How Common is Subsequent Posterior Tibial Tendon Dysfunction or Tarsal Tunnel Syndrome After Ankle Sprain Injury?

Foster, Kaitlyn; Greenlee, Tina A.; Young, Jodi L.; Janney, Cory; Rhon, Daniel I.

doi:10.1055/s-0042-1751246

Cited by 1 publication

(2 citation statements)

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“…We did not examine how similar the subsequent injuries were compared with the original injuries. However, a subsequent injury can still be related to the original injury regardless of whether it was the same injury [8, 53]. Hallegraeff et al [15] successfully predicted chronic low back pain 12 weeks after medical care that was sought for new episodes of acute low back pain, by capturing concerns about chronicity of symptoms, locus of control, impact on life, and knowledge and emotions surrounding the condition.…”

Section: Discussionmentioning

confidence: 99%

“…Because these variables alone are not comprehensive enough to determine the risk of subsequent injury, psychologic factors might provide additional insight. Unlike previously identified injury risk factors such as age [8,18,33,47], gender [4,38], and prior injury [9,44,51], which are nonmodifiable [39], psychologic variables have been known to fluctuate across different stages of the health injury continuum [48], similar to physical function, and could be future targets of intervention to aid in successful return to full duty. There is no universal consensus on the defintion of "psychologic readiness" to return to sports [32]; however, relationships between several different psychologic constructs and return to sport [27], future injury [44], rehabilitation adherence [12], and functional outcomes [7] after injuries have been reported.…”

Section: Introductionmentioning

confidence: 99%

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Can a Psychologic Profile Predict Successful Return to Full Duty After a Musculoskeletal Injury?

Greenlee,

Bullock,

Teyhen

et al. 2023

Clin Orthop Relat Res

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Background Psychologic variables have been shown to have a strong relationship with recovery from injury and return to work or sports. The extent to which psychologic variables predict successful return to work in military settings is unknown. Questions/purposes In a population of active duty soldiers, (1) can a psychologic profile determine the risk of injury after return to full duty? (2) Do psychologic profiles differ between soldiers sustaining injuries in the spine (thoracic or lumbar) and those with injuries to the lower extremities? Methods Psychologic variables were assessed in soldiers returning to full, unrestricted duty after a recent musculoskeletal injury. Most of these were noncombat injuries from work-related physical activity. Between February 2016 and September 2017, 480 service members who were cleared to return to duty after musculoskeletal injuries (excluding those with high-velocity collisions, pregnancy, or amputation) were enrolled in a study that tracked subsequent injuries over the following year. Of those, we considered individuals with complete 12-month follow-up data as potentially eligible for analysis. Based on that, approximately 2% (8 of 480) were excluded because they did not complete baseline surveys, approximately 2% (11 of 480) were separated from the military during the follow-up period and had incomplete injury data, 1% (3 of 480) were excluded for not serving in the Army branch of the military, and approximately 2% (8 of 480) were excluded because they were not cleared to return to full duty. This resulted in 450 soldiers analyzed. Individuals were 86% (385 of 450) men; 74% (331 of 450) had lower extremity injuries and 26% (119 of 450) had spinal injuries, including soft tissue aches and pains (for example, strains and sprains), fractures, and disc herniations. Time-loss injury within 1 year was the primary outcome. While creating and validating a new prediction model using only psychological variables, 19 variables were assessed for nonlinearity, further factor selection was performed through elastic net, and models were internally validated through 2000 bootstrap iterations. Performance was deciphered through calibration, discrimination (area under the curve [AUC]), R2, and calibration in the large. Calibration assesses predicted versus actual risk by plotting the x and y intersection of these values; the more similar predicted risk values are to actual ones, the closer the slope of the line formed by the intersection points of all subjects is to equaling “1” (optimal calibration). Likewise, perfect discrimination (predicted injured versus actual injured) presents as an AUC of 1. Perfect calibration in the large would equal 0 because it represents the average predicted risk versus the actual outcome rate. Sensitivity analyses stratified groups by prior injury region (thoracic or lumbar spine and lower extremity) as well as the severity of injury by days of limited duty (moderate [7-27 days] and severe [28 + days]). Results A model comprising primarily psychologic variables including depression, anxiety, kinesiophobia, fear avoidance beliefs, and mood did not adequately determine the risk of subsequent injury. The derived logistic prediction model had 18 variables: R2 = 0.03, calibration = 0.63 (95% confidence interval [CI] 0.30 to 0.97), AUC = 0.62 (95% CI 0.52 to 0.72), and calibration in the large = -0.17. Baseline psychologic profiles between body regions differed only for depression severity (mean difference 1 [95% CI 0 to 1]; p = 0.04), with greater mean scores for spine injuries than for lower extremity injuries. Performance was poor for those with prior spine injuries compared with those with lower extremity injuries (AUC 0.50 [95% CI 0.42 to 0.58] and 0.63 [95% CI 0.57 to 0.69], respectively) and moderate versus severe injury during the 1-year follow-up (AUC 0.61 [95% CI 0.51 to 0.71] versus 0.64 [95% CI 0.64 to 0.74], respectively). Conclusion The psychologically based model poorly predicted subsequent injury. This study does not minimize the value of assessing the psychologic profiles of injured athletes, but rather suggests that models looking to identify injury risk should consider a multifactorial approach that also includes other nonpsychologic factors such as injury history. Future studies should refine the most important psychologic constructs that can add the most value and precision to multifactorial models aimed at identifying the risk of injury. Level of Evidence Level III, prognostic study.

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Section: Discussionmentioning

confidence: 99%