport and exercise biomechanics, forward dynamics analyses or simulations have frequently been used in attempts to establish optimal techniques for performance of a wide range of motor activities. However, the accuracy and validity of these simulations is largely dependent on the complexity of the mathematical model used to represent the neuromusculoskeletal system. It could be argued that complex mathematical models are superior to simple mathematical models as they enable basic mechanical insights to be made and individual-specific optimal movement solutions to be identified. Contrary to some claims in the literature, however, we suggest that it is currently not possible to identify the complete optimal solution for a given motor activity. For a complete optimization of human motion, dynamical systems theory implies that mathematical models must incorporate a much wider range of organismic, environmental and task constraints. These ideas encapsulate why sports medicine specialists need to adopt more individualized clinical assessment procedures in interpreting why performers' movement patterns may differ.

Paul S. Glazier

Papers

Movement systems as dynamical systems: The functional role of variability and its implications for sports medicine

Movement systems as dynamical systems : The functional role of variability and its implications for sports medicine

Game, set and match? Substantive issues and future directions in performance analysis.

Towards a Grand Unified Theory of sports performance.

Constraints on the complete optimization of human motion.